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Kutumova E, Kovaleva A, Sharipov R, Lifshits G, Kolpakov F. Mathematical modelling of the influence of ACE I/D polymorphism on blood pressure and antihypertensive therapy. Heliyon 2024; 10:e29988. [PMID: 38707445 PMCID: PMC11068647 DOI: 10.1016/j.heliyon.2024.e29988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/29/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
The angiotensin-converting enzyme (ACE) gene (ACE) insertion/deletion (I/D) polymorphism raises the possibility of personalising ACE inhibitor therapy to optimise its efficiency and reduce side effects in genetically distinct subgroups. However, the extent of its influence among these subgroups is unknown. Therefore, we extended our computational model of blood pressure regulation to investigate the effect of the ACE I/D polymorphism on haemodynamic parameters in humans undergoing antihypertensive therapy. The model showed that the dependence of blood pressure on serum ACE activity is a function of saturation and therefore, the lack of association between ACE I/D and blood pressure levels may be due to high ACE activity in specific populations. Additionally, in an extended model simulating the effects of different classes of antihypertensive drugs, we explored the relationship between ACE I/D and the efficacy of inhibitors of the renin-angiotensin-aldosterone system. The model predicted that the response of cardiovascular and renal parameters to treatment directly depends on ACE activity. However, significant differences in parameter changes were observed only between groups with high and low ACE levels, while different ACE I/D genotypes within the same group had similar changes in absolute values. We conclude that a single genetic variant is responsible for only a small fraction of heredity in treatment success and its predictive value is limited.
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Affiliation(s)
- Elena Kutumova
- Department of Computational Biology, Sirius University of Science and Technology, Sirius, Krasnodar region, Russia
- Laboratory of Bioinformatics, Federal Research Center for Information and Computational Technologies, Novosibirsk, Russia
- Biosoft.Ru, Ltd., Novosibirsk, Russia
| | - Anna Kovaleva
- Laboratory for Personalized Medicine, Center of New Medical Technologies, Institute of Chemical Biology and Fundamental Medicine SB RAS, Novosibirsk, Russia
| | - Ruslan Sharipov
- Laboratory of Bioinformatics, Federal Research Center for Information and Computational Technologies, Novosibirsk, Russia
- Biosoft.Ru, Ltd., Novosibirsk, Russia
- Specialized Educational Scientific Center, Novosibirsk State University, Novosibirsk, Russia
| | - Galina Lifshits
- Laboratory for Personalized Medicine, Center of New Medical Technologies, Institute of Chemical Biology and Fundamental Medicine SB RAS, Novosibirsk, Russia
| | - Fedor Kolpakov
- Department of Computational Biology, Sirius University of Science and Technology, Sirius, Krasnodar region, Russia
- Laboratory of Bioinformatics, Federal Research Center for Information and Computational Technologies, Novosibirsk, Russia
- Biosoft.Ru, Ltd., Novosibirsk, Russia
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Desplanche E, Grillet PE, Wynands Q, Bideaux P, Alburquerque L, Charrabi A, Bourdin A, Cazorla O, Gouzi F, Virsolvy A. Elevated Blood Pressure Occurs without Endothelial Dysfunction in a Rat Model of Pulmonary Emphysema. Int J Mol Sci 2023; 24:12609. [PMID: 37628790 PMCID: PMC10454081 DOI: 10.3390/ijms241612609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/21/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease involving airway closure and parenchyma destruction (emphysema). Cardiovascular diseases are the main causes of morbi-mortality in COPD and, in particular, hypertension and heart failure with preserved ejection fraction (HFpEF). However, no mechanistic link has currently been established between the onset of COPD, elevated blood pressure (BP) and systemic vascular impairment (endothelial dysfunction). Thus, we aimed to characterize BP and vascular function and remodeling in a rat model of exacerbated emphysema focusing on the role of sympathetic hyperactivity. Emphysema was induced in male Wistar rats by four weekly pulmonary instillations of elastase (4UI) and exacerbation by a single dose of lipopolysaccharides (LPS). Five weeks following the last instillation, in vivo and ex vivo cardiac and vascular functions were investigated. Exacerbated emphysema induced cardiac dysfunction (HFpEF) and a BP increase in this COPD model. We observed vasomotor changes and hypotrophic remodeling of the aorta without endothelial dysfunction. Indeed, changes in contractile and vasorelaxant properties, though endothelium-dependent, were pro-relaxant and NO-independent. A β1-receptor antagonist (bisoprolol) prevented HFpEF and vascular adaptations, while the effect on BP increase was partial. Endothelial dysfunction would not trigger hypertension and HFpEF in COPD. Vascular changes appeared as an adaptation to the increased BP. The preventing effect of bisoprolol revealed a pivotal role of sympathetic hyperactivation in BP elevation. The mechanistic link between HFpEF, cardiac sympathetic activation and BP deserves further studies in this exacerbated-emphysema model, as well as in COPD patients.
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Affiliation(s)
- Elodie Desplanche
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Pierre-Edouard Grillet
- PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, 34295 Montpellier, France; (P.-E.G.); (A.B.); (F.G.)
| | - Quentin Wynands
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Patrice Bideaux
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Laurie Alburquerque
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Azzouz Charrabi
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Arnaud Bourdin
- PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, 34295 Montpellier, France; (P.-E.G.); (A.B.); (F.G.)
| | - Olivier Cazorla
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Fares Gouzi
- PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, 34295 Montpellier, France; (P.-E.G.); (A.B.); (F.G.)
| | - Anne Virsolvy
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
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Kutumova E, Kiselev I, Sharipov R, Lifshits G, Kolpakov F. Mathematical modeling of antihypertensive therapy. Front Physiol 2022; 13:1070115. [PMID: 36589434 PMCID: PMC9795234 DOI: 10.3389/fphys.2022.1070115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Hypertension is a multifactorial disease arising from complex pathophysiological pathways. Individual characteristics of patients result in different responses to various classes of antihypertensive medications. Therefore, evaluating the efficacy of therapy based on in silico predictions is an important task. This study is a continuation of research on the modular agent-based model of the cardiovascular and renal systems (presented in the previously published article). In the current work, we included in the model equations simulating the response to antihypertensive therapies with different mechanisms of action. For this, we used the pharmacodynamic effects of the angiotensin II receptor blocker losartan, the calcium channel blocker amlodipine, the angiotensin-converting enzyme inhibitor enalapril, the direct renin inhibitor aliskiren, the thiazide diuretic hydrochlorothiazide, and the β-blocker bisoprolol. We fitted therapy parameters based on known clinical trials for all considered medications, and then tested the model's ability to show reasonable dynamics (expected by clinical observations) after treatment with individual drugs and their dual combinations in a group of virtual patients with hypertension. The extended model paves the way for the next step in personalized medicine that is adapting the model parameters to a real patient and predicting his response to antihypertensive therapy. The model is implemented in the BioUML software and is available at https://gitlab.sirius-web.org/virtual-patient/antihypertensive-treatment-modeling.
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Affiliation(s)
- Elena Kutumova
- Department of Computational Biology, Sirius University of Science and Technology, Sochi, Russia,Laboratory of Bioinformatics, Federal Research Center for Information and Computational Technologies, Novosibirsk, Russia,Biosoft.Ru, Ltd., Novosibirsk, Russia,*Correspondence: Elena Kutumova,
| | - Ilya Kiselev
- Department of Computational Biology, Sirius University of Science and Technology, Sochi, Russia,Laboratory of Bioinformatics, Federal Research Center for Information and Computational Technologies, Novosibirsk, Russia,Biosoft.Ru, Ltd., Novosibirsk, Russia
| | - Ruslan Sharipov
- Department of Computational Biology, Sirius University of Science and Technology, Sochi, Russia,Laboratory of Bioinformatics, Federal Research Center for Information and Computational Technologies, Novosibirsk, Russia,Biosoft.Ru, Ltd., Novosibirsk, Russia,Specialized Educational Scientific Center, Novosibirsk State University, Novosibirsk, Russia
| | - Galina Lifshits
- Laboratory for Personalized Medicine, Center of New Medical Technologies, Institute of Chemical Biology and Fundamental Medicine SB RAS, Novosibirsk, Russia
| | - Fedor Kolpakov
- Department of Computational Biology, Sirius University of Science and Technology, Sochi, Russia,Laboratory of Bioinformatics, Federal Research Center for Information and Computational Technologies, Novosibirsk, Russia,Biosoft.Ru, Ltd., Novosibirsk, Russia
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Foch C, Allignol A, Hohenberger T, Boutmy E, Schaefer S, Hostalek U. Effectiveness of bisoprolol versus other β-blockers and other antihypertensive classes: a cohort study in the Clinical Practice Research Datalink. J Comp Eff Res 2022; 11:423-436. [PMID: 35189710 DOI: 10.2217/cer-2021-0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare blood pressure (BP) and safety outcomes in patients with hypertension initiating bisoprolol, versus other β-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, calcium channel blockers or diuretics. Materials & methods: New user cohort study. Patients initiating bisoprolol were matched with up to four patients, in each comparator cohort using propensity score. BP outcomes were compared using linear mixed models and safety outcomes using Cox proportional hazards. Results: Differences in average systolic and diastolic BP variation were ≤3 mmHg between bisoprolol versus the compared classes. No difference was observed in risk of diabetes, obesity or erectile dysfunction. An increased dyslipidemia risk was only observed versus diuretics (hazard ratio: 0.76; 98.75% CI: 0.58, 0.99). Conclusion: No differences in BP variation and safety outcomes.
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Affiliation(s)
- Caroline Foch
- Merck KGaA, Frankfurter Str 250, Darmstadt, 64293, Germany
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Chen YD, Yang XC, Pham VN, Huang SA, Fu GS, Chen XP, Truong BQ, Yang Y, Liu SW, Ma TR, Kim DS, Kim TH. Resting heart rate control and prognosis in coronary artery disease patients with hypertension previously treated with bisoprolol: a sub-group analysis of the BISO-CAD study. Chin Med J (Engl) 2020; 133:1155-1165. [PMID: 32433047 PMCID: PMC7249722 DOI: 10.1097/cm9.0000000000000802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Resting heart rate (RHR) is considered as a strong predictor of total mortality and hospitalization due to heart failure in hypertension patients. Bisoprolol fumarate, a second-generation beta-adrenoreceptor blockers (β-blocker) is commonly prescribed drug to manage hypertension. The present study was to retrospectively evaluate changes in the average RHR and its association with cardiovascular outcomes in bisoprolol-treated coronary artery disease (CAD) patients from the CAD treated with bisoprolol (BISO-CAD) study who had comorbid hypertension. METHODS We performed ad-hoc analysis for hypertension sub-group of the BISO-CAD study (n = 866), which was a phase IV, multination, multi-center, single-arm, observational study carried out from October 2011 to July 2015 across China, South Korea, and Vietnam. Multivariate regression analysis was used to identify factors associated with incidence of composite cardiac clinical outcome (CCCO), the results were presented as adjusted odds ratio (OR) along with 95% confidence interval (CI) and adjusted P value. RESULTS A total of 681 patients (mean age: 64.77 ± 10.33 years) with hypertension from BISO-CAD study were included in the analysis. Bisoprolol improved CCCOs in CAD patients with comorbid hypertension, with RHR <65 and <70 beats/min compared with RHR ≥65 and ≥75 beats/min, respectively, in the efficacy analysis (EA) set. In addition, it lowered RHR in both intent-to-treat (ITT) and EA groups after 6, 12, and 18 months of treatment. Further, RHR 70 to 74 beats/min resulted in significantly higher risk of CCCOs EA set of patients (adjusted OR: 4.34; 95% CI: 1.19-15.89; P = 0.03). Also, events of hospitalization due to acute coronary syndrome were higher when RHR 69 to 74 beats/min compared to RHR <69 beats/min in ITT patients. CONCLUSION Bisoprolol can effectively reduce RHR in Asian CAD patients with comorbid hypertension and hence, improve CCCO without affecting their blood pressure.
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Affiliation(s)
- Yun-Dai Chen
- Department of Cardiology, China PLA General Hospital, Beijing 100853, China
| | - Xin-Chun Yang
- Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Vinh Nguyen Pham
- Department of Cardiology, Tam Duc Hospital, Ho Chi Minh City 700000, Vietnam
| | - Shi-An Huang
- Department of Cardiology, Affiliated Hospital of Guangdong Medical College, Guangzhou, Guangdong 524001, China
| | - Guo-Sheng Fu
- Department of Cardiology, Sir Run Shaw Hospital, Affiliated with School of Medicine Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Xiao-Ping Chen
- Department of Cardiology, West China Hospital, Chengdu, Sichuan 610041, China
| | - Binh Quang Truong
- Department of Cardiology, University Medical Centre HCMC, Ho Chi Minh 700000, Vietnam
| | - Yu Yang
- Geriatrics Department, The Second Xiangya Hospital of Central South University, Tianxin, Changsha 410011, China
| | - Shao-Wen Liu
- Department of Cardiology, Shanghai First People's Hospital, Shanghai 200080, China
| | - Tian-Rong Ma
- Department of Medical Affairs, Merck Serono Co., Ltd., Beijing 100016, China
| | - Dong-Soo Kim
- Department of Cardiology, Inje University Busan Paik Hospital, Busan 47392, Korea
| | - Tae-hoon Kim
- Department of Cardiology, Sejong Hospital, Gyeonggi-do 14754, Korea
- Department of Cardiology, New Korea Hospital, Gyeonggi-do 10086, Korea
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Cheng HM, Chuang SY, Wang TD, Kario K, Buranakitjaroen P, Chia YC, Divinagracia R, Hoshide S, Minh HV, Nailes J, Park S, Shin J, Siddique S, Sison J, Soenarta AA, Sogunuru GP, Sukonthasarn A, Tay JC, Teo BW, Turana Y, Verma N, Zhang Y, Wang JG, Chen CH. Central blood pressure for the management of hypertension: Is it a practical clinical tool in current practice? J Clin Hypertens (Greenwich) 2019; 22:391-406. [PMID: 31841279 DOI: 10.1111/jch.13758] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/12/2019] [Accepted: 11/17/2019] [Indexed: 12/31/2022]
Abstract
Since noninvasive central blood pressure (BP) measuring devices are readily available, central BP has gained growing attention regarding its clinical application in the management of hypertension. The disagreement between central and peripheral BP has long been recognized. Some previous studies showed that noninvasive central BP may be better than the conventional brachial BP in association with target organ damages and long-term cardiovascular outcomes. Recent studies further suggest that the central BP strategy for confirming a diagnosis of hypertension may be more cost-effective than the conventional strategy, and guidance of hypertension management with central BP may result in less use of medications to achieve BP control. Despite the use of central BP being promising, more randomized controlled studies comparing central BP-guided therapeutic strategies with conventional care for cardiovascular events reduction are required because noninvasive central and brachial BP measures are conveniently available. In this brief review, the rationale supporting the utility of central BP in clinical practice and relating challenges are summarized.
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Affiliation(s)
- Hao-Min Cheng
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan
| | - Tzung-Dau Wang
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Peera Buranakitjaroen
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Romeo Divinagracia
- University of the East Ramon Magsaysay Memorial Medical Center Inc, Quezon City, Philippines
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Huynh Van Minh
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Jennifer Nailes
- University of the East Ramon Magsaysay Memorial Medical Center Inc, Quezon City, Philippines
| | - Sungha Park
- Division of Cardiology, Cardiovascular Hospital, Yonsei Health System, Seoul, Korea
| | - Jinho Shin
- Faculty of Cardiology Service, Hanyang University Medical Center, Seoul, Korea
| | | | - Jorge Sison
- Section of Cardiology, Department of Medicine, Medical Center Manila, Manila, Philippines
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia-National Cardiovascular Center, Jakarta, Indonesia
| | - Guru Prasad Sogunuru
- MIOT International Hospital, Chennai, India.,College of Medical Sciences, Kathmandu University, Bharatpur, Nepal
| | - Apichard Sukonthasarn
- Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jam Chin Tay
- Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Boon Wee Teo
- Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Yuda Turana
- Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Narsingh Verma
- Indian Society of Hypertension, King George's Medical University, Lucknow, India
| | - Yuqing Zhang
- Divisions of Hypertension and Heart Failure, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, the Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chen-Huan Chen
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Serinel Y, Hoyos C, Qasem A, Yee BJ, Grunstein RR, Wong KH, Phillips CL. Diurnal changes in central blood pressure and pulse pressure amplification in patients with obstructive sleep apnoea. Int J Cardiol Hypertens 2019; 1:100002. [PMID: 33447736 PMCID: PMC7803064 DOI: 10.1016/j.ijchy.2019.100002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/27/2019] [Indexed: 01/20/2023] Open
Abstract
STUDY OBJECTIVES Recent evidence suggests that compared to peripheral blood pressure (BP), central BP may be more strongly associated with target organ damage and cardiovascular morbidity and mortality. Technological advances now allow the ambulatory measurement of peripheral and central BP over 24 h. For the first time, we set out to characterise the diurnal profile of central BP and pulse pressure amplification (PPA) in patients with obstructive sleep apnoea (OSA). METHODS In this observational study, patients with moderate to severe OSA underwent 24 h central and peripheral BP testing before and after at least 4 weeks of CPAP therapy. Concurrent actigraphy was performed to confirm sleep and wake times. RESULTS 36 patients were screened, 31 had successful testing (mean (SD) age 45 ± 10 years, AHI 58 ± 27 events/hr, Office BP 136/89 ± 10.7/9.5 mmHg, 32% on anti-hypertensives, 77% dippers), 21 completed testing post CPAP. Central systolic and diastolic BP followed the same nocturnal dipping profile as peripheral BP, however the peripheral pulse pressure (PP) narrowed in sleep (-3.2 mmHg, p < 0.001), whereas the central PP remained unchanged (0.124 mmHg, NS), causing a significant reduction in PPA overnight (-10.7%, p < 0.001). The magnitude of dip in central systolic pressure was less than peripheral systolic pressure (by 2.3 mmHg, p < 0.001). After treatment with CPAP, the PPA reduction overnight was attenuated (by -3.3%, p = 0.004). CONCLUSIONS In moderate to severe OSA, central BP and PPA reduce overnight during sleep. Further randomised controlled studies are needed to quantify the differential effects of CPAP and anti-hypertensives on central versus peripheral BP.
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Affiliation(s)
- Yasmina Serinel
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Nepean Hospital, Derby St, Penrith NSW 2750, Australia
| | - Camilla Hoyos
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Ahmad Qasem
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, 2 Technology Place, NSW 2109 Australia
| | - Brendon J. Yee
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Rd, Newtown NSW 2050, Australia
| | - Ronald R. Grunstein
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Rd, Newtown NSW 2050, Australia
| | - Keith H. Wong
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Rd, Newtown NSW 2050, Australia
| | - Craig L. Phillips
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Reserve Rd, St Leonards, Sydney, NSW 2065, Australia
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Adverse influence of bisoprolol on central blood pressure in the upright position: a double-blind placebo-controlled cross-over study. J Hum Hypertens 2019; 34:301-310. [PMID: 30886326 PMCID: PMC7165126 DOI: 10.1038/s41371-019-0188-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/22/2019] [Accepted: 02/18/2019] [Indexed: 02/01/2023]
Abstract
Treatment with beta-blockers is characterized by inferior reduction of central versus peripheral blood pressure. We examined changes in blood pressure, cardiac function, and vascular resistance after 3 weeks of bisoprolol treatment (5 mg/day) during passive head-up tilt in 16 never-treated Caucasian males with grade I–II primary hypertension. A double-blind, randomized, placebo-controlled cross-over design was applied, and hemodynamics were recorded using continuous tonometric pulse wave analysis and whole-body impedance cardiography. Bisoprolol decreased blood pressure in the aorta (~8/10 mmHg, p ≤ 0.032) and radial artery (~10/9 mmHg, p ≤ 0.037), but upright aortic systolic blood pressure was not significantly reduced (p = 0.085). Bisoprolol reduced heart rate and left cardiac work, and increased subendocardial viability index in supine and upright positions (p ≤ 0.044 for all). Bisoprolol increased stroke volume in the supine (~11 ml, p = 0.02) but not in the upright position, while only upright (~1 l/min, p = 0.007) but not supine cardiac output was reduced. Upright elevation in systemic vascular resistance was increased 2.7-fold (p = 0.002), while upright pulse pressure amplification was decreased by ~20% (p = 0.002) after bisoprolol. Aortic augmentation index, augmentation pressure, and pulse pressure were not changed in the supine position but were increased in the upright position (from 9% to 17%, 3–6 mmHg, and 30–34 mmHg, respectively, p ≤ 0.016 for all). In conclusion, although bisoprolol treatment reduced peripheral blood pressure, central systolic blood pressure in the upright position was not decreased. Importantly, the harmful influences of bisoprolol on central pulse pressure and pressure wave reflection were manifested in the upright position.
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