Showing papers in "Journal of Human Hypertension in 2010"
University of Milan1, National and Kapodistrian University of Athens2, Maastricht University3, Tohoku University4, Jichi Medical University5, University of Valencia6, University of Bonn7, St. Michael's Hospital8, University of Edinburgh9, University of Padua10, Columbia University11, Complutense University of Madrid12, King's College London13, Semmelweis University14
TL;DR: The present document, which provides concise and updated guidelines on the use of HBPM for practising physicians, was prepared by including the comments and feedback of general practitioners.
Abstract: Self-monitoring of blood pressure by patients at home (home blood pressure monitoring (HBPM)) is being increasingly used in many countries and is well accepted by hypertensive patients. Current hypertension guidelines have endorsed the use of HBPM in clinical practice as a useful adjunct to conventional office measurements. Recently, a detailed consensus document on HBPM was published by the European Society of Hypertension Working Group on Blood Pressure Monitoring. However, in daily practice, briefer documents summarizing the essential recommendations are needed. It is also accepted that the successful implementation of clinical guidelines in routine patient care is dependent on their acceptance by involvement of practising physicians. The present document, which provides concise and updated guidelines on the use of HBPM for practising physicians, was therefore prepared by including the comments and feedback of general practitioners.
442 citations
TL;DR: The study aimed to develop prediction algorithms for hypertensive disorders based on multivariate analysis of factors from the maternal history and compare the estimated performance of such algorithms in the prediction of early preeclampsia, late-PE and gestational hypertension with that recommended by the National Institute for Clinical Excellence (NICE).
Abstract: The study aimed to develop prediction algorithms for hypertensive disorders based on multivariate analysis of factors from the maternal history and compare the estimated performance of such algorithms in the prediction of early preeclampsia (PE), late-PE and gestational hypertension (GH) with that recommended by the National Institute for Clinical Excellence (NICE). Logistic regression analysis was used to determine which of the maternal characteristics and history had significant contribution in predicting early-PE, late-PE and GH. There were 37 cases with early-PE, 128 with late-PE, 140 with GH and 8061 cases that were unaffected by PE or GH. Predictors of early-PE were Black race, chronic hypertension, prior PE and use of ovulation drugs. Predictors of late-PE and GH were increased maternal age and body mass index, and family history or history of PE. Additionally, late-PE was more common in Black, Indian and Pakistani women. The detection rates of early-PE, late-PE and GH in screening by maternal factors were 37.0, 28.9 and 20.7%, respectively, for a 5% false positive rate. Screening as suggested by NICE would have resulted in a false positive rate of 64.1% with detection rates of 89.2, 93.0 and 85.0% for early-PE, late-PE and GH, respectively. Meaningful screening for hypertensive disorders in pregnancy by maternal history necessitates the use of algorithms derived by logistic regression analysis.
311 citations
TL;DR: The ARCSolver method is a novel method determining AIx and aSBP based on an oscillometric system with a cuff that is easy and for widespread use and the results agree with common accepted tonometric measurements.
Abstract: In the European Society of Cardiology–European Society of Hypertension guidelines of the year 2007, the consequences of arterial stiffness and wave reflection on cardiovascular mortality have a major role. But the investigators claimed the poor availability of devices/methods providing easy and widely suitable measuring of arterial wall stiffness or their surrogates like augmentation index (AIx) or aortic systolic blood pressure (aSBP). The aim of this study was the validation of a novel method determining AIx and aSBP based on an oscillometric method using a common cuff (ARCSolver) against a validated tonometric system (SphygmoCor). aSBP and AIx measured with the SphygmoCor and ARCSolver method were compared for 302 subjects. The mean age was 56 years with an s.d. of 20 years. At least two iterations were performed in each session. This resulted in 749 measurements. For aSBP the mean difference was −0.1 mm Hg with an s.d. of 3.1 mm Hg. The mean difference for AIx was 1.2% with an s.d. of 7.9%. There was no significant difference in reproducibility of AIx for both methods. The variation estimate of inter- and intraobserver measurements was 6.3% for ARCSolver and 7.5% for SphygmoCor. The ARCSolver method is a novel method determining AIx and aSBP based on an oscillometric system with a cuff. The results agree with common accepted tonometric measurements. Its application is easy and for widespread use.
294 citations
TL;DR: Preliminary evidence is provided that treatment with a mineralocorticoid receptor antagonist substantially reduces the severity of OSA and if confirmed in a randomized assessment, it will support aldosterone-mediated chronic fluid retention as an important mediator of Osa severity in patients with resistant hypertension.
Abstract: Obstructive sleep apnoea (OSA) and hyperaldosteronism are very common in subjects with resistant hypertension. We hypothesized that aldosterone-mediated chronic fluid retention may influence OSA severity in patients with resistant hypertension. We tested this in an open-label evaluation by assessing the changes in the severity of OSA in patients with resistant hypertension after treatment with spironolactone. Subjects with resistant hypertension (clinical blood pressure (BP) >or=140/90 mm Hg on >or=3 antihypertensive medications, including a thiazide diuretic and OSA (defined as an apnoea-hypopnoea index (AHI) >or=15) had full diagnostic, polysomnography before and 8 weeks after spironolactone (25-50 mg a day) was added to their ongoing antihypertensive therapy. In all, 12 patients (mean age 56 years and body mass index 36.8 kg m(-2)) were evaluated. After treatment with spironolactone, the AHI (39.8+/-19.5 vs 22.0+/-6.8 events/h; P<0.05) and hypoxic index (13.6+/-10.8 vs 6.7+/-6.6 events/h; P<0.05), weight and clinic and ambulatory BP were significantly reduced. Plasma renin activity (PRA) and serum creatinine were significantly higher. This study provides preliminary evidence that treatment with a mineralocorticoid receptor antagonist substantially reduces the severity of OSA. If confirmed in a randomized assessment, it will support aldosterone-mediated chronic fluid retention as an important mediator of OSA severity in patients with resistant hypertension.
259 citations
TL;DR: It is now important to assess treatment options that reduce oxidative stress in the hope that they reverse endothelial dysfunction and left ventricular hypertrophy and the clinical sequelae of these abnormalities.
Abstract: Oxidative stress has been increasingly linked to the high incidence of cardiovascular events in patients with chronic kidney disease (CKD), especially as traditional cardiovascular risk factors seem to not be able to account for the huge cardiovascular morbidity and mortality in this population group. Oxidative stress is increased in patients with renal impairment as a result of increased oxidant activity and reduced antioxidant capacity, and this is increased in a graded manner with increasing renal dysfunction. Inflammation, which is also present in CKD, further amplifies the oxidant generation process. The two clinical sequelae of oxidative stress are endothelial dysfunction and left ventricular hypertrophy, which have adverse cardiovascular consequences. With our new understanding of oxidative stress, it is now important to assess treatment options that reduce it in the hope that they reverse endothelial dysfunction and left ventricular hypertrophy and the clinical sequelae of these abnormalities.
194 citations
TL;DR: In participants at higher age, both training programmes exert similar effects on systolic blood pressure at rest, during exercise and during post-exercise recovery, whereas the effects on HR are more pronounced after higher intensity training.
Abstract: We aimed to investigate the effects of endurance training intensity (1) on systolic blood pressure (SBP) and heart rate (HR) at rest before exercise, and during and after a maximal exercise test; and (2) on measures of HR variability at rest before exercise and during recovery from the exercise test, in at least 55-year-old healthy sedentary men and women. A randomized crossover study comprising three 10-week periods was performed. In the first and third period, participants exercised at lower or higher intensity (33% or 66% of HR reserve) in random order, with a sedentary period in between. Training programmes were identical except for intensity, and were performed under supervision thrice for 1 h per week. The results show that in the three conditions, that is, at rest before exercise, during exercise and during recovery, we found endurance training at lower and higher intensity to reduce SBP significantly (P<0.05) and to a similar extent. Further, SBP during recovery was, on average, not lower than at rest before exercise, and chronic endurance training did not affect the response of SBP after an acute bout of exercise. The effect of training on HR at rest, during exercise and recovery was more pronounced (P<0.05) with higher intensity. Finally, endurance training had no significant effect on sympathovagal balance. In conclusion, in participants at higher age, both training programmes exert similar effects on SBP at rest, during exercise and during post-exercise recovery, whereas the effects on HR are more pronounced after higher intensity training.
193 citations
TL;DR: Major efforts are required to improve BP-management, especially in women, as gender differences were more pronounced in diabetic as compared with non-diabetic patients and became evident at an age 55 years old.
Abstract: Antihypertensive drug therapy and blood pressure control in men and women: an international perspective
114 citations
TL;DR: DASH is more effective than potassium, magnesium and fibre supplements for lowering BP in obese hypertensives, which suggest that high fruits and vegetables DASH lowers BP and improves endothelial function in this group by nutritional factors in addition to potassium,nesium and fibre.
Abstract: The mechanism underlying blood pressure (BP) reduction in the high fruits and vegetables arm of the Dietary Approaches to Stop Hypertension (DASH) study is unknown but may include potassium, magnesium and fibre. This study was designed to separate minerals and fibre from other components of DASH on BP in abdominally obese individuals with metabolic syndrome with pre-hypertension to stage 1 hypertension (obese hypertensives). A total of 15 obese hypertensives and 15 lean normotensives were studied on a standardized usual diet, randomized to DASH or usual diet supplemented with potassium, magnesium and fibre to match DASH, then crossed over to the complementary diet. All diets were 3 weeks long, isocaloric and matched for sodium and calcium. In obese hypertensives, BP was lower after 3 weeks on DASH than usual diet (-7.6+/-1.4/-5.3+/-1.4 mm Hg, P 0.50). DASH is more effective than potassium, magnesium and fibre supplements for lowering BP in obese hypertensives, which suggest that high fruits and vegetables DASH lowers BP and improves endothelial function in this group by nutritional factors in addition to potassium, magnesium and fibre.
112 citations
TL;DR: The results of this study showed that the mean values of Cd, Ni and Pb were significantly higher in scalp hair, blood and urine samples of both smoker and nonsmoker patients than in referents, whereas the concentration of Zn was lower in the scalp hair and blood, but higher in the urine sample of hypertensive patients.
Abstract: The objective of this study was to evaluate the association between trace and toxic elements zinc (Zn), cadmium (Cd), nickel (Ni) and lead (Pb) in biological samples (scalp hair, blood and urine) of smoker and nonsmoker hypertensive patients (n=457), residents of Hyderabad, Pakistan. For the purpose of comparison, the biological samples of age-matched healthy controls were selected as referents. The concentrations of trace and toxic elements were measured by atomic absorption spectrophotometer prior to microwave-assisted acid digestion. The validity and accuracy of the methodology were checked using certified reference materials and by the conventional wet acid digestion method on the same certified reference materials and real samples. The recovery of all the studied elements was found to be in the range of 97.8–99.3% in certified reference materials. The results of this study showed that the mean values of Cd, Ni and Pb were significantly higher in scalp hair, blood and urine samples of both smoker and nonsmoker patients than in referents (P<0.001), whereas the concentration of Zn was lower in the scalp hair and blood, but higher in the urine samples of hypertensive patients. The deficiency of Zn and the high exposure of toxic metals as a result of tobacco smoking may be synergistic with risk factors associated with hypertension.
108 citations
TL;DR: The prevalence of hypertension in subclinical hypothyroidism group was significantly higher than in euthyroid group in females, and both SBP and DBP were similar among the three groups, and change of TSH in normal range did not affect blood pressure.
Abstract: It is still controversial whether subclinical hypothyroidism and euthyroidism affect blood pressure. The study aimed to explore the relationship between different levels of thyroid-stimulating hormone (TSH) and blood pressure in the participants with subclinical hypothyroidism and euthyroidism. A total of 1319 participants were administered a questionnaire survey, and their blood pressure, height and body weight measurements were taken. Blood samples were taken to test serum TSH. FT3 and FT4 were further examined if TSH was abnormal. Participants were divided into euthyroid group and subclinical hypothyroidism group. Euthyroid group was further divided into three groups: group A (TSH 0.3–0.99 mIU l−1), group B (TSH 1.0–1.9 mIU l−1) and group C (TSH 1.91–4.8 mIU l−1). Results showed that different levels of serum TSH had no relation with systolic blood pressure (SBP) and diastolic blood pressure (DBP). The prevalence of hypertension in subclinical hypothyroidism group was significantly higher than euthyroid group in females (41.3 vs 25.6%, P<0.05). The risk of hypertension in subclinical hypothyroidism group was significantly higher than that in the euthyroid group after adjusted for age, gender, smoking status, HOMA-IR (homoeostasis model assessment of insulin resistance) and body mass index (odds ratio (OR)=1.753, 95% confidence interval (CI) 1.067–2.879, P=0.027). This association was stronger in females (OR=3.545, 95% CI 1.576–7.975, P=0.004), but there was no statistical significance in males. Within normal range of TSH, both SBP and DBP were similar among the three groups. The prevalence and risk of hypertension were also similar among the three groups. In conclusion, the prevalence of hypertension in subclinical hypothyroidism group was significantly higher than in euthyroid group in females. Change of TSH in normal range did not affect blood pressure.
102 citations
TL;DR: Despite the difficulty of obtaining replication results for a complex trait genetic association between blood pressure and hypertension, the GWA study was able to identify consistent genetic factors in both the Korean cohorts in ATP2B1, CSK, ARSG and CSMD1 genes.
Abstract: Blood pressure, one of the important vital signs, is affected by multiple genetic and environmental factors. Recently, several genome-wide association (GWA) studies have successfully identified genetic factors that influence blood pressure and hypertension risk. In this study, we report results of the Korean Association REsource (KARE, 8842 subjects) GWA study on blood pressure and hypertension risk. In all, 10 single-nucleotide polymorphisms (SNPs) that showed significant association with hypertension were further analysed for replication associations in the Health2 project (7861 subjects). Among these 10 SNPs, 3 were replicated in the Health2 cohort for an association with systolic or diastolic blood pressure. The most significant SNP (rs17249754 located in ATPase, Ca++ transporting, plasma membrane 1 (ATP2B1)) has been previously reported, and the other two SNPs are rs1378942 in the c-src tyrosine kinase (CSK) gene and rs12945290 in the arylsulphatase G (ARSG) gene. An additional hypertension case–control study confirmed that rs17249754 (in ATP2B1) increases hypertension risk in both the KARE and Health2 (meta-analysis, P-value=4.25 × 10−9) cohorts. One more SNP, rs995322, located in the CUB and Sushi multiple domains 1 (CSMD1), is also associated with increased risk of hypertension (meta-analysis, P-value=1.00 × 10−4). Despite the difficulty of obtaining replication results for a complex trait genetic association between blood pressure and hypertension, we were able to identify consistent genetic factors in both the Korean cohorts in ATP2B1, CSK, ARSG and CSMD1 genes.
TL;DR: Modifiable risk factors (such as BMI, dietary intake and physical activity) are associated with HTN prevalence in this population, indicating potential opportunities for prevention measures.
Abstract: Substantial evidence suggests an increasing burden of hypertension (HTN) in urban sub-Saharan Africa (SSA). However, data on HTN prevalence in rural SSA are sparse. In a cross-sectional study, we investigated magnitude and correlates of HTN in rural SSA. Study participants (N=1485), 18 years and above, were selected using a stratified random sampling technique from three villages (in Malawi, Rwanda and Tanzania) that participated in the Millennium Villages Project. Information on socio-demographic characteristics, risk factors and blood pressure measures was collected using standardized protocols. Prevalence of HTN and pre-HTN were 22 and 44%, respectively. Older age (P<0.001), higher body mass index (BMI) (P=0.07), television ownership (P=0.01) and less work-related vigorous physical activity (P=0.02) were associated with higher prevalence of HTN and higher blood pressure measures (all P<0.05). Frequent meat and fat intake were associated with higher HTN prevalence (trend P=0.02 and 0.07, respectively). Frequent fruit and vegetable intake was significantly associated with lower blood pressure measures (all P<0.05). HTN and pre-HTN are common in rural SSA. Modifiable risk factors (such as BMI, dietary intake and physical activity) are associated with HTN prevalence in this population, indicating potential opportunities for prevention measures.
TL;DR: Treatment with antihypertensive agents, but not with lipid-lowering agents, was associated with a sizeable residual cardiovascular risk, suggesting that more efficient risk reduction strategies in hypertension should be developed as a priority.
Abstract: Although pharmacological treatments of hypertension and dyslipidaemia are both associated with a reduction in cardiovascular risk, little is known about the degree of cardiovascular risk remaining in treated individuals, by assessing the levels of their risk factors achieved, that is their 'residual cardiovascular risk'. We then used the data from the Prospective Epidemiological Study of Myocardial Infarction (PRIME), which involved 9649 men aged 50-59 years, from France and Northern Ireland with a 10-year follow-up, to test the presence of specific residual cardiovascular risks of coronary heart disease, stroke, total of fatal and non-fatal cardiovascular events and cardiovascular mortality, in patients treated with antihypertensive agents or lipid-lowering agents. In the whole cohort, a total of 796 patients developed a fatal or non-fatal cardiovascular event. Antihypertensive drug use at baseline was significantly associated (RR=1.50, 95% CI: 1.25-1.80) with total cardiovascular event risk, but not lipid-lowering drug use, after adjusting for classic risk factors (age, smoking, total cholesterol, high-density lipoprotein cholesterol, systolic blood pressure and diabetes). Similar results were obtained for coronary heart disease (RR=1.46, 95% CI: 1.18-1.80), stroke (RR=1.75, 95% CI: 1.14-2.70) and cardiovascular death (RR=1.62, 95% CI: 1.02-2.58), but neither for total death (RR=1.15, 95% CI: 0.89-1.48) nor for non-cardiovascular death (RR=1.00, 95% CI: 0.74-1.36). For any cardiovascular end point, residual risks did not globally differ according to the antihypertensive drug class prescribed at baseline. In conclusion, treatment with antihypertensive agents, but not with lipid-lowering agents, was associated with a sizeable residual cardiovascular risk, suggesting that more efficient risk reduction strategies in hypertension should be developed as a priority.
TL;DR: The results suggest that isometric exercise may be of value as part of lifestyle advice in maintaining a desirable blood pressure.
Abstract: Dynamic physical exercise (walking, swimming, and so on) is an important component of lifestyle changes to reduce blood pressure; however, many individuals are unwilling or unable to adopt this lifestyle change Isometric exercise has not traditionally been recommended as an alternative to dynamic exercise and has not been well studied A meta-analysis of controlled trials of isometric exercise on resting blood pressure was therefore undertaken Five trials were identified including a total of 122 subjects Isometric exercise for <1 h per week reduced systolic blood pressure by 104 mm Hg and diastolic blood pressure by 67 mm Hg These changes are similar to those achieved with a single pharmacological agent These results suggest that isometric exercise may be of value as part of lifestyle advice in maintaining a desirable blood pressure
TL;DR: In elderly patients with systolic hypertension, aliskiren proved to be more effective and better overall anti-hypertensive therapy compared to ramipril.
Abstract: Efficacy and safety of the direct renin inhibitor aliskiren was compared with ramipril for treatment of essential systolic hypertension in elderly patients. A 36-week, randomized, double-blind, parallel-group, active-controlled, optional-titration study was performed in 901 patients (aliskiren, n=457; ramipril, n=444) > or =65 years of age with systolic blood pressure (SBP) > or =140 mm Hg. Aliskiren 150-300 mg per day or ramipril 5-10 mg per day for was administered for 12 weeks with optional add-on therapy of hydrochlorothiazide (12.5-25 mg per day) at week 12 and amlodipine (5-10 mg per day) at week 22. The primary end point was non-inferiority of aliskiren vs ramipril monotherapy for change from baseline in mean sitting SBP (msSBP) at week 12. Decreases from baseline msSBP and mean sitting diastolic BP with aliskiren monotherapy (-14.0 and -5.1 mm Hg, respectively) were non-inferior (P<0.001 for both values) and superior to ramipril monotherapy (-11.6, -3.6 mm Hg; P=0.02, P<0.01, respectively). More patients achieved BP control with aliskiren (42%) than ramipril (33%; P<0.01). At week 36, fewer patients receiving aliskiren-based therapy required add-on treatment with hydrochlorothiazide or amlodipine (P=0.01 and 0.048, respectively). Tolerability was similar, but more patients receiving ramipril reported cough (P<0.001). In elderly patients with systolic hypertension, aliskiren proved to be more effective and better overall anti-hypertensive therapy compared to ramipril.
TL;DR: Ass associations were not completely consistent across the different vessel beds and for men and women, but generally the same risk factors are present for atherosclerosis in the coronary, aortic arch and carotid circulation.
Abstract: This study was performed to examine the association of cardiovascular risk factors with calcification in the coronary arteries, aortic arch and carotid arteries, assessed by multislice computed tomography (MSCT). This study was embedded in the Rotterdam Study, a population-based study in subjects aged 55 years and over. From October 2003 until December 2004, subjects were invited to undergo a MSCT scan. Coronary, aortic arch and carotid calcification were quantified according to the Agatston score. Analyses were performed in the first 1003 subjects. Age and current smoking were the strongest independent risk factors for arterial calcification. The odds ratio (OR) for age in women, irrespective of the vessel bed, was 1.1 (P<0.001) and in men it was 1.2 with aortic arch and 1.1 with carotid calcification (both P<0.001). Current smoking was associated with aortic arch calcification with an OR of 3.5 in women and of 4.7 in men (both P<0.001); and with carotid calcification with an OR of 2.1 in women (P<0.05) and of 4.1 in men (P<0.01). Hypertension, hypercholesterolemia and diabetes were also independently related to calcification, although not consistent across all vessel beds and for men and women. Obesity tended to be inversely related to arterial calcification in women, whereas low high-density lipoprotein-cholesterol showed no relation with arterial calcification. In conclusion, although associations were not completely consistent across the different vessel beds and for men and women, our results indicate that generally the same risk factors are present for atherosclerosis in the coronary, aortic arch and carotid circulation.
TL;DR: The results support previous evidence for CF to lower BP, however more research is needed to establish the most effective dose and food matrix.
Abstract: Consumption of flavanol-containing cocoa products has been shown to lower blood pressure (BP), but the minimum dose required to reduce BP is not known. This study aimed to examine the effect of three different doses of cocoa flavanols (CF) on 24-h mean arterial BP. Twenty four hour ambulatory BP (24-ABP) monitoring was performed in 32 men and 20 postmenopausal women with untreated mild hypertension (seated clinic BP >130/85 and <160/100 mm Hg). Participants were randomized and instructed to consume daily a reconstituted cocoa beverage containing 33, 372, 712 or 1052 mg day(-1) of CF for 6 weeks in a double-blind, parallel comparison. Seated clinic BP and 24-h ABP were measured at 0, 3 and 6 weeks. Seated clinic BP did not change during the study period. There were significant reductions in 24-h systolic (5.3+/-5.1 mm Hg; P=0.001), diastolic (3+/-3.2 mm Hg; P=0.002) and mean arterial BP (3.8+/-3.2 mm Hg; P=0.0004) at the 1052 mg day(-1) CF only. No reduction in BP was seen at any other dose. No evidence of dose-response was seen in this experiment. The highest dose of 1052 mg CF per day was found to significantly lower BP. These results support previous evidence for CF to lower BP, however more research is needed to establish the most effective dose and food matrix.
TL;DR: In this small-scale study, the DASH diet lowered BP independently of peripheral mechanisms, with significant reductions in systolic and diastolic BP, and in plasma C-reactive protein and apolipoprotein B, a novel finding.
Abstract: We tested whether lowering of blood pressure (BP) on the dietary approaches to stop hypertension (DASH) diet was associated with changes in peripheral vascular function: endothelial function, assessed by flow-mediated vasodilatation (FMD) of the brachial artery, and subcutaneous adipose tissue blood flow (ATBF). We also assessed effects on heart rate variability (HRV) as a measure of autonomic control of the heart. We allocated 27 men and women to DASH diet and control groups. We measured FMD, ATBF and HRV on fasting and after ingestion of 75 g glucose, before and after 30 days on dietary intervention, aiming for weight maintenance. The control group did not change their diet. The DASH-diet group complied with the diet as shown by significant reductions in systolic (P<0.001) and diastolic (P=0.005) BP, and in plasma C-reactive protein (P<0.01), LDL-cholesterol (P<0.01) and apolipoprotein B (P=0.001), a novel finding. Body weight changed by <1 kg. There were no changes in the control group. We found no changes in FMD, or in ATBF, in the DASH-diet group, although heart rate fell (P<0.05). Glucose and insulin concentrations did not change. In this small-scale study, the DASH diet lowered BP independently of peripheral mechanisms.
TL;DR: Findings are consistent with the conclusion that a short-term, autonomic mechanism mediated the observed changes in resting BP, but provided no evidence that regular DGB affected factors involved in long-term BP regulation.
Abstract: Previous studies reported that a device-guided slow-breathing (DGB) exercise decreases resting blood pressure (BP) in hypertensive patients. This study investigated the effects of daily practice of DGB on (a) 24-h BP and breathing patterns in the natural environment, as well as (b) BP and breathing pattern during clinic rest. Altogether, 40 participants with pre-hypertension or stage 1 hypertension were trained to decrease breathing rate through DGB or to passively attend to breathing (control, CTL) during daily 15-min sessions. The participants practiced their breathing exercise at home for 4 weeks. The DGB (but not the CTL) intervention decreased clinic resting BP, mid-day ambulatory systolic BP (in women only) and resting breathing rate, and increased resting tidal volume. However, 24-h BP level was not changed by DGB or CTL interventions, nor was overnight breathing pattern. These findings are consistent with the conclusion that a short-term, autonomic mechanism mediated the observed changes in resting BP, but provided no evidence that regular DGB affected factors involved in long-term BP regulation. Additional research will be needed to determine whether 24-h BP can be lowered by a more prolonged intervention.
TL;DR: Aliskiren 300 mg provided a sustained BP-lowering effect beyond the 24-h dosing interval, with a significantly smaller loss of BP- Lowering effect in the 24–48 h period after dose than irbesartan 300’mg or ramipril 10”mg.
Abstract: Most patients inadvertently miss an occasional dose of antihypertensive therapy, and hence drugs that provide sustained blood-pressure (BP) reduction beyond the 24-h dosing interval are desirable. The primary objective of this study was to compare the 24-h mean ambulatory BP reductions from baseline after a simulated missed dose of the direct renin inhibitor aliskiren, irbesartan or ramipril. In this double-blind study, 654 hypertensive patients (24-h mean ambulatory diastolic BP (MADBP) ⩾85 mm Hg) were randomized 1:1:1 to once-daily aliskiren 150 mg, irbesartan 150 mg or ramipril 5 mg. Doses were doubled after 2 weeks. At day 42, patients were again randomized equally within each group to receive 1 day of placebo (‘missed dose’) on either day 42 or day 49. Patients with a successful 24-h ambulatory BP measurement at baseline and on day 42/49 were included in the analyses. The 24-h mean ambulatory systolic BP (MASBP)/MADBP reductions from baseline after a missed dose of aliskiren 300 mg (9.3/7.0 mm Hg) were similar to irbesartan 300 mg (9.5/7.3 mm Hg) and significantly larger than ramipril 10 mg (7.1/5.0 mm Hg, P⩽0.008). Loss of BP-lowering effect with aliskiren in the 24 h after a missed dose (1.0/0.7 mm Hg for 24–48-h vs 0–24-h MASBP/MADBP) was significantly lower than with irbesartan (3.6/2.2 mm Hg, P<0.01) or ramipril (4.0/2.6, P<0.0001). This equates to maintenance of 91/91% of the MASBP/MADBP-lowering effect with aliskiren, greater than irbesartan (73/77%) or ramipril (64/65%). The incidence of adverse events was similar across treatments (32.9–36.0%), although ramipril treatment was associated with an increased incidence of cough (ramipril, 6.1%; aliskiren, 0.5%; irbesartan, 1.8%). Aliskiren 300 mg provided a sustained BP-lowering effect beyond the 24-h dosing interval, with a significantly smaller loss of BP-lowering effect in the 24–48 h period after dose than irbesartan 300 mg or ramipril 10 mg.
TL;DR: Recently diagnosed treatment-naïve essential hypertensives showed a relationship between the endothelial dysfunction, serum markers of inflammation and remodelling and levels of antioxidant substances, which could be potentially helpful markers of high risk in hypertensive patients.
Abstract: To assess the correlation between endothelial dysfunction and the serum levels of biomarkers of inflammation, remodelling and oxidative stress in essential hypertension, 78 treatment-naive essential hypertensives (mean age 43 years) underwent measurement of endothelial dysfunction, using the maximal acetylcholine-induced forearm vasodilation and serum levels of adhesion molecules, selectins, chemokines, metalloproteinases, copper, zinc, selenium, vitamins, homocysteine, malondialdehyde, erythrocyte glutathione peroxidase and erythrocyte superoxide dismutase. Mean (+/-s.e.m.) maximal acetylcholine-induced vasodilation was 367+/-20%. Patients with a more impaired acetylcholine-dependent vasodilation (first tertile) had increased levels of e-selectin (P=0.009), p-selectin (P<0.001), monocyte chemotactic protein type 1 (MCP-1; P=0.012) and the tissue inhibitor of metalloproteinases type 1 (TIMP-1; P=0.044), which in turn showed significant inverse correlations with maximal endothelium-dependent vasodilation. Serum levels of selenium (P=0.012), vitamin C (P=0.038), erythrocyte glutathione peroxidase (P<0.001) and superoxide dismutase (P=0.022) activities were reduced in patients with a more impaired endothelium-dependent vasodilation. Recently diagnosed treatment-naive essential hypertensives showed a relationship between the endothelial dysfunction, serum markers of inflammation and remodelling and levels of antioxidant substances. These could be potentially helpful markers of high risk in hypertensive patients.
TL;DR: There was no difference in blood pressure reduction when comparing the losartan and candesartan groups during follow-up suggesting that other mechanisms related to different pharmacological properties of the drugs may explain the divergent clinical outcomes.
Abstract: Although angiotensin receptor blockers have different receptor binding properties no comparative studies with cardiovascular disease (CVD) end points have been performed within this class of drugs. The aim of this study was to test the hypothesis that there are blood pressure independent CVD-risk differences between losartan and candesartan treatment in patients with hypertension without known CVD. Seventy-two primary care centres in Sweden were screened for patients who had been prescribed losartan or candesartan between the years 1999 and 2007. Among the 24 943 eligible patients, 14 100 patients were diagnosed with hypertension and prescribed losartan (n=6771) or candesartan (n=7329). Patients were linked to Swedish national hospitalizations and death cause register. There was no difference in blood pressure reduction when comparing the losartan and candesartan groups during follow-up. Compared with the losartan group, the candesartan group had a lower adjusted hazard ratio for total CVD (0.86, 95% confidence interval (CI) 0.77–0.96, P=0.0062), heart failure (0.64, 95% CI 0.50–0.82, P=0.0004), cardiac arrhythmias (0.80, 95% CI 0.65–0.92, P=0.0330), and peripheral artery disease (0.61, 95% CI 0.41–0.91, P=0.0140). No difference in blood pressure reduction was observed suggesting that other mechanisms related to different pharmacological properties of the drugs may explain the divergent clinical outcomes.
TL;DR: It is concluded that true resistant hypertension is associated with silent target organ damage, especially UAE, and assessment of 24 h ambulatory BP is the most accurate way to detect a population with high risk for target-organ damage.
Abstract: Resistant (or refractory) hypertension (RH) is a clinical diagnosis based on blood pressure (BP) office measurements. About one third of subjects with suspected RH have indeed pseudo-resistant hypertension and 24-h ambulatory-blood pressure-monitoring aids to precisely identify them. Our aim was to determine those clinical, laboratory or echocardiographic variables that may be associated with subjects with sustained hypertension (namely true RH). We carried out a cross-sectional analysis of 143 patients consecutively enrolled with the clinical diagnosis of RH. All patients underwent clinicaldemographic, laboratory evaluation, 2D-echocardiography and 24-h ambulatory-blood pressure-monitoring. Pseudoresistant hypertension or white-coat RH was defined if office BP was X140 and/or 90mmHg and 24-h BP o130/ 80mmHg. One-hundred and three (72%) patients had true RH and 40 (28%) patients had white-coat RH. True RH patients had significantly higher diabetes prevalence and higher office-systolic blood pressure (SBP) levels. Regarding target organ damage, left ventricular mass index (LVMI) and 24-h urinary albumin excretion (UAE) were also higher in true RH after adjustment for possible confounders (P ¼0.031 and P ¼0.012, respectively). In a logistic regression analysis, only office-SBP (multivariate OR (95%CI): 1.030 (1.003–1.057), P ¼0.030) and UAE (multivariate OR (95% CI): 2.376 (1.225–4.608), P ¼0.010) were independently associated with true RH. We conclude that true resistant hypertension is associated with silent target organ damage, especially UAE. In patients with suspected RH, assessment of 24 h ambulatory BP is the most accurate way to detect a population with high risk for target-organ damage.
TL;DR: In this paper, the authors investigated the optimal monitoring schedule for home blood pressure (HBP) monitoring that has the greatest prognostic ability and provides the most reliable assessment of HBP.
Abstract: This study investigated the optimal schedule for home blood pressure (HBP) monitoring that has the greatest prognostic ability and provides the most reliable assessment of HBP. The Didima study assessed the value of HBP (duplicate morning and evening measurements, 3 days) in predicting cardiovascular events in the general population (662 adults, 8.2+/-0.2 years follow-up). Criteria for the optimal monitoring schedule were stabilization of mean HBP, its variability (standard deviation (s.d.)) and hazard ratios (HRs) of cardiovascular events per 1 mm Hg HBP increase. By averaging more readings (1-12), there was a progressive decline in average HBP and its s.d. and increase in HR, with most of these benefits achieved on the second day (8 readings) and little additional benefit obtained on the third day (12 readings). The first day gave higher and more unstable HBP values (higher s.d.) with less prognostic ability (lower HR). The first HBP readings per occasion gave higher values but with similar prognostic ability as the second readings taken 1 min later. There was little difference in average HBP between morning and evening readings with no prognostic superiority of morning readings. In conclusion, by averaging more readings the average HBP and its variability are reduced and the prognostic ability improved. Any aspect of HBP monitoring (first or second readings, morning or evening) has similar prognostic ability. The first day gives higher and unstable values with lower prognostic ability and should be better discarded. These data validate the HBP monitoring schedule proposed by the European Society of Hypertension.
TL;DR: It is suggested that higher cardiorespiratory fitness is associated with lower arterial stiffness, BP and RWT in older women.
Abstract: Arterial stiffening, hypertension and left ventricular (LV) remodelling are associated with increased risk of cardiovascular disease. Cardiorespiratory fitness is associated with cardiovascular function and reduced risk of cardiovascular disease. This cross-sectional study was carried out to determine the relationships between cardiorespiratory fitness, arterial stiffness, blood pressure (BP) and LV remodelling in women. On the basis of peak oxygen uptake, a total of 159 premenopausal (young) and postmenopausal (older) women were categorized into either low (unfit) or high (fit) cardiorespiratory fitness groups. The arterial stiffness and LV remodelling were measured by brachial-ankle pulse wave velocity (baPWV) and carotid augmentation index (AI) and LV relative wall thickness (RWT). Two-way analysis of variance indicated a significant interaction between age and cardiorespiratory fitness in baPWV, carotid AI, BP and RWT. In the older group, arterial stiffness (baPWV; 1401+/-231 vs 1250+/-125 cm s(-1), P<0.01, AI; 32.9+/-9.9 vs 24.8+/-10.1%, P<0.01), systolic blood pressure (SBP) (130+/-22 vs 117+/-15 mm Hg, P<0.01) and RWT (0.47+/-0.08 vs 0.42+/-0.04, P<0.05) in fit women were lower than in unfit women. In older women, RWT was significantly related to baPWV (r=0.46, P<0.01), carotid AI (r=0.29, P<0.05), SBP (r=0.57, P<0.01) \[V(2peak) (r=-0.32, P<0.05). In young women, they were not significant correlations, except for a weak correlation between RWT and SBP (r=0.21, P<0.05). These results suggest that higher cardiorespiratory fitness is associated with lower arterial stiffness, BP and RWT in older women.
TL;DR: There are dramatic counterregulatory haemodynamic and hormonal adaptations to maintain a relatively constant BP in men and women with either normal BP or early hypertension.
Abstract: Seasonal variation in blood pressure (BP) has been described in some people, although the variation is small for both systolic and diastolic BPs. The aim of this study was to elucidate underlying haemodynamic and hormonal mechanisms that may occur to defend seasonal changes in BP. Participants were 27 men and 7 women with either normal BP or early hypertension. Measurements of haemodynamics (cardiac output by dual-gas rebreathing) and hormones (resting catecholamines, renin activity, and aldosterone by radioenzymatic assay or radioimmunoassay) were performed during the summer, fall, winter, and spring seasons. Student's paired t-test with Bonferroni modification and regression analyses were used to examine the data with a significance level of P<0.05. Systolic and diastolic BP remained relatively constant across seasons. Cardiac output and stroke volume significantly decreased 10 and 15%, respectively, from summer to winter, whereas heart rate and systemic vascular resistance significantly increased 5 and 11%, respectively. Plasma aldosterone (PA) significantly increased 59% from summer to winter, whereas plasma norepinephrine (PNE), plasma epinephrine, and plasma renin activity (PRA) increased 19, 2, and 17%, respectively (pNS for each). Across the four seasons, mean arterial pressure significantly correlated with PRA and PA, whereas systemic vascular resistance significantly correlated with PNE and PRA. There are dramatic counterregulatory haemodynamic and hormonal adaptations to maintain a relatively constant BP. Norepinephrine, PRA, and aldosterone have a function in mediating the changes in haemodynamics.
TL;DR: Investigation of the prevalence of the MS and its components in the two major forms of PA, in unilateral aldosterone-producing adenoma (APA) and bilateral ald testosterone overproduction because of idiopathic hyperaldosteronism (IHA), found metabolic profiles of patients with bilateral form of PA (because of IHA) were similar to EH, but differed from those in patients with unilateral form of APA.
Abstract: Metabolic syndrome (MS) is frequent clinical condition in patients with hypertension. Primary aldosteronism (PA) is a common form of secondary hypertension. This study was aimed at investigating the prevalence of the MS and its components in the two major forms of PA, in unilateral aldosterone-producing adenoma (APA) and bilateral aldosterone overproduction because of idiopathic hyperaldosteronism (IHA). The diagnosis of the particular form of PA was based on adrenal venous sampling and/or successful surgery confirmed by histopathological examination. We analyzed clinical and laboratory data from 100 patients with PA (50 patients with IHA and 50 patients with APA) and from 90 patients with essential hypertension (EH). Metabolic profiles of patients with bilateral form of PA (because of IHA) were similar to EH, but differed from those in patients with unilateral form of PA (APA). The prevalence of the MS (62% in IHA, 34% in APA and 56% in EH), the body mass index value (30±4 kg m(-2) in IHA, 27±5 kg m(-2) in APA and 29±5 kg m(-2) in EH) and triglycerides levels (1.9±0.9 mmol l(-1) in IHA,1.4±0.8 mmol l(-1) in APA and 2.01±1.39 mmol l(-1) in EH) were all significantly (P<0.05) higher in IHA compared with APA patients. Metabolic profile of patients with bilateral form of PA (because of IHA) is similar to EH in contrast to unilateral form of PA (APA).
TL;DR: The aim of this study is to systematically examine the proportion of accurate readings attained by automatic digital blood pressure (BP) devices in published validation studies, and to provide clinicians and patients with accurate information on which to base diagnostic and treatment decisions.
Abstract: The aim of this study is to systematically examine the proportion of accurate readings attained by automatic digital blood pressure (BP) devices in published validation studies. We included studies of automatic digital BP devices using recognized protocols. We summarized the data as mean and s.d. of differences between measured and observed BP, and proportion of measurements within 5 mm Hg. We included 79 articles (10,783 participants) reporting 113 studies from 22 different countries. Overall, 25/31 (81%), 37/41 (90%) and 34/35 (97%) devices passed the relevant protocols [BHS, AAMI and ESH international protocol (ESH-IP), respectively]. For devices that passed the BHS protocol, the proportion of measured values within 5 mm Hg of the observed value ranged from 60 to 86% (AAMI protocol 47-94% and ESH-IP 54-89%). The results for the same device varied significantly when a different protocol was used (Omron HEM-907 80% of readings were within 5 mm Hg using the AAMI protocol compared with 62% with the ESH-IP). Even devices with a mean difference of zero show high variation: a device with 74% of BP measurements within 5 mm Hg would require six further BP measurements to reduce variation to 95% of readings within 5 mm Hg. Current protocols for validating BP monitors give no guarantee of accuracy in clinical practice. Devices may pass even the most rigorous protocol with as few as 60% of readings within 5 mm Hg of the observed value. Multiple readings are essential to provide clinicians and patients with accurate information on which to base diagnostic and treatment decisions.
TL;DR: These patient-identified inhibitors and enablers of PA can be a useful framework for promoting PA in hypertensive patients, particularly from immigrant groups.
Abstract: Regular physical activity (PA) can reduce blood pressure, but hypertensive patients in ethnic minority populations are often inactive. The objective of this qualitative study was to explore inhibitors and enablers of PA from the perspective of hypertensive Ghanaian, African-Surinamese and White-Dutch patients in Amsterdam, The Netherlands. In-depth individual interviews with 46 patients were analysed for thematic content, using Maxqda software. All three groups mentioned their hypertension, the presence of other health conditions, lack of priority, lack of social support, limited financial resources or access to PA facilities as inhibitors for maintaining or increasing their level of PA. Common enablers included health-related incentives, support from physicians or family and having physically demanding work. Specific inhibitors only mentioned by Ghanaians and Surinamese included inexperience with recommended 'Western' activities (cycling), little access to their habitual forms of PA, cultural preferences for large body sizes, unfamiliarity with the host country and the pressure of social demands from the Dutch society and their own communities. Specific enablers for Ghanaians and Surinamese included access to community or church-based support groups. These patient-identified inhibitors and enablers can be a useful framework for promoting PA in hypertensive patients, particularly from immigrant groups. Physicians may build their advice on the identified enablers and tackle the inhibitors.
TL;DR: In silico analysis of the protein structure, it is shown that the substitution of a polar residue, serine, for a non-polar alanine at amino-acid residue 288 affects a conformational change in ADC, and that Arg172 in PLD2 resides in the PX domain, which is important for membrane trafficking.
Abstract: In this study, we determined the association of 1180 non-synonymous single-nucleotide polymorphisms (SNPs) with systolic blood pressure (SBP) and hypertensive status. A total of 8842 subjects were taken from two community-based cohorts—Ansung (n=4183) and Ansan (n=4659), South Korea—which had been established for genome-wide association studies (GWAS). Five SNPs (rs16835244, rs2286672, rs6265, rs17237198 and rs7312017) were significantly associated (P-values: 0.003–0.0001, not corrected for genome-wide significance) with SBP in both cohorts. Of these SNPs, rs16835244 and rs2286672 correlated with risk for hypertension. The rs16835244 SNP replaces Ala288 in arginine decarboxylase (ADC) with serine, and rs2286672 replaces Arg172 in phospholipase D2 (PLD2) with cysteine. A comparison of peptide sequences between vertebrate homologues revealed that the SNPs identified occur at conserved amino-acid residues. In silico analysis of the protein structure showed that the substitution of a polar residue, serine, for a non-polar alanine at amino-acid residue 288 affects a conformational change in ADC, and that Arg172 in PLD2 resides in the PX domain, which is important for membrane trafficking. These results provide insights into the function of these non-synonymous SNPs in the development of hypertension. The study investigating non-synonymous SNPs from GWAS not only by statistical association analysis but also by biological relevance through the protein structure might be a good approach for identifying genetic risk factors for hypertension, in addition to discovering causative variations.