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Zhou X, Wei C, Chen Z, Xia X, Wang L, Li X. Potential mechanisms of ischemic stroke induced by heat exposure. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 952:175815. [PMID: 39197783 DOI: 10.1016/j.scitotenv.2024.175815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/04/2024] [Accepted: 08/24/2024] [Indexed: 09/01/2024]
Abstract
Recent decades of epidemiological and clinical research have suggested that heat exposure could be a potential risk factor for ischemic stroke. Despite climate factors having a minor impact on individuals compared with established risk factors such as smoking, their widespread and persistent effects significantly affect public health. The mechanisms by which heat exposure triggers ischemic stroke are currently unclear. However, several potential mechanisms, such as the impact of temperature variability on stroke risk factors, inflammation, oxidative stress, and coagulation system changes, have been proposed. This article details the potential mechanisms by which heat exposure may induce ischemic stroke, aiming to guide the prevention and treatment of high-risk groups in hot climates and support public health policy development.
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Affiliation(s)
- Xiao Zhou
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Chanjuan Wei
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhuangzhuang Chen
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lin Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China; Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China.
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Ye XF, Wang WYY, Wang XY, Huang QF, Sheng CS, Li Y, Wang JG. Seasonal variation in ambulatory blood pressure control in patients on clinic blood pressure-guided antihypertensive treatment. J Hypertens 2024; 42:909-916. [PMID: 38230620 DOI: 10.1097/hjh.0000000000003666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND We investigated seasonal variation in ambulatory blood pressure control in hypertensive patients on clinic blood pressure-guided antihypertensive treatment. METHODS The study participants were hypertensive patients enrolled in an 8-week therapeutic study. Antihypertensive treatment was initiated with long-acting dihydropyridine calcium channel blockers amlodipine 5 mg/day or the gastrointestinal therapeutic system (GITS) formulation of nifedipine 30 mg/day, with the possible up-titration to amlodipine 10 mg/day or nifedipine-GITS 60 mg/day at 4 weeks of follow-up. RESULTS The proportion of up-titration to higher dosages of antihypertensive drugs at 4 weeks of follow-up was higher in patients who commenced treatment in autumn/winter ( n = 302) than those who commenced treatment in spring/summer ( n = 199, 24.5 vs. 12.0%, P < 0.001). The control rate of clinic blood pressure, however, was lower in autumn/winter than in spring/summer at 4 (56.7 vs. 70.7%, P = 0.003) and 8 weeks of follow-up (52.5 vs. 74.9%, P < 0.001). At 8 weeks, patients who commenced treatment in autumn/winter, compared with those who commenced treatment in spring/summer, had a significantly ( P ≤0.03) smaller daytime (mean between-season difference -3.2/-2.8 mmHg) but greater nighttime SBP/DBP reduction (3.6/1.6 mmHg). Accordingly, at 8 weeks, the prevalence of nondippers was significantly ( P < 0.001) higher in spring/summer than in autumn/winter for both SBP (54.8 vs. 30.0%) and DBP (53.4 vs. 28.8%). CONCLUSION Clinic blood pressure-guided antihypertensive treatment requires a higher dosage of medication in cold than warm seasons, which may have led to over- and under-treatment of nighttime blood pressure, respectively.
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Affiliation(s)
- Xiao-Fei Ye
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Yuan-Yue Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin-Yu Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi-Fang Huang
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang-Sheng Sheng
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Cheng Y, Sheng CS, Huang JF, Zhang DY, Li MX, Cheng YB, An DW, Guo QH, Wang Y, Huang QF, Xu TY, Li Y, Wang JG. Seasonality in nighttime blood pressure and its associations with target organ damage. Hypertens Res 2023:10.1038/s41440-023-01201-5. [PMID: 36788302 DOI: 10.1038/s41440-023-01201-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
There is some evidence that nighttime blood pressure varies between seasons. In the present analysis, we investigated the seasonal variation in ambulatory nighttime blood pressure and its associations with target organ damage. In 1054 untreated patients referred for ambulatory blood pressure monitoring, we performed measurements of urinary albumin-to-creatinine ratio (ACR, n = 1044), carotid-femoral pulse wave velocity (cfPWV, n = 1020) and left ventricular mass index (LVMI, n = 622). Patients referred in spring (n = 337, 32.0%), summer (n = 210, 19.9%), autumn (n = 196, 18.6%) and winter (n = 311, 29.5%) had similar 24-h ambulatory systolic/diastolic blood pressure (P ≥ 0.25). However, both before and after adjustment for confounding factors, nighttime systolic/diastolic blood pressure differed significantly between seasons (P < 0.001), being highest in summer and lowest in winter (adjusted mean values 117.0/75.3 mm Hg vs. 111.4/71.1 mm Hg). After adjustment for confounding factors, nighttime systolic/diastolic blood pressure were significantly and positively associated with ACR, cfPWV and LVMI (P < 0.006). In season-specific analyses, statistical significance was reached for all the associations of nighttime blood pressure with target organ damage in summer (P ≤ 0.02), and for some of the associations in spring, autumn and winter. The association between nighttime systolic blood pressure and ACR was significantly stronger in patients examined in summer than those in winter (standardized β, 0.31 vs 0.11 mg/mmol, P for interaction = 0.03). In conclusion, there is indeed seasonality in nighttime blood pressure level, as well as in its association with renal injury in terms of urinary albumin excretion. Our study shows that there is indeed seasonal variability in nighttime blood pressure, highest in summer and lowest in winter, and its association with renal injury in terms of urinary albumin excretion varies between summer and winter as well.
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Affiliation(s)
- Yi Cheng
- Department of Cardiovascular Medicine, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang-Sheng Sheng
- Department of Cardiovascular Medicine, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jian-Feng Huang
- Department of Cardiovascular Medicine, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong-Yan Zhang
- Department of Cardiovascular Medicine, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming-Xuan Li
- Department of Cardiovascular Medicine, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Bang Cheng
- Department of Cardiovascular Medicine, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - De-Wei An
- Department of Cardiovascular Medicine, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian-Hui Guo
- Department of Cardiovascular Medicine, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Cardiovascular Medicine, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi-Fang Huang
- Department of Cardiovascular Medicine, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting-Yan Xu
- Department of Cardiovascular Medicine, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Khraishah H, Alahmad B, Ostergard RL, AlAshqar A, Albaghdadi M, Vellanki N, Chowdhury MM, Al-Kindi SG, Zanobetti A, Gasparrini A, Rajagopalan S. Climate change and cardiovascular disease: implications for global health. Nat Rev Cardiol 2022; 19:798-812. [PMID: 35672485 DOI: 10.1038/s41569-022-00720-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 12/15/2022]
Abstract
Climate change is the greatest existential challenge to planetary and human health and is dictated by a shift in the Earth's weather and air conditions owing to anthropogenic activity. Climate change has resulted not only in extreme temperatures, but also in an increase in the frequency of droughts, wildfires, dust storms, coastal flooding, storm surges and hurricanes, as well as multiple compound and cascading events. The interactions between climate change and health outcomes are diverse and complex and include several exposure pathways that might promote the development of non-communicable diseases such as cardiovascular disease. A collaborative approach is needed to solve this climate crisis, whereby medical professionals, scientific researchers, public health officials and policymakers should work together to mitigate and limit the consequences of global warming. In this Review, we aim to provide an overview of the consequences of climate change on cardiovascular health, which result from direct exposure pathways, such as shifts in ambient temperature, air pollution, forest fires, desert (dust and sand) storms and extreme weather events. We also describe the populations that are most susceptible to the health effects caused by climate change and propose potential mitigation strategies, with an emphasis on collaboration at the scientific, governmental and policy levels.
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Affiliation(s)
- Haitham Khraishah
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. .,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Barrak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Environmental & Occupational Health Department, Faculty of Public Health, Kuwait University, Hawalli, Kuwait
| | | | - Abdelrahman AlAshqar
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Mazen Albaghdadi
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nirupama Vellanki
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammed M Chowdhury
- Department of Vascular and Endovascular Surgery, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Sadeer G Al-Kindi
- University Hospitals, Harrington Heart & Vascular Institute, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Antonio Gasparrini
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK.,Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK.,Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Sanjay Rajagopalan
- University Hospitals, Harrington Heart & Vascular Institute, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Zhou Y, Zhao L, Meng X, Cai QJ, Zhao XL, Zhou XL, Hu AH. Seasonal variation of ambulatory blood pressure in Chinese hypertensive adolescents. Front Pediatr 2022; 10:1022865. [PMID: 36467472 PMCID: PMC9715761 DOI: 10.3389/fped.2022.1022865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/19/2022] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Blood pressure (BP) exhibits seasonal variation with lower levels at higher temperatures and vice versa. This phenomenon affects both sexes and all age groups. So far, only a few research studies have investigated this condition in adolescents and none of them were based on hypertensive population or ever applied ambulatory blood pressure monitor (ABPM). Therefore, we carried out the first study that used ABPM to record seasonal variation of blood pressure in hypertensive adolescents. METHODS From March 2018 to February 2019, 649 ABPMs from hypertensive adolescents between 13 and 17 years who were referred to wear an ABPM device in Beijing and Baoding were extracted. Seasonal change in ambulatory BP value, dipping status, and prevalence of different BP phenotypes were analyzed and compared. RESULTS Mean age of participants was 14.9 ± 1.5 years and 65.8% of them were boys. Of the participants, 75.3% met the criteria of overweight or obesity. From summer to winter, average 24-hour, day-time, and night-time BP showed significant rise, which was 9.8/2.8, 9.8/3.0, and 10.9/3.4 mmHg, respectively. This seasonal effect on BP was not dependent on the obesity degree. In addition, higher prevalence of nondippers and risers existed in winter while white coat hypertension was more frequent in warmer seasons. CONCLUSION Hypertensive adolescents showed evident seasonal change in their ABPM results, which was featured by elevated BP level and more frequent abnormal dipping patterns in winter. On the contrary, higher prevalence of white coat hypertension was found in warmer seasons. Physicians should take seasonal variation into consideration when managing adolescent hypertension.
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Affiliation(s)
- Yi Zhou
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lin Zhao
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Qiu-Jing Cai
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiao-Lei Zhao
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Ai-Hua Hu
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Tang L, Zhang J, Xu Y, Xu T, Yang Y, Wang J. Novel insights into the association between seasonal variations, blood pressure, and blood pressure variability in patients with new-onset essential hypertension. BMC Cardiovasc Disord 2022; 22:401. [PMID: 36076170 PMCID: PMC9461197 DOI: 10.1186/s12872-022-02840-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/31/2022] [Indexed: 11/11/2022] Open
Abstract
Background Blood pressure (BP) exhibits seasonal variations, with peaks reported in winter. However, the association between seasonal variations and blood pressure variability in patients with new-onset essential hypertension is not fully understood. This study evaluated the potential association of seasonal variations with new-onset essential hypertension. Methods This retrospective observational study recruited a total of 440 consecutive patients with new-onset essential hypertension who underwent 24-h ambulatory electrocardiograph (ECG) and BP measurement at our department between January 2019 and December 2019. Demographic and baseline clinical data including BP variability, heart rate variability, and blood tests were retrieved. Multivariate linear regression analysis was performed to identify factors independently associated with mean BP and BP variability. Results Among the 440 patients recruited, 93 cases were admitted in spring, 72 in summer, 151 in autumn, and 124 in winter. Univariate analysis revealed that systolic BP (SBP), diastolic BP (DBP), high-sensitivity C-reactive protein, SBP drop rate, DBP drop rate, 24-h standard deviation of SBP, 24-h standard deviation of DBP, 24-h SBP coefficient of variation, and 24-h DBP coefficient of variation were associated with patients admitted in winter (P < 0.05 for all). Multivariate linear regression analysis showed that winter was the influencing factor of 24-h standard deviation of SBP (B = 1.851, t = 3.719, P < 0.001), 24-h standard deviation of DBP (B = 1.176, t = 2.917, P = 0.004), 24-h SBP coefficient of variation (B = 0.015, t = 3.670, P < 0.001), and 24-h DBP coefficient of variation (B = 0.016, t = 2.849, P = 0.005) in hypertensive patients. Conclusions Seasonal variations are closely associated with BP variability in patients with new-onset essential hypertension. Our study provides insight into the underlying pathogenesis of new-onset essential hypertension.
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Affiliation(s)
- Long Tang
- Department of Cardiology, The People's Hospital of Xuancheng City, Anhui, 242000, China
| | - Jingshui Zhang
- Department of Cardiology, The People's Hospital of Xuancheng City, Anhui, 242000, China
| | - Yanan Xu
- Respiratory medicine department, The People's Hospital of Xuancheng City, Anhui, 242000, China
| | - Tingting Xu
- Dermatology department, The People's Hospital of Xuancheng City, Anhui, 242000, China
| | - Yi Yang
- Department of Cardiology Fourth Ward, the Xinjiang Medical University Affiliated Hospital of Traditional Chinese Medicine, Ürümqi, 830011, China.
| | - Jun Wang
- Department of Cardiology, The People's Hospital of Xuancheng City, Anhui, 242000, China.
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Liddle L, Monaghan C, Burleigh MC, Baczynska KA, Muggeridge DJ, Easton C. Reduced nitric oxide synthesis in winter: A potential contributing factor to increased cardiovascular risk. Nitric Oxide 2022; 127:1-9. [PMID: 35792235 DOI: 10.1016/j.niox.2022.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nitric oxide is a key signalling molecule that elicits a range of biological functions to maintain vascular homeostasis. A reduced availability of nitric oxide is implicated in the progression of cardiovascular diseases and increases the risk of pathogenic events. AIMS To compare the concentration of nitric oxide metabolites in healthy adults between winter and summer months. DESIGN An observational study of healthy adults (age 32 ± 9 years) living in central Scotland. METHODS Thirty-four healthy adults (13 females) were monitored for 7 days in summer and winter to record sunlight exposure (ultraviolet-A (UV-A) radiation), diet, and physical activity. At the end of each phase, blood pressure was measured, and samples of blood and saliva collected. The samples were analysed to determine the concentrations of plasma and salivary nitrate and nitrite and serum 25-hydroxyvitamin D (25(OH)D). RESULTS The participants maintained similar diets in each measurement phase but were exposed to more UV-A radiation (550%) and undertook more moderate-vigorous physical activity (23%) in the summer than in winter. Plasma nitrite (46%) and serum 25(OH)D (59%) were higher and blood pressure was lower in the summer compared to winter months. Plasma nitrite concentration was negatively associated with systolic, diastolic, and mean arterial blood pressure. CONCLUSIONS Plasma nitrite, an established marker of nitric oxide synthesis, is higher in healthy adults during the summer than in winter. This may be mediated by a greater exposure to UV-A which stimulates the release of nitric oxide metabolites from skin stores. While it is possible that seasonal variation in nitric oxide availability may contribute to an increased blood pressure in the winter months, the overall impact on cardiovascular health remains to be determined.
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Affiliation(s)
- Luke Liddle
- Institute for Clinical Exercise and Health Science, University of the West of Scotland, Blantyre, UK; School of Sport and Health Sciences, St. Luke's Campus, University of Exeter, Exeter, UK
| | - Christopher Monaghan
- Institute for Clinical Exercise and Health Science, University of the West of Scotland, Blantyre, UK
| | - Mia C Burleigh
- Institute for Clinical Exercise and Health Science, University of the West of Scotland, Blantyre, UK
| | - Katarzyna A Baczynska
- Laser and Optical Radiation Dosimetry Group, Centre for Radiation, Chemical and Environmental Hazards, UK Health Security Agency, Chilton, UK
| | | | - Chris Easton
- Institute for Clinical Exercise and Health Science, University of the West of Scotland, Blantyre, UK.
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Zhou Y, Zhao L, Meng X, Cai QJ, Zhao XL, Zhou XL, Hu AH. Seasonal variation of ambulatory blood pressure in Chinese hypertensive adolescents. Front Pediatr 2022. [PMID: 36467472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Blood pressure (BP) exhibits seasonal variation with lower levels at higher temperatures and vice versa. This phenomenon affects both sexes and all age groups. So far, only a few research studies have investigated this condition in adolescents and none of them were based on hypertensive population or ever applied ambulatory blood pressure monitor (ABPM). Therefore, we carried out the first study that used ABPM to record seasonal variation of blood pressure in hypertensive adolescents. METHODS From March 2018 to February 2019, 649 ABPMs from hypertensive adolescents between 13 and 17 years who were referred to wear an ABPM device in Beijing and Baoding were extracted. Seasonal change in ambulatory BP value, dipping status, and prevalence of different BP phenotypes were analyzed and compared. RESULTS Mean age of participants was 14.9 ± 1.5 years and 65.8% of them were boys. Of the participants, 75.3% met the criteria of overweight or obesity. From summer to winter, average 24-hour, day-time, and night-time BP showed significant rise, which was 9.8/2.8, 9.8/3.0, and 10.9/3.4 mmHg, respectively. This seasonal effect on BP was not dependent on the obesity degree. In addition, higher prevalence of nondippers and risers existed in winter while white coat hypertension was more frequent in warmer seasons. CONCLUSION Hypertensive adolescents showed evident seasonal change in their ABPM results, which was featured by elevated BP level and more frequent abnormal dipping patterns in winter. On the contrary, higher prevalence of white coat hypertension was found in warmer seasons. Physicians should take seasonal variation into consideration when managing adolescent hypertension.
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Affiliation(s)
- Yi Zhou
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lin Zhao
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Qiu-Jing Cai
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiao-Lei Zhao
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Ai-Hua Hu
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Narita K, Hoshide S, Kario K. Seasonal variation in blood pressure: current evidence and recommendations for hypertension management. Hypertens Res 2021; 44:1363-1372. [PMID: 34489592 DOI: 10.1038/s41440-021-00732-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/25/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
Blood pressure (BP) exhibits seasonal variation, with an elevation of daytime BP in winter and an elevation of nighttime BP in summer. The wintertime elevation of daytime BP is largely attributable to cold temperatures. The summertime elevation of nighttime BP is not due mainly to temperature; rather, it is considered to be related to physical discomfort and poor sleep quality due to the summer weather. The winter elevation of daytime BP is likely to be associated with the increased incidence of cardiovascular disease (CVD) events in winter compared to other seasons. The suppression of excess seasonal BP changes, especially the wintertime elevation of daytime BP and the summertime elevation of nighttime BP, would contribute to the prevention of CVD events. Herein, we review the literature on seasonal variations in BP, and we recommend the following measures for suppressing excess seasonal BP changes as part of a regimen to manage hypertension: (1) out-of-office BP monitoring, especially home BP measurements, throughout the year to evaluate seasonal variations in BP; (2) the early titration and tapering of antihypertensive medications before winter and summer; (3) the optimization of environmental factors such as room temperature and housing conditions; and (4) the use of information and communication technology-based medicine to evaluate seasonal variations in BP and provide early therapeutic intervention. Seasonal BP variations are an important treatment target for the prevention of CVD through the management of hypertension, and further research is necessary to clarify these variations.
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Affiliation(s)
- Keisuke Narita
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
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Narita K, Hoshide S, Kanegae H, Kario K. Seasonal Variation in Masked Nocturnal Hypertension: The J-HOP Nocturnal Blood Pressure Study. Am J Hypertens 2021; 34:609-618. [PMID: 33245326 DOI: 10.1093/ajh/hpaa193] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/09/2020] [Accepted: 11/20/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about seasonal variation in nighttime blood pressure (BP) measured by a home device. In this cross-sectional study, we sought to assess seasonal variation in nighttime home BP using data from the nationwide, practice-based Japan Morning Surge-Home BP (J-HOP) Nocturnal BP study. METHODS In this study, 2,544 outpatients (mean age 63 years; hypertensives 92%) with cardiovascular risks underwent morning, evening, and nighttime home BP measurements (measured at 2:00, 3:00, and 4:00 am) using validated, automatic, and oscillometric home BP devices. RESULTS Our analysis showed that nighttime home systolic BP (SBP) was higher in summer than in other seasons (summer, 123.3 ± 14.6 mmHg vs. spring, 120.7 ± 14.8 mmHg; autumn, 121.1 ± 14.8 mmHg; winter, 119.3 ± 14.0 mmHg; all P<0.05). Moreover, we assessed seasonal variation in the prevalence of elevated nighttime home SBP (≥120 mmHg) in patients with non-elevated daytime home SBP (average of morning and evening home SBP <135 mmHg; n = 1,565), i.e., masked nocturnal hypertension, which was highest in summer (summer, 45.6% vs. spring, 27.2%; autumn, 28.8%; winter, 24.9%; all P<0.05). Even in intensively controlled morning home SBP (<125 mmHg), the prevalence of masked nocturnal hypertension was higher in summer (summer, 27.4% vs. spring, 14.2%; autumn, 8.9%; winter, 9.0%; all P<0.05). The urine albumin-creatinine ratio in patients with masked nocturnal hypertension tended to be higher than that in patients with non-elevated both daytime and nighttime SBP throughout each season. CONCLUSIONS The prevalence of masked nocturnal hypertension was higher in summer than other seasons and the difference proved to be clinically meaningful.
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Affiliation(s)
- Keisuke Narita
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
- Department of Cardiovascular Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiroshi Kanegae
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
- Genki Plaza Medical Center for Health Care, Tokyo, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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11
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Chen CW, Wu CH, Liou YS, Kuo KL, Chung CH, Lin YT, Kuo TBJ, Yang CCH. Roles of cardiovascular autonomic regulation and sleep patterns in high blood pressure induced by mild cold exposure in rats. Hypertens Res 2021; 44:662-673. [PMID: 33742169 DOI: 10.1038/s41440-021-00619-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/08/2020] [Accepted: 12/18/2020] [Indexed: 11/09/2022]
Abstract
Increased blood pressure (BP) caused by exposure to cold temperatures can partially explain the increased incidence of cardiovascular events in winter. However, the physiological mechanisms involved in cold-induced high BP are not well established. Many studies have focused on physiological responses to severe cold exposure. In this study, we aimed to perform a comprehensive analysis of cardiovascular autonomic function and sleep patterns in rats during exposure to mild cold, a condition relevant to humans in subtropical areas, to clarify the physiological mechanisms underlying mild cold-induced hypertension. BP, electroencephalography, electromyography, electrocardiography, and core body temperature were continuously recorded in normotensive Wistar-Kyoto rats over 24 h. All rats were housed in thermoregulated chambers at ambient temperatures of 23, 18, and 15 °C in a randomized crossover design. These 24-h physiological recordings either with or without sleep scoring showed that compared with the control temperature of 23 °C, the lower ambient temperatures of 18 and 15 °C not only increased BP, vascular sympathetic activity, and heart rate but also decreased overall autonomic activity, parasympathetic activity, and baroreflex sensitivity in rats. In addition, cold exposure reduced the delta power percentage and increased the incidence of interruptions during sleep. Moreover, a correlation analysis revealed that all of these cold-induced autonomic dysregulation and sleep problems were associated with elevation of BP. In conclusion, mild cold exposure elicits autonomic dysregulation and poor sleep quality, causing BP elevation, which may have critical implications for cold-related cardiovascular events.
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Affiliation(s)
- Chieh-Wen Chen
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Han Wu
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Syuan Liou
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Kuan-Liang Kuo
- Institute of BioMedical Informatics, National Yang-Ming University, Taipei, Taiwan
- Family Medicine Department, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Cheng-Hung Chung
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Ting Lin
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Terry B J Kuo
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan.
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.
- Institute of BioMedical Informatics, National Yang-Ming University, Taipei, Taiwan.
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
| | - Cheryl C H Yang
- Sleep Research Center, National Yang-Ming University, Taipei, Taiwan.
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
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12
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Abstract
: Extreme dipping (i.e. a marked blood pressure fall during night-time period) is an alteration of circadian blood pressure (BP) rhythm frequently observed in the setting of systemic hypertension as well as in the general population. Some reports have suggested that cardiovascular prognosis in extreme dippers (ED) is similar as in dippers, whereas other studies have documented either a better or worse prognosis in ED. Available information on clinical and prognostic implications of ED is scanty and data provided by studies are controversial. Furthermore, a comprehensive report summarizing the key features of this BP pattern is lacking. The present review focuses on a number of issues concerning ED pattern such as the prevalence and clinical correlates, mechanisms underlying this BP phenotype association with hypertension mediated organ damage (HMOD) and prognostic value in predicting cardiovascular events and all-cause mortality. The reported prevalence of this BP rhythm alteration ranges from 5% to 30%, depending on diagnostic criteria, clinical and demographic characteristics of subjects. Most studies targeting the association of this condition with HMOD failed to find consistent findings in support of an adverse impact of ED on vascular, renal of cardiac structure and function. Available data on ED as compared to low risk reference group (i.e. dippers) do not allow to conclude that high BP variability resulting from a marked BP fall at night adversely affects cardiovascular prognosis at the community level and in the general hypertensive population. Thus, further studies aimed to assess the prognostic significance of ED as well as the impact of therapeutic interventions aimed to normalize this circadian BP pattern, are highly needed.
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13
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Seasonal blood pressure variation assessed by different measurement methods: systematic review and meta-analysis. J Hypertens 2020; 38:791-798. [DOI: 10.1097/hjh.0000000000002355] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Seasonal variation in blood pressure: Evidence, consensus and recommendations for clinical practice. Consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens 2020; 38:1235-1243. [DOI: 10.1097/hjh.0000000000002341] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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15
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[Seasonal variability of blood pressure: Summer-winter differences detected by ambulatory monitoring]. HIPERTENSION Y RIESGO VASCULAR 2019; 36:110-113. [PMID: 30850336 DOI: 10.1016/j.hipert.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 11/22/2022]
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16
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Seasonal variation in 24 h blood pressure profile in healthy adults- A prospective observational study. J Hum Hypertens 2019; 33:626-633. [PMID: 30755660 DOI: 10.1038/s41371-019-0173-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/19/2018] [Accepted: 01/18/2019] [Indexed: 01/06/2023]
Abstract
The clinical and experimental data on seasonal variation in blood pressure is mainly from office and home blood pressure (BP) monitoring studies. There are few studies from temperate climates on seasonal changes with ambulatory blood pressure (ABP) monitoring and none from India. This is a prospective, observational study among healthy adults. ABP was measured in four different seasons in 28 subjects. Mean arterial pressure (MAP), ambulatory systolic blood pressure (SBP), and ambulatory diastolic blood pressure (DBP) were significantly higher in winter compared to summer season. 24-hour MAP was lowest in summer while highest MAP was recorded in winter (97.04 ± 8.30 and 103.89 ± 8.54, respectively). The mean difference was -6.86 mm Hg (95% CI: -10.74 to -2.97, p = 0.001). This difference was mainly due to increase in day time MAP. There was no difference in 24 h systolic and diastolic blood pressure between summer and winter. There was significant difference between summer and winter in the SBP (day time) [125.61 ± 11.44 and 131.93 ± 9.46, mean difference -6.32 (95% CI: -10.69 to -1.95, p = 0.005)] and DBP (day time) [79.57 ± 9.95 and 87.07 ± 9.9, mean difference -7.50 (95% CI: -12.49 to -2.51, p = 0.003)]. The night time systolic and diastolic BP was similar during winter and summer. Thus, BP increases significantly during winter compared to summer season. This change is primarily in the day time systolic, diastolic and mean blood pressures. Larger studies are required to further validate our findings.
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17
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Sun D, Chen K, Wang J, Zhou L, Zeng C. In-utero cold stress causes elevation of blood pressure via impaired vascular dopamine D1 receptor in offspring. Clin Exp Hypertens 2019; 42:99-104. [PMID: 30698033 DOI: 10.1080/10641963.2019.1571603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Dongdong Sun
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, P.R. China
- Chongqing Institute of Cardiology, Chongqing, P.R. China
| | - Ken Chen
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, P.R. China
- Chongqing Institute of Cardiology, Chongqing, P.R. China
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, P.R. China
| | - Jialiang Wang
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, P.R. China
- Chongqing Institute of Cardiology, Chongqing, P.R. China
| | - Lin Zhou
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, P.R. China
- Chongqing Institute of Cardiology, Chongqing, P.R. China
| | - Chunyu Zeng
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, P.R. China
- Chongqing Institute of Cardiology, Chongqing, P.R. China
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18
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Hypotensive Effect of Heated Water-Based Exercise Persists After 12-Week Cessation of Training in Patients With Resistant Hypertension. Can J Cardiol 2018; 34:1641-1647. [PMID: 30527153 DOI: 10.1016/j.cjca.2018.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Heated water-based exercise (HEx) promotes a marked reduction of blood pressure (BP), but it is not entirely clear whether its effects on BP persist after cessation of HEx. METHODS We analyzed the effects of cessation of HEx on 24-hour ambulatory BP monitoring (ABPM) in patients with resistant hypertension (RH). Thirty-two patients (aged 53 ± 6 years) with RH (4 to 6 antihypertensive drugs) were randomly assigned to HEx (n = 16) or control (n = 16) groups. Antihypertensive therapy remained unchanged during the protocol. The HEx group participated in 36 sessions (60 minutes) in a heated pool (32oC [89.6°F]) for 12 weeks (training), followed by 12 weeks of cessation of training. The control group was evaluated during the same period and instructed to maintain their habitual activities. RESULTS HEx and control groups had similar BP levels at baseline. HEx training reduced the 24-hour systolic (-19.5 ± 4.6 vs 3.0 ± 0.7 mm Hg, P = 0.001) and diastolic BP (-11.1 ± 2.4 vs 2.06 ± 0.9 mm Hg, P = 0.001) at week 12, compared with the control group. After 12 weeks of training cessation (week 24), 24-hour BP remained significantly lower in the HEx group than in the control group (-9.6 ± 3.8 vs 6.3 ± 3.5 mm Hg, P = 0.01 and -7.5±2.2 vs 2.2 ± 1.0 mm Hg, P = 0.009, for systolic and diastolic BP, respectively), although these differences were attenuated. CONCLUSIONS BP remained lower after cessation of 12-week training among patients with RH who underwent HEx compared with the controls. The carryover effects of HEx on BP may help to overcome the challenging problem of exercise compliance in long-term follow-up.
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19
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Echoes from Gaea, Poseidon, Hephaestus, and Prometheus: environmental risk factors for high blood pressure. J Hum Hypertens 2018; 32:594-607. [PMID: 29899375 DOI: 10.1038/s41371-018-0078-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/01/2018] [Indexed: 12/14/2022]
Abstract
High blood pressure (BP) affects over one billion people and is the leading risk factor for global mortality. While many lifestyle and genetic risk factors are well-accepted to increase BP, the role of the external environment is typically overlooked. Mounting evidence now supports that numerous environmental factors can promote an elevation in BP. Broadly speaking these include aspects of the natural environment (e.g., cold temperatures, higher altitude, and winter season), natural disasters (e.g., earthquakes, volcanic eruptions), and man-made exposures (e.g., noise, air pollutants, and toxins/chemicals). This is important for health care providers to recognize as one (or several) of these environmental factors could be playing a clinically meaningful role in elevating BP or disrupting hypertension control among their patients. At the population level, certain environmental exposures may even be contributing to the growing pandemic of hypertension. Here we provide an updated review of the literature linking environment exposures with high BP and outline practical recommendations for clinicians.
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20
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Modesti PA, Rapi S, Rogolino A, Tosi B, Galanti G. Seasonal blood pressure variation: implications for cardiovascular risk stratification. Hypertens Res 2018; 41:475-482. [DOI: 10.1038/s41440-018-0048-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 12/19/2022]
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21
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Hanazawa T, Asayama K, Watabe D, Tanabe A, Satoh M, Inoue R, Hara A, Obara T, Kikuya M, Nomura K, Metoki H, Imai Y, Ohkubo T. Association Between Amplitude of Seasonal Variation in Self-Measured Home Blood Pressure and Cardiovascular Outcomes: HOMED-BP (Hypertension Objective Treatment Based on Measurement By Electrical Devices of Blood Pressure) Study. J Am Heart Assoc 2018; 7:JAHA.117.008509. [PMID: 29728372 PMCID: PMC6015300 DOI: 10.1161/jaha.117.008509] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The clinical significance of long‐term seasonal variations in self‐measured home blood pressure (BP) has not been elucidated for the cardiovascular disease prevention. Methods and Results Eligible 2787 patients were classified into 4 groups according to the magnitude of their seasonal variation in home BP, defined as an average of all increases in home BP from summer (July–August) to winter (January–February) combined with all decreases from winter to summer throughout the follow‐up period, namely inverse‐ (systolic/diastolic, <0/<0 mm Hg), small‐ (0–4.8/0–2.4 mm Hg), middle‐ (4.8–9.1/2.4–4.5 mm Hg), or large‐ (≥9.1/≥4.5 mm Hg) variation groups. The overall cardiovascular risks illustrated U‐shaped relationships across the groups, and hazard ratios for all cardiovascular outcomes compared with the small‐variation group were 3.07 (P=0.004) and 2.02 (P=0.041) in the inverse‐variation group and large‐variation group, respectively, based on systolic BP, and results were confirmatory for major adverse cardiovascular events. Furthermore, when the summer‐winter home BP difference was evaluated among patients who experienced titration and tapering of antihypertensive drugs depending on the season, the difference was significantly smaller in the early (September–November) than in the late (December–February) titration group (3.9/1.2 mm Hg versus 7.3/3.1 mm Hg, P<0.001) as well as in the early (March–May) than in the late (June–August) tapering group (4.4/2.1 mm Hg versus 7.1/3.4 mm Hg, P<0.001). Conclusions The small‐to‐middle seasonal variation in home BP (0–9.1/0–4.5 mm Hg), which may be partially attributed to earlier adjustment of antihypertensive medication, were associated with better cardiovascular outcomes.
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Affiliation(s)
- Tomohiro Hanazawa
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.,Japan Development and Medical Affairs, GlaxoSmithKline KK, Tokyo, Japan
| | - Kei Asayama
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan .,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Daisuke Watabe
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.,Department of Pharmacy, National Cancer Center Hospital, Tokyo, Japan
| | - Ayumi Tanabe
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University Faculty of Medicine, Sendai, Japan
| | - Ryusuke Inoue
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Azusa Hara
- Department of Social Pharmacy and Public Health, Showa Pharmaceutical University, Tokyo, Japan
| | - Taku Obara
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization Tohoku University, Sendai, Japan
| | - Masahiro Kikuya
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization Tohoku University, Sendai, Japan
| | - Kyoko Nomura
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Department of Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Tohoku Medical and Pharmaceutical University Faculty of Medicine, Sendai, Japan
| | - Yutaka Imai
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan
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22
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Tabara Y, Matsumoto T, Murase K, Nagashima S, Hirai T, Kosugi S, Nakayama T, Wakamura T, Chin K, Matsuda F. Seasonal variation in nocturnal home blood pressure fall: the Nagahama study. Hypertens Res 2018; 41:198-208. [DOI: 10.1038/s41440-017-0003-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 11/09/2022]
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23
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24
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Impact of seasonality and air pollutants on carotid-femoral pulse wave velocity and wave reflection in hypertensive patients. PLoS One 2017; 12:e0172550. [PMID: 28231259 PMCID: PMC5322949 DOI: 10.1371/journal.pone.0172550] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 02/05/2017] [Indexed: 12/22/2022] Open
Abstract
Objective The effects of seasonality on blood pressure (BP) and cardiovascular (CV) events are well established, while the influence of seasonality and other environmental factors on arterial stiffness and wave reflection has never been analyzed. This study evaluated whether seasonality (daily number of hours of light) and acute variations in outdoor temperature and air pollutants may affect carotid-femoral pulse wave velocity (PWV) and pressure augmentation. Design and method 731 hypertensive patients (30–88 years, 417 treated) were enrolled in a cross-sectional study during a 5-year period. PWV, central BP, Augmentation Index (AIx) and Augmentation Pressure (AP) were measured in a temperature-controlled (22–24°C) room. Data of the local office of the National Climatic Data Observatory were used to estimate meteorological conditions and air pollutants (PM10, O3, CO, N2O) exposure on the same day. Results PWV (mean value 8.5±1.8 m/s) was related to age (r = 0.467, p<0.001), body mass index (r = 0.132, p<0.001), central systolic (r = 0.414, p<0.001) and diastolic BP (r = 0.093, p = 0.013), daylight hours (r = -0.176, p<0.001), mean outdoor temperature (r = -0.082, p = 0.027), O3 (r = -0.135, p<0.001), CO (r = 0.096, p = 0.012), N2O (r = 0.087, p = 0.022). In multiple linear regression analysis, adjusted for confounders, PWV remained independently associated only with daylight hours (β = -0.170; 95% CI: -0.273 to -0.067, p = 0.001). No significant correlation was found between pressure augmentation and daylight hours, mean temperature or air pollutants. The relationship was stronger in untreated patients and women. Furthermore, a positive, independent association between O3 levels and PWV emerged in untreated patients (β: 0.018; p = 0.029; CI: 0.002 to 0.034) and in women (β: 0.027; p = 0.004; CI: 0.009 to 0.045). Conclusions PWV showed a marked seasonality in hypertensive patients. Environmental O3 levels may acutely reduce arterial stiffness in hypertensive women and in untreated patients.
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Sheng CS, Cheng YB, Wei FF, Yang WY, Guo QH, Li FK, Huang QF, Thijs L, Staessen JA, Wang JG, Li Y. Diurnal Blood Pressure Rhythmicity in Relation to Environmental and Genetic Cues in Untreated Referred Patients. Hypertension 2017; 69:128-135. [DOI: 10.1161/hypertensionaha.116.07958] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 06/23/2016] [Accepted: 10/11/2016] [Indexed: 11/16/2022]
Abstract
No previous study has addressed the relative contributions of environmental and genetic cues to the diurnal blood pressure rhythmicity. From 24-hour ambulatory recordings of systolic blood pressure obtained in untreated patients (51% women; mean age, 51 years), we computed the night-to-day ratio in 897 and morning surge in 637. Environmental cues included season, mean daily outdoor temperature, atmospheric pressure, humidity and weekday, and the genetic cues 14 single nucleotide polymorphisms in 10 clock genes. Systolic blood pressure averaged (±SD) 126.7±11.9 mm Hg, night-to-day ratio 0.86±0.07, and morning surge 24.8±10.7 mm Hg. In adjusted analyses, night-to-day ratio was 2.4% higher in summer and 1.8% lower in winter (
P
<0.001) compared with the annual average with a small effect of temperature (
P
=0.079); morning surge was 1.7 mm Hg lower in summer and 1.1 mm Hg higher in winter (
P
<0.001). The other environmental cues did not add to the night-to-day ratio or morning surge variance (
P
≥0.37). Among the 14 genetic variations, only
CLOCK
rs180260 was significantly associated with morning surge after adjustment for season, temperature, and other host factors and after Bonferroni correction (
P
=0.044). In
CLOCK
rs1801260
C
allele carriers (n=83), morning surge was 3.7 mm Hg higher than in
TT
homozygotes (n=554). Of the night-to-day ratio and morning surge variance, season and temperature explained ≈8% and ≈3%, while for genetic cues, these proportions were ≈1% or less. In conclusion, environmental compared with genetic cues are substantially stronger drivers of the diurnal blood pressure rhythmicity.
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Affiliation(s)
- Chang-Sheng Sheng
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L
| | - Yi-Bang Cheng
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L
| | - Fang-Fei Wei
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L
| | - Wen-Yi Yang
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L
| | - Qian-Hui Guo
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L
| | - Fei-Ka Li
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L
| | - Qi-Fang Huang
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L
| | - Lutgarde Thijs
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L
| | - Jan A. Staessen
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L
| | - Ji-Guang Wang
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L
| | - Yan Li
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (C.-S.S., Y.-B.C., Q.-H.G., F.-K.L., Q.-F.H., J.-G.W., Y.L.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (F.-F.W., W.-Y.Y., L
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Ott C, Lobo MD, Sobotka PA, Mahfoud F, Stanton A, Cockcroft J, Sulke N, Dolan E, van der Giet M, Hoyer J, Furniss SS, Foran JP, Witkowski A, Januszewicz A, Schoors D, Tsioufis K, Rensing BJ, Saxena M, Scott B, Ng GA, Achenbach S, Schmieder RE. Effect of Arteriovenous Anastomosis on Blood Pressure Reduction in Patients With Isolated Systolic Hypertension Compared With Combined Hypertension. J Am Heart Assoc 2016; 5:JAHA.116.004234. [PMID: 28003251 PMCID: PMC5210451 DOI: 10.1161/jaha.116.004234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Options for interventional therapy to lower blood pressure (BP) in patients with treatment‐resistant hypertension include renal denervation and the creation of an arteriovenous anastomosis using the ROX coupler. It has been shown that BP response after renal denervation is greater in patients with combined hypertension (CH) than in patients with isolated systolic hypertension (ISH). We analyzed the effect of ROX coupler implantation in patients with CH as compared with ISH. Methods and Results The randomized, controlled, prospective ROX Control Hypertension Study included patients with true treatment‐resistant hypertension (office systolic BP ≥140 mm Hg, average daytime ambulatory BP ≥135/85 mm Hg, and treatment with ≥3 antihypertensive drugs including a diuretic). In a post hoc analysis, we stratified patients with CH (n=31) and ISH (n=11). Baseline office systolic BP (177±18 mm Hg versus 169±17 mm Hg, P=0.163) and 24‐hour ambulatory systolic BP (159±16 mm Hg versus 154±11 mm Hg, P=0.463) did not differ between patients with CH and those with ISH. ROX coupler implementation resulted in a significant reduction in office systolic BP (CH: −29±21 mm Hg versus ISH: −22±31 mm Hg, P=0.445) and 24‐hour ambulatory systolic BP (CH: −14±20 mm Hg versus ISH: −13±15 mm Hg, P=0.672), without significant differences between the two groups. The responder rate (office systolic BP reduction ≥10 mm Hg) after 6 months was not different (CH: 81% versus ISH: 82%, P=0.932). Conclusions Our data suggest that creation of an arteriovenous anastomosis using the ROX coupler system leads to a similar reduction of office and 24‐hour ambulatory systolic BP in patients with combined and isolated systolic hypertension. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01642498.
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Affiliation(s)
- Christian Ott
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Melvin D Lobo
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom
| | | | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Alice Stanton
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - John Cockcroft
- Cardiolgy Department, Wales Heart Research Institute, Cardiff, United Kingdom
| | - Neil Sulke
- Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom
| | - Eamon Dolan
- Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland
| | - Markus van der Giet
- Department of Endocrinology and Nephrology, Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Hoyer
- Department of Internal Medicine and Nephrology, Universitätsklinikum Gießen und Marburg GmbH, Marburg, Germany
| | - Stephen S Furniss
- Department of Cardiology, East Sussex Healthcare NHS Trust, East Sussex, United Kingdom
| | - John P Foran
- Cardiac Department, Royal Brompton Hospital, London, United Kingdom.,Cardiolgy Department, St. Helier Hospital, Surrey, United Kingdom
| | | | | | - Danny Schoors
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Benno J Rensing
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Manish Saxena
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom
| | - Benjamin Scott
- Department of Cardiology, ZNA - Cardio Middelheim, Antwerp, Belgium
| | - G André Ng
- Department of Cardiovascular Sciences, University of Leicester Glenfield Hospital/NIHR Leicester Cardiovascular Biomedical Research, Leicester, United Kingdom
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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27
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Seasonal variation in self-measured home blood pressure among patients on antihypertensive medications: HOMED-BP study. Hypertens Res 2016; 40:284-290. [DOI: 10.1038/hr.2016.133] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/03/2016] [Accepted: 08/12/2016] [Indexed: 01/20/2023]
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28
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Wallbach M, Lehnig LY, Schroer C, Lüders S, Böhning E, Müller GA, Wachter R, Koziolek MJ. Effects of Baroreflex Activation Therapy on Ambulatory Blood Pressure in Patients With Resistant Hypertension. Hypertension 2016; 67:701-9. [DOI: 10.1161/hypertensionaha.115.06717] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/19/2016] [Indexed: 11/16/2022]
Abstract
Baroreflex activation therapy (BAT) has been demonstrated to decrease office blood pressure (BP) in the randomized, double-blind Rheos trial. There are limited data on 24-hour BP changes measured by ambulatory BP measurements (ABPMs) using the first generation rheos BAT system suggesting a significant reduction but there are no information about the effect of the currently used, unilateral BAT neo device on ABPM. Patients treated with the BAT neo device for uncontrolled resistant hypertension were prospectively included into this study. ABPM was performed before BAT implantation and 6 months after initiation of BAT. A total of 51 patients were included into this study, 7 dropped out from analysis because of missing or insufficient follow-up. After 6 months, 24-hour ambulatory systolic (from 148±17 mm Hg to 140±23 mm Hg,
P
<0.01), diastolic (from 82±13 mm Hg to 77±15 mm Hg,
P
<0.01), day- and night-time systolic and diastolic BP (all
P
≤0.01) significantly decreased while the number of prescribed antihypertensive classes could be reduced from 6.5±1.5 to 6.0±1.8 (
P
=0.03). Heart rate and pulse pressure remained unchanged. BAT was equally effective in reducing ambulatory BP in all subgroups of patients. This is the first study demonstrating a significant BP reduction in ABPM in patients undergoing chronically stimulation of the carotid sinus using the BAT neo device. About that BAT-reduced office BP and improved relevant aspects of ABPM, BAT might be considered as a new therapeutic option to reduce cardiovascular risk in patients with resistant hypertension. Randomized controlled trials are needed to evaluate BAT effects on ABPM in patients with resistant hypertension accurately.
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Affiliation(s)
- Manuel Wallbach
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Luca-Yves Lehnig
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Charlotte Schroer
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Stephan Lüders
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Enrico Böhning
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Gerhard A. Müller
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Rolf Wachter
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Michael J. Koziolek
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
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29
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Hermann JM, Rosenbauer J, Dost A, Steigleder‐Schweiger C, Kiess W, Schöfl C, Holl RW. Seasonal Variation in Blood Pressure in 162,135 Patients With Type 1 or Type 2 Diabetes Mellitus. J Clin Hypertens (Greenwich) 2016; 18:270-8. [PMID: 26663673 PMCID: PMC8031834 DOI: 10.1111/jch.12743] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/31/2015] [Accepted: 09/07/2015] [Indexed: 01/20/2024]
Abstract
Seasonal variation in blood pressure (BP) has been observed in different populations. However, only few studies have focused on BP seasonality in diabetic patients. This study examined the seasonal patterns in BP in 62,589 patients with type 1 diabetes mellitus (T1DM) and in 99,546 patients with type 2 diabetes mellitus (T2DM) from the German/Austrian Diabetes Follow-up Registry. Adjusted mean BP values revealed seasonal cycles of 12 months, with higher BP in colder months. Using harmonic regression models, the estimated systolic BP difference throughout the year was 2.28/2.48 mm Hg in T1DM/T2DM (both P<.001). Interestingly, seasonal variation in diastolic BP was larger in T1DM than in T2DM (1.24/0.64 mm Hg, P<.001). A sex difference was observed in T1DM only, while age differences occurred in both types of diabetes. Correlations between BP and potentially related factors such as outdoor temperature indicated that reasons underlying BP seasonality are likely to be complex and vary by subgroup.
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Affiliation(s)
- Julia M. Hermann
- Institute of Epidemiology and Medical BiometryZIBMTUniversity of UlmUlmGermany
- German Center for Diabetes Research (DZD)München‐NeuherbergGermany
| | - Joachim Rosenbauer
- Institute for Biometrics and EpidemiologyGerman Diabetes CentreLeibniz Centre at Heinrich‐Heine University DüsseldorfDüsseldorfGermany
- German Center for Diabetes Research (DZD)München‐NeuherbergGermany
| | - Axel Dost
- Department of PediatricsUniversity Hospital JenaJenaGermany
| | | | - Wieland Kiess
- Department of Woman and Child HealthCenter for Pediatric ResearchUniversity Hospital for Children and AdolescentsUniversity of LeipzigLeipzigGermany
| | - Christof Schöfl
- Division of Endocrinology and DiabetesDepartment of Medicine IFriedrich‐Alexander‐UniversityErlangen‐NurembergGermany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical BiometryZIBMTUniversity of UlmUlmGermany
- German Center for Diabetes Research (DZD)München‐NeuherbergGermany
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30
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Seasonal variation in meteorological parameters and office, ambulatory and home blood pressure: predicting factors and clinical implications. Hypertens Res 2015; 38:869-75. [DOI: 10.1038/hr.2015.96] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 06/28/2015] [Accepted: 07/02/2015] [Indexed: 11/08/2022]
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31
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Summertime dosage-dependent hypersensitivity to an angiotensin II receptor blocker. BMC Res Notes 2015; 8:227. [PMID: 26055103 PMCID: PMC4467666 DOI: 10.1186/s13104-015-1215-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/29/2015] [Indexed: 01/08/2023] Open
Abstract
Background Summertime dips in blood pressure (BP), both in normotensive and hypertensive subjects, are well known. However, the dips are small and are not related to particular forms or doses of antihypertensive medication. Nevertheless it is the practice in some quarters to decrease antihypertensive medication in summer, and/or to increase in winter. Large scale studies being inconclusive, there are calls for long-term examination of the relationship between environmental temperature and blood pressure in single individuals under medication. Case presentation While analyzing data from a subject whose BP had been controlled for a decade with the angiotensin-II receptor blocker losartan, an extreme, dosage-dependent, summertime dip came to light. Downward dosage adjustment appeared essential and may have prevented hypotension-related pathology. Conclusion The benefits of aggressive medication (the “J curve” phenomenon) being debated, the possibility of seasonal hypersensitivity, perhaps explicable in terms of differential signaling by countervailing receptors, should be taken into account when considering dosage adjustments in hypertensive subjects.
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Yang L, Li L, Lewington S, Guo Y, Sherliker P, Bian Z, Collins R, Peto R, Liu Y, Yang R, Zhang Y, Li G, Liu S, Chen Z. Outdoor temperature, blood pressure, and cardiovascular disease mortality among 23 000 individuals with diagnosed cardiovascular diseases from China. Eur Heart J 2015; 36:1178-85. [PMID: 25690792 PMCID: PMC4430682 DOI: 10.1093/eurheartj/ehv023] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 01/15/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction Blood pressure is a major cause of cardiovascular disease (CVD) and both may increase as outdoor temperatures fall. However, there are still limited data about seasonal variation in blood pressure and CVD mortality among patients with prior-CVD. Methods We analysed data on 23 000 individuals with prior-CVD who were recruited from 10 diverse regions into the China Kadoorie Biobank during 2004–8. After 7 years of follow-up, 1484 CVD deaths were recorded. Baseline survey data were used to assess seasonal variation in systolic blood pressure (SBP) and its association with outdoor temperature. Cox regression was used to examine the association of usual SBP with subsequent CVD mortality, and seasonal variation in CVD mortality was assessed by Poisson regression. All analyses were adjusted for age, sex, and region. Results Mean SBP was significantly higher in winter than in summer (145 vs. 136 mmHg, P < 0.001), especially among those without central heating. Above 5°C, each 10°C lower outdoor temperature was associated with 6.2 mmHg higher SBP. Systolic blood pressure predicted subsequent CVD mortality, with each 10 mmHg higher usual SBP associated with 21% (95% confidence interval: 16–27%) increased risk. Cardiovascular disease mortality varied by season, with 41% (21–63%) higher risk in winter compared with summer. Conclusion Among adult Chinese with prior-CVD, there is both increased blood pressure and CVD mortality in winter. Careful monitoring and more aggressive blood pressure lowering treatment in the cold months are needed to help reduce the winter excess CVD mortality in high-risk individuals.
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Affiliation(s)
- Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Liming Li
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China Department of Epidemiology, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China Department of Epidemiology, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Paul Sherliker
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China Department of Epidemiology, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Yun Liu
- NCDs Prevention and Control Department, Liuzhou CDC, Liuzhou, Guangxi, China
| | - Rong Yang
- NCDs Prevention and Control Department, Pengzhou CDC, Pengzhou, Sichuan, China
| | - Yongrui Zhang
- NCDs Prevention and Control Department, Gansu CDC, Lanzhou, Gansu, China
| | - Guangchun Li
- NCDs Prevention and Control Department, Hunan CDC, Changsha, Hunan, China
| | - Shumei Liu
- NCDs Prevention and Control Department, Heilongjiang CDC, Harbin, Heilongjiang, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
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Guimaraes GV, de Barros Cruz LG, Fernandes-Silva MM, Dorea EL, Bocchi EA. Heated water-based exercise training reduces 24-hour ambulatory blood pressure levels in resistant hypertensive patients: a randomized controlled trial (HEx trial). Int J Cardiol 2014; 172:434-41. [PMID: 24491874 DOI: 10.1016/j.ijcard.2014.01.100] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 12/12/2013] [Accepted: 01/19/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Regular exercise is an effective intervention to decrease blood pressure (BP) in hypertension, but no data are available concerning the effects of heated water-based exercise (HEx). This study examines the effects of HEx on BP in resistant hypertensive patients. METHODS This is a parallel, randomized controlled trial. 125 nonconsecutive sedentary patients with resistant hypertension from a hypertension outpatient clinic in a university hospital were screened; 32 patients fulfilled the study requirements. The training was performed for 60-minute sessions in a heated pool (32°C), three times a week for 12 weeks. The HEx protocol consisted of callisthenic exercises and walking inside the pool. The control group was asked to maintain habitual activities. The main outcome measure was change in mean 24-hour ambulatory BP (ABPM). RESULTS 32 patients (HEx n=16; control n=16) were randomized; none were lost to follow-up. Office BPs decreased significantly after heated water exercise (36/12 mmHg). HEx decreased 24-hour systolic (from 137±23 to 120±12 mmHg, p=0.001) and diastolic BPs (from 81±13 to 72±10 mmHg, p=0.009); daytime systolic (from 141±24 to 120±13 mmHg, p<0.0001) and diastolic BPs (from 84±14 to 73±11 mmHg, p=0.003); and nighttime systolic (from 129±22 to 114±12 mmHg, p=0.006) and diastolic BPs (from 74±11 to 66±10 mmHg, p<0.0001). The control group after 12 weeks significantly increased in 24-hour systolic and diastolic BPs, and daytime and nighttime diastolic BPs. CONCLUSION HEx reduced office BPs and 24-hour ABPM levels in resistant hypertensive patients. These effects suggest that HEx may be a potential new therapeutic approach in these patients.
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Affiliation(s)
- Guilherme Veiga Guimaraes
- Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
| | | | | | - Egidio Lima Dorea
- University Hospital, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Edimar Alcides Bocchi
- Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
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34
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Ott C, Mahfoud F, Schmid A, Ditting T, Sobotka PA, Veelken R, Spies A, Ukena C, Laufs U, Uder M, Böhm M, Schmieder RE. Renal Denervation in Moderate Treatment-Resistant Hypertension. J Am Coll Cardiol 2013; 62:1880-6. [DOI: 10.1016/j.jacc.2013.06.023] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 06/05/2013] [Accepted: 06/11/2013] [Indexed: 11/26/2022]
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35
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Modesti PA. Season, temperature and blood pressure: a complex interaction. Eur J Intern Med 2013; 24:604-7. [PMID: 23972926 DOI: 10.1016/j.ejim.2013.08.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/31/2013] [Accepted: 08/02/2013] [Indexed: 10/26/2022]
Abstract
An increase in blood pressure values measured during winter either in the office, at home, or at ambulatory blood pressure monitoring was consistently observed. Besides potentially contributing to increase the risk for cardiovascular events during the cold season, long term blood pressure variations can influence results of clinical trials, epidemiological surveys, and require personalized management of antihypertensive medications in the single patient. Those variations are often considered as an effect of climate, due to the close correlation observed in various countries and in different settings between temperature and blood pressure among children, adults, and specially the elderly. However, obtaining true measurements of exposition is a main problem when investigating the effects of climate on human health especially when the aim is to disentangle the effects of climate from those of seasonality. The aim of the present note is not to provide a complete review of the literature demonstrating the implications of seasonal blood pressure changes in the clinical and experimental setting; rather it is to consider methodological aspects useful to investigate the interaction between seasonality and temperature on blood pressure and to make health care providers aware of the implications of environmental factors on blood pressure in clinical and research settings.
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Affiliation(s)
- Pietro Amedeo Modesti
- Dept. of Clinical and Experimental Medicine, University of Florence, Florence, Italy; Centre for Civil Protection and Risk Studies, University of Florence (CESPRO), Florence, Italy.
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36
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Mahfoud F, Ukena C, Schmieder RE, Cremers B, Rump LC, Vonend O, Weil J, Schmidt M, Hoppe UC, Zeller T, Bauer A, Ott C, Blessing E, Sobotka PA, Krum H, Schlaich M, Esler M, Böhm M. Ambulatory blood pressure changes after renal sympathetic denervation in patients with resistant hypertension. Circulation 2013; 128:132-40. [PMID: 23780578 DOI: 10.1161/circulationaha.112.000949] [Citation(s) in RCA: 215] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Catheter-based renal sympathetic denervation (RDN) reduces office blood pressure (BP) in patients with resistant hypertension according to office BP. Less is known about the effect of RDN on 24-hour BP measured by ambulatory BP monitoring and correlates of response in individuals with true or pseudoresistant hypertension. METHODS AND RESULTS A total of 346 uncontrolled hypertensive patients, separated according to daytime ambulatory BP monitoring into 303 with true resistant (office systolic BP [SBP] 172.2±22 mm Hg; 24-hour SBP 154±16.2 mm Hg) and 43 with pseudoresistant hypertension (office SBP 161.2±20.3 mm Hg; 24-hour SBP 121.1±19.6 mm Hg), from 10 centers were studied. At 3, 6, and 12 months follow-up, office SBP was reduced by 21.5/23.7/27.3 mm Hg, office diastolic BP by 8.9/9.5/11.7 mm Hg, and pulse pressure by 13.4/14.2/14.9 mm Hg (n=245/236/90; P for all <0.001), respectively. In patients with true treatment resistance there was a significant reduction with RDN in 24-hour SBP (-10.1/-10.2/-11.7 mm Hg, P<0.001), diastolic BP (-4.8/-4.9/-7.4 mm Hg, P<0.001), maximum SBP (-11.7/-10.0/-6.1 mm Hg, P<0.001) and minimum SBP (-6.0/-9.4/-13.1 mm Hg, P<0.001) at 3, 6, and 12 months, respectively. There was no effect on ambulatory BP monitoring in pseudoresistant patients, whereas office BP was reduced to a similar extent. RDN was equally effective in reducing BP in different subgroups of patients. Office SBP at baseline was the only independent correlate of BP response. CONCLUSIONS RDN reduced office BP and improved relevant aspects of ambulatory BP monitoring, commonly linked to high cardiovascular risk, in patients with true-treatment resistant hypertension, whereas it only affected office BP in pseudoresistant hypertension.
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str, Geb 40, 66421 Homburg/Saar, Germany.
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Seasonal variation in blood pressure is modulated by gender and age but not by BMI in a large Taiwanese population, 1996-2006. ACTA ACUST UNITED AC 2013; 7:216-28. [PMID: 23490614 DOI: 10.1016/j.jash.2013.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 01/22/2013] [Accepted: 01/31/2013] [Indexed: 11/20/2022]
Abstract
Previous research has found that blood pressure tends to be higher in winter and lower in summer. The present study examined seasonal variation in blood pressure by gender, hypertension medication, age group, and body mass index using contemporary Taiwanese data. Over 400,000 health screening records collected biennially between 1996 and 2006 were used to calculate average monthly systolic (SBP) and diastolic blood pressure (DBP) measurements. Generalized estimating equations were used to estimate the difference between the highest and lowest mean monthly blood pressure measurements. Mean monthly blood pressure measurements were higher in winter than in summer for all age groups, regardless of medication for hypertension. The largest difference in mean monthly blood pressure between summer and winter months was 5.3 mm Hg (Standard error = 0.7) for SBP and 3.2 mm Hg (Standard error = 0.7) for DBP. These differences were more pronounced: in SBP than in DBP; in men than in women; and in older than in younger participants. Body mass index was not clearly associated with seasonal variation in blood pressure. Seasonal variation in blood pressure among contemporary Taiwanese populations is modest and may only approach clinical significance for the diagnosis and treatment of hypertension and the prevention of cardiovascular disease amongst older male individuals.
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Modesti PA, Morabito M, Massetti L, Rapi S, Orlandini S, Mancia G, Gensini GF, Parati G. Seasonal blood pressure changes: an independent relationship with temperature and daylight hours. Hypertension 2013; 61:908-14. [PMID: 23381792 DOI: 10.1161/hypertensionaha.111.00315] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Seasonal blood pressure (BP) changes have been found to be related to either outdoor or indoor temperature. No information regarding the independent effects of temperature measured proximally to the patient, the personal-level environmental temperature (PET), is available. Inclusion of daylight hours in multivariate analysis might allow exploring the independent interaction of BP with seasonality. To investigate whether ambulatory BP monitoring is affected by PET or by seasonality, 1897 patients referred to our hypertension units underwent ambulatory BP monitoring with a battery-powered temperature data logger fitted to the carrying pouch of the monitor. Predictors of 24-hour daytime and nighttime BP and of morning BP surge were investigated with a multivariate stepwise regression model, including age, sex, body mass index, antihypertensive treatment, office BP, ambulatory heart rate, PET, relative humidity, atmospheric pressure, and daylight hours as independent variables. At adjusted regression analysis, daytime systolic BP was negatively related to PET (-0.14; 95% confidence interval, -0.25 to -0.02); nighttime BP was positively related to daylight hours (0.63; 0.37-0.90); and morning BP surge was negatively related to daylight hours (-0.54; -0.87 to -0.21). These results provide new evidence that PET and seasonality (daylight hours) are 2 independent predictors of ambulatory BP monitoring.
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Affiliation(s)
- Pietro Amedeo Modesti
- Clinica Medica Generale e Cardiologia, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
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