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Ozcan M, Abdellatif M, Javaheri A, Sedej S. Risks and Benefits of Intermittent Fasting for the Aging Cardiovascular System. Can J Cardiol 2024; 40:1445-1457. [PMID: 38354947 DOI: 10.1016/j.cjca.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
Population aging and the associated increase in cardiovascular disease rates pose serious threats to global public health. Different forms of fasting have become an increasingly attractive strategy to directly address aging and potentially limit or delay the onset of cardiovascular diseases. A growing number of experimental studies and clinical trials indicate that the amount and timing of food intake as well as the daily time window during which food is consumed, are crucial determinants of cardiovascular health. Indeed, intermittent fasting counteracts the molecular hallmarks of cardiovascular aging and promotes different aspects of cardiometabolic health, including blood pressure and glycemic control, as well as body weight reduction. In this report, we summarize current evidence from randomized clinical trials of intermittent fasting on body weight and composition as well as cardiovascular and metabolic risk factors. Moreover, we critically discuss the preventive and therapeutic potential of intermittent fasting, but also possible detrimental effects in the context of cardiovascular aging and related disease. We delve into the physiological mechanisms through which intermittent fasting might improve cardiovascular health, and raise important factors to consider in the design of clinical trials on the efficacy of intermittent fasting to reduce major adverse cardiovascular events among aged individuals at high risk of cardiovascular disease. We conclude that despite growing evidence and interest among the lay and scientific communities in the cardiovascular health-improving effects of intermittent fasting, further research efforts and appropriate caution are warranted before broadly implementing intermittent fasting regimens, especially in elderly persons.
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Affiliation(s)
- Mualla Ozcan
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Mahmoud Abdellatif
- Department of Cardiology, Medical University of Graz, Graz, Austria; BioTechMed Graz, Graz, Austria
| | - Ali Javaheri
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA; John J. Cochran Veterans Affairs Medical Center, St. Louis, Missouri, USA
| | - Simon Sedej
- Department of Cardiology, Medical University of Graz, Graz, Austria; BioTechMed Graz, Graz, Austria; Institute of Physiology, Faculty of Medicine, University of Maribor, Maribor, Slovenia.
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Ohashi N, Sakao Y, Uchiyama Y, Aoki T, Ishigaki S, Iwakura T, Isobe S, Fujikura T, Kato A, Yasuda H. Effects of salt reduction education from a salt questionnaire on inter-dialysis weight gain in patients on hemodialysis. Clin Exp Nephrol 2024:10.1007/s10157-024-02541-3. [PMID: 39068295 DOI: 10.1007/s10157-024-02541-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Heart failure is the leading cause of death in patients undergoing hemodialysis (HD), with fluid overload being the most common cause. Therefore, it is important for patients undergoing HD to reduce salt intake. We recently developed a highly accurate and simple self-administered salt questionnaire. Using this salt questionnaire, we aimed to determine whether salt intake and inter-HD weight gain decrease when patients with HD are instructed to reduce their salt intake. METHODS Seventy-eight outpatients at a maintenance HD facility were assessed for dietary salt intake using a salt questionnaire. After one month of dietary guidance, salt intake was assessed again using the salt questionnaire. RESULTS The mean age of the patients was 72.2 ± 11.9 years; 47 (60.3%) were men, 23 had diabetic nephropathy as the primary disease, and the median HD vintage was 74 months. Salt intake significantly decreased from 8.41 ± 2.43 g/day before the salt questionnaire intervention to 7.67 ± 2.60 g/day after the intervention (p = 0.010). Changes in salt intake before and after the intervention were significantly positively correlated with changes in weight gain before the start of HD sessions with an interval of 2 days (r = 0.24, p = 0.037). Furthermore, changes in salt intake significantly and positively correlated with changes in weight gain after adjusting for age, sex, and dry weight. CONCLUSION The salt questionnaire may be an effective tool for reducing salt intake and controlling weight gain during HD.
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Affiliation(s)
- Naro Ohashi
- Postgraduate Clinical Education Center, Hamamatsu University School of Medicine, 1-20-1 Handayama Chuo-ku, Hamamatsu, 431-3192, Japan.
| | - Yukitoshi Sakao
- Internal Medicine 1, Hamamatsu University School of Medicine, 1-20-1 Handayama Chuo-ku, Hamamatsu, 431-3192, Japan
- Hamana Clinic, 235-1 Numa, Hamana-ku, Hamamatsu, 434-0037, Japan
| | - Yuri Uchiyama
- Internal Medicine 1, Hamamatsu University School of Medicine, 1-20-1 Handayama Chuo-ku, Hamamatsu, 431-3192, Japan
| | - Taro Aoki
- Internal Medicine 1, Hamamatsu University School of Medicine, 1-20-1 Handayama Chuo-ku, Hamamatsu, 431-3192, Japan
| | - Sayaka Ishigaki
- Blood Purification Unit, Hamamatsu University School of Medicine, 1-20-1 Handayama Chuo-ku, Hamamatsu, 431-3192, Japan
| | - Takamasa Iwakura
- Internal Medicine 1, Hamamatsu University School of Medicine, 1-20-1 Handayama Chuo-ku, Hamamatsu, 431-3192, Japan
| | - Shinsuke Isobe
- Internal Medicine 1, Hamamatsu University School of Medicine, 1-20-1 Handayama Chuo-ku, Hamamatsu, 431-3192, Japan
| | - Tomoyuki Fujikura
- Internal Medicine 1, Hamamatsu University School of Medicine, 1-20-1 Handayama Chuo-ku, Hamamatsu, 431-3192, Japan
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University School of Medicine, 1-20-1 Handayama Chuo-ku, Hamamatsu, 431-3192, Japan
| | - Hideo Yasuda
- Internal Medicine 1, Hamamatsu University School of Medicine, 1-20-1 Handayama Chuo-ku, Hamamatsu, 431-3192, Japan
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Argan O, Avci E, Bozyel S, Yildirim T, Safak O, Yildirim SE, Dolapoglu A, Kisacik HL. Elevated levels of short-term blood pressure variability: A marker for ascending aortic dilatation in hypertensive patients. Clin Exp Hypertens 2021; 43:311-319. [PMID: 33423545 DOI: 10.1080/10641963.2021.1871915] [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: 10/22/2022]
Abstract
Background: Ascending aortic aneurysms are one of the primary causes of mortality. However, not much is known about the etiologies of aortic aneurysm. Recently, in hypertensive (HT) patients, blood pressure variability (BPV) has been recommended as a remarkable risk factor for adverse cardiovascular outcomes. This study aimed to explore the association between short-term BPV and ascending aortic dilatation (AAD).Methods: In this study, a total of 53 HT patients with AAD (aortic size index [ASI] ≥21 mm/m2) and 126 HT patients with a normal ascending aortic diameter (ASI <21 mm/m2) were included. Baseline, echocardiographic, and 24-h ambulatory blood pressure (BP) monitoring results were compared between groups. Standard deviation (SD) and coefficient of variation (CV) of BP were used to determine short-term BPV.Results: Except for daytime SBP values, daytime, nighttime, and 24-h mean systolic (SBP) and diastolic (DBP) BP levels were similar between groups. Compared with the HT patients with normal AA, daytime SBP, daytime SD of SBP, 24-h SD of SBP, daytime CV of SBP, and 24-h CV of SBP were significantly higher in HT patients with AAD. Compared with the HT patients with normal AA, the frequency of nondipper pattern was higher and dipper pattern was lower in HT patients with AAD. In multivariate logistic regression analysis, the daytime CV of SBP, daytime SD of SBP, 24-h SD of SBP, daytime SBP, and left ventricular mass index were independently associated with AAD. In receiver operating characteristic curve analysis, the daytime CV of SBP levels of >12.95 had a sensitivity of 61% and a specificity of 59% (area under the curve, 0.659; 95% CI, 0.562-0.756; P= .01); moreover, daytime SD of SBP > 16.4 had sensitivity of 62% and specificity of 61% (AUC, 0.687; 95% CI, 0.591-0.782; P< .001).:Conclusion Increased short-term BPV is independently associated with AAD and may be recommended as a remarkable factor risk for AAD in HT patients.
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Affiliation(s)
- Onur Argan
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Eyup Avci
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Tarik Yildirim
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Ozgen Safak
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Seda Elcim Yildirim
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Ahmet Dolapoglu
- Department of Cardiovascular Surgery, Balikesir University Medical Faculty, Balikesir, Turkey
| | - Halil Lutfi Kisacik
- Department of Cardiology, Balikesir University Medical Faculty, Balikesir, Turkey
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4
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Smith TO, Sillito JA, Goh CH, Abdel-Fattah AR, Einarsson A, Soiza RL, Mamas MA, Tan MP, Potter JF, Loke YK, Myint PK. Association between different methods of assessing blood pressure variability and incident cardiovascular disease, cardiovascular mortality and all-cause mortality: a systematic review. Age Ageing 2020; 49:184-192. [PMID: 31985773 DOI: 10.1093/ageing/afz178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 10/16/2019] [Accepted: 12/17/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Blood pressure variability (BPV) is a possible risk factor for adverse cardiovascular outcomes and mortality. There is uncertainty as to whether BPV is related to differences in populations studied, measurement methods or both. We systematically reviewed the evidence for different methods to assess blood pressure variability (BPV) and their association with future cardiovascular events, cardiovascular mortality and all-cause mortality. METHODS Literature databases were searched to June 2019. Observational studies were eligible if they measured short-term BPV, defined as variability in blood pressure measurements acquired either over a 24-hour period or several days. Data were extracted on method of BPV and reported association (or not) on future cardiovascular events, cardiovascular mortality and all-cause mortality. Methodological quality was assessed using the CASP observational study tool and data narratively synthesised. RESULTS Sixty-one studies including 3,333,801 individuals were eligible. BPV has been assessed by various methods including ambulatory and home-based BP monitors assessing 24-hour, "day-by-day" and "week-to-week" variability. There was moderate quality evidence of an association between BPV and cardiovascular events (43 studies analysed) or all-cause mortality (26 studies analysed) irrespective of the measurement method in the short- to longer-term. There was moderate quality evidence reporting inconsistent findings on the potential association between cardiovascular mortality, irrespective of methods of BPV assessment (17 studies analysed). CONCLUSION An association between BPV, cardiovascular mortality and cardiovascular events and/or all-cause mortality were reported by the majority of studies irrespective of method of measurement. Direct comparisons between studies and reporting of pooled effect sizes were not possible.
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Affiliation(s)
- Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Norwich Medical School, University of East Anglia, Norwich, UEA Norwich, UK
| | - Julia Ann Sillito
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Choon-Hian Goh
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Abdel-Rahman Abdel-Fattah
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Alice Einarsson
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
- Academic Department of Medicine for the Elderly, NHS Grampian, Aberdeen, UK
| | - Roy L Soiza
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
- Academic Department of Medicine for the Elderly, NHS Grampian, Aberdeen, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Keele, UK
- Farr Institute, University of Manchester, Manchester, UK
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, UEA Norwich, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UEA Norwich, UK
| | - Phyo K Myint
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
- Academic Department of Medicine for the Elderly, NHS Grampian, Aberdeen, UK
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Coccina F, Pierdomenico AM, Cuccurullo C, Pierdomenico SD. Prognostic value of average real variability of systolic blood pressure in elderly treated hypertensive patients. Blood Press Monit 2019; 24:179-184. [PMID: 31116150 DOI: 10.1097/mbp.0000000000000381] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The independent prognostic significance of ambulatory blood pressure variability in the elderly is incompletely clear. We investigated the prognostic value of average real variability of 24-hour blood pressure in elderly treated hypertensive patients. METHODS The occurrence of a combined end-point including stroke, coronary events, heart failure requiring hospitalization and peripheral revascularization was evaluated in 757 elderly treated hypertensive patients. According to tertiles of average real variability of 24-hour systolic blood pressure patients were classified as having low (≤8.66 mmHg; n = 252), medium (8.67-10.05 mmHg; n = 252) or high (>10.05 mmHg; n = 253) average real variability. RESULTS During the follow-up (6.9 ± 3.4 years, range 0.4-12.9 years), 195 events occurred. The event rate of the population was 3.74 per 100 patient-years. After adjustment for age, sex, previous events, diabetes, estimated glomerular filtration rate, left ventricular hypertrophy, left atrial enlargement, asymptomatic left ventricular systolic dysfunction at baseline, 24-hour systolic blood pressure, non-dipping and dipping with high morning surge of blood pressure, patients with high average real variability were at higher cardiovascular risk than those with low average real variability (hazard ratio 1.64, 95% confidence interval 1.12-2.40). CONCLUSIONS In elderly treated hypertensive patients, high average real variability of 24-hour systolic blood pressure is associated with higher cardiovascular risk independently of other risk markers, average 24-hour systolic blood pressure and circadian blood pressure changes.
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Affiliation(s)
| | | | | | - Sante D Pierdomenico
- Medical, Oral and Biotechnological Sciences, University 'Gabriele d'Annunzio', Chieti-Pescara, Chieti, Italy
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Okamura T, Ushigome E, Kitagawa N, Oyabu C, Tanaka T, Hasegawa G, Nakamura N, Ohnishi M, Tsunoda S, Ushigome H, Yokota I, Hamaguchi M, Asano M, Yamazaki M, Fukui M. Maximum morning home systolic blood pressure is an indicator of the development of diabetic nephropathy: The KAMOGAWA-HBP study. J Diabetes Investig 2019; 10:1543-1549. [PMID: 30884176 PMCID: PMC6825917 DOI: 10.1111/jdi.13040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 01/14/2023] Open
Abstract
AIMS/INTRODUCTION The maximum value of home systolic blood pressure is correlated with damage to target organs, including diabetic nephropathy. However, the precise relationship between the development of diabetic nephropathy and maximum home systolic blood pressure has not been elucidated. MATERIALS AND METHODS In this prospective 2-year cohort subanalysis of the KAMOGAWA-HBP study, the patient population was 477 Japanese patients with normoalbuminuria. We investigated the effects of mean and maximum home blood pressure on the development of diabetic nephropathy, which we defined as a urinary albumin excretion value ≥30 mg/g creatinine. Among the 477 patients, 67 developed diabetic nephropathy. RESULTS In our multivariate logistic regression analyses, the maximum morning home systolic blood pressure was significantly positively associated with the development of diabetic nephropathy after adjusting for patient sex and age, smoking status, the diabetes mellitus duration, body mass index, creatinine, total cholesterol, hemoglobin A1c, and antihypertensive medication use (odds ratio 1.21, 95% confidence interval 1.03-1.42, P = 0.021). CONCLUSIONS Maximum home blood pressure can be identified at a glance, and its measurement would thus be helpful to healthcare providers who treat patients with diabetes and normoalbuminuria.
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Affiliation(s)
- Takuro Okamura
- Department of Endocrinology and MetabolismGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Emi Ushigome
- Department of Endocrinology and MetabolismGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Nobuko Kitagawa
- Department of Endocrinology and MetabolismGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Chikako Oyabu
- Department of Endocrinology and MetabolismKyoto First Red Cross HospitalKyotoJapan
| | - Toru Tanaka
- Department of Endocrinology and MetabolismKyoto First Red Cross HospitalKyotoJapan
| | - Goji Hasegawa
- Department of Endocrinology and MetabolismKyoto Second Red Cross HospitalKyotoJapan
| | | | - Masayoshi Ohnishi
- Department of Endocrinology and MetabolismOsaka General Hospital of West Japan Railway CompanyOsakaJapan
| | | | - Hidetaka Ushigome
- Department of Organ Transplantation and General SurgeryGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Isao Yokota
- Department of BiostatisticsGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Masahide Hamaguchi
- Department of Endocrinology and MetabolismGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Mai Asano
- Department of Endocrinology and MetabolismGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Masahiro Yamazaki
- Department of Endocrinology and MetabolismGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Michiaki Fukui
- Department of Endocrinology and MetabolismGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
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Cucci MD, Benken ST. Blood pressure variability in the management of hypertensive emergency: A narrative review. J Clin Hypertens (Greenwich) 2019; 21:1684-1692. [PMID: 31553128 PMCID: PMC8030327 DOI: 10.1111/jch.13694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/16/2019] [Accepted: 07/26/2019] [Indexed: 11/29/2022]
Abstract
Hypertensive emergencies (HTNe) primarily focus on decreasing the blood pressure to specific targets. However, there are emerging data surrounding the potential clinical effects of blood pressure variability (BPV) in patients with HTNe. This narrative review highlights the various definitions of BPV, the emerging role of BPV, and the clinical data surrounding BPV in the HTNe setting. Clinical studies were obtained from a PubMed search through October 2018 utilizing PICO methodology. Original research articles, systematic reviews, and meta-analyses were considered for inclusion. Articles were selected for inclusion based on the relevancy of the article investigating BPV in the HTNe setting. There is currently no accepted standard to express BPV in the acute care setting of HTNe, and various parameters have been reported. There are very limited data regarding BPV outside of the neurologic HTNe setting. In the acute treatment phase of neurologic HTNe, BPV is consistently associated with increased risk of unfavorable outcomes. In the HTNe setting, continuous infusion of calcium channel blockers may optimize BPV compared to other agents. Based on current data, BPV should be investigated in a prospective systemic fashion. Efforts should be taken to ensure that BPV is minimized in the acute phase of HTNe, especially for those patients with intracranial hemorrhage. This reduced BPV is associated with improved favorable outcomes, but further study investigating specific pharmacologic agents is needed.
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Affiliation(s)
| | - Scott T. Benken
- University of Illinois Medical CenterUniversity of Illinois‐Chicago College of PharmacyChicagoIllinois
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Morano A, Ravera A, Agosta L, Sappa M, Falcone Y, Fonte G, Isaia G, Isaia GC, Bo M. Extent of, and variables associated with, blood pressure variability among older subjects. Aging Clin Exp Res 2018; 30:1327-1333. [PMID: 29476481 DOI: 10.1007/s40520-018-0917-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/14/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Blood pressure variability (BPV) may have prognostic implications for cardiovascular risk and cognitive decline; however, BPV has yet to be studied in old and very old people. AIMS Aim of the present study was to evaluate the extent of BPV and to identify variables associated with BPV among older subjects. METHODS A retrospective study of patients aged ≥ 65 years who underwent 24-h ambulatory blood pressure monitoring (ABPM) was carried out. Three different BPV indexes were calculated for systolic and diastolic blood pressure (SBP and DBP): standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). Demographic variables and use of antihypertensive medications were considered. RESULTS The study included 738 patients. Mean age was 74.8 ± 6.8 years. Mean SBP and DBP SD were 20.5 ± 4.4 and 14.6 ± 3.4 mmHg. Mean SBP and DBP CV were 16 ± 3 and 20 ± 5%. Mean SBP and DBP ARV were 15.7 ± 3.9 and 11.8 ± 3.6 mmHg. At multivariate analysis older age, female sex and uncontrolled mean blood pressure were associated with both systolic and diastolic BPV indexes. The use of calcium channel blockers and alpha-adrenergic antagonists was associated with lower systolic and diastolic BPV indexes, respectively. CONCLUSIONS Among elderly subjects undergoing 24-h ABPM, we observed remarkably high indexes of BPV, which were associated with older age, female sex, and uncontrolled blood pressure values.
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Affiliation(s)
- Arianna Morano
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy.
| | - Agnese Ravera
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
| | - Luca Agosta
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
| | - Matteo Sappa
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
| | - Yolanda Falcone
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
| | - Gianfranco Fonte
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
| | - Gianluca Isaia
- San Luigi Gonzaga Hospital, Corso Bramante 88, Orbassano, Turin, Italy
| | - Giovanni Carlo Isaia
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
| | - Mario Bo
- Department of Geriatric, Città della Salute e della Scienza-Molinette Torino, Corso Bramante 88, Turin, Italy
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9
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Fujiwara T, Hoshide S, Kanegae H, Eguchi K, Kario K. Exaggerated blood pressure variability is associated with memory impairment in very elderly patients. J Clin Hypertens (Greenwich) 2018; 20:637-644. [PMID: 29466618 DOI: 10.1111/jch.13231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/17/2017] [Accepted: 12/26/2017] [Indexed: 01/08/2023]
Abstract
We investigated the association between working memory (WM) impairment and blood pressure variability (BPV) in very elderly patients. Japanese outpatients ≥80 years who engaged in normal activities of daily living were the study cohort. WM function was evaluated by a simple visual WM test consisting of 3 figures. We considered the number of figures recalled by the patient his/her test score. We defined the patients with a score of 0 or 1 as those with WM impairment and those with scores of 2 or 3 as those without. To investigate the relative risk of WM impairment, we evaluated each patient's 24 hour ambulatory systolic blood pressure (SBP) and its weighted standard deviation (SDSBP ), office SBP, and the visit-to-visit SDSBP during the 1 year period from the patient's enrollment. A total of 66 patients (mean 84 ± 3.6 years) showed WM impairment, and 431 patients (mean 83 ± 3.1 years) showed no WM impairment. There were no significant differences in 24 hour ambulatory SBP or office SBP between these two groups. However, the WM impairment patients showed significantly higher weighted SDSBP and visit-to-visit SDSBP values compared to the no-impairment group even after adjusting for age. Among these ≥80-year-old patients, those with the highest quartile of both weighted SDSBP (≥21.4 mm Hg) and visit-to-visit SDSBP (≥14.5 mm Hg) showed the highest relative risk (odds ratio 3.52, 95% confidence interval 1.42-8.72) for WM impairment. Exaggerated blood pressure variability parameters were significantly associated with working memory impairment in very elderly individuals.
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Affiliation(s)
- Takeshi Fujiwara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.,Higashiagatsuma-machi National Health Insurance Clinic, Gunma, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Hiroshi Kanegae
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.,Genkiplaza Medical Center for Health Care, Tokyo, Japan
| | - Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
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10
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Age modifies the relation between intraindividual measurement-to-measurement variation in blood pressure and cognitive function: the Maine-Syracuse Study. J Hypertens 2017; 36:268-276. [PMID: 28787305 DOI: 10.1097/hjh.0000000000001510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is evidence to suggest that intraindividual variability in blood pressure (BP IIV) may be superior to mean BP for predicting cognitive function, taken from both within a single visit and between-visits. BP IIV increases with age in studies of persons middle-aged and older. The aim was therefore to investigate age by BP IIV (SBP and DBP) interactions with regard to cognitive functioning while considering medication class and polypharmacy, which may also affect BP IIV with advancing age. METHOD AND RESULTS Cross-sectional analyses were performed on 980 community-dwelling individuals from the Maine-Syracuse Longitudinal Study. Automated BP measures were taken 15 times (five times each in sitting, reclining, and standing positions). Cognitive function was assessed using a thorough neuropsychological test battery following the BP assessment. A significant age by BP IIV interaction was observed. For individuals aged over age 60 years, IIV in SBP and DBP was inversely associated with Global Composite, Scanning and Tracking, and the Similarities test. IIV in SBP was additionally associated with Verbal Memory and the Mini-Mental State Examination. DBP IIV was additionally related to the Visual-Spatial Memory and Organization composite. There were no significant associations between BP IIV and cognitive function in those aged less than 60 years. CONCLUSION BP IIV is an important predictor of cognition with advancing age.
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11
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Correlation between ambulatory blood pressure variability and vasodilator function in middle-aged normotensive individuals. Blood Press Monit 2017; 22:355-363. [PMID: 28489612 DOI: 10.1097/mbp.0000000000000267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association between ambulatory blood pressure variability and vasodilator function in a cohort of normotensive middle-aged individuals. PARTICIPANTS AND METHODS This was a cross-sectional study of 285 randomly selected 40-59-year-old normotensive participants who underwent 24-h ambulatory blood pressure monitoring and brachial artery ultrasound assessment. Systolic and diastolic blood pressure variability (BPV) of 24-h, daytime, and night-time were calculated using the coefficients of variation (CV) and the average real variability (ARV) index. Brachial arterial endothelium-dependent vasodilation (EDD) was assessed in response to increased flow and endothelium-independent vasodilation (EID) was assessed in response to nitroglycerin. Relationships were explored using univariate and multivariate linear regression. RESULTS The EDD were negatively associated with the CV of 24-h systolic blood pressure (SBP), the ARV of 24-h SBP, and diastolic blood pressure (DBP) in univariate analysis. However, the CV and ARV of 24-h SBP remained associated independently with % EDD in multivariate analysis. In addition, the mean levels of 24-h SBP and DBP, the CV of 24-h SBP and DBP, the ARV of 24-h SBP and DBP, the CV of daytime SBP, and the ARV of daytime DBP were all associated with % EID. However, in a multiple linear regression model, adjusting for covariates, only the CV and ARV of 24-h SBP, and the ARV of 24-h DBP were correlated negatively but weakly with % EID. CONCLUSION Our results indicated that a higher 24-h BPV was associated independently with decreased endothelial-dependent and endothelial-independent vasodilator functions in a middle-aged normotensive population. Although 24-h BPV was associated with vasodilator function, relationships were attenuated after adjusting for covariates.
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12
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Visit-to-visit SBP variability and cardiovascular disease in a multiethnic primary care setting. J Hypertens 2017; 35 Suppl 1:S50-S56. [DOI: 10.1097/hjh.0000000000001333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Short-term blood pressure variability and long-term blood pressure variability: which one is a reliable predictor for recurrent stroke. J Hum Hypertens 2017; 31:568-573. [PMID: 28447627 DOI: 10.1038/jhh.2017.32] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/02/2017] [Accepted: 03/20/2017] [Indexed: 01/13/2023]
Abstract
The relationship between blood pressure variability (BPV) and stroke recurrence is controversial. This study aimed to evaluate the predictive value of short-term and long-term BPV for stroke recurrence. The data from blood pressure and clinical outcome in TIA or ischemic stroke (BOSS) study included participants with acute ischemic stroke or transient ischemic attack (TIA) within 7 days after onset. Short-term BPV was measured by 24-h ambulatory BP measurement during hospitalisation. Long-term BPV, based on home blood pressure measurement, was measured by patients or their families from discharge to 90 days after qualifying events onset (twice daily). Variability for systolic blood pressure (SBP) was assessed as the s.d., coefficients of variance (CV). The clinical outcome was recurrent stroke within 1 year. Cox proportional hazards models were used to test the association of short-term BPV, long-term BPV and stroke recurrence. Among 1764 participants, the mean age was 62.45±10.99 years, and 32.1% were females, during 1-year follow-up, 106 (6.0%) participants experienced recurrent stroke. Indices of long-term BPV were significantly associated with stroke recurrence (s.d.: adjusted HR: 1.939, 95% CI: 1.122-3.351; CV: adjusted HR 1.955, 95% CI: 1.174-3.255), independent of mean SBP. However, all indices of short-term BPV (s.d., CV) were not associated with stroke recurrence (s.d.: adjusted HR: 1.245, 95% CI: 0.680-2.280; CV: adjusted HR: 1.142, 95% CI: 0.640-2.038). In conclusion, long-term variation of SBP is a better predictor than short-term variation of SBP for recurrent stroke after acute ischemic stroke or TIA.
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Weiss A, Rudman Y, Beloosesky Y, Akirov A, Shochat T, Grossman A. High blood pressure variability predicts 30-day mortality but not 1-year mortality in hospitalized elderly patients. Blood Press 2017; 26:259-263. [PMID: 28270031 DOI: 10.1080/08037051.2017.1300859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The association of blood pressure (BP) variability (BPV) in hospitalized patients, which represents day-to-day variability, with mortality has been extensively reported in patients with stroke, but poorly defined for other medical conditions. AIM AND METHOD To assess the association of day-to-day blood pressure variability in hospitalized patients, 10 BP measurements were obtained in individuals ≥75 years old hospitalized in a geriatric ward. Day-to-day BPV, measured 3 times a day, was calculated in each patient as the coefficient of variation of systolic BP. Patients were stratified by quartiles of coefficient of variation of systolic BP, and 30-day and 1-year mortality data were compared between those in the highest versus the lowest (reference) group. RESULTS Overall, 469 patients were included in the final analysis. Mean coefficient of variation of systolic BP was 12.1%. 30-day mortality and 1-year mortality occurred in 29/469 (6.2%) and 95/469 (20.2%) individuals respectively. Patients in the highest quartile of BPV were at a significantly higher risk for 30-day mortality (HR =4.12, CI 1.12-15.10) but not for 1-year mortality compared with the lowest BPV quartile (HR =1.61, CI 0.81-3.23). CONCLUSIONS Day-to-day BPV is associated with 30-day, but not with 1-year mortality in hospitalized elderly patients.
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Affiliation(s)
- Avraham Weiss
- a Department of Geriatrics , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Yaron Rudman
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Internal Medicine E , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel
| | - Yichayaou Beloosesky
- a Department of Geriatrics , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Amit Akirov
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,d Unit of Endocrinology and Metabolism , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel
| | - Tzippy Shochat
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,e Bio-statistical Unit , Rabin Medical Center, Beilinson Campus , Petah Tikva , Israel
| | - Alon Grossman
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Internal Medicine E , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel
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15
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Rapalis A, Janušauskas A, Marozas V, Lukoševičius A. Estimation of blood pressure variability during orthostatic test using instantaneous photoplethysmogram frequency and pulse arrival time. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2016.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Abstract
Ambulatory blood pressure (ABP) has long been recognized by researchers as the gold standard of blood pressure (BP) measurement. Researchers and clinicians typically rely on the mean measure of ABP; however, there is considerable variability in the beat-to-beat BP. Although often ignored, this variability has been found to be an independent predictor of cardiovascular disease and mortality. The aim of this paper is to provide a conceptual review of ABP variability (ABPV) focusing on the following: associations between ABPV and health, whether ABPV is reliable, how to calculate ABPV, predictors of ABPV, and treatments for ABPV. Two future directions are discussed involving better understanding ABPV by momentary assessments and improving knowledge of the underlying physiology that explains ABPV. The results of this review suggest that the unique characteristics of ABPV provide insight into the role of BP variability in hypertension and subsequent cardiovascular illness.
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17
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Saito I, Kario K, Kushiro T, Teramukai S, Yaginuma M, Mori Y, Okuda Y, Shimada K. Home blood pressure and cardiovascular risk in treated hypertensive patients: the prognostic value of the first and second measurements and the difference between them in the HONEST study. Hypertens Res 2016; 39:857-862. [PMID: 27488173 PMCID: PMC5506240 DOI: 10.1038/hr.2016.99] [Citation(s) in RCA: 4] [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: 03/10/2016] [Revised: 06/16/2016] [Accepted: 06/18/2016] [Indexed: 12/12/2022]
Abstract
Hypertension guidelines recommend using the average of two home blood pressure (HBP) measurements obtained on one occasion to monitor blood pressure. We studied the prognostic value of the first and second measurements or their average value during the follow-up period, as well as the relationships among the difference between the first and second HBP measurements and the prognosis using data from the HONEST (HBP measurement with Olmesartan-Naive patients to Establish Standard Target blood pressure) study. During the mean 2.02 years follow-up, 280 patients had cardiovascular events. Hazard ratios (HRs) for cardiovascular events for each 1 mm Hg increase in the first, second and averaged morning home systolic blood pressure (MHSBP) were similar. Hazards were significantly higher in patients with a large difference between the first and second MHSBP (ΔMHSBP) of <-5 mm Hg (HR: 2.12) or ⩾5 mm Hg (HR: 1.44) compared with those with a small ΔMHSBP of ⩾-5 to <5 mm Hg using the Cox proportional hazards model adjusted for the averaged MHSBP during the follow-up and other risk factors. Hazards in patients with an averaged MHSBP ⩾145 mmHg and a small ΔMHSBP (HR: 3.11), those with an averaged MHSBP ⩾125 to <145 mm Hg and a large ΔMHSBP (HR: 1.91) and those with an averaged MHSBP ⩾145 mm Hg and a large ΔMHSBP (HR: 4.63) were higher compared with those with an averaged MHSBP <125 mm Hg and a small ΔMHSBP. In conclusion, the first, second and averaged MHSBP measurements have similar prognostic values. Prognosis is worse for patients with a large ΔMHSBP. In clinical practice, it would be prudent to measure the HBP two times and use the average HBP of two measurements obtained on one occasion with particular attention to patients with a large ΔMHSBP.
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Affiliation(s)
- Ikuo Saito
- Keio University Health Center, Yokohama, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | | | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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McDonald C, Pearce MS, Wincenciak J, Kerr SRJ, Newton JL. Ambulatory Blood Pressure Variability Increases Over a 10-Year Follow-Up in Community-Dwelling Older People. Am J Hypertens 2016; 29:560-7. [PMID: 26310662 DOI: 10.1093/ajh/hpv150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 08/06/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Greater ambulatory blood pressure variability (ABPV) is associated with end-organ damage and increased mortality. Age-related changes in the cardiovascular and autonomic nervous systems make age-associated increases in ABPV likely. Cross-sectional studies support this hypothesis, showing greater ABPV among older compared to younger adults. The only longitudinal study to examine changes in ABPV, however, found ABPV decreased over 5 years follow-up. This unexpected observation probably reflected the highly selected nature of the study participants. METHODS In this longitudinal study, we assessed changes in ABPV over 10 years in a community-cohort of older people. In addition, we examined the extent to which ABPV was predicted by demographics, cardiovascular risk factors, and medication. Clinical examination and 24-hour ambulatory blood pressure monitoring were carried out at baseline and at 10 years follow-up in 83 people, median age 70 years. ABPV was calculated using SD and coefficient of variation (Cv). Three time periods were examined: daytime, nighttime, and 24 hours. RESULTS Daytime and 24-hour, systolic and diastolic, SD, and Cv were significantly greater at follow-up than at baseline (P < 0.001 in all cases). Mean BP did not change. CONCLUSIONS Multilevel modeling showed follow-up interval had a significant, positive effect on SD and Cv (P < 0.004), independent of age, sex, and medication.ABPV increased over a 10-year follow-up despite stable mean BP. ABPV may therefore be an additional target for treatment in older people. Future studies should examine what degree of ABPV is harmful and if control of ABPV reduces adverse outcome.
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Affiliation(s)
- Claire McDonald
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK; Newcastle Hospitals NHS Foundation Trust, Newcastle, UK;
| | - Mark S Pearce
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | | | - Simon R J Kerr
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK; Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Julia L Newton
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK; Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
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19
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Goh CH, Ng SC, Kamaruzzaman SB, Chin AV, Poi PJH, Chee KH, Imran ZA, Tan MP. Evaluation of Two New Indices of Blood Pressure Variability Using Postural Change in Older Fallers. Medicine (Baltimore) 2016; 95:e3614. [PMID: 27175670 PMCID: PMC4902512 DOI: 10.1097/md.0000000000003614] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To evaluate the utility of blood pressure variability (BPV) calculated using previously published and newly introduced indices using the variables falls and age as comparators.While postural hypotension has long been considered a risk factor for falls, there is currently no documented evidence on the relationship between BPV and falls.A case-controlled study involving 25 fallers and 25 nonfallers was conducted. Systolic (SBPV) and diastolic blood pressure variability (DBPV) were assessed using 5 indices: standard deviation (SD), standard deviation of most stable continuous 120 beats (staSD), average real variability (ARV), root mean square of real variability (RMSRV), and standard deviation of real variability (SDRV). Continuous beat-to-beat blood pressure was recorded during 10 minutes' supine rest and 3 minutes' standing.Standing SBPV was significantly higher than supine SBPV using 4 indices in both groups. The standing-to-supine-BPV ratio (SSR) was then computed for each subject (staSD, ARV, RMSRV, and SDRV). Standing-to-supine ratio for SBPV was significantly higher among fallers compared to nonfallers using RMSRV and SDRV (P = 0.034 and P = 0.025). Using linear discriminant analysis (LDA), 3 indices (ARV, RMSRV, and SDRV) of SSR SBPV provided accuracies of 61.6%, 61.2%, and 60.0% for the prediction of falls which is comparable with timed-up and go (TUG), 64.4%.This study suggests that SSR SBPV using RMSRV and SDRV is a potential predictor for falls among older patients, and deserves further evaluation in larger prospective studies.
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Affiliation(s)
- Choon-Hian Goh
- From the Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya (C-HG, SBK, A-VC, PJHP, MPT), Department of Biomedical Engineering, Faculty of Engineering, University of Malaya (C-HG, S-CN), Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya (SBK, A-VC, PJHP, MPT), and Division of Cardiology, Department of Medicine (KHC, ZAI), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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20
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Wittke EI, Fuchs SC, Moreira LB, Foppa M, Fuchs FD, Gus M. Blood pressure variability in controlled and uncontrolled blood pressure and its association with left ventricular hypertrophy and diastolic function. J Hum Hypertens 2015; 30:483-7. [PMID: 26467817 DOI: 10.1038/jhh.2015.106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 12/25/2022]
Abstract
High systolic blood pressure (SBP) variability has been associated with higher risk for target-organ damage. In a cross-sectional study done in a tertiary outpatient hypertension clinic, we compared short-term SBP variability among controlled and uncontrolled hypertensive patients and evaluated the association between higher levels of SBP variability and diastolic function and left ventricular hypertrophy (LVH). Patients were evaluated by 24-h ambulatory blood pressure monitoring and transthoracic Doppler echocardiogram. Blood pressure (BP) variability was evaluated by the time-rate index and high variability corresponded to index values in the top quartile of distribution. Echocardiographic parameters were compared in patients with and without higher BP variability within controlled and uncontrolled office BP (⩽140/90 mm Hg). The analyses included 447 patients with 58±12 years of age, 67% were women, 68% white, 43% current or previous smokers and 32% with diabetes mellitus. Among the whole sample, 137 patients had controlled and 310 uncontrolled BP. The 75th percentile cutoff points for the time-rate index were 0.502 mm Hg min(-1) and 0.576 mm Hg min(-1) for participants with controlled and uncontrolled BP, respectively. After adjustment for confounders, the time-rate index did not differ between controlled and uncontrolled patients. BP variability was not associated with LVH or diastolic function in controlled and uncontrolled BP after adjustment for 24-h SBP and age. Patients with controlled and uncontrolled BP had similar SBP variability assessed by time-rate index, which was not associated with LVH or diastolic function. These findings should be confirmed in studies with larger sample size.
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Affiliation(s)
- E I Wittke
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - S C Fuchs
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Division of Cardiology, Hypertension Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - L B Moreira
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Division of Cardiology, Hypertension Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - M Foppa
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Division of Cardiology, Hypertension Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - F D Fuchs
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Division of Cardiology, Hypertension Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - M Gus
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Division of Cardiology, Hypertension Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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21
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Kai H, Kudo H, Takayama N, Yasuoka S, Aoki Y, Imaizumi T. Molecular mechanism of aggravation of hypertensive organ damages by short-term blood pressure variability. Curr Hypertens Rev 2015; 10:125-33. [PMID: 25544288 PMCID: PMC4428492 DOI: 10.2174/1573402111666141217112655] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 12/12/2014] [Indexed: 11/22/2022]
Abstract
There is increasing evidence that not only the elevation of systolic and diastolic blood pressure (BP) but also the increase in BP variability (or fluctuation) are associated with hypertensive organ damages and the morbidity and mortality of cerebrovascular and cardiovascular events. However, the molecular mechanism whereby the increase in BP variability aggravates hypertensive organ damages remains unknown. Thus, we created a rat chronic model of a combination of hypertension and large BP variability by performing bilateral sino-aortic denervation in spontaneously hypertensive rat. A series of our studies using this model revealed that large BP variability induces chronic myocardial inflammation by activating local angiotensin II and mineralocorticoid receptor systems and thereby aggravates cardiac hypertrophy and myocardial fibrosis, leading to systolic dysfunction, in hypertensive hearts. In addition, large BP variability induces the aggravation of arteriolosclerotic changes and ischemic cortical fibrosis in hypertensive kidney via local angiotensin II system.
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22
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Mulè G, Calcaterra I, Costanzo M, Geraci G, Guarino L, Foraci AC, Vario MG, Cerasola G, Cottone S. Relationship Between Short-Term Blood Pressure Variability and Subclinical Renal Damage in Essential Hypertensive Patients. J Clin Hypertens (Greenwich) 2015; 17:473-80. [PMID: 25808042 PMCID: PMC8031799 DOI: 10.1111/jch.12534] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/02/2015] [Accepted: 02/04/2015] [Indexed: 12/14/2022]
Abstract
The authors aimed to analyze the relationship between subclinical renal damage, defined as the presence of microalbuminuria or an estimated glomerular filtration rate (eGFR) between 30 mL/min/1.73 m(2) and 60 mL/min/1.73 m(2) and short-term blood pressure (BP) variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24-hour BP, and SD of daytime and nighttime BP. A total of 328 hypertensive patients underwent 24-hour ambulatory BP monitoring, 24-hour albumin excretion rate determination, and eGFR calculation using the Chronic Kidney Disease Epidemiology Collaboration equation. ARV of 24-hour systolic BP (SBP) was significantly higher in patients with subclinical renal damage (P=.001). This association held (P=.04) after adjustment for potential confounders. In patients with microalbuminuria, ARV of 24-hour SBP, weighted SD of 24-hour SBP, and SD of daytime SBP were also independently and inversely related to eGFR. These results seem to suggest that in essential hypertension, short-term BP variability is independently associated with early renal abnormalities.
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Affiliation(s)
- Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS)Unit of Nephrology and HypertensionEuropean Society of Hypertension Excellence CentreUniversità di PalermoPalermoItaly
| | - Ilenia Calcaterra
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS)Unit of Nephrology and HypertensionEuropean Society of Hypertension Excellence CentreUniversità di PalermoPalermoItaly
| | - Miriam Costanzo
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS)Unit of Nephrology and HypertensionEuropean Society of Hypertension Excellence CentreUniversità di PalermoPalermoItaly
| | - Giulio Geraci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS)Unit of Nephrology and HypertensionEuropean Society of Hypertension Excellence CentreUniversità di PalermoPalermoItaly
| | - Laura Guarino
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS)Unit of Nephrology and HypertensionEuropean Society of Hypertension Excellence CentreUniversità di PalermoPalermoItaly
| | - Anna C. Foraci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS)Unit of Nephrology and HypertensionEuropean Society of Hypertension Excellence CentreUniversità di PalermoPalermoItaly
| | - Maria G. Vario
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS)Unit of Nephrology and HypertensionEuropean Society of Hypertension Excellence CentreUniversità di PalermoPalermoItaly
| | - Giovanni Cerasola
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS)Unit of Nephrology and HypertensionEuropean Society of Hypertension Excellence CentreUniversità di PalermoPalermoItaly
| | - Santina Cottone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS)Unit of Nephrology and HypertensionEuropean Society of Hypertension Excellence CentreUniversità di PalermoPalermoItaly
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Cardiovascular risk stratification and blood pressure variability on ambulatory and home blood pressure measurement. Curr Hypertens Rep 2015; 16:470. [PMID: 25097109 DOI: 10.1007/s11906-014-0470-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED Variability is a phenomenon attributed to most biological processes and is a particular feature of blood pressure (BP) that concerns many physicians regarding the clinical meaning and the impact on their clinical practice. In this review, we assessed the role of different indices of BP variability in cardiovascular risk stratification. We reviewed the indices of BP variability derived from ambulatory BP monitoring (day-to-night ratio, morning surge of BP, and short-term BP variability) and home BP measurement (standardized conventional BP measurement and self-BP measurement), and summarized our recent results with the intention to provide a clear message for clinical practice. CONCLUSION BP variability, either derived from ambulatory BP measurement or home BP measurement does not substantially refine cardiovascular risk prediction over and beyond the BP level. Practitioners should be aware that BP level remains the main modifiable risk factor derived from BP measurement and contributes to improving the control of hypertension and adverse health outcomes.
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Sasaki N, Ozono R, Edahiro Y, Okita T, Teramen K, Kisaka T, Fujiwara S, Kihara Y. Short-term blood pressure variability in hypertensive patients with obstructive sleep apnea syndrome. Sleep Biol Rhythms 2014. [DOI: 10.1111/sbr.12094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nobuo Sasaki
- Health Management and Promotion Center; Hiroshima Atomic Bomb Casualty Council; Hiroshima Japan
| | - Ryoji Ozono
- Department of General Medicine; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
| | - Yoshinobu Edahiro
- Department of Clinical Laboratories; Mitsubishi Mihara Hospital; Mihara Japan
| | - Tomomi Okita
- Department of Clinical Laboratories; Mitsubishi Mihara Hospital; Mihara Japan
| | - Kazushi Teramen
- Department of Internal Medicine; Mitsubishi Mihara Hospital; Mihara Japan
| | - Tomohiko Kisaka
- Department of Cardiovascular Medicine; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
| | - Saeko Fujiwara
- Health Management and Promotion Center; Hiroshima Atomic Bomb Casualty Council; Hiroshima Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
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25
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Impact of antihypertensive combination and monotreatments on blood pressure variability. J Hypertens 2014; 32:1326-33. [DOI: 10.1097/hjh.0000000000000169] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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26
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Qin X, Zhang Q, Yang S, Sun Z, Chen X, Huang H. Blood Pressure Variability and Morning Blood Pressure Surge in Elderly Chinese Hypertensive Patients. J Clin Hypertens (Greenwich) 2014; 16:511-7. [PMID: 24775732 DOI: 10.1111/jch.12333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/02/2014] [Accepted: 04/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Xiaobo Qin
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Qin Zhang
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Suping Yang
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Zhongbo Sun
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Xiaojie Chen
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Huiling Huang
- Department of Cardiovascular Medicine; Affiliated First Hospital of Sun Yat-sun University; Guangzhou China
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Omboni S, Malacco E, Mallion JM, Fabrizzi P, Volpe M. Olmesartan vs. ramipril in elderly hypertensive patients: review of data from two published randomized, double-blind studies. High Blood Press Cardiovasc Prev 2014; 21:1-19. [PMID: 24435506 DOI: 10.1007/s40292-013-0037-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 12/30/2013] [Indexed: 12/22/2022] Open
Abstract
Hypertension is a frequent condition among individuals over 65 years of age worldwide and is one of the most important risk factors for cardiovascular (CV) disease. Effective drug treatment of elderly hypertensives is usually associated with a marked reduction in CV morbidity and mortality. Among the different classes of antihypertensive agents, angiotensin receptor blockers (ARBs) and ACE-inhibitors are supposed to provide the best efficacy in lowering blood pressure (BP) and protecting target organ damage while featuring a good tolerability profile. However, up to date, few randomized clinical studies have directly compared the activity and safety of ARBs and ACE-inhibitors in elderly hypertensive patients. Aim of this review of published and unpublished pooled data from two recent randomized, double-blind, controlled trials, is to offer a comprehensive head-to-head comparison of the antihypertensive efficacy of the ARB olmesartan medoxomil vs. the ACE-inhibitor ramipril in a large study population including more than 1,400 hypertensive subjects aged 65-89 years with mild-to-moderate essential hypertension. The efficacy of the two drugs was separately evaluated in subgroups of patients classified according to the presence of metabolic syndrome, reduced renal function, CV risk level, gender, class of age, type of arterial hypertension and previous antihypertensive treatments. Olmesartan showed a greater efficacy than ramipril both in terms of clinic BP reduction and rate normalization. Olmesartan appeared significantly superior to ramipril in providing a more homogeneous and long-lasting 24-h BP control and maintaining an effective antihypertensive action in the last 6-h period from drug intake. In subgroups of patients with additional clinical conditions, olmesartan gave comparable, and in some cases greater, BP responses than those achieved with the ACE-inhibitor. The incidence of adverse events was similar for both drugs. Olmesartan may thus represent an effective alternative to ACE-inhibitors among first-line drug treatments for hypertension in older people.
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Affiliation(s)
- Stefano Omboni
- Italian Institute of Telemedicine, Via Colombera 29, 21048, Solbiate Arno (Varese), Italy,
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Yoshida H, Akasaka H, Saitoh S, Shimamoto K, Miura T. Comparative effects of telmisartan and valsartan as add-on agents for hypertensive patients with morning blood pressure insufficiently controlled by amlodipine monotherapy. Hypertens Res 2013; 37:225-31. [PMID: 24108237 DOI: 10.1038/hr.2013.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/02/2013] [Accepted: 08/22/2013] [Indexed: 11/09/2022]
Abstract
The aim of this study was to determine the efficacies of valsartan and telmisartan as add-on agents for the control of morning blood pressure (BP) in patients already on amlodipine monotherapy. A total of 414 hypertensive patients were prospectively enrolled in a 4-week run-in period when they were treated with amlodipine (5 mg/day), and home BP was measured in the morning and evening. Patients with home systolic BP (SBP) being 135-159 mm Hg in the morning at the end of the run-in period were randomized to additional treatment with valsartan (80 mg/day) or with telmisartan (40 mg/day) for 8 weeks. The primary endpoint was the change in morning home BP, and secondary endpoints included variability of morning home BP. Of the 282 patients randomized, 262 patients (n=131, in each treatment) completed the protocols. Demographic parameters and baseline morning SBP/diastolic BP (DBP) (146.3±7.1/84.8±9.3 vs. 146.0±7.1/84.2±9.1 mm Hg) were comparable in the valsartan group and telmisartan group, and changes in SBP/DBP after 8-week treatment were not significantly different between the two groups (-7.4±10.6/-3.9±6.1 vs. -8.3±9.9/-5.0±5.9 mm Hg). Valsartan significantly increased individual standard deviation and variation coefficient of morning SBP, but telmisartan did not change either of these indices of SBP variation. In subgroups with baseline SBP being above the median (145.2 mm Hg), change in DBP was significantly larger by telmisartan than by valsartan (-6.3±5.6 vs. -3.9±6.7 mm Hg, P<0.05). These results suggest that telmisartan is more useful than valsartan as an add-on agent for reducing the level and variability of morning BP in patients on amlodipine monotherapy.
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Affiliation(s)
- Hideaki Yoshida
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Hiroshi Akasaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Shigeyuki Saitoh
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Kazuaki Shimamoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, School of Medicine, Sapporo, Japan
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Addition of aliskiren to Angiotensin receptor blocker improves ambulatory blood pressure profile and cardiorenal function better than addition of benazepril in chronic kidney disease. Int J Mol Sci 2013; 14:15361-75. [PMID: 23887656 PMCID: PMC3759864 DOI: 10.3390/ijms140815361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 06/25/2013] [Accepted: 06/28/2013] [Indexed: 01/08/2023] Open
Abstract
An altered ambulatory blood pressure (BP) and heart rate (HR) profile is related to chronic kidney disease (CKD) and cardiorenal syndrome. In this study, we examined the effects of aliskiren, when added to angiotensin II type 1 receptor blockers, on ambulatory BP and cardiorenal function in CKD. Thirty-six hypertensive CKD patients were randomly assigned to the aliskiren add-on group (n = 18) or the benazepril add-on group (n = 18). Ambulatory BP and cardiorenal function parameters were measured at baseline and 24 weeks after treatment. Compared with the benazepril group, nighttime systolic BP variability in the aliskiren group was lower after treatment. Albuminuria was decreased in the aliskiren group, but not in the benazepril group. In addition, left ventricular mass index (LVMI) was significantly lower in the aliskiren group than in the benazepril group after treatment. In the aliskiren group, multivariate linear regression analysis showed an association between changes in albuminuria and changes in nighttime systolic BP. Furthermore, there were associations between changes in LVMI and changes in daytime HR variability, as well as between changes in LVMI and changes in plasma aldosterone concentration. These results suggest that aliskiren add-on therapy may be beneficial for suppression of renal deterioration and pathological cardiac remodeling through an improvement that is effected in ambulatory BP and HR profiles.
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Shinji M. A study of the association with blood pressure difference causing body temperature ≥37·5°C and hypertension in department of primary care. Clin Physiol Funct Imaging 2013; 33:441-9. [PMID: 23711334 DOI: 10.1111/cpf.12050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/16/2013] [Indexed: 11/29/2022]
Abstract
Previous studies reported the relationship between significant blood pressure difference (ΔBP) and early atherosclerotic markers. Although it is known that body temperature is associated with BP and blood flow, as measured on Korotkoff sound graph (KSG), as well as heart rate and sympathetic nerve activity, it remains unclear whether moderate fever (≥37·5°C) can be caused by significant ΔBP. ΔBP was calculated by subtracting the BP of the left arm from that of the right arm. The aim of our study was to investigate whether an association exists among ΔBP, body temperature, hypertension and KSG area ratio in 1802 new outpatients examined in a seated position in routine clinical practice. Our study documented that absolute systolic blood pressure difference (|ΔSBP|) ≥ 10 mmHg (observed in 14·6% of the patients) was associated with a significantly higher heart rate, moderate fever, tachycardia and hypertension. In multivariate analysis, the odds ratios (ORs) of |ΔSBP| ≥ 10 mmHg showed significant associated markers of body temperature and hypertension, while the ORs of KSG area ratio ≥ 170% showed significant associated markers of sex, age, body temperature, hypertension, diabetes mellitus, prior vascular event and smoking. In conclusion, our study of new outpatients in the department of primary care demonstrated that |ΔSBP| ≥ 10 mmHg and KSG area ratio ≥ 170% were associated with moderate fever and hypertension. Furthermore, our study suggests that the association of moderate fever with |ΔSBP| ≥ 10 mmHg and KSG area ratio ≥ 170% is physiologic as well as pathologic.
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Affiliation(s)
- Maeda Shinji
- Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan; Department of General Medicine, Harasanshin Hospital, Fukuoka, Japan
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Abstract
With the increase in the aging population, it is important to understand the individual diseases and their interactions which are prevalent and have a great impact on the health status of the elderly. Hypertension is one of the most common diseases in older age and may impact the health status because it is the main risk factor for cardiovascular and cerebrovascular diseases such as heart failure and stroke. Recently, much evidence has been accumulated showing that hypertension plays an important role in the development and progression of cognitive impairment and dementia. Cerebral hypoperfusion secondary to severe atherosclerosis resulting from long-standing hypertension may be a major biological pathway linking high blood pressure (BP) to cognitive decline and dementia. Furthermore, increased BP variability has also been reported to be significantly associated with white matter hyperintensities and brain atrophy, which are predisposing conditions of dementia, depression, and falls in the elderly even after adjusting for BP levels and other confounding variables. Several mechanisms have been shown to be involved in the association between BP variability and cognitive impairment in elderly individuals. In addition to an increased cerebral blood flow fluctuation, neurohumoral activation, endothelial dysfunction, inflammation, and oxidative stress have been suggested to be the underlying mechanisms. However, clinical trials provide limited evidence for a protective effect of antihypertensive therapy against dementia and stroke-related cognitive decline. In this article, we aimed to review the existing evidence of the connection between BP variability and cognitive impairment in elderly people.
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Affiliation(s)
- Hee-Won Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Elliott MR, Soto Soto JM, Haley WE, Fitzpatrick PM, Dwyer JP. Labile Hypertension: Characteristics of a Referred Cohort. Clin Exp Hypertens 2012; 35:207-12. [DOI: 10.3109/10641963.2012.712180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Questionable link between normo- to microalbuminuria and home-measured blood pressure variability in hypertension. Hypertens Res 2012; 35:802-4. [DOI: 10.1038/hr.2012.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kanaoka T, Tamura K, Ohsawa M, Yanagi M, Haku S, Wakui H, Maeda A, Dejima T, Azushima K, Mitsuhashi H, Okano Y, Fujikawa T, Toya Y, Mizushima S, Tochikubo O, Umemura S. Relationship of ambulatory blood pressure and the heart rate profile with renal function parameters in hypertensive patients with chronic kidney disease. Clin Exp Hypertens 2012; 34:264-9. [PMID: 22578052 DOI: 10.3109/10641963.2012.681082] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Strict blood pressure (BP) control is reportedly important for the management of hypertensive patients with chronic kidney disease (CKD). The purpose of this cross-sectional study was to examine whether the variables of ambulatory BP and the heart rate (HR) profile, central hemodynamics, and arterial stiffness were closely related to the renal function parameters (urine albumin excretion rate [UACR] and estimated glomerular filtration rate [eGFR]) observed in 25 consecutive hospitalized hypertensive patients with CKD. There were significant positive relationships between UACR and 24-hour, daytime, and nighttime ambulatory systolic BP. In addition, there were significant negative relationships between UACR and 24-hour and daytime HR variability. The circulating B-type natriuretic peptide level and hemoglobin A1c were also positively related to UACR. With respect to eGFR, although the 24-hour and nighttime HR variability were positively associated with eGFR, the circulating pentosidine and nighttime HR had a negative relationship with eGFR. On the other hand, central hemodynamics and arterial stiffness did not exhibit any significant association with renal function parameters. These results indicate that ambulatory BP and the HR profile are closely modulated by renal function deterioration. Further studies are needed to investigate the causal relationship between ambulatory BP and the HR profile and renal function parameters in hypertensive patients with CKD.
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Affiliation(s)
- Tomohiko Kanaoka
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Maeda A, Tamura K, Kanaoka T, Ohsawa M, Haku S, Azushima K, Dejima T, Wakui H, Yanagi M, Okano Y, Fujikawa T, Toya Y, Mizushima S, Tochikubo O, Umemura S. Combination Therapy of Angiotensin II Receptor Blocker and Calcium Channel Blocker Exerts Pleiotropic Therapeutic Effects in Addition to Blood Pressure Lowering: Amlodipine and Candesartan Trial in Yokohama (ACTY). Clin Exp Hypertens 2012; 34:249-57. [DOI: 10.3109/10641963.2012.681081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kanaoka T, Tamura K, Ohsawa M, Wakui H, Maeda A, Dejima T, Azushima K, Haku S, Mitsuhashi H, Yanagi M, Oshikawa J, Uneda K, Aoki K, Fujikawa T, Toya Y, Uchino K, Umemura S. Effects of Aliskiren-Based Therapy on Ambulatory Blood Pressure Profile, Central Hemodynamics, and Arterial Stiffness in Nondiabetic Mild to Moderate Hypertensive Patients. J Clin Hypertens (Greenwich) 2012; 14:522-9. [DOI: 10.1111/j.1751-7176.2012.00640.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Yokote S, Yokoo T, Matsumoto K, Utsunomiya Y, Kawamura T, Hosoya T. The effect of metanephros transplantation on blood pressure in anephric rats with induced acute hypotension. Nephrol Dial Transplant 2012; 27:3449-55. [PMID: 22513705 DOI: 10.1093/ndt/gfs006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The kidney is an important organ for maintaining blood pressure. We have previously reported that transplanted metanephroi can reproduce some kidney functions. The aim of the present study was to determine the metabolic function of transplanted metanephroi with particular reference to maintaining blood pressure. METHODS Male Wistar rats were transplanted with metanephroi (transplanted group, n = 28), following unilateral nephrectomy. For comparison, we performed unilateral nephrectomy without transplantation in 32 rats (non-transplanted group, n = 18; haeminephrectomy control group, n = 14). The remaining kidney was removed 2 weeks after the initial operation, while control rats had a sham operation. Hypotension was induced by intravenous infusion of diltiazem hydrochloride or rapid withdrawal of blood. Mean arterial blood pressure (MAP) was invasively monitored and plasma renin activity (PRA) was analysed at multiple time points. Renin expression by metanephroi was evaluated by real-time polymerase chain reaction and immunohistochemistry. RESULTS Metanephroi in the transplanted group expressed renin messenger RNA. Metanephros transplantation significantly raised PRA and maintained MAP compared with the non-transplanted group. No significant differences between the transplanted and control groups were found with respect to PRA or MAP. PRA was positively correlated with metanephroi weight as well as MAP in the transplanted group. CONCLUSION The present study shows that transplantation of metanephroi produces PRA and contributes to raising MAP in a rat model of acute hypotension.
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Affiliation(s)
- Shinya Yokote
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Cay S, Cagirci G, Demir AD, Balbay Y, Erbay AR, Aydogdu S, Maden O. Ambulatory blood pressure variability is associated with restenosis after percutaneous coronary intervention in normotensive patients. Atherosclerosis 2011; 219:951-7. [PMID: 22005197 DOI: 10.1016/j.atherosclerosis.2011.09.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 09/07/2011] [Accepted: 09/23/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies have showed that BP variability is associated with cardiovascular events. However, no data were available regarding binary restenosis as an end-point after percutenous coronary intervention (PCI). METHODS AND RESULTS This multicenter study included 100 consecutive normotensive patients with stable coronary artery disease who were planned for PCI. Before the index procedure, office BP and 24-h ambulatory BP measurements were performed. BP variability indices including systolic and diastolic 24-h average, the day and the night values of standard deviation (SD) and variation coefficient (VC) were measured and calculated. All patients underwent repeat coronary angiography at 6-month. According to angiographic results, 2 groups were formed; a restenosis group (n=30) with binary restenosis of the stented segment and a control group (n=70) with a stenosis diameter of <50% in stented segment. Systolic SD and VC values for 24-h average (14.0±2.8mmHg vs. 9.5±1.6mmHg, p<0.001 and 16%±3 vs. 11%±2, p<0.001, respectively), the day (15.2±3.9mmHg vs. 10.6±1.7mmHg, p<0.001 and 17%±4 vs. 12%±2, p<0.001, respectively), and the night (12.8±4.1mmHg vs. 8.4±2.4mmHg, p<0.001 and 14%±5 vs. 11%±3, p=0.004, respectively) values were significantly higher in restenosis group compared to control group. Similarly, diastolic SD and VC values for 24-h average (10.6±2.5mmHg vs. 8.1±1.5mmHg, p<0.001 and 12%±3 vs. 9%±2, p=0.001, respectively), the day (11.1±2.9mmHg vs. 9.0±1.8mmHg, p=0.003 and 12%±3 vs. 10%±2, p=0.006, respectively), and the night (10.0±3.6mmHg vs. 7.2±2.0mmHg, p=0.001 and 11%±5 vs. 9%±3, p=0.059, respectively) values were significantly higher in restenosis group compared to no restenosis group except for diastolic VC night. All systolic and diastolic BP variability indices except diastolic VC night were found to be independent predictors of risk of restenosis in multivariate analysis. In addition, the cut-off values of 11.4mmHg and 13% for 24-h systolic SD and VC, respectively, were found to be highly sensitive (93% for both) and specific (94% and 91%, respectively) for predicting binary restenosis at 6-month after PCI. CONCLUSIONS BP variability indices are significantly and independently associated with binary restenosis and higher values can predict restenosis after PCI sensitively and specifically.
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Affiliation(s)
- Serkan Cay
- Department of Cardiology, Gulhane Military Medical Academy Haydarpasa Education Hospital, Istanbul, Turkey.
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Abstract
Exactly how hypertension causes end organ damage and vascular events is poorly understood. Yet the concept that underlying "usual" blood pressure (BP) accounts for all BP-related risk of vascular events and for the benefits of BP-lowering drugs has come to underpin clinical guidelines on the diagnosis and treatment of hypertension. This article reviews evidence that variability in BP also predicts risk of stroke and other vascular events independently of mean BP and evidence that drug-class effects on variability in BP explain differences in the effectiveness of BP-lowering drugs in preventing stroke.
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Affiliation(s)
- Peter M Rothwell
- University Department of Clinical Neurology, John Radcliffe Hospital, Level 6, West Wing, Headington, Oxford OX3 9DU, UK.
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Zhang Y, Agnoletti D, Safar ME, Blacher J. Effect of antihypertensive agents on blood pressure variability: the Natrilix SR versus candesartan and amlodipine in the reduction of systolic blood pressure in hypertensive patients (X-CELLENT) study. Hypertension 2011; 58:155-60. [PMID: 21747047 DOI: 10.1161/hypertensionaha.111.174383] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To investigate the effect of different antihypertensive agents on blood pressure (BP) variability (BPV) and the underlying mechanism, we analyzed the ambulatory BP monitoring data of 577 patients before and after 3-month antihypertensive treatment, in the Natrilix SR Versus Candesartan and Amlodipine in the Reduction of Systolic Blood Pressure in Hypertensive Patients (X-CELLENT) Study, a multicenter, multinational, randomized, double-blind, placebo-controlled study with 4 parallel treatment arms (placebo, candesartan, indapamide sustained release, and amlodipine). Within-subject mean and SD of 24-hour BP, weighted by time interval between consecutive readings, were calculated in 3 time frames (daytime, nighttime, and 24 hours) to evaluate BP and BPV. The mean 24-hour heart rate (HR) and HR variability were calculated with the same algorithms. We found that the 3 antihypertensive drugs had a similar BP-lowering effect (P<0.001 for all), but amlodipine (P<0.007) and indapamide sustained release (P<0.04) were the only agents associated with a significantly decreased BPV after 3-month treatment. On the other hand, the major determinants of BPV at baseline were age, mean BP, and the corresponding HR variability. However, the reduction in BPV by amlodipine was significantly associated with the reduction in BP (P<0.006) and the reduction in HR variability (P<0.02), whereas the corresponding reduction by indapamide sustained release was only associated with the reduction in HR variability at night (P=0.004). In summary, 3-month amlodipine or indapamide sustained release treatment was associated with a significant reduction in BPV, and the mechanism of those reductions was possibly attributable to lowering BP or ameliorating the autonomic nervous system regulation or both. The combination of the 2 agents might help to optimize such properties.
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Affiliation(s)
- Yi Zhang
- Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, 1, Place du Parvis Notre-Dame, 75181 Paris Cedex 04, France
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Kanaoka T, Tamura K, Moriya T, Tanaka K, Konno Y, Kondoh S, Toyoda M, Umezono T, Fujikawa T, Ohsawa M, Dejima T, Maeda A, Wakui H, Haku S, Yanagi M, Mitsuhashi H, Ozawa M, Okano Y, Ogawa N, Yamakawa T, Mizushima S, Suzuki D, Umemura S. Effects of Multiple Factorial Intervention on Ambulatory BP Profile and Renal Function in Hypertensive Type 2 Diabetic Patients with Overt Nephropathy – A Pilot Study. Clin Exp Hypertens 2011; 33:255-63. [DOI: 10.3109/10641963.2011.583971] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Parati G, Ochoa JE, Ramos C, Hoshide S, Lonati L, Bilo G. Efficacy and tolerability of olmesartan/amlodipine combination therapy in patients with mild-to-severe hypertension: focus on 24-h blood pressure control. Ther Adv Cardiovasc Dis 2011; 4:301-13. [PMID: 20921092 DOI: 10.1177/1753944710380228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
European guidelines recommend that treating patients with hypertension to blood pressure (BP) goal is an important target for cardiovascular (CV) risk reduction. However, office BP may be a suboptimal target, given its limitations. Indeed, there is evidence that 24-h ambulatory BP monitoring (ABPM) parameters may score better in this regard, representing more accurate predictors of CV risk. In particular, mean 24-h BP and BP variability both correlate closely with hypertension end-organ damage and rate of CV events, which suggests that antihypertensive therapy should provide smooth BP control over the full 24-h dosing interval. The use of ABPM has demonstrated that fixed-dose combination therapy, comprising agents with complementary mechanisms of action, may overcome the challenge of suboptimal BP control by providing improvements in antihypertensive efficacy and tolerability throughout the 24-h period. Olmesartan/amlodipine is one of the latest combination therapies to be approved, and a number of large clinical trials have demonstrated the efficacy and tolerability of this combination in patients with mild-to-severe hypertension. Furthermore, recent ABPM studies of olmesartan/amlodipine-based treatment algorithms have shown the satisfactory 24-h antihypertensive efficacy of this fixed-dose combination. This review provides an overview of recent clinical data on the efficacy and tolerability of fixed-dose olmesartan/amlodipine combination therapy for the treatment of mild-to-severe hypertension, with a focus on sustained 24-h BP control.
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Affiliation(s)
- Gianfranco Parati
- Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Department of Cardiology, S. Luca Hospital, IRCCS Istituto Auxologico Italiano, via Spagnoletto, 3 20149 Milan, Italy.
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Simvastatin prevents large blood pressure variability induced aggravation of cardiac hypertrophy in hypertensive rats by inhibiting RhoA/Ras–ERK pathways. Hypertens Res 2010; 34:341-7. [DOI: 10.1038/hr.2010.229] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Wittke E, Fuchs SC, Fuchs FD, Moreira LB, Ferlin E, Cichelero FT, Moreira CM, Neyeloff J, Moreira MB, Gus M. Association between different measurements of blood pressure variability by ABP monitoring and ankle-brachial index. BMC Cardiovasc Disord 2010; 10:55. [PMID: 21050495 PMCID: PMC2991275 DOI: 10.1186/1471-2261-10-55] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 11/05/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Blood pressure (BP) variability has been associated with cardiovascular outcomes, but there is no consensus about the more effective method to measure it by ambulatory blood pressure monitoring (ABPM). We evaluated the association between three different methods to estimate BP variability by ABPM and the ankle brachial index (ABI). METHODS AND RESULTS In a cross-sectional study of patients with hypertension, BP variability was estimated by the time rate index (the first derivative of SBP over time), standard deviation (SD) of 24-hour SBP; and coefficient of variability of 24-hour SBP. ABI was measured with a doppler probe. The sample included 425 patients with a mean age of 57 ± 12 years, being 69.2% women, 26.1% current smokers and 22.1% diabetics. Abnormal ABI (≤ 0.90 or ≥ 1.40) was present in 58 patients. The time rate index was 0.516 ± 0.146 mmHg/min in patients with abnormal ABI versus 0.476 ± 0.124 mmHg/min in patients with normal ABI (P = 0.007). In a logistic regression model the time rate index was associated with ABI, regardless of age (OR = 6.9, 95% CI = 1.1- 42.1; P = 0.04). In a multiple linear regression model, adjusting for age, SBP and diabetes, the time rate index was strongly associated with ABI (P < 0.01). None of the other indexes of BP variability were associated with ABI in univariate and multivariate analyses. CONCLUSION Time rate index is a sensible method to measure BP variability by ABPM. Its performance for risk stratification of patients with hypertension should be explored in longitudinal studies.
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Affiliation(s)
- Estefânia Wittke
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Brazil
- Postgraduate Program in Medicine: Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Brazil
| | - Sandra C Fuchs
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Brazil
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Brazil
| | - Flávio D Fuchs
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Brazil
- Postgraduate Program in Medicine: Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Brazil
| | - Leila B Moreira
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Brazil
- Postgraduate Program in Medicine: Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Brazil
| | - Elton Ferlin
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Brazil
| | - Fábio T Cichelero
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Brazil
| | | | - Jeruza Neyeloff
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Brazil
| | - Marina B Moreira
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Brazil
| | - Miguel Gus
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Brazil
- Postgraduate Program in Medicine: Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Brazil
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Stolarz-Skrzypek K, Thijs L, Richart T, Li Y, Hansen TW, Boggia J, Kuznetsova T, Kikuya M, Kawecka-Jaszcz K, Staessen JA. Blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome. Hypertens Res 2010; 33:757-66. [PMID: 20613762 DOI: 10.1038/hr.2010.110] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ambulatory blood pressure (BP) monitoring provides information not only on the BP level but also on the diurnal changes in BP. In the present review, we summarized the main findings of the International Database on Ambulatory BP in relation to Cardiovascular Outcome (IDACO) with regard to risk stratification based on BP variability. The predictive accuracy of daytime and nighttime BP and the night-to-day BP ratio depended on the disease outcome under study and treatment status, and differed for fatal outcomes compared with the composite of fatal and nonfatal diseases. An exaggerated morning surge, exceeding the 90th percentile of the population, is an independent risk factor for mortality and cardiovascular and cardiac events. Conversely, a sleep-trough or preawakening morning surge in systolic BP below 20 mm Hg is probably not associated with an increased risk of death or cardiovascular events. BP variability as captured by the average of the daytime and nighttime s.d. weighted for the duration of the daytime and nighttime interval (s.d.(dn)) and the average real variability (ARV(24)) predicted the outcome, but improved the prediction of the composite of all cardiovascular events by only 0.1%. In conclusion, the IDACO observations support the concept that BP variability adds to risk stratification, but above all highlight that 24-h ambulatory BP level remains the main predictor to be considered in clinical practice.
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Hansen TW, Thijs L, Li Y, Boggia J, Kikuya M, Björklund-Bodegård K, Richart T, Ohkubo T, Jeppesen J, Torp-Pedersen C, Dolan E, Kuznetsova T, Stolarz-Skrzypek K, Tikhonoff V, Malyutina S, Casiglia E, Nikitin Y, Lind L, Sandoya E, Kawecka-Jaszcz K, Imai Y, Wang J, Ibsen H, O'Brien E, Staessen JA. Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension 2010; 55:1049-57. [PMID: 20212270 DOI: 10.1161/hypertensionaha.109.140798] [Citation(s) in RCA: 355] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In previous studies, of which several were underpowered, the relation between cardiovascular outcome and blood pressure (BP) variability was inconsistent. We followed health outcomes in 8938 subjects (mean age: 53.0 years; 46.8% women) randomly recruited from 11 populations. At baseline, we assessed BP variability from the SD and average real variability in 24-hour ambulatory BP recordings. We computed standardized hazard ratios (HRs) while stratifying by cohort and adjusting for 24-hour BP and other risk factors. Over 11.3 years (median), 1242 deaths (487 cardiovascular) occurred, and 1049, 577, 421, and 457 participants experienced a fatal or nonfatal cardiovascular, cardiac, or coronary event or a stroke. Higher diastolic average real variability in 24-hour ambulatory BP recordings predicted (P<or=0.03) total (HR: 1.14) and cardiovascular (HR: 1.21) mortality and all types of fatal combined with nonfatal end points (HR: >or=1.07) with the exception of cardiac and coronary events (HR: <or=1.02; P>or=0.58). Higher systolic average real variability in 24-hour ambulatory BP recordings predicted (P<0.05) total (HR: 1.11) and cardiovascular (HR: 1.16) mortality and all fatal combined with nonfatal end points (HR: >or=1.07), with the exception of cardiac and coronary events (HR: <or=1.03; P>or=0.54). SD predicted only total and cardiovascular mortality. While accounting for the 24-hour BP level, average real variability in 24-hour ambulatory BP recordings added <1% to the prediction of a cardiovascular event. Sensitivity analyses considering ethnicity, sex, age, previous cardiovascular disease, antihypertensive treatment, number of BP readings per recording, or the night:day BP ratio were confirmatory. In conclusion, in a large population cohort, which provided sufficient statistical power, BP variability assessed from 24-hour ambulatory recordings did not contribute much to risk stratification over and beyond 24-hour BP.
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Affiliation(s)
- Tine W Hansen
- Department of Clinical Physiology, Faculty of Health Sciences, Hvidovre University Hospital, Research Center for Prevention and Health, Copenhagen, Denmark
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48
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Chen JM, Heran BS, Perez MI, Wright JM. Blood pressure lowering efficacy of beta-blockers as second-line therapy for primary hypertension. Cochrane Database Syst Rev 2010:CD007185. [PMID: 20091622 DOI: 10.1002/14651858.cd007185.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Beta-blockers are one of the more commonly prescribed classes of anti-hypertensive drugs, both as first-line and second-line. OBJECTIVES To quantify the effect on systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate and withdrawals due to adverse effects of beta-blocker therapy when given as a second-line drug in adult patients with primary hypertension. SEARCH STRATEGY CENTRAL (The Cochrane Library 2009, Issue 2), MEDLINE (1966-Aug 2009), EMBASE (1988-Aug 2009) and bibliographic citations of articles and reviews were searched. SELECTION CRITERIA Double-blind, randomized controlled trials comparing a beta-blocker in combination with a drug from another class of anti-hypertensive drugs compared with that drug alone for a duration of 3 to 12 weeks in patients with primary hypertension were included. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted the data and assessed trial quality of each included study. MAIN RESULTS 20 double-blind RCTs evaluated the BP lowering efficacy of beta-blockers as second-line drug in 3744 hypertensive patients (baseline BP of 158/102 mmHg; mean duration of 7 weeks). The BP reduction from adding a beta-blocker as the second drug was estimated by comparing the difference in BP reduction between the combination and monotherapy groups. A reduction in BP was seen with adding a beta-blocker to thiazide diuretics or calcium channel blockers at doses as low as 0.25 times the manufacturer's recommended starting dose. The BP lowering efficacy of beta-blockers as a second drug was 6/4 mmHg at 1 times the starting dose and 8/6 mmHg at 2 times the starting dose. Beta-blockers reduced heart rate by 10 beats/min at 1 to 2 times the starting dose. Beta-blockers did not statistically significantly increase withdrawals due to adverse effects but this was likely due to the lack of reporting of this outcome in 35% of the included RCTs. AUTHORS' CONCLUSIONS Addition of a beta-blocker to diuretics or calcium-channel blockers reduces BP by 6/4mmHg at 1 times the starting dose and by 8/6 mmHg at 2 times the starting dose. When the blood pressure lowering effect of beta-blockers from this review was compared to that of thiazide diuretics from our previous review (Chen 2009), second-line beta-blockers reduce systolic BP to the same extent as second-line thiazide diuretics, but reduce diastolic BP to a greater degree. The different effect on diastolic BP means that beta-blockers have little or no effect on pulse pressure whereas thiazides cause a significant dose-related decrease in pulse pressure. This difference in the pattern of BP lowering with beta-blockers as compared to thiazides might be the explanation for the fact that beta-blockers appear to be less effective at reducing adverse cardiovascular outcomes than thiazide diuretics, particularly in older individuals.
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Affiliation(s)
- Jenny Mh Chen
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, BC, Canada, V6T 1Z3
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Masuda SI, Tamura K, Wakui H, Kanaoka T, Ohsawa M, Maeda A, Dejima T, Yanagi M, Azuma K, Umemura S. Effects of angiotensin II type 1 receptor blocker on ambulatory blood pressure variability in hypertensive patients with overt diabetic nephropathy. Hypertens Res 2009; 32:950-5. [PMID: 19713965 DOI: 10.1038/hr.2009.131] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Previous studies have shown increases in ambulatory short-term blood pressure (BP) variability to be related to cardiovascular disease. In this study, we examined whether the angiotensin II type 1 receptor blocker (ARB) would improve ambulatory short-term BP variability in hypertensive patients with diabetic nephropathy. A total of 30 patients with type II diabetes, along with hypertension and overt nephropathy, were enrolled in this randomized, two-period, crossover trial of 12 weeks of treatment with losartan (50 mg daily) and telmisartan (40 mg daily). At baseline and at the end of each treatment period, 24-h ambulatory BP monitoring with power spectral analysis of heart rate and measurements of proteinuria, estimated glomerular filtration rate and brachial-ankle pulse wave velocity (baPWV) were performed. After 12 weeks of treatment, 24-h, daytime and nighttime short-term BP variability, assessed on the basis of the coefficient of variation of ambulatory BP, was significantly decreased by telmisartan. Both losartan and telmisartan reduced urinary protein excretion and baPWV. However, compared with losartan, telmisartan significantly decreased urinary protein excretion, baPWV and low-frequency (LF)-to-high-frequency (HF) ratio, an index of sympathovagal balance. Multiple regression analysis showed significant correlations between urinary protein excretion and baPWV, 24-h LF-to-HF ratio, nighttime systolic BP and 24-h short-term systolic BP variability. These results suggest that ARB, particularly telmisartan, is effective in reducing proteinuria in hypertensive patients with overt diabetic nephropathy, partly through inhibitory effects on ambulatory short-term BP variability and sympathetic nerve activity, in addition to its longer duration of action on nighttime BP reduction.
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Affiliation(s)
- Shin-ichiro Masuda
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Kudo H, Kai H, Kajimoto H, Koga M, Takayama N, Mori T, Ikeda A, Yasuoka S, Anegawa T, Mifune H, Kato S, Hirooka Y, Imaizumi T. Exaggerated blood pressure variability superimposed on hypertension aggravates cardiac remodeling in rats via angiotensin II system-mediated chronic inflammation. Hypertension 2009; 54:832-8. [PMID: 19704105 DOI: 10.1161/hypertensionaha.109.135905] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hypertensive patients with large blood pressure variability (BPV) have aggravated end-organ damage. However, the pathogenesis remains unknown. We investigated whether exaggerated BPV aggravates hypertensive cardiac remodeling and function by activating inflammation and angiotensin II-mediated mechanisms. A model of exaggerated BPV superimposed on chronic hypertension was created by performing bilateral sinoaortic denervation (SAD) in spontaneously hypertensive rats (SHRs). SAD increased BPV to a similar extent in Wistar Kyoto rats and SHRs without significant changes in mean blood pressure. SAD aggravated left ventricular and myocyte hypertrophy and myocardial fibrosis to a greater extent and impaired left ventricular systolic function in SHRs. SAD induced monocyte chemoattractant protein-1, transforming growth factor-beta, and angiotensinogen mRNA upregulations and macrophage infiltration of the heart in SHRs. The effects of SAD on cardiac remodeling and inflammation were much smaller in Wistar Kyoto rats compared with SHRs. Circulating levels of norepinephrine, the active form of renin, and inflammatory cytokines were not affected by SAD in Wistar Kyoto rats and SHRs. A subdepressor dose of candesartan abolished the SAD-induced left ventricular/myocyte hypertrophy, myocardial fibrosis, macrophage infiltration, and inductions of monocyte chemoattractant protein-1, transforming growth factor-beta, and angiotensinogen and subsequently prevented systolic dysfunction in SHRs with SAD. These findings suggest that exaggerated BPV induces chronic myocardial inflammation and thereby aggravates cardiac remodeling and systolic function in hypertensive hearts. The cardiac angiotensin II system may play a role in the pathogenesis of cardiac remodeling and dysfunction induced by a combination of hypertension and exaggerated BPV.
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Affiliation(s)
- Hiroshi Kudo
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, 67 Asahimachi, Kurume, Japan
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