Showing papers in "Blood Pressure in 2010"
TL;DR: The Turkish population consumes a great amount of salt; salt intake and blood pressure was positively correlated; Efforts in sodium restriction are therefore crucial in the management of hypertension as part of national and global health policies.
Abstract: This population-based epidemiological study was aimed to evaluate the daily salt intake and its relation to blood pressure in a representative group of Turkish population. The enrolled normotensive and hypertensive individuals (n = 1970) completed a questionnaire including demographics, dietary habits, hypertension awareness and drug usage. Blood pressure was measured and to estimate salt consumption, 24-h urine samples were collected. The daily urinary sodium excretion was 308.3 ± 143.1 mmol/day, equal to a salt intake of 18.01 g/day. Salt intake was higher in obese participants, rural residents, participants with lower education levels and elderly. A positive linear correlation between salt intake and systolic and diastolic blood pressures was demonstrated (r = 0.450, p = 0.020; r = 0.406, p = 0.041; respectively), and each 100 mmol/day of salt intake resulted in 5.8 and 3.8 mmHg increase in systolic and diastolic blood pressures, respectively. Salt intake and systolic blood pressure was signifi...
115 citations
TL;DR: The findings suggest that the beneficial effects of SIRT1 activator resveratrol on Ang II-induced cardiac remodeling are mediated by blood pressure-dependent pathways and are linked to increased mitochondrial biogenesis.
Abstract: There is compelling evidence to indicate an important role for increased local renin-angiotensin system activity in the pathogenesis of cardiac hypertrophy and heart failure. Resveratrol is a natural polyphenol that activates SIRT1, a novel cardioprotective and longevity factor having NAD(+)-dependent histone deacetylase activity. We tested the hypothesis whether resveratrol could prevent from angiotensin II (Ang II)-induced cardiovascular damage. Four-week-old double transgenic rats harboring human renin and human angiotensinogen genes (dTGR) were treated for 4 weeks either with SIRT1 activator resveratrol or SIRT1 inhibitor nicotinamide. Untreated dTGR and their normotensive Sprague-Dawley control rats (SD) received vehicle. Untreated dTGR developed severe hypertension as well as cardiac hypertrophy, and showed pronounced cardiovascular mortality compared with normotensive SD rats. Resveratrol slightly but significantly decreased blood pressure, ameliorated cardiac hypertrophy and prevented completely Ang II-induced mortality, whereas nicotinamide increased blood pressure without significantly influencing cardiac hypertrophy or survival. Resveratrol decreased cardiac ANP mRNA expression and induced cardiac mRNA expressions of mitochondrial biogenesis markers peroxisome proliferator-activated receptor-gamma coactivator (PGC-1alpha), mitochondrial transcription factor (Tfam), nuclear respiratory factor 1 (NRF-1) and cytochrome c oxidase subunit 4 (cox4). Resveratrol dose-dependently increased SIRT1 activity in vitro. Our findings suggest that the beneficial effects of SIRT1 activator resveratrol on Ang II-induced cardiac remodeling are mediated by blood pressure-dependent pathways and are linked to increased mitochondrial biogenesis.
80 citations
TL;DR: Clinical inertia, either diagnostic or therapeutic, was present in one of every three cases of high BP, and the most frequent factors associated with clinical inertia were the presence of associated conditions, which requires lower BP goals and the BP values.
Abstract: Objectives. The objective of the present study was to quantify both diagnostic and therapeutic inertia in hypertension and to identify patient-associated variables. Patients and methods. Cross-sectional, multicenter study of 35 424 subjects carried out in 428 health centers and/or primary care clinics in the Valencian Community, Spain, in a preventive activity conducted during 2003 and 2004. Diagnostic inertia was identified when a patient without known hypertension had high blood pressure (BP) but was labeled “normal” by the medical staff, and therapeutic inertia when treatment was not modified for a hypertensive patient on the presence of high BP values. Bivariate and multivariate statistical analyses were performed to identify patient's characteristics associated with inertia. Results. Diagnostic inertia was present in 32.5% (95% CI 31.4–33.6) and therapeutic inertia in 37.0% (95% CI 35.6–38.5) of the cases. Both were more frequent in cases of isolated systolic or diastolic high BP. In the mult...
62 citations
TL;DR: LA diameter at baseline and during antihypertensive treatment were equally strong predictors of new-onset AF independent of the level of arterial pressure, LV mass and other covariates.
Abstract: LA diameter at baseline and during antihypertensive treatment were equally strong predictors of new-onset AF independent of the level of arterial pressure, LV mass and other covariates. Prevention ...
61 citations
TL;DR: Pulse wave analysis has a potential as a screening tool in women at high risk for pre-eclampsia and gestational hypertension but not in treated women with chronic hypertension, and aortic stiffness, as assessed by pulse wave analysis, is significantly increased.
Abstract: The objective of this study was to examine whether aortic stiffness, as assessed by pulse wave analysis, could reliably discriminate between normal and hypertensive pregnancies. One hundred pregnant women were studied: five with severe pre-eclampsia, 27 with gestational hypertension, 14 with chronic hypertension and 54 with normal pregnancy. Central hemodynamic parameters were obtained by an applanation tonometry and included central aortic systolic blood pressure (CSBP), central aortic diastolic blood pressure (CDBP), augmentation pressure (AP), augmentation index (AIx), AIx corrected to a heart rate of 75 (AIx@75) and time to reflection (Tr). All measures of aortic stiffness, including AP, AIx and AIx@75 were significantly higher in women with gestational hypertension and pre-eclampsia compared with normal pregnancies and women with chronic hypertension (p 0.05 for all comparisons). Tr was significantly shorter in women with pre-eclampsia and gestational hypertension compared with normal pregnancies (p < 0.05). Aortic stiffness, as assessed by pulse wave analysis, is significantly increased in women with pre-eclampsia and gestational hypertension but not in treated women with chronic hypertension. Pulse wave analysis has a potential as a screening tool in women at high risk for pre-eclampsia. The final role of this method should be determined in prospective studies.
52 citations
TL;DR: In patients with essential hypertension, smoking is independently associated with chronic increase in MSNA, which may have implications for the understanding of the mechanisms linking smoking to cardiovascular events.
Abstract: Objective. Previous studies have shown that smoking contributes importantly to short-term modulation of sympathetic nerve traffic. However, effect of smoking status on resting muscle sympathetic nerve activity (MSNA) in hypertension is unknown. Therefore, we tested the hypothesis that smoking is associated with chronic sympathetic activation in patients with essential hypertension. Methods. We measured MSNA, heart rate (HR) and blood pressure during undisturbed supine rest and in 30 hypertensive smokers (22 males, age 38±4 years, body mass index, BMI 27±1 kg/m2, mean±SEM). These measurements were compared with those obtained 38 non-smoking hypertensive patients matched for gender, age and BMI. All hypertensives underwent 24-h ambulatory blood pressure monitoring. Patients were newly diagnosed, never treated for hypertension and were free of any other known diseases. Results. In comparison with non-smokers, smokers had smaller office–daytime systolic blood pressure difference (6±2 vs 15±3 mmHg, res...
50 citations
TL;DR: It is suggested that MPV, a determinant of platelet activation, has a positively correlation with blood pressure and elevated in non-dipper patients compared with dippers and controls, and could contribute to increase the atherosclerotic risk innon-dippers.
Abstract: Objectives. Increased platelet activation plays an important role in the development of atherosclerosis. Mean platelet volume (MPV) is a determinant of platelet activation. In our study, we aimed to determine whether MPV levels are elevated in non-dipper patients compared with dippers and healthy controls. In addition, we tried to find out if MPV levels are correlated with blood pressure measurements in hypertensive patients. Methods. This cross-sectional study included 56 hypertensive patients; 27 age- and sex-matched healthy volunteers were enrolled to study as a control subjects. Ambulatory blood pressure monitoring was performed for all patients. Hypertensive patients were divided into two groups: 28 dipper patients (10 male, mean age 51 ±8 years) and 28 non-dipper patients (11 male, mean age 53±10 years). MPV was measured in a blood sample collected in EDTA tubes and was also used for whole blood counts in all patients. Results. In non-dipper patients, 24-h systolic blood pressure (141.5±10.2...
47 citations
TL;DR: Hypertension is the main clinic characteristic of ASH and asymmetric LV hypertrophy in patients with asymptomatic aortic stenosis independent of severity of aortIC stenosis.
Abstract: Background. Some patients with aortic stenosis develop asymmetric septal hypertrophy (ASH) that may influence the surgical approach and is associated with higher perioperative morbidity. The aim of...
39 citations
TL;DR: MDA-modified LDL estimation has a diagnostic accuracy and may be used as an independent biochemical marker for atherosclerosis in patients with postinfarct cardiosclerosis.
Abstract: Background. Cardiovascular diseases are accompanied by the presence of active oxygen species and organic free radical generation. The aim of this study was to examine the possibility of using malon...
38 citations
TL;DR: The CFR of patients with hypertensive LVH but not coronary artery disease could increase with 6-month carvedilol therapy, which is inversely correlated with blood pressure and heart rate decreases.
Abstract: Objective. Patients with hypertensive left-ventricular hypertrophy (LVH) have lower coronary fl ow reserve (CFR). Whether carvedilol can improve CFR of patients with hypertensive LVH is unknown. We aimed to investigate the effects of carvedilol on CFR in patients with hypertensive LVH. Methods. Sixty-three patients were randomly divided into two groups for treatment with carvedilol or metoprolol. The peak diastolic coronary fl ow velocity in the left anterior descending coronary artery at rest and at maximal vasodilation with dipyridamole infusion was recorded by transesophageal echocardiography (TEE), then CFR was calculated at baseline and at the end of 6 months of therapy. Left-ventricular mass index (LVMI) was calculated by 2-D echocardiography. Endothelium-dependent and -independent reactivity of the brachial artery was measured. Levels of plasma endothelin-1 (ET-1), nitric oxide (NO) and other metabolites were monitored and analyzed before and after 6-month therapy. Results. Both blood pressure and heart rate decreased signifi cantly in the two treatment groups after therapy (p0.05). With carvedilol treatment, LVMI was lower (p0.05), endothelium function of the brachial artery was higher (p0.05), and peak diastolic coronary fl ow velocity at rest and at maximal vasodilation after dipyridamole infusion was signifi cantly higher (p0.05) than with metoprolol treatment, which led to a signifi cantly higher CFR (p0.05). Changes in CFR and LVMI with carvedilol treatment were inversely correlated (R 2 0.474, p0.036). With carvedilol treatment, plasma level of ET-1 was lower, but that of NO was signifi cantly higher than with metoprolol treatment (both p0.05). Conclusions. The CFR of patients with hypertensive LVH but not coronary artery disease could increase with 6-month carvedilol therapy.
33 citations
TL;DR: While the oscillometric automated device used in this study was not accurate enough to be recommended, it shows that the accuracy of blood pressure oscillometric devices can differ between children and adults.
Abstract: Clinical validation of blood pressure oscillometric devices are almost exclusively conducted in adults. Because oscillometric devices are used in children, it is critical to assess their accuracy also in this population. We compared blood pressure readings using an oscillometric automated device (Dinamap XL, model CR9340) with readings obtained with the mercury auscultatory method in children and adults. Blood pressure was measured in 30 children (15 boys and 15 girls; 9.5+/-1.0 years old) and their parents (25 mothers and 15 fathers; 41.0+/-5.0 years old). In children, mean difference (+/-SD) in systolic blood pressure (DeltaBP) readings (oscillometric-auscultatory) was +0.6+/-4.7 mmHg (range: -10 to +11); mean diastolic DeltaBP was 21.3+/-7.5 mmHg (range: -18 to +19) and decreased with increasing diastolic BP. In adults, mean systolic DeltaBP was +0.4+/-5.2 mmHg (range: -12 to +15) and mean diastolic DeltaBP was -5.2+/-6.0 mmHg (range: -25 to +8) (p<0.001). While the device was not accurate enough to be recommended, our study also shows that the accuracy of blood pressure oscillometric devices can differ between children and adults. Clinical accuracy of oscillometric devices should be tested in the specific populations in whom blood pressure is measured.
TL;DR: It was showed that MPV is higher in non-dipping than dipping hypertensive patients, indicating that platelet activation or dysfunction probably is an alternative mechanism for increasing cardiovascular events innon-dippers.
Abstract: Patients with non-dipper hypertension are known to carry a high risk of cardiovascular complications. In this study, we hypothesized that non-dippers may be associated with platelet dysfunction and it can be determined by mean platelet volume (MPV). A total of 216 outpatients treated with antihypertensive drugs for at least 6 months were enrolled. Dipper and non-dipper patterns were detected and clinical, laboratory and ambulatory blood pressure recording data were matched between non-dipping and dipping groups. MPV was significantly higher in patients in non-dipping than dipping groups (p<0.001). In correlation analyses, MPV was negatively correlated with the rate of systolic and diastolic fall at night (p<0.001, r=-0.46) and (p<0.001, r=-0.43), respectively. Also MPV was correlated with nocturnal pulse pressure (p=0.001, r=0.22). Other variables were similar between non-dipping and dipping groups. The present study showed that MPV is higher in non-dipping than dipping hypertensive patients. Platelet activation or dysfunction probably is an alternative mechanism for increasing cardiovascular events in non-dippers.
TL;DR: Physicians’ gender may influence the control of risk factors for cardiovascular disease in both men and women on combined antihypertensive and lipid-lowering therapy.
Abstract: The objective was to study gender differences in cardiovascular risk factors, lipid and blood pressure control in patients on combined lipid-lowering and antihypertensive treatment, in relation to gender of their physician. This was a cross-sectional study of 4319 patients (53% men) on lipid-lowering and antihypertensive treatment from two national surveys. Male physicians included 1643 men and 1311 women, and female physicians 605 men and 648 women. All data were collected consecutively from medical records. Women were older, had a higher systolic blood pressure (SBP), pulse pressure (PP), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), SBP >= 140 mmHg, and more often isolated systolic hypertension (ISH) compared with men. Men compared with women had more often diabetes, higher cardiovascular risk (SCORE) and achieved treatment goals more often for blood pressure in non-diabetics and TC in both non-diabetics and diabetics. Both men and women in well controlled and intermediate controlled groups were more often treated by physicians of their own gender. The female diabetes patients treated by female primary healthcare physicians more often achieved treatment goals for blood pressure [SBP/diastolic blood pressure (DBP) <130/80 mmHg]. Female physicians' male patients with diabetes more often belonged to the well controlled group. Physicians' gender may influence the control of risk factors for cardiovascular disease in both men and women on combined antihypertensive and lipid-lowering therapy. (Less)
TL;DR: This study did not provide support that smoking was a risk factor of hypertension and elevated blood pressure, and the multivariate adjusted odds ratios of hypertension for three smoking groups were all not statistically significant.
Abstract: Background. The relationship between smoking and hypertension is still unclear and controversial; we examine effects of smoking on blood pressure stratified by body mass index (BMI) in the Mongolian population. Methods. A total of 2589 Mongolians aged 20 years or more were recruited as study subjects. Demographic data, lifestyle factors, family history of hypertension, blood pressure measurements, physical examination and blood sample were obtained and analyzed for all subjects. Results. Among subjects with BMI25 kg/m 2 , adjusted mean diastolic blood pressure in all smokers (82, 83 and 82 mmHg for subjects who smoke 1–9, 10–19 and 20 cigarettes/day, respectively) were lower than that in non-smokers (84 mmHg), all p- values 0.05; among subjects with BMI25 kg/m 2 , mean systolic blood pressure (137 mmHg for nonsmokers, 141, 135 and 132 mmHg for subjects who smoke 1–9, 10–19 and 20 cigarettes/day, respectively) decreased with amount of smoking and linear trend was statistically significant, p 0.05. Multivariate adjusted odds ratios of hypertension for three smoking groups were all not statistically significant. Conclusions. This study did not provide support that smoking was a risk factor of hypertension and elevated blood pressure.
TL;DR: HIV duration was an independent predictor of ABP and hypertension in a selected group of HIV-infected individuals and Nocturnal hypertension was prevalent, and white coat hypertension was present in one fourth of the patients.
Abstract: Objective. There is a scarcity of data on ambulatory blood pressure (ABP) in HIV-infected individuals. The aim of the study was to identify possible predictors of ABP in HIV-infected individuals. Methods. From a cohort of 542 HIV-infected patients, ABP monitoring was undertaken in 77 patients with high office blood pressure (BP) readings and without antihypertensive treatment. Results. 24-h and daytime ABPs were associated with HIV duration (r=0.24–0.33, p=0.004–0.033), but not with duration of combined antiretroviral therapy. In multivariate linear regression analyses with the different ABPs as dependent variables, HIV duration (unstandardized β=0.41–0.89, p=0.008–0.045) and log-transformed urinary albumin excretion (p=0.003–0.043) were predictors of all 24-h and daytime ABPs. Multiple logistic regression analysis revealed HIV duration (OR=1.14/year (95% CI 1.03–1.26)) as predictor of hypertension defined according to daytime ABP. Nocturnal hypertension was observed in 81%, white coat hypertensio...
TL;DR: High-dose atorvastatin resulted in reduction of BP independently of lipid-lowering effect, changes in endothelial function and oxidative stress, but it was related to the increase in NO and decrease in autoantibodies against ox-LDL.
Abstract: Aims. The aim of the study was to determine whether a high dose of atorvastatin lowers blood pressure (BP) in normolipemic patients with well controlled primary arterial hypertension and if this effect is associated with alteration of biomarkers of endothelial function and oxidative stress. In this open-label study, normolipemic patients (n=56) were randomized in the proportion of 2:1 to receive atorvastatin 80 mg daily for 3 months (statin-treated, ST n=39), or to previous therapy (statin-free, SF). BP was measured using a 24-h ambulatory BP measurement device. Plasma levels of 6-keto-PGF1α (prostacyclin metabolite), serum nitric oxide (NO) and levels of autoantibodies immunoglobulin G against oxidatively modified low-density lipoprotein (ox-LDL) were measured. Major findings. The mean change in systolic BP and diastolic BP for ST was – 5.7 mmHg (95% CI –4.1 to –7.2 mmHg) and –3.9 mmHg (95% CI –2.7 to –5.0 mmHg), respectively. Hypotensive statin effect was independent of lipid lowering. No change...
TL;DR: It is suggested that aortic stiffness measurement could be used for assessment of cardiovascular risk in Psoriasis patients, and that only continuous long-term disease control may be helpful in reducing the cardiovascular risk associated with psoriasis.
Abstract: Objective. Psoriasis is a chronic inflammatory disease affecting approximately 1.5–3% of the general population. Several studies have demonstrated an association between psoriasis and atherosclerosis. The aim of this study is the investigate relation between aortic wall stiffness and duration and severity of the disease in patients with psoriasis. Method. The study population included 58 patients with psoriasis (27 men, mean age = 36.3 ± 10.6 years, and mean disease duration = 9.8 ± 6.7 years) and 36 healthy control subjects (17 men, and mean age = 40.0 ± 11.1 years). Aortic stiffness index, aortic strain and distensibility, were calculated from the aortic systolic and diastolic diameters measured by echocardiography and blood pressure obtained by sphygmomanometer. Cardiac functions were determined by using echocardiography, consisting of standard two-dimensional and conventional Doppler. Results. The conventional echocardiographic parameters were similar between patients and controls. There were ...
TL;DR: The ovine 1K1C model produces reliable and reproducible hypertension with demonstrable cardiac end-organ damage in sheep subjected to unilateral nephrectomy and clamping of the remaining renal artery 3 weeks later.
Abstract: Objective. The aim of this study is to characterize cardiac remodeling in a large animal model of hypertension. Methods. 23 sheep were subjected to unilateral nephrectomy followed by clamping of the remaining renal artery to 60% (“one kidney-one clip”, 1K1C) 3 weeks later. Blood pressure (BP) was monitored invasively over 73±28 days. Cardiac function was assessed with magnetic resonance imaging and compared with 12 size-matched controls. Detailed atrial histopathological analysis was performed. Results. In the 1K1C animals, BP rose from baseline to reach a plateau by 4 weeks (systolic BP: 107±12 to 169±27, diastolic BP: 71±10 to 118±29 mmHg, both p< 0.0001); cardiac hypertrophy was significant when compared with controls with increased left ventricular weight [left ventricular (LV)/body wt: 2.7±0.5 vs 2.1±0.2 g/kg, p=0.01] as well as bi-atrial enlargement (right atrial, RA: 22.9±4.9 vs 15.7±2.8g, p=0.003; left atrial, LA: 35.5±6.7 vs 20.9±4.1g, p=0.0003); cardiac magnetic imaging demonstrated sign...
TL;DR: In patients with previous coronary or cerebrovascular events, PAD occurs with a much higher prevalence than previously estimated and it is suggested that screening for PAD is justified and should be carried out in these patients in order to regulate the possible lifestyle and medical intervention.
Abstract: Aim. The presence of peripheral arterial disease (PAD) in patients with other manifestations of cardiovascular disease identifies a population at increased risk of complications both during acute coronary events and on a long-term basis and possibly a population in whom secondary prevention of cardiovascular events should be addressed aggressively. The present study was aimed at providing a valid estimate on the prevalence of PAD in patients attending their general practitioner and having previously suffered a cardio- or cerebrovascular event. Patients and methods. 1000 patients with a previous cardiovascular event were screened and PAD was considered present when the ankle–brachial index (ABI) of systolic blood pressure was less than 0.90 using the current recommended technique. Results. 965 (659 men) patients met the inclusion criteria and had detectable systolic blood pressures on the arms and ankles. Mean age was 70±8 years, 77% were current or previous smokers, and 188 patients were diabetics...
TL;DR: An elevated nocturnal HR, ?
Abstract: Background: The relationship between basal heart rate (HR) and the occurrence of myocardial ischemia, sudden death, cardiovascular mortality have been described. Therefore, further studies are warranted to evaluate the behaviour of heart rate in different scenarios. We sought to determine whether ambulatory heart rate is associated with the presence of target organ damage (TOD) in hypertensive patients. Patients and Methods: Crossectional study of essential hypertensive patients in whom a twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed. The relationship between TOD and 24 hour ambulatory heart rate (HR) was analyzed. Results: Five hundred and sixty-six patients with arterial hypertension were included (55.8% male, mean age 59.9 ± 14.2 years). 15% were smokers, 62.2% had dyslipidemia, 18.4% diabetes mellitus. Heart rate values were higher during activity as compared to the resting period (72.8 vs 63.3 bpm, p < 0.001). Heart rate, in both periods, was not associated with t...
TL;DR: The studied home-based antihypertensive care system was not more effective than the ordinary office-based treatment and the system based on mailing the results to the physician office does not seem to be a suitable method in communication between the patient and the physician.
Abstract: Effective antihypertensive care is not possible without regular and reliable blood pressure measurements. The use of blood pressure home measurement has increased a lot during the last years. Various methods have been used in communication between the patients and physicians. In a randomized study we compared traditional office-based hypertension treatment protocol (n=68) to the home-based blood pressure measurement protocol (n=89) in which the patient mailed their home-measured BP diary in a letter to the office of their physician. The studied home-based antihypertensive care system was not more effective than the ordinary office-based treatment. The results highlight the importance of continuous home measurement data interpretation by the physician. The system based on mailing the results to the physician office does not seem to be a suitable method in communication between the patient and the physician. Online or other telemedicine-aided means of communication might yield better antihypertensive control.
TL;DR: More than a quarter of hypertensive women ≥65 years may have clinical data of unrecognized HF, and Hypertensive women with unrecognized clinical HF have a worse clinical profile and worse BP control rates than those without HF.
Abstract: Objective. To determine the proportion and clinical features of unrecognized heart failure (HF) in hypertensive women ≥65 years attended in Spain. Methods. A cross-sectional study carried out in primary healthcare setting. Patients were considered to present unrecognized clinical diagnosis of HF if they had not been previously diagnosed but fulfilled Framingham criteria for HF diagnosis. Results. Of 3500 patients, the proportion of unrecognized clinical HF was 26.3%. In comparison with women without HF, all cardiovascular risk factors were more prevalent in patients with unrecognized HF; the same was observed for target organ damage, being the most frequent left ventricular hypertrophy (LVH) (54.1% vs 15.5%, p<0.0001), and for the presence of cardiovascular disease, being the most common coronary heart disease (24.8% vs 9.8%, p<0.0001). Predictive factors associated with the presence of unrecognized HF were LVH (OR =4.84) and the presence of previous cardiovascular disease (OR =2.26) Blood pressur...
TL;DR: In elderly people diagnosed with hypertension general obesity (high BMI) appears to have an important influence on uncontrolled hypertension in men, whereas abdominal obesity appears to be an important factor in women.
Abstract: Objective. Control of blood pressure is important in old age for prevention of hypertension-associated complications. This study aimed to investigate the factors associated with control of hypertension in elderly people (≥60 years old) diagnosed with hypertension. Methods. The subjects were those who had a self-reported diagnosis of hypertension (532 men and 1078 women) from a stratified random cluster sample of 4201 people aged 60 years or older. Controlled hypertension was defined as a systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg, and SBP <130 mmHg and DBP <80 mmHg for subjects with diabetes. Results. The prevalence of controlled hypertension (25.9%) was low. In older women, the prevalence of isolated uncontrolled SBP was increased. After adjusting for other covariates, uncontrolled hypertension was positively associated with body mass index (BMI≥23 kg/m2), and negatively associated with balanced diet and a past history of cardiovascular disease in men, whe...
TL;DR: In spite of many risk factors, co-existing cardiovascular diseases and severe hypertension, 95% of the patients achieved target BP when treated in a nurse-led hypertension clinic, suggesting that the data serves as an inspiration for other clinics and GPs to implement the concept.
Abstract: Aims. This manuscript presents results from 4 years experience in a nurse-led hypertension clinic. The aim of the hypertension clinic was to optimize hypertension treatment and to reduce the number of physician consultations. Materials and methods. All patients were initially examined by cardiologists. All follow-up visits were performed by nurses. They initiated and titrated antihypertensive medication according to a stepwise treatment algorithm or the physicians' instructions. The blood pressure (BP) measurement technique and the recording of risk profile were performed as instructed by guidelines from the European Hypertension Society. Results. During the first 4 years, 186 patients were treated in the hypertension clinic. One hundred and thirty patients were treated by the nurses alone and hereafter discharged to general practitioners; 95% of these patients reached target BP. Most of the patients received combination therapy with two to seven different antihypertensive drugs. The three primary...
TL;DR: Cystatin C is closely related to left ventricular mass in hypertensive patients, and could be a marker for cardiac hypertrophy in these patients, according to a logistic regression analysis.
Abstract: Introduction. Cystatin C is a marker of kidney function and a predictor of cardiovascular morbidity and mortality. It is unknown whether this protein may be related to the cardiac involvement that is common among patients with essential hypertension. Patients and methods. We evaluated the relationship between serum cystatin C, serum creatinine, estimated glomerular filtration rate and cardiac structure assessed by echocardiography, in a group of 49 non-diabetic patients with primary hypertension and normal serum creatinine. Results. Mean cystatin C levels were 0.74 ± 0.15 mg/l. Age, body mass index, triglycerides and creatinine, estimated glomerular filtration rate and left ventricular mass index were independently associated with cystatin C levels. Seventy three per cent of patients had cardiac hypertrophy. The prevalence of left ventricular hypertrophy was higher in patients who had cystatin C levels above the 70th percentile (0.79 mg/dl) than patients below this percentile (93.3% vs 66.7%, resp...
TL;DR: The results suggest that the TGF-β1 +869 C allele is potentially a genetic factor of EH in these two ethnicities, the CG haplotype can be a genetic marker of Eh in the Kazakh Chinese and the high concentration of TGF -β1 is possibly associated with EH, especially in the Kazakhstan population.
Abstract: Aims. Based on a case–control study, we investigated the relationship between +869T/C and +915G/C gene polymorphisms in transforming growth factor-β1 (TGF-β1), protein levels and essential hypertension (EH) in the Kazakh and Han Chinese populations selected from the Boertonggu countryside of Shawan region in the Xinjiang Uygur Autonomous Region of China (n=1600). The polymorphisms of TGF-β1 and the blood levels were detected using polymerase chain reaction–restriction fragment length polymorphism assays and sandwich ELISA, respectively. Major findings. An association was found between +869C-allele with higher risk of EH in these two populations. We also found that the CG haplotype of the two polymorphisms was associated with EH in the Kazakh EH patients. The levels of TGF-β1 in the blood were positively correlated with diastolic blood pressure both in the Kazakh and Han EH patients. Levels of the TGF-β1 protein in the Kazakh EH patients were significantly higher than those in the Han EH patients. ...
TL;DR: Oscillometric devices may be used for self-BP measurement in patients with ISH without clinically important disadvantages compared with the patients with MHT.
Abstract: Object i ve. Wide pulse pressure (PP) affects the accuracy of oscillometric blood pressure measurements (OBPM): however, the degree of this impact on different patient groups with wide PPs is unclear. This study will investigate the accuracy of OBPM in achieving target BP and PP in isolated systolic hypertension (ISH) group compared with mixed hypertension (MHT) group. Method. A total of 115 patients (70 with ISH and 45 with MHT) were enrolled in the study. Upper arm and wrist OBPM, obtained by OmronM3 and OmronR6 devices respectively, were compared with the simultaneously measured values from the ascending aorta. The ISH was defi ned as a systolic blood pressure (SBP) 140 mmHg and a diastolic blood pressure (DBP) 90 mmHg. MHT was defi ned as a SBP140 mmHg and a DBP90 mmHg. Results. The mean central arterial blood pressure (BP) and central PP were higher in the ISH group than those in the MHT group. The upper arm OBPM underestimated the central SBP in two groups (5 mmHg, 3 mmHg, p 0.5, respectively), but overestimated DBP in the ISH group compared with MHT patients (6.8 mmHg, 1 mmHg, p 0.04, respectively). Wrist OBPM similarly underestimated to the central SBP in each group (16 mmHg, 19 mmHg, p 0.15), whereas the sum of overestimation of DBP was signifi cantly higher in the ISH than in the MHT group (6 mmHg, 1 mmHg, p 0.001, respectively). Also, each of the devices underestimated the central PP in the ISH group (about 10 mmHg) as being higher than that of the MHT group. Conclus i on. Oscillometric devices may be used for self-BP measurement in patients with ISH without clinically important disadvantages compared with the patients with MHT. For PP measurement in patients with ISH, there were substantial differences between intra-arterial and indirect arm BP measurements.
TL;DR: The aim of this review was to investigate the clinical impact of the additive prognostic information provided by measuring subclinical organ damage and the economic costs and health benefits associated with measuring markers of sub clinical organ damage.
Abstract: Traditional cardiovascular risk factors have poor prognostic value for individuals and screening for subclinical organ damage has been recommended in hypertension in recent guidelines. The aim of this review was to investigate the clinical impact of the additive prognostic information provided by measuring subclinical organ damage. We have (i) reviewed recent studies linking markers of subclinical organ damage in the heart, blood vessels and kidney to cardiovascular risk; (ii) discussed the evidence for improvement in cardiovascular risk prediction using markers of subclinical organ damage; (iii) investigated which and how many markers to measure and (iv) finally discussed whether measuring subclinical organ damage provided benefits beyond risk prediction. In conclusion, more studies and if possible randomized studies are needed to investigate (i) the importance of markers of subclinical organ damage for risk discrimination, calibration and reclassification; and (ii) the economic costs and health ...
TL;DR: Although candesartan-based treatment was not superior to non-ARB treatment in prevention of cardiac mortality, ARB-based therapy may be beneficial in reducing risk of coronary events in hypertensive patients with CAD and impaired renal function.
Abstract: The aim of this study was to assess the effects of angiotensin receptor blocker (ARB)-based therapy on cardiovascular events in high-risk hypertensive patients with coronary artery disease (CAD) and impaired renal function in post hoc analysis of HIJ-CREATE (Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease). Patients (n=2049) were randomly assigned to candesartan-based or non-ARB treatment arms; 1022 patients (age 70 ± 6 years, 28% female) with impaired renal function, defined as creatinine clearance <60 ml/min at baseline. There was no difference in major adverse cardiac event (MACE), a composite of cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke and other cardiovascular events requiring hospitalization between the two arms in patients without impaired renal function. However, there was a lower incidence of MACE in the candesartan-based treatment arm than in the non-ARB treatment arm (HR=0.79, 95% CI 0.63-0.99, p=0.039) in patients with impaired renal function. Among the MACE, candesartan-based treatment reduced hospitalization for unstable angina (HR=0.71, 95% CI 0.52-0.96, p=0.028). Although candesartan-based treatment was not superior to non-ARB treatment in prevention of cardiac mortality, ARB-based therapy may be beneficial in reducing risk of coronary events in hypertensive patients with CAD and impaired renal function.
TL;DR: Enhanced external counterpulsation treatment affects the blood pressure in patients with refractory angina pectoris and may be a result of an improved exercise capacity, an improved endothelial function and vasoreactivity in general.
Abstract: Objective. Enhanced external counterpulsation (EECP) is a non-invasive technique that has been shown to reduce the frequency and severity of angina pectoris. Little is known how EECP affects the blood pressure. Methods. 153 patients with refractory angina were treated with either EECP or retained on their pharmacological treatment (reference group). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate were measured pre- and post-treatment and at 12 months follow-up. Results. EECP treatment altered the blood pressure in patients with refractory angina pectoris. A decrease in the blood pressure was more common in the EECP group compared with the reference group. In the reference group, an increase in the blood pressure was more common. A correlation between a decrease in blood pressure after EECP treatment and a higher baseline MAP, SBP and DBP was seen. No such correlation was seen in the reference group. The blood pressure response did no...