1
|
Li Y, Jiang Y, Tang Y. Is remote blood pressure monitoring and management a better approach for patients with hypertension? A narrative review. J Clin Hypertens (Greenwich) 2023; 25:121-126. [PMID: 36602447 PMCID: PMC9903197 DOI: 10.1111/jch.14624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023]
Abstract
Hypertension is a global public health problem which affects the physical and mental health of individuals. The management of hypertension is a long-term process that requires the cooperation of both doctors and patients, and the blood pressure variability is closely related to the clinical prognosis. In recent years, the development of telemedicine has promoted better blood pressure monitoring and management for patients, as well as better medical intervention and health education for patients by medical staff. This article provides a review of remote blood pressure monitoring and management.
Collapse
Affiliation(s)
- Yan Li
- Department of General MedicineChongqing University Central HospitalChongqing Emergency Medical CenterChongqingChina
| | - Yi Jiang
- Department of General MedicineChongqing University Central HospitalChongqing Emergency Medical CenterChongqingChina
| | - Yuping Tang
- Department of General MedicineChongqing University Central HospitalChongqing Emergency Medical CenterChongqingChina
| |
Collapse
|
2
|
Khan Mamun MMR, Sherif A. Advancement in the Cuffless and Noninvasive Measurement of Blood Pressure: A Review of the Literature and Open Challenges. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 10:bioengineering10010027. [PMID: 36671599 PMCID: PMC9854981 DOI: 10.3390/bioengineering10010027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Hypertension is a chronic condition that is one of the prominent reasons behind cardiovascular disease, brain stroke, and organ failure. Left unnoticed and untreated, the deterioration in a health condition could even result in mortality. If it can be detected early, with proper treatment, undesirable outcomes can be avoided. Until now, the gold standard is the invasive way of measuring blood pressure (BP) using a catheter. Additionally, the cuff-based and noninvasive methods are too cumbersome or inconvenient for frequent measurement of BP. With the advancement of sensor technology, signal processing techniques, and machine learning algorithms, researchers are trying to find the perfect relationships between biomedical signals and changes in BP. This paper is a literature review of the studies conducted on the cuffless noninvasive measurement of BP using biomedical signals. Relevant articles were selected using specific criteria, then traditional techniques for BP measurement were discussed along with a motivation for cuffless measurement use of biomedical signals and machine learning algorithms. The review focused on the progression of different noninvasive cuffless techniques rather than comparing performance among different studies. The literature survey concluded that the use of deep learning proved to be the most accurate among all the cuffless measurement techniques. On the other side, this accuracy has several disadvantages, such as lack of interpretability, computationally extensive, standard validation protocol, and lack of collaboration with health professionals. Additionally, the continuing work by researchers is progressing with a potential solution for these challenges. Finally, future research directions have been provided to encounter the challenges.
Collapse
Affiliation(s)
| | - Ahmed Sherif
- School of Computing Sciences and Computer Engineering, The University of Southern Mississippi, Hattiesburg, MS 39406, USA
| |
Collapse
|
3
|
Gyanwali B, Cai CXT, Chen C, Vrooman H, Tan CS, Hilal S. The Effects of Mean of Visit-to-Visit Blood Pressure on Incident Brain Vascular Lesions and Functional-Cognitive Decline. J Alzheimers Dis 2021; 82:561-573. [PMID: 34057087 DOI: 10.3233/jad-210188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cerebrovascular disease (CeVD) is an underlying cause of cognitive impairment and dementia. Hypertension is a known risk factor of CeVD, but the effects of mean of visit-to-visit blood pressure (BP) on incident CeVD and functional-cognitive decline remains unclear. OBJECTIVE To determine the association between mean of visit-to-visit BP with the incidence and progression of CeVD [white matter hyperintensities (WMH), infarcts (cortical infarcts and lacunes), cerebral microbleeds (CMBs), intracranial stenosis, and hippocampal volume] as well as functional-cognitive decline over 2 years of follow-up. METHODS 373 patients from a memory-clinic underwent BP measurements at baseline, year 1, and year 2. The mean of visit-to-visit systolic BP, diastolic BP, pulse pressure, and mean arterial pressure were calculated. Baseline and year 2 MRI scans were graded for WMH, infarcts, CMBs, intracranial stenosis, and hippocampal volume. Functional-cognitive decline was assessed using locally validated protocol. Logistic and linear regression models with odds ratios, mean difference, and 95%confidence interval were constructed to analyze associations of visit-to-visit BP on CeVD incidence and progression as well as functional-cognitive decline. RESULTS Higher mean of visit-to-visit diastolic BP was associated with WMH progression. Higher tertiles of diastolic BP was associated with WMH progression and incident CMBs. There was no association between mean of visit-to-visit BP measures with incident cerebral infarcts, intracranial stenosis, change in hippocampal volume, and functional-cognitive decline. CONCLUSION These findings suggest the possibility of hypertension-related vascular brain damage. Careful monitoring and management of BP in elderly patients is essential to reduce the incidence and progression of CeVD.
Collapse
Affiliation(s)
- Bibek Gyanwali
- Department of Biochemistry, National University of Singapore, Singapore.,Memory Aging and Cognition Centre, National University Health System, Singapore
| | - Celestine Xue Ting Cai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Christopher Chen
- Memory Aging and Cognition Centre, National University Health System, Singapore.,Department of Pharmacology, National University of Singapore, Singapore
| | - Henri Vrooman
- Departments of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Saima Hilal
- Memory Aging and Cognition Centre, National University Health System, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Department of Pharmacology, National University of Singapore, Singapore
| |
Collapse
|
4
|
Association of self-measured home, ambulatory, and strictly measured office blood pressure and their variability with intracranial arterial stenosis. J Hypertens 2021; 39:2030-2039. [PMID: 34173797 DOI: 10.1097/hjh.0000000000002900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Hypertension and intracranial artery stenosis (ICAS) are closely related; however, few studies have compared the strength of the relationship between strictly measured office and out-of-office blood pressure (BP) measurements. The relationship of day-by-day or short-term variability in BP to asymptomatic ICAS also remains unclear. METHODS In apparently healthy 677 men (mean age, 70 years) from a population-based cohort, we examined the association of strictly measured office BP and 7-day home BP with ICAS on magnetic resonance angiography. We conducted 24-h ambulatory BP monitoring in 468 of the men. Variability indices included day-by-day, daytime, and night-time variability, nocturnal decline, and morning pressor surge. Any ICAS was defined as either mild (1-49%) or severe (≥50%) stenosis. RESULTS We observed mild and severe ICAS in 153 (22.6%) and 36 (5.3%) participants, respectively. In multivariable-adjusted Poisson regression with robust error variance, higher SBP in office, home, or ambulatory BP monitoring was associated with the presence of any or severe ICAS. The associations with ICAS were comparable between office, home, and ambulatory SBP (all heterogeneity P values >0.1). Independent of mean SBP, greater nocturnal decline or morning pressor surge, but not day-by-day, daytime, or night-time variability, in SBP was associated with higher burden of any or severe ICAS. CONCLUSION The magnitude of association of strictly measured office BP for asymptomatic ICAS was comparable with that of BP measured at home or in ambulatory BP monitoring. Circadian BP variation based on ambulatory BP monitoring was positively associated with asymptomatic ICAS burden.
Collapse
|
5
|
Salman E, Kadota A, Hisamatsu T, Segawa H, Torii S, Fujiyoshi A, Kondo K, Watanabe Y, Arima H, Shiino A, Nozaki K, Ueshima H, Miura K, The Sessa Research Group F. Relationship of Four Blood Pressure Indexes to Subclinical Cerebrovascular Diseases Assessed by Brain MRI in General Japanese Men. J Atheroscler Thromb 2021; 29:174-187. [PMID: 33487617 PMCID: PMC8803566 DOI: 10.5551/jat.58537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim:
The relationship of blood pressure (BP) indexes (systolic blood pressure [SBP], diastolic blood pressure [DBP], pulse pressure [PP], mean arterial pressure [MAP]) to subclinical cerebrovascular diseases (SCVDs) remains unclear. This study aimed to elucidate the relationship of four BP indexes measured at two visits on SCVDs assessed by magnetic resonance imaging (MRI) in general Japanese men.
Methods:
In general Japanese men aged 40–79 years (
N
=616), office BP indexes were measured at two visits (Visits 1 [2006–2008] and 2 [2010–2014]). MRI images obtained on the third visit (2012–2015) were examined for prevalent SCVDs: lacunar infarction, periventricular hyperintensity (PVH), deep subcortical white matter hyperintensity (DSWMH), microbleeds, and intracranial artery stenosis (ICAS). Using a multivariable logistic regression analysis, we computed and estimated the odds ratio of each prevalent SCVD for one standard deviation higher BP indexes. The same analyses were performed using home BP.
Results:
All four office BP indexes at both visits associated with lacunar infarction. Visit 1 and 2 DBP and Visit 1 MAP associated with PVH and DSWMH, and Visit 1 SBP associated with DSWMH. All Visit 2 BP indexes appear to show stronger association with microbleeds than Visit 1 indexes, and Visit 1 and 2 SBP, PP, and MAP showed similar associations with ICAS. Additional analyses using home BP indexes revealed similar relationships; however, the significance of some relationships decreased.
Conclusion:
In general Japanese men, BP indexes were associated with most of SCVDs, and BP indexes measured at different periods associated with different SCVDs assessed by MRI.
Collapse
Affiliation(s)
- Ebtehal Salman
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Takashi Hisamatsu
- Department of Public Health, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University
| | - Hiroyoshi Segawa
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Sayuki Torii
- Department of Public Health, Shiga University of Medical Science
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science.,Department of Hygiene, School of Medicine, Wakayama Medical University
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science
| | | | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University
| | - Akihiko Shiino
- Molecular Neuroscience Research Center, Shiga University of Medical Science
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | | |
Collapse
|
6
|
Kario K. Management of Hypertension in the Digital Era: Small Wearable Monitoring Devices for Remote Blood Pressure Monitoring. Hypertension 2020; 76:640-650. [PMID: 32755418 PMCID: PMC7418935 DOI: 10.1161/hypertensionaha.120.14742] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Out-of-office blood pressure measurement is an essential part of diagnosing and managing hypertension. In the era of advanced digital health information technology, the approach to achieving this is shifting from traditional methods (ambulatory and home blood pressure monitoring) to wearable devices and technology. Wearable blood pressure monitors allow frequent blood pressure measurements (ideally continuous beat-by-beat monitoring of blood pressure) with minimal stress on the patient. It is expected that wearable devices will dramatically change the quality of detection and management of hypertension by increasing the number of measurements in different situations, allowing accurate detection of phenotypes that have a negative impact on cardiovascular prognosis, such as masked hypertension and abnormal blood pressure variability. Frequent blood pressure measurements and the addition of new features such as monitoring of environmental conditions allows interpretation of blood pressure data in the context of daily stressors and different situations. This new digital approach to hypertension contributes to anticipation medicine, which refers to strategies designed to identify increasing risk and predict the onset of cardiovascular events based on a series of data collected over time, allowing proactive interventions to reduce risk. To achieve this, further research and validation is required to develop wearable blood pressure monitoring devices that provide the same accuracy as current approaches and can effectively contribute to personalized medicine.
Collapse
Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan; and the Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network
| |
Collapse
|
7
|
Kario K, Chia Y, Sukonthasarn A, Turana Y, Shin J, Chen C, Buranakitjaroen P, Nailes J, Hoshide S, Siddique S, Sison J, Soenarta AA, Sogunuru GP, Tay JC, Teo BW, Zhang Y, Park S, Minh HV, Tomitani N, Kabutoya T, Verma N, Wang T, Wang J. Diversity of and initiatives for hypertension management in Asia-Why we need the HOPE Asia Network. J Clin Hypertens (Greenwich) 2020; 22:331-343. [PMID: 31773883 PMCID: PMC8029896 DOI: 10.1111/jch.13733] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022]
Abstract
The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was set up to improve the management of hypertension in Asia with the ultimate goal of achieving "zero" cardiovascular events. Asia is a diverse continent, and the prevalence of hypertension has increased over the last 30 years. There are a number of Asia-specific features of hypertension and hypertension-related cardiovascular complications, which means that a region-specific approach is needed. White-coat hypertension will become more of an issue over time as Asian populations age, and masked hypertension is more prevalent in Asian than in Western countries. Identifying and treating masked hypertension is important to reduce cardiovascular risk. Abnormal patterns of blood pressure (BP) variability common in Asia include exaggerated early morning BP surge and nocturnal hypertension. These are also important cardiovascular risk factors that need to be managed. Home blood pressure monitoring (HBPM) is an important tool for detecting white-coat and masked hypertension, and monitoring BP variability, and practices in Asia are variable. Use of HBPM is important given the Asia-specific features of hypertension, and strategies are needed to improve and standardize HBPM usage. Development of HBPM devices capable of measuring nocturnal BP along with other information and communication technology-based strategies are key developments in the widespread implementation of anticipation medicine strategies to detect and prevent cardiovascular events in patients with hypertension. Region-wide differences in hypertension prevalence, control, and management practices in Asia highlight the importance of information sharing to facilitate best practices.
Collapse
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yook‐Chin Chia
- Department of Medical SciencesSchool of Healthcare and Medical SciencesSunway UniversityBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Apichard Sukonthasarn
- Cardiology DivisionDepartment of Internal MedicineFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Yuda Turana
- Faculty of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Jinho Shin
- Faculty of Cardiology ServiceHanyang University Medical CenterSeoulKorea
| | - Chen‐Huan Chen
- Department of MedicineSchool of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
| | - Peera Buranakitjaroen
- Department of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Jennifer Nailes
- University of the East Ramon Magsaysay Memorial Medical Center Inc.Quezon CityPhilippines
| | - Satoshi Hoshide
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | | | - Jorge Sison
- Section of CardiologyDepartment of MedicineMedical Center ManilaManilaPhilippines
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversity of Indonesia‐National Cardiovascular Center, Harapan KitaJakartaIndonesia
| | - Guru Prasad Sogunuru
- MIOT International HospitalChennaiIndia
- College of Medical SciencesKathmandu UniversityBharatpurNepal
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingapore CitySingapore
| | - Boon Wee Teo
- Division of NephrologyDepartment of MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore CitySingapore
| | - Yu‐Qing Zhang
- Divisions of Hypertension and Heart FailureFu Wai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Sungha Park
- Division of CardiologyCardiovascular HospitalYonsei Health SystemSeoulKorea
| | - Huynh Van Minh
- Department of Internal MedicineUniversity of Medicine and PharmacyHue UniversityHue CityVietnam
| | - Naoko Tomitani
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Narsingh Verma
- Department of PhysiologyKing George's Medical UniversityLucknowIndia
| | - Tzung‐Dau Wang
- Department of Internal MedicineCardiovascular Center and Division of CardiologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Ji‐Guang Wang
- Department of HypertensionCentre for Epidemiological Studies and Clinical Trialsthe Shanghai Institute of HypertensionShanghai Key Laboratory of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| |
Collapse
|
8
|
Sun YA, Han Q, Hou XH, Peng XZ, Tong L, Zheng X, Yu JT, Tan L. Association of antinuclear antibodies with the risk of intracranial arterial stenosis. Aging (Albany NY) 2020; 12:1322-1331. [PMID: 31961801 PMCID: PMC7053607 DOI: 10.18632/aging.102685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/25/2019] [Indexed: 12/05/2022]
Abstract
The prevalence of intracranial arterial stenosis (IAS) as well as antinuclear antibody (ANA) positivity was found to be higher in Asians than that in the Western population. To investigate the relation of ANAs with IAS in patients with acute ischemic cerebrovascular disease, we enrolled 2492 patients with acute ischemic stroke or transient ischemic attack into the study. All the patients were categorized into 3 groups according to the IAS burden. Multinomial logistic regression analyses were used in statistical analysis. The positive rate of ANAs in the IAS ≥ 2 group was higher than that in the single IAS group and the no IAS group (p<0.001). The adjusted odds ratio (OR) for IAS ≥ 2 in ANAs-positive patients was 3.737 (95%CI=2.676-5.220, p<0.001) compared with the ANAs-negative patients. ANAs were associated with multiple IAS rather than single IAS in both male and female subgroups. Besides, ANAs were significantly associated with single and multiple IAS in individuals ≤ 60 years. However, ANAs were only associated with two or more IAS in two age groups (between 61 to 75 years and >75 years old). In summary, ANAs are associated with IAS in patients with acute ischemic cerebrovascular disease.
Collapse
Affiliation(s)
- Yong-An Sun
- Department of Neurology, First Affiliated Hospital of Kangda College, Nanjing Medical University, Lianyungang, China.,Department of Neurology, Qingdao Municipal Hospital, Qingdao Clinical Medical College, Nanjing Medical University, Qingdao, China
| | - Qiu Han
- Department of Neurology, Qingdao Municipal Hospital, Qingdao Clinical Medical College, Nanjing Medical University, Qingdao, China.,Department of Neurology, Huai'an First People's Hospital, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Xiao-He Hou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xian-Zhen Peng
- Department of Public Health and Preventive Medicine, Kangda College of Nanjing Medical University, Lianyungang, China
| | - Lin Tong
- Department of Neurology, Yantai Affiliated Hospital of Binzhou Medical Universtiy, Yantai, China
| | - Xu Zheng
- Department of Clinical Laboratory, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao Clinical Medical College, Nanjing Medical University, Qingdao, China.,Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| |
Collapse
|
9
|
Shilkina NP, Spirin NN, Yunonin IE, Vinogradov AA. [Cerebral perfusion, arterial hypertension and endothelial dysfunction in rheumatoid arthritis]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:68-75. [PMID: 31184627 DOI: 10.17116/jnevro201911903268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To study the relationship between cerebral perfusion with arterial hypertension (AH) and the state of endothelium in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS Seventy-eight patients with RA were divided into two groups: with- and without AH.The functional methods included ultrasonic duplex angioscanning and dopplerografy of the extracranial and intracranial arteries of the head and neck and daily 24 hour monitoring of arterial blood pressure (BP). C-reactive protein (CRP), vascular endothelial adhesion molecule type 1 (sVCAM-1), von Willebrand Factor antigen (vWF AG), interleukin-8 (Il-8), rheumatoid factor (RF) IgG, endothelin-1 (ET-1) were determined by immunoenzyme analysis and velocity of sedimentation (VS). The dysfunction of endothelium was evaluated by calculation of the number of desquamated endotheliocytes cells (DE). RESULTS AH occurred in 46 (59%) patients. Cerebral hypoperfusion was observed in patients with RA in whom the reduction in the high-speed indices of blood flow were correlated with BP increase. There were negative correlations between the linear speed of blood flow on the common carotid arteries and average day and night systolic BP, average day and night diastolic BP, indices of time systolic BP and diastolic BP and avariability of BP. The same results were established for the intracranial arteries: inverse correlations between the linear speed on the anterior cerebral arteries and average day systolic BP. The signs of endothelial dysfunction represented by significant differences among the indices of activation of endothelium in RA patients in comparison with the control group were shown. Content of ET-1, sVCAM-1, vWF AG, Il-8, CRP was higher in RA. The number of DE was significantly higher as well. These indices showed significant differences depending on RA activity. Correlation analysis revealed that the markers of endothelium activation sVCAM-1, vWF AG were positively correlated with the indices of immune inflammation. CONCLUSION An increase in the activity of inflammatory process in RA leads to endothelial dysfunction, which contributes to the increase in the peripheral vascular resistance of cerebral arteries, reduction in the high-speed indices of blood flow, growth of BP variability and the increase in load by pressure.
Collapse
Affiliation(s)
- N P Shilkina
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - N N Spirin
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - I E Yunonin
- Yaroslavl State Medical University, Yaroslavl, Russia
| | | |
Collapse
|
10
|
Bomfim GF, Cau SBA, Bruno AS, Fedoce AG, Carneiro FS. Hypertension: a new treatment for an old disease? Targeting the immune system. Br J Pharmacol 2019; 176:2028-2048. [PMID: 29969833 PMCID: PMC6534786 DOI: 10.1111/bph.14436] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/14/2018] [Accepted: 06/24/2018] [Indexed: 12/22/2022] Open
Abstract
Arterial hypertension represents a serious public health problem, being a major cause of morbidity and mortality worldwide. The availability of many antihypertensive therapeutic strategies still fails to adequately treat around 20% of hypertensive patients, who are considered resistant to conventional treatment. In the pathogenesis of hypertension, immune system mechanisms are activated and both the innate and adaptive immune responses play a crucial role. However, what, when and how the immune system is triggered during hypertension development is still largely undefined. In this context, this review highlights scientific advances in the manipulation of the immune system in order to attenuate hypertension and end-organ damage. Here, we discuss the potential use of immunosuppressants and immunomodulators as pharmacological tools to control the activation of the immune system, by non-specific and specific mechanisms, to treat hypertension and improve end-organ damage. Nevertheless, more clinical trials should be performed with these drugs to establish their therapeutic efficacy, safety and risk-benefit ratio in hypertensive conditions. LINKED ARTICLES: This article is part of a themed section on Immune Targets in Hypertension. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.12/issuetoc.
Collapse
Affiliation(s)
| | - Stefany Bruno Assis Cau
- Department of Pharmacology, Institute of Biological ScienceFederal University of Minas GeraisBelo HorizonteMGBrazil
| | - Alexandre Santos Bruno
- Department of Pharmacology, Institute of Biological ScienceFederal University of Minas GeraisBelo HorizonteMGBrazil
| | - Aline Garcia Fedoce
- Department of Pharmacology, Ribeirão Preto Medical SchoolUniversity of São PauloSão PauloBrazil
| | - Fernando S Carneiro
- Department of Pharmacology, Ribeirão Preto Medical SchoolUniversity of São PauloSão PauloBrazil
| |
Collapse
|
11
|
Guo QH, Cheng YB, Zhang DY, Wang Y, Huang QF, Sheng CS, Xu TY, Li Y, Wang JG. Comparison Between Home and Ambulatory Morning Blood Pressure and Morning Hypertension in Their Reproducibility and Associations With Vascular Injury. Hypertension 2019; 74:137-144. [PMID: 31104566 DOI: 10.1161/hypertensionaha.119.12955] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Morning blood pressure (BP) is recommended to be assessed by either 24-hour ambulatory or home BP monitoring. By which methods morning BP assessed is more reproducible and more closely associated with vascular injury remains unknown. We, therefore, addressed this issue in 1049 referred untreated outpatients (51.9% women; average age, 51 years) who had performed 24-hour ambulatory and 7-day home BP monitoring and vascular evaluations. Irrespective of the assessment methods, morning BPs were all significantly ( P≤0.027) associated with the arterial measures. The partial correlation coefficients of carotid-femoral pulse wave velocity and urinary albumin-to-creatinine ratio with home morning BPs were greater than those with the ambulatory morning pressures among the first 2 hours after awakening (0.21-0.37 versus 0.15-0.24; P<0.05). The associations with home morning systolic BP remained significant ( P≤0.002) after full adjustment for evening BP, whereas those with ambulatory morning BPs became nonsignificant after full adjustment for 24-hour BP except that of the carotid-femoral pulse wave velocity with ambulatory morning (6:00-10:00) systolic BP. Of the 135 subjects who had both home and repeated 24-hour ambulatory BP monitoring within 1 month, the coefficients of variation were ≈11% for ambulatory morning BPs and 5% for home self-measurements. In conclusion, morning BP, irrespective of the assessment methods and definitions, was generally reproducible and significantly associated with vascular indices. Nevertheless, home morning BP might be preferred than ambulatory measurements because of better reproducibility and stronger correlation with vascular indices.
Collapse
Affiliation(s)
- Qian-Hui Guo
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Yi-Bang Cheng
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Dong-Yan Zhang
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Ying Wang
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Qi-Fang Huang
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Chang-Sheng Sheng
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Ting-Yan Xu
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Yan Li
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Ji-Guang Wang
- From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| |
Collapse
|
12
|
Shilkina NP, Yunonin IE, Butusova SV, Mikhailova EV, Vinogradov AA. [Endothelial damage and circadian blood pressure profile in rheumatoid arthritis]. TERAPEVT ARKH 2019; 91:89-95. [PMID: 32598682 DOI: 10.26442/00403660.2019.05.000052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
AIM To study the influence of the state of endothelium on the daily profile of arterial pressure (AP) in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS In 70 RA pts carried out C-reactive protein (CRP), vascular endothelial adhesion molecule type 1 (sVCAM-1), antigen von Willebrand Factor (AG WF), interleukin-8 (Il-8), rheumatoid factor (RF), IgG, endotheline-1 (ET-1), number of desquamated endotheliocytes cells (DE), VS, activity of renin by immunoenzyme analysis. The dysfunction of endothelium was evaluated by calculation of DE. The functional methods included the daily monitoring of arterial pressure (AP). RESULTS Arterial hypertension (AH) occurred in 40 (57.1%) pts. RA pts are revealed the signs of endothelial dysfunction, about which significant differences among the indices of activation of endothelium in comparison with control group testify. ET-1, sVCAM-1, vWF AG, Il-8, CRP content was higher in RA pts. Reliably above there was a number of DE. Reliable differences according to these indices depending of RA activity were discovered. With conducting of correlation analysis it is revealed, that markers of the activation of endothelium: sVCAM-1, vWF AG positively correlated with increasing RF IgG and indices of the immune inflammation: CRP, and DE number. In patients suffering from RA, showed signs of endothelial dysfunction. The positive correlation between endothelial damage and daily profile of AP show the relationship of these processes. CONCLUSION Positive correlations between the damage of endothelium and disturbance of AP daily profile testify about the interrelation of these processes.
Collapse
Affiliation(s)
- N P Shilkina
- Yaroslavl State Medical University of the Ministry of Healthcare of the Russian Federation
| | - I E Yunonin
- Yaroslavl State Medical University of the Ministry of Healthcare of the Russian Federation
| | - S V Butusova
- State budgetary clinical institution of public health of the Yaroslavl region "Central City Hospital"
| | - E V Mikhailova
- Yaroslavl State Medical University of the Ministry of Healthcare of the Russian Federation
| | - A A Vinogradov
- Yaroslavl State Medical University of the Ministry of Healthcare of the Russian Federation
| |
Collapse
|
13
|
Wanthong S, Kabutoya T, Hoshide S, Buranakitjaroen P, Kario K. Early morning-Best time window of hourly 24-hour ambulatory blood pressure in relation to hypertensive organ damage: The Japan Morning Surge-Home Blood Pressure study. J Clin Hypertens (Greenwich) 2019; 21:579-586. [PMID: 30868744 PMCID: PMC8030499 DOI: 10.1111/jch.13498] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/04/2018] [Accepted: 12/14/2018] [Indexed: 10/13/2023]
Abstract
The correlations between organ damage and hourly ambulatory blood pressure (BP) have not been established. The patients were 1464 participants of the Japan Morning Surge-Home Blood Pressure (J-HOP) study participants who underwent ambulatory BP monitoring. The hourly systolic BP (SBP) at x o'clock was defined as the average of SBP values measured at times x - 30 minutes, x, and x + 30 minutes. The mean age was 64.8 ± 11.6 years. The percentage of male participants was 47.8%. The left ventricular mass index (LVMI) was significantly associated with SBP at 6 o'clock (r = 0.166, P < 0.001). The carotid intima-media thickness was significantly associated with SBP at 5 o'clock (r = 0.196, P < 0.001). After adjustment for age, sex, smoking, hyperlipidemia, diabetes mellitus, antihypertensive drug use, clinic SBP, and 24-hour ambulatory SBP, the correlations of the LVMI and hourly SBP at 6 o'clock remained significant (beta coefficient = 0.125, P < 0.01). In conclusion, morning ambulatory systolic BP especially at 5 and 6 o'clock was independently associated with organ damage.
Collapse
Affiliation(s)
- Sirisawat Wanthong
- Division of Cardiovascular Medicine, Department of MedicineJichi Medical University School of MedicineTochigiJapan
- Department of Medicine, Faculty of Medicine, Siriraj HospitalMahidol UniversityBangkokThailand
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine, Department of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Peera Buranakitjaroen
- Department of Medicine, Faculty of Medicine, Siriraj HospitalMahidol UniversityBangkokThailand
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of MedicineJichi Medical University School of MedicineTochigiJapan
| |
Collapse
|
14
|
Ma YH, Leng XY, Dong Y, Xu W, Cao XP, Ji X, Wang HF, Tan L, Yu JT. Risk factors for intracranial atherosclerosis: A systematic review and meta-analysis. Atherosclerosis 2018; 281:71-77. [PMID: 30658194 DOI: 10.1016/j.atherosclerosis.2018.12.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/13/2018] [Accepted: 12/13/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Intracranial atherosclerosis (ICAS) is a predictable and preventable condition, but existing evidence concerning its risk factors has not been quantitatively assessed. The aim of this meta-analysis is to identify the non-modifiable and modifiable risk factors for ICAS. METHODS PubMed and EMBASE were searched (1995-May 15, 2018) for cross-sectional and longitudinal studies exploring risk factors for ICAS. The risk estimates and 95% confidence intervals (CIs) in multivariate analysis were aggregated using random-effect models. RESULTS Thirty-four studies comprising 59,736 subjects met the inclusion criteria for the systematic review involving thirty-one risk or protective factors. Seven factors were associated with ICAS, as suggested by the meta-analysis, including advanced age (odds ratio (OR) 1.05, 95% CI 1.03-1.08), metabolic syndrome (OR 2.13, 95% CI 1.35-3.37), diabetes mellitus (OR 1.98, 95% CI 1.69-2.31), hypertension (OR 1.97, 95% CI 1.69-2.31), dyslipidemia (OR 1.29, 95% CI 1.04-1.59), high levels of low-density lipoprotein cholesterol (OR 1.06, 95% CI 1.00-1.12) and high levels of apolipoprotein A1 (OR 0.34, 95% CI 0.15-0.75). The subgroup analysis for study populations indicated advanced age, metabolic syndrome, diabetes mellitus and hypertension as an elevated risk of ICAS among community subjects and stroke patients; according to the subgroup analysis for ethnicity, similar associations remained in Asians, but only metabolic syndrome and diabetes mellitus were correlated with ICAS in Caucasians. CONCLUSIONS Individuals with advanced age, metabolic syndrome, diabetes mellitus, hypertension and dyslipidemia might have a higher risk of ICAS, whereas high levels of apolipoprotein A1 might protect against ICAS.
Collapse
Affiliation(s)
- Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian, China
| | - Xin-Yi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yi Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xi-Peng Cao
- Clinical Research Center, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xi Ji
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian, China
| | - Hui-Fu Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian, China; Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| | - Jin-Tai Yu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| |
Collapse
|
15
|
Wang Y, Zhang J, Qian Y, Tang X, Ling H, Chen K, Li Y, Gao P, Zhu D. Association of Homocysteine with Aysmptomatic Intracranial and Extracranial Arterial Stenosis in Hypertension Patients. Sci Rep 2018; 8:595. [PMID: 29330520 PMCID: PMC5766541 DOI: 10.1038/s41598-017-19125-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/21/2017] [Indexed: 01/26/2023] Open
Abstract
Elevated plasma homocysteine (Hcy) is suggested as an independent risk factor for stroke. We aimed to investigate the association of Hcy concentration with intracranial atherosclerosis (ICAS) and extracranial AS (ECAS) in hypertensive patients without stroke in Chinese population and to explore modified effect of methylenetetrahydrofolate reductase (MTHFR) C677T on their relationship. The stenosis of intracranial and extracranial arteries were evaluated in a total of 929 subjects through computerized tomographic angiography (CTA) from aortic arch to the skull base. Hcy concentration showed significantly association with both ICAS (OR: 1.105; 95% CI: 1.057-1.155) and ECAS (OR: 1.096; 95% CI: 1.047-1.146) for 1 µmol/L increment in Hcy. Meanwhile, hyperhomocysteinemia (≥15 µmol/L) was also displayed association with ICAS (OR: 1.587; 95% CI: 1.029-2.446) and ECAS (OR: 2.164; 95% CI: 1.392-3.364) after fully adjustment. Furthermore, in the subgroup analysis, such association remained significant only in the subjects that were younger, with normal renal function and with MTHFR 677 C allele. Our study showed the significant association of Hcy with ECAS and ICAS in asymptomatic hypertension patients. Hcy played a universal effect on the cervico-cerebral atherosclerosis. Such association was modified by the MTHFR C677T genotype.
Collapse
Affiliation(s)
- Yan Wang
- Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Jin Zhang
- Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuesheng Qian
- Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaofeng Tang
- Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huawei Ling
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kemin Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Pingjin Gao
- Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dingliang Zhu
- Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| |
Collapse
|
16
|
Morning hypertension is more common in elderly hypertensive patients with controlled documented office blood pressure in primary care clinics. J Hypertens 2017. [DOI: 10.1097/hjh.0000000000001449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Association of Inter-arm Blood Pressure Difference with Asymptomatic Intracranial and Extracranial Arterial Stenosis in Hypertension Patients. Sci Rep 2016; 6:29894. [PMID: 27412818 PMCID: PMC4944122 DOI: 10.1038/srep29894] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/22/2016] [Indexed: 02/07/2023] Open
Abstract
Inter-arm blood pressure (BP) difference has been associated with ischemic stroke. Local atherosclerosis of stroke differ among vulnerable individuals, whereas intracranial arterial stenosis (ICAS) is more frequently affected Asians, and extracranial arterial stenosis (ECAS) is more prevalent among whites. We hereby sought to explore the association of inter-arm BP difference with ICAS and ECAS in stroke-free hypertensive patients in Chinese population. All the 885 subjects were evaluated of ICAS and ECAS through computerized tomographic angiography. Both arm BP was measured simultaneously by Vascular Profiler-1000 device. In the continuous study, ICAS was significantly associated with age, male, average brachial SBP, diabetes, anti-hypertensive treatment and inter-arm DBP difference. ECAS was associated with age, inter-arm SBP and LDL. In the categorical study, subjects with the top quartile of inter-arm DBP difference (≥4 mmHg) showed significantly higher risk of ICAS (OR = 2.109; 95% CI, 1.24–3.587). And the participants with the top quartile of inter-arm SBP difference (≥6 mmHg) showed significantly higher risk of ECAS (OR = 2.288; 95% CI, 1.309–3.998). In conclusion, we reported a diverse association of inter-arm SBP/DBP difference with the ICAS/ECAS. Inter-arm DBP difference might be the early symbol of ICAS in Chinese population, which need further verification in long-term cohort study.
Collapse
|
18
|
Kario K, Tomitani N, Matsumoto Y, Hamasaki H, Okawara Y, Kondo M, Nozue R, Yamagata H, Okura A, Hoshide S. Research and Development of Information and Communication Technology-based Home Blood Pressure Monitoring from Morning to Nocturnal Hypertension. Ann Glob Health 2016; 82:254-73. [DOI: 10.1016/j.aogh.2016.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
19
|
Wang Y, Zhang J, Qain Y, Tang X, Ling H, Chen K, Li Y, Gao P, Zhu D. Association of Brachial-Ankle Pulse Wave Velocity with Asymptomatic Intracranial Arterial Stenosis in Hypertension Patients. J Stroke Cerebrovasc Dis 2016; 25:1922-8. [PMID: 27184616 DOI: 10.1016/j.jstrokecerebrovasdis.2016.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/07/2016] [Accepted: 04/14/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intracranial arterial stenosis is a common cause of ischemic stroke in Asians. We therefore sought to explore the relationship of brachial-ankle pulse wave velocity and intracranial arterial stenosis in 834 stroke-free hypertensive patients. METHODS Intracranial arterial stenosis was evaluated through computerized tomographic angiography. Brachial-ankle pulse wave velocity was measured by an automated cuff device. RESULTS The top decile of brachial-ankle pulse wave velocity was significantly associated with intracranial arterial stenosis (P = .027, odds ratio = 1.82; 95% confidence interval: 1.07-3.10). The patients with the top decile of brachial-ankle pulse wave velocity showed 56% higher risk for the presence of intracranial arterial stenosis to the whole population, which was more significant in patients younger than 65 years old. We also found that brachial-ankle pulse wave velocity related to both intracranial arterial stenosis and homocysteine. CONCLUSION Our study showed the association of brachial-ankle pulse wave velocity with asymptomatic intracranial arterial stenosis in hypertension patients, especially in relative younger subjects. Brachial-ankle pulse wave velocity might be a relatively simple and repeatable measurement to detect hypertension patients in high risk of intracranial arterial stenosis.
Collapse
Affiliation(s)
- Yan Wang
- Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai, China
| | - Jin Zhang
- Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai, China
| | - Yuesheng Qain
- Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai, China
| | - Xiaofeng Tang
- Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai, China
| | - Huawei Ling
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kemin Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai, China
| | - Pingjin Gao
- Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai, China
| | - Dingliang Zhu
- Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Research Center for Hypertension Management and Prevention in Community, Shanghai Institute of Hypertension, Shanghai, China.
| |
Collapse
|
20
|
Different blood pressure indexes on intracranial arterial stenosis in Asymptomatic Polyvascular Abnormalities in Community study in China. J Hypertens 2016; 33:1452-7. [PMID: 25882861 DOI: 10.1097/hjh.0000000000000577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The association between hypertension and cerebrovascular events is shown in some large-scale studies, but it remains unclear which blood pressure index is the most sensitive risk factor for cerebrovascular stenosis. METHODS We investigated the potential associations between different blood pressure indexes and intracranial arterial stenosis (ICAS) in the study. The population-based Asymptomatic Polyvascular Abnormalities in Community study examined asymptomatic intracranial arterial abnormalities in a Chinese population and included participants aged more than 40 years without a history of stroke, transient ischemic attack, and coronary heart disease. ICAS was diagnosed by transcranial Doppler sonography. Blood pressure was measured with a mercury manometer three times; an average result of SBP and DBP was used, and mean arterial pressure (MAP) and pulse pressure (PP) were calculated for the statistical analysis. RESULTS Out of the 4422 study participants, 711 (16.1%) showed an asymptomatic ICAS. After adjusting for age, waist circumference, drinking, diabetes, dyslipidemia, and blood concentration of uric acid, C-reactive protein, and homocysteine, ICAS was significantly associated with a higher SBP [from decile 6, odds ratio (OR) 3.093; 95% confidence interval (CI) 1.909, 5.012; P < 0.01), a higher MAP (from decile 7, OR 2.889; 95% CI 1.853, 4.504; P < 0.01), and a higher PP (from decile 5, OR 2.295;95% CI 1.463, 3.601; P < 0.01). Using a receiver-operating characteristic curve to estimate the predictive value of different blood pressure indexes for ICAS, SBP, MAP, and PP, were predictive indexes for ICAS and PP showed the largest predictive value (area under the curve = 0.737). CONCLUSIONS The current study results suggest that SBP, MAP, and PP are all associated with asymptomatic ICAS. PP may be the most sensitive index to predict ICAS.
Collapse
|
21
|
Association of Lp-PLA2 Mass and Aysmptomatic Intracranial and Extracranial Arterial Stenosis in Hypertension Patients. PLoS One 2015; 10:e0130473. [PMID: 26098634 PMCID: PMC4476589 DOI: 10.1371/journal.pone.0130473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/20/2015] [Indexed: 12/16/2022] Open
Abstract
Background and Purpose Intracranial arterial stenosis (ICAS) is a common cause of ischemic stroke in Asians, whereas whites tend to have more extracranial lesions. Lipoprotein-associated phospholipase A2 (Lp-PLA2) has been associated with ischemic stroke by a large amount of work. However, there are few studies focusing on the relationship of Lp-PLA2 and asymptomatic ICAS or extracranial arterial stenosis (ECAS). Wehereby sought to explore the relationship of Lp-PLA2 and ICAS, ECAS and concurrent stenosis in stroke-free hypertensive patients in Chinese population. Methods All the subjects were evaluated for the presence and severity of ICAS and ECAS through computerized tomographic angiography (CTA) covered the whole brain down to the level of aortic arch. Lp-PLA2 mass was measured by enzyme linked immunoassay. The association of Lp-PLA2 and vascular stenosis was analyzed through multivariate logistic regression. Results Among 414 participants, 163 (39.4%) had no ICAS or ECAS, 63 (15.2%) had ECAS only, 111 (26.8%) had ICAS only and 77 (18.6%) had concurrent extraintracranial stenosis. Lp-PLA2 mass was significantly associated with isolated ICAS (OR: 2.3; 95% CI: 1.14-4.64), and concurrent stenosis (OR: 3.93; 95% CI: 1.62-9.51), but was not related to isolated ECAS (OR: 1.54; 95% CI: 0.68-3.48). Lp-PLA2 mass was also associated with moderate to severe ICAS no matter how was the ECAS. Moreover, patients with higher Lp-PLA2 mass showed more sever ICAS and had more intracranial arterial lesions. Conclusion This study revealed the association of Lp-PLA2 mass with ICAS in stroke-free hypertensive patients in Chinese population. The further long-term cohort study was warranted to elucidate the concrete effect of Lp-PLA2 on the asymptomatic ICAS.
Collapse
|
22
|
Kario K. Key Points of the Japanese Society of Hypertension Guidelines for the Management of Hypertension in 2014. Pulse (Basel) 2015; 3:35-47. [PMID: 26587456 PMCID: PMC4646136 DOI: 10.1159/000381300] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The Japanese Society of Hypertension (JSH) published the new JSH guidelines for the management of hypertension in 2014, which is the revision of the JSH guidelines of 2009. The primary objective of the guideline is to provide physicians the standard treatment strategy of hypertension to prevent the hypertension-related target organ damage and cardiovascular events. The management of hypertension should be performed in hypertensive patients with a blood pressure of ≥140/90 mm Hg. As Asians have a higher prevalence of stroke than of coronary artery disease and stroke is more steeply associated with the level of blood pressure, the target blood pressure should be lower than 130/80 mm Hg for high-risk patients such as those with diabetes or chronic kidney disease. Because of the increasing prevalence of obesity and the related metabolic syndrome, more salt intake and higher salt sensitivity in the population, lifestyle modifications are necessary in hypertensive patients and subjects with high normal blood pressure. This guideline provides evidence-based recommendations for the management of patients with hypertension with the characteristics of our society.
Collapse
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| |
Collapse
|
23
|
Wang D, Zhou Y, Guo Y, Wang C, Wang A, Jin Z, Gao X, Wu S, Zhao X, Jonas JB. Arterial pre-hypertension and hypertension in intracranial versus extracranial cerebrovascular stenosis. Eur J Neurol 2014; 22:533-9. [PMID: 25516072 DOI: 10.1111/ene.12611] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- D. Wang
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - Y. Zhou
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - Y. Guo
- Department of Epidemiology and Biostatistics; School of Population Health; University of Queensland; Brisbane QLD Australia
| | - C. Wang
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - A. Wang
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - Z. Jin
- Department of Emergency Medicine; Anzhen Hospital; Capital Medical University; Beijing Institute of Heart Lung and Blood Vessels; Beijing China
| | - X. Gao
- Channing Laboratory; Department of Medicine, Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Nutrition; Harvard University School of Public Health; Boston MA USA
| | - S. Wu
- Department of Cardiology; Kailuan Hospital; Tangshan China
| | - X. Zhao
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - J. B. Jonas
- Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing China
- Key Laboratory of Ophthalmology and Visual Science; Beijing Tongren Hospital; Capital Medical University; Beijing China
- Department of Ophthalmology; Medical Faculty Mannheim of the Ruprecht- Karls-University; Heidelberg Germany
| |
Collapse
|
24
|
Liu J, Kou Z, Tian Y. Diffuse axonal injury after traumatic cerebral microbleeds: an evaluation of imaging techniques. Neural Regen Res 2014; 9:1222-30. [PMID: 25206786 PMCID: PMC4146289 DOI: 10.4103/1673-5374.135330] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 12/11/2022] Open
Abstract
Previous neuropathological studies regarding traumatic brain injury have primarily focused on changes in large structures, for example, the clinical prognosis after cerebral contusion, intracerebral hematoma, and epidural and subdural hematoma. In fact, many smaller injuries can also lead to severe neurological disorders. For example, cerebral microbleeds result in the dysfunction of adjacent neurons and the disassociation between cortex and subcortical structures. These tiny changes cannot be adequately visualized on CT or conventional MRI. In contrast, gradient echo sequence-based susceptibility-weighted imaging is very sensitive to blood metabolites and microbleeds, and can be used to evaluate traumatic cerebral microbleeds with high sensitivity and accuracy. Cerebral microbleed can be considered as an important imaging marker for diffuse axonal injury with potential relevance for prognosis. For this reason, based on experimental and clinical studies, this study reviews the role of imaging data showing traumatic cerebral microbleeds in the evaluation of cerebral neuronal injury and neurofunctional loss.
Collapse
Affiliation(s)
- Jun Liu
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China ; Department of Biomedical Engineering and Radiology, School of Medicine, Wayne State University, 3990 John R St, Detroit, MI, USA ; School of Public Administration, Central South University, Changsha, Hunan Province, China
| | - Zhifeng Kou
- Department of Biomedical Engineering and Radiology, School of Medicine, Wayne State University, 3990 John R St, Detroit, MI, USA
| | - Yongquan Tian
- School of Public Administration, Central South University, Changsha, Hunan Province, China
| |
Collapse
|