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Di Gennaro F, D'Amato C, Morganti R, Greco C, Longo S, Corradini D, Lauro D, Spallone V. Morning blood pressure surge is associated with autonomic neuropathy and peripheral vascular disease in patients with diabetes. J Hum Hypertens 2019; 34:495-504. [PMID: 31624311 DOI: 10.1038/s41371-019-0270-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 11/09/2022]
Abstract
Although vascular and autonomic nervous system have been involved in the regulation of morning surge in blood pressure (MBPS), data on clinical correlates of MBPS in diabetic population are scarce, in particular with regard to diabetic complications. This study was aimed at investigating predictors and correlates of MBPS in diabetes. In a cross-sectional study including 167 patients with diabetes (age 58.5 ± 11.1 years, duration 15.9 ± 12.1 years), clinical variables, diabetic and neuropathic complications, and MBPS (using 24-h ambulatory blood pressure monitoring) were measured. The upper quartile of MBPS (>30.5 mmHg) was associated with higher values of waist circumference (P = 0.027), triglycerides (P = 0.021), and Michigan Diabetic Neuropathy Score (P = 0.042), with lower HDL cholesterol (P = 0.030), and with the presence of cardiovascular autonomic neuropathy (CAN) (P = 0.016) and peripheral vascular disease (PVD) (P < 0.0001). In a logistic regression analysis, PVD (odds ratio: 10.2, P = 0.001), CAN (odds ratio: 6.09, P = 0.016), and diastolic blood pressure (BP) (odds ratio: 1.06, P = 0.022) predicted MBPS upper quartile (r2 = 0.20, P = 0.0005). In a multiple regression analysis, PVD (P = 0.002) and diastolic BP (P = 0.003) were the only determinants of MBPS (r2 = 0.20). MBPS upper quartile was associated with BP dipping (systolic BP day-night reduction > 10%) (P = 0.012), and MBPS was positively related to systolic (rho = 0.41, P < 0.0001) and diastolic BP day-night reduction. In conclusion, metabolic syndrome stigmata, diastolic BP, CAN and PVD are the main predictors of MBPS in the diabetic population. Excessive MBPS and nondipping are not concurrent 24-h BP alterations. Autonomic dysfunction might exert an exacerbating effect on MBPS phenomenon.
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Affiliation(s)
- Federica Di Gennaro
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia D'Amato
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Morganti
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carla Greco
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Susanna Longo
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Diana Corradini
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Davide Lauro
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Vincenza Spallone
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Abstract
BACKGROUND The morning period which is recognized as the highest risk for cardiovascular events is associated with a surge in blood pressure (BP). However, it is unclear what aspect of this rise is important. AIM To determine whether the rate of rise (RoR), the magnitude (day night difference) or the product [BP power (BPPower)] is associated with increased cardiovascular risk. METHODS We developed a logistic equation method to fit individual 24-h patterns of BP to determine RoR, amplitude and BPPower using the ambulatory recordings from the Ohasama study including 564 men and 971 women (16.6 years follow-up). RESULTS Men had a higher risk of cardiovascular events than women (24, 16%, P < 0.001). Age and night BP were strong linear risk predictors. In men sorting risk by quintiles of BPPower (adjusted for age, night BP, smoking status) revealed no clear linear or nonlinear pattern. However, in women BPPower had a U-shaped relationship with the lowest risk being the 2-3rd quintile for all cardiovascular events (Pquadratic = 0.01) including cardiovascular death (Pquadratic = 0.03) and nonfatal stroke (Pquadratic = 0.02). A similar but less clear trend was observed with the RoR but only stroke (infarct) reached significance (Pquadratic = 0.03) while sorting by range showed a U shaped pattern for combined cardiovascular events (Pquadratic = 0.04). CONCLUSION These findings suggest that the morning BPPower is an important independent risk factor for predicting cardiovascular events and stroke but only in women with median levels having the lowest risk.
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Sung B. Time to First Cigarette and Self-Reported Health Among US Adult Smokers. Tob Use Insights 2019; 12:1179173X18825262. [PMID: 30728728 PMCID: PMC6351964 DOI: 10.1177/1179173x18825262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Numerous studies have reported that shorter time to first cigarette (TTFC) is linked to elevated risk for smoking-related morbidity. However, little is known about the influence of early TTFC on self-reported health among current smokers. Hence, the objective of this study was to examine the association between TTFC and self-reported health among US adult smokers. Methods: Data came from the 2012-2013 National Adult Tobacco Survey (NATS). Current smokers aged 18 years and older (N = 3323) were categorized into 2 groups based on TTFC: ≤ 5 minutes (n = 1066) and >5 minutes (n = 2257). Propensity score matching (PSM) was used to control selection bias. Results: After adjusting for sociodemographic and smoking behavior factors, current smokers with early TTFC had higher odds for poor health in comparison with current smokers with late TTFC in the prematching (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.31-2.08) and postmatching (AOR = 1.60; 95% CI = 1.22-2.09) samples. Conclusions: In conclusion, smokers with early TTFC were associated with increased risk of poor health in the United States. To reduce early TTFC, elaborate efforts are needed to educate people about harms of early TTFC and benefits of stopping early TTFC.
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Affiliation(s)
- Baksun Sung
- Department of Sociology, Social Work, and Anthropology, Utah State University, Logan, UT, USA
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Abstract
PURPOSE OF REVIEW The major health issue of being overweight or obese relates to the development of hypertension, insulin resistance and diabetic complications. One of the major underlying factors influencing the elevated blood pressure in obesity is increased activity of the sympathetic nerves to particular organs such as the kidney. RECENT FINDINGS There is now convincing evidence from animal studies that major signals such as leptin and insulin have a sympathoexcitatory action in the hypothalamus to cause hypertension. Recent studies suggest that this may involve 'neural plasticity' within hypothalamic signalling driven by central actions of leptin mediated via activation of melanocortin receptor signalling and activation of brain neurotrophic factors. This review describes the evidence to support the contribution of the SNS to obesity related hypertension and the major metabolic and adipokine signals.
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Eikelis N, Lambert EA, Phillips S, Sari CI, Mundra PA, Weir JM, Huynh K, Grima MT, Straznicky NE, Dixon JB, Schlaich MP, Meikle PJ, Lambert GW. Muscle Sympathetic Nerve Activity Is Associated With Elements of the Plasma Lipidomic Profile in Young Asian Adults. J Clin Endocrinol Metab 2017; 102:2059-2068. [PMID: 28323975 DOI: 10.1210/jc.2016-3738] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/10/2017] [Indexed: 02/13/2023]
Abstract
BACKGROUND Asian subjects are at increased cardio-metabolic risk at comparatively lower body mass index (BMI) compared with white subjects. Sympathetic nervous system activation and dyslipidemia, both characteristics of increased adiposity, appear to be related. We therefore analyzed the association of muscle sympathetic nerve activity (MSNA) with the plasma lipidomic profile in young adult Asian and white subjects. METHODS Blood samples were collected from 101 participants of either Asian or white background (age, 18 to 30 years; BMI, 28.1 ± 5.9 kg/m2). Lipids were extracted from plasma and analyzed using electrospray ionization-tandem mass spectrometry. MSNA was quantified using microneurography. The association of MSNA and obesity with lipid species was examined using linear regression analysis. RESULTS The plasma concentrations of total dihydroceramide, ceramide, GM3 ganglioside, lysoalkylphosphatidylcholine, alkenylphosphatidylethanolamine, and lysophosphatidylinositol were elevated in the Asian subjects relative to the white subjects. After adjustment for confounders, diacylglycerols and triacylglycerols, cholesterol esters, phosphatidylinositols, phosphatidylethanolamines, and phosphatidylglycerols bore significant associations with MSNA but only in the Asian subjects. These associations remained significant after further adjustment for the participants' degree of insulin resistance and appeared not to be related to differences in diet macronutrient content between groups. CONCLUSIONS The lipidomic profile differs between Asian and white subjects. There exists a strong relationship between certain lipid species and MSNA. The association is stronger in Asian subjects, despite their lower BMI. This study demonstrates an association between circulating lipids and central sympathetic outflow. Whether the stronger association between the lipid profile and sympathetic activation underpins the apparent greater risk posed by increased adiposity in Asian individuals merits further attention.
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Affiliation(s)
- Nina Eikelis
- Human Neurotransmitters, Baker Heart & Diabetes Institute, Melbourne, Victoria 3004, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria 3122, Australia
| | - Elisabeth A Lambert
- Human Neurotransmitters, Baker Heart & Diabetes Institute, Melbourne, Victoria 3004, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria 3122, Australia
| | - Sarah Phillips
- Human Neurotransmitters, Baker Heart & Diabetes Institute, Melbourne, Victoria 3004, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria 3122, Australia
| | - Carolina Ika Sari
- Human Neurotransmitters, Baker Heart & Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Piyushkumar A Mundra
- Metabolomics Laboratories, Baker Heart & Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Jacquelyn M Weir
- Metabolomics Laboratories, Baker Heart & Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Kevin Huynh
- Metabolomics Laboratories, Baker Heart & Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Mariee T Grima
- Human Neurotransmitters, Baker Heart & Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Nora E Straznicky
- Human Neurotransmitters, Baker Heart & Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - John B Dixon
- Human Neurotransmitters, Baker Heart & Diabetes Institute, Melbourne, Victoria 3004, Australia
- Primary Care Research, Monash University, Melbourne, Victoria 3800, Australia
| | - Markus P Schlaich
- Neurovascular Hypertension & Kidney Disease, Baker Heart & Diabetes Institute, Melbourne, Victoria 3004, Australia
- Dobney Hypertension Centre, School of Medicine, University of Western Australia - Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia 6000, Australia
| | - Peter J Meikle
- Metabolomics Laboratories, Baker Heart & Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Gavin W Lambert
- Human Neurotransmitters, Baker Heart & Diabetes Institute, Melbourne, Victoria 3004, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria 3122, Australia
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The Effects of Rilmenidine and Perindopril on Arousal Blood Pressure during 24 Hour Recordings in SHR. PLoS One 2016; 11:e0168425. [PMID: 28002478 PMCID: PMC5176293 DOI: 10.1371/journal.pone.0168425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/30/2016] [Indexed: 11/22/2022] Open
Abstract
The surge in arterial pressure during arousal in the waking period is thought to be largely due to activation of the sympathetic nervous system. In this study we compared in SHR the effects of chronic administration of the centrally acting sympatholytic agent rilmenidine with an angiotensin converting enzyme inhibitor perindopril on the rate of rise and power of the surge in mean arterial pressure (MAP) that occurs with arousal associated with the onset of night. Recordings were made using radiotelemetry in 17 adult SHR before and after treatment with rilmenidine (2mg/kg/day), perindopril (1mg/kg/day) or vehicle in the drinking water for 2 weeks. Rilmenidine reduced MAP by 7.2 ± 1.7mmHg while perindopril reduced MAP by 19 ± 3mmHg. Double logistic curve fit analysis showed that the rate and power of increase in systolic pressure during the transition from light to dark was reduced by 50% and 65%, respectively, but had no effect on diastolic pressure. Rilmenidine also reduced blood pressure variability in the autonomic frequency in the active period as assessed by spectral analysis which is consistent with reduction in sympathetic nervous system activity. Perindopril had no effect on the rate or power of the arousal surge in either systolic or diastolic pressure. These results suggest that the arousal induced surge in blood pressure can largely be reduced by an antihypertensive agent that inhibits the sympathetic nervous system and that angiotensin converting enzyme inhibition, while effective in reducing blood pressure, does not alter the rate or power of the surge associated with arousal.
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Lee S, Jang M, Noh HM, Oh HY, Song HJ, Park KH, Paek YJ. Time to First Cigarette and Hypertension in Korean Male Smokers. Korean J Fam Med 2015; 36:221-6. [PMID: 26435812 PMCID: PMC4591387 DOI: 10.4082/kjfm.2015.36.5.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/26/2015] [Accepted: 07/09/2015] [Indexed: 11/30/2022] Open
Abstract
Background Morning blood pressure surge affects to cardiovascular disease risk. Short time to first cigarette (TTFC) after waking can enhance morning blood pressure surge, and accelerate atherosclerosis Methods We investigated that the relationship between TTFC and blood pressure. The study subjects included male current smokers (n=211) who had health check-up in Hallym University Sacred Heart Hospital from July to September, 2014. We categorized the subjects into 2 groups according to TTFC; early TTFC (TTFC <30 minutes) and late TTFC (TTFC ≥30 minutes), and the subjects who were taking antihypertensive medications or had a high blood pressure (>140 mm Hg or 90 mm Hg) were defined as hypertensive group. Multivariate logistic regression was performed to estimate the odds ratio and 95% confidence interval to investigate the association between TTFC and hypertensive group. Results Compared with late TTFC, early TTFC had higher odds (odds ratio [OR], 3.87; 95% confidence interval [CI], 1.89-7.94) for hypertensive group. After adjusting confounding factors, early TTFC was significantly associated with an increased risk of hypertension (OR, 4.43; 95% CI, 1.84-10.70). Conclusion early TTFC after waking is associated with hypertension. It suggests delaying TTFC might help to control of blood pressure among the current smokers who are not ready to immediately quit smoking.
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Affiliation(s)
- Saerom Lee
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Miae Jang
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hye-Mi Noh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hye-Young Oh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hong Ji Song
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Yu-Jin Paek
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Özpelit ME, Özpelit E, Doğan NB, Pekel N, Ozyurtlu F, Yılmaz A, Saygı S, Tengiz İ, Ercan E. Impact of anxiety level on circadian rhythm of blood pressure in hypertensive patients. Int J Clin Exp Med 2015; 8:16252-8. [PMID: 26629141 PMCID: PMC4659029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/18/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Considering the high prevalence rates and growing incidences of hypertension (HT) and anxiety disorders in the modern world, a full understanding of anxiety's relationship to HT is crucial. In this study we aimed to investigate the effects of anxiety level on circadian rhythm of blood pressure (BP) in hypertensive patients. MATERIAL AND METHOD This cross-sectional study included 160 previously diagnosed essential hypertensive patients (80 female, 80 male, mean age: 55.3±15.1 years). All participants underwent 24 h ambulatory blood pressure monitoring (ABPM) and filled State-Trait Anxiety Inventory (STAI) (trait) Questionnaire. The study population was divided into 2 groups according to their STAI scores; an anxiety group (n=97; STAI ≥45) and a control group (n=63; STAI<44). Clinical characteristics, laboratory findings and ABPM measurements were compared between the groups. RESULTS There was no significant difference between the groups for ABPM parameters except morning blood pressure surge (MBPS). Anxiety group had a significantly higher MBPS compared to control group (14.4±17.0 vs 9.1±11.9 mmHg, P:0.03). Multivariate analysis showed that duration of HT and STAI score were the only independent predictors of MBPS. CONCLUSION Patients' anxiety level is associated with MBPS which is an independent risk factor for cardiovascular complications. Assessment and control of anxiety seems to be worthy in effective treatment of hypertension.
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Affiliation(s)
- Mehmet Emre Özpelit
- Department of Cardiology, School of Medicine, Izmir University Izmir, Turkey
| | - Ebru Özpelit
- Department of Cardiology, School of Medicine, DokuzEylul University Izmir, Turkey
| | | | - Nihat Pekel
- Department of Cardiology, School of Medicine, Izmir University Izmir, Turkey
| | - Ferhat Ozyurtlu
- Department of Cardiology, Grand Medical Hospital Manisa, Turkey
| | - Akar Yılmaz
- Department of Cardiology, School of Medicine, Izmir University Izmir, Turkey
| | - Serkan Saygı
- Department of Cardiology, School of Medicine, Izmir University Izmir, Turkey
| | - İstemihan Tengiz
- Department of Cardiology, School of Medicine, Izmir University Izmir, Turkey
| | - Ertugrul Ercan
- Department of Cardiology, School of Medicine, Izmir University Izmir, Turkey
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