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EBioMedicine Jun 2023Arterial stiffening is central to the vascular ageing process and a powerful predictor and cause of diverse vascular pathologies and mortality. We investigated age and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Arterial stiffening is central to the vascular ageing process and a powerful predictor and cause of diverse vascular pathologies and mortality. We investigated age and sex trajectories, regional differences, and global reference values of arterial stiffness as assessed by pulse wave velocity (PWV).
METHODS
Measurements of brachial-ankle or carotid-femoral PWV (baPWV or cfPWV) in generally healthy participants published in three electronic databases between database inception and August 24th, 2020 were included, either as individual participant-level or summary data received from collaborators (n = 248,196) or by extraction from published reports (n = 274,629). Quality was appraised using the Joanna Briggs Instrument. Variation in PWV was estimated using mixed-effects meta-regression and Generalized Additive Models for Location, Scale, and Shape.
FINDINGS
The search yielded 8920 studies, and 167 studies with 509,743 participants from 34 countries were included. PWV depended on age, sex, and country. Global age-standardised means were 12.5 m/s (95% confidence interval: 12.1-12.8 m/s) for baPWV and 7.45 m/s (95% CI: 7.11-7.79 m/s) for cfPWV. Males had higher global levels than females of 0.77 m/s for baPWV (95% CI: 0.75-0.78 m/s) and 0.35 m/s for cfPWV (95% CI: 0.33-0.37 m/s), but sex differences in baPWV diminished with advancing age. Compared to Europe, baPWV was substantially higher in the Asian region (+1.83 m/s, P = 0.0014), whereas cfPWV was higher in the African region (+0.41 m/s, P < 0.0001) and differed more by country (highest in Poland, Russia, Iceland, France, and China; lowest in Spain, Belgium, Canada, Finland, and Argentina). High vs. other country income was associated with lower baPWV (-0.55 m/s, P = 0.048) and cfPWV (-0.41 m/s, P < 0.0001).
INTERPRETATION
China and other Asian countries featured high PWV, which by known associations with central blood pressure and pulse pressure may partly explain higher Asian risk for intracerebral haemorrhage and small vessel stroke. Reference values provided may facilitate use of PWV as a marker of vascular ageing, for prediction of vascular risk and death, and for designing future therapeutic interventions.
FUNDING
This study was supported by the excellence initiative VASCage funded by the Austrian Research Promotion Agency, by the National Science Foundation of China, and the Science and Technology Planning Project of Hunan Province. Detailed funding information is provided as part of the Acknowledgments after the main text.
Topics: Humans; Male; Female; Ankle Brachial Index; Pulse Wave Analysis; Vascular Stiffness; Blood Pressure; China
PubMed: 37229905
DOI: 10.1016/j.ebiom.2023.104619 -
Journal of Clinical Hypertension... Jul 2019The study aims to evaluate the effectiveness of different durations of aerobic exercise on hypertensive patients. Four electronic databases (PubMed, Embase, Cochrane... (Meta-Analysis)
Meta-Analysis
The study aims to evaluate the effectiveness of different durations of aerobic exercise on hypertensive patients. Four electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) were searched from their inception until July 2018. English publications and randomized controlled trials involving aerobic exercise treatment for hypertensive population were included. Two reviewers independently extracted the data. The Cochrane's Risk of Bias tool was used to assess the quality of included studies. In this systematic review, a total of 14 articles were included, involving 860 participants. The quality of the included studies ranged from moderate to high. The results of the meta-analysis showed that compared with the control group, significant effects of aerobic exercise were observed on reducing systolic blood pressure (SBP) (mean difference [MD] = -12.26 mm Hg, 95% confidence interval [CI] = -15.17 to -9.34, P < 0.05), diastolic blood pressure (DBP; MD = -6.12 mm Hg, 95% CI = -7.76 to -4.48, P < 0.05), and heart rate (MD = -4.96 bpm, 95% CI = -6.46 to -3.43, P < 0.05). In addition, significant reductions were observed in ambulatory DBP (MD = -4.90 mm Hg, 95% CI = -8.55 to -1.25, P < 0.05) and ambulatory SBP (MD = -8.77mm Hg, 95% CI = -13.97 to -3.57, P < 0.05). Therefore, aerobic exercise might be an effective treatment for blood pressure improvement in hypertensive patients. However, the effectiveness between the duration of different treatment needs to be well-designed and rigorous studies will be required to verify the dataset.
Topics: Blood Pressure; Duration of Therapy; Exercise; Exercise Therapy; Humans; Hypertension; Randomized Controlled Trials as Topic
PubMed: 31169988
DOI: 10.1111/jch.13583 -
Sleep Medicine Reviews Oct 2022Obstructive sleep apnea (OSA) is an established risk factor for high blood pressure (BP) in adults. However, it remains unclear whether the same association could be... (Meta-Analysis)
Meta-Analysis Review
Obstructive sleep apnea (OSA) is an established risk factor for high blood pressure (BP) in adults. However, it remains unclear whether the same association could be found in children and adolescents. Therefore, we conducted a systematic review and meta-analysis of observational studies to evaluate the associations between childhood OSA and BP outcomes. The review protocol was registered in PROSPERO (CRD42021225683). We performed a systematic literature search to identify relevant cross-sectional and longitudinal studies up to July 6, 2021. Of the 4902 identified articles, a total of 12 cross-sectional studies and 2 cohort studies were included in the final analyses. In the cross-sectional analyses, the mean systolic BP (SBP) were significantly higher in children with mild or moderate-to-severe OSA compared to the healthy controls, and these effects were more pronounced during the nighttime. In prospective studies, moderate-to-severe childhood OSA was associated with a risk of elevated SBP in adulthood (Mean difference = 4.02 mm Hg, 95% CI = 1.32 to 6.72). Taken together, our results suggest that moderate-to-severe childhood OSA is associated with a higher risk of adverse SBP outcomes. Early detection and treatment of OSA may promote cardiovascular health in children and adolescents and possibly in future adulthood.
Topics: Adolescent; Adult; Blood Pressure; Child; Cross-Sectional Studies; Humans; Hypertension; Polysomnography; Prospective Studies; Sleep Apnea, Obstructive
PubMed: 36087456
DOI: 10.1016/j.smrv.2022.101663 -
British Journal of Sports Medicine Jul 2019To compare the effect of exercise regimens and medications on systolic blood pressure (SBP). (Meta-Analysis)
Meta-Analysis
How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure.
OBJECTIVE
To compare the effect of exercise regimens and medications on systolic blood pressure (SBP).
DATA SOURCES
Medline (via PubMed) and the Cochrane Library.
ELIGIBILITY CRITERIA
Randomised controlled trials (RCTs) of angiotensin-converting enzyme inhibitors (ACE-I), angiotensin-2 receptor blockers (ARBs), β-blockers, calcium channel blockers (CCBs) and diuretics were identified from existing Cochrane reviews. A previously published meta-analysis of exercise interventions was updated to identify recent RCTs that tested the SBP-lowering effects of endurance, dynamic resistance, isometric resistance, and combined endurance and resistance exercise interventions (up to September 2018).
DESIGN
Random-effects network meta-analysis.
OUTCOME
Difference in mean change from baseline SBP between comparator treatments (change from baseline in one group minus that in the other group) and its 95% credible interval (95% CrI), measured in mmHg.
RESULTS
We included a total of 391 RCTs, 197 of which evaluated exercise interventions (10 461 participants) and 194 evaluated antihypertensive medications (29 281 participants). No RCTs compared directly exercise against medications. While all medication trials included hypertensive populations, only 56 exercise trials included hypertensive participants (≥140 mmHg), corresponding to 3508 individuals. In a 10% random sample, risk of bias was higher in exercise RCTs, primarily due to lack of blinding and incomplete outcome data. In analyses that combined all populations, antihypertensive medications achieved higher reductions in baseline SBP compared with exercise interventions (mean difference -3.96 mmHg, 95% CrI -5.02 to -2.91). Compared with control, all types of exercise (including combination of endurance and resistance) and all classes of antihypertensive medications were effective in lowering baseline SBP. Among hypertensive populations, there were no detectable differences in the SBP-lowering effects of ACE-I, ARB, β-blocker and diuretic medications when compared with endurance or dynamic resistance exercise. There was no detectable inconsistency between direct and indirect comparisons. Although there was evidence of small-study effects, this affected both medication and exercise trials.
CONCLUSIONS
The effect of exercise interventions on SBP remains under-studied, especially among hypertensive populations. Our findings confirm modest but consistent reductions in SBP in many studied exercise interventions across all populations but individuals receiving medications generally achieved greater reductions than those following structured exercise regimens. Assuming equally reliable estimates, the SBP-lowering effect of exercise among hypertensive populations appears similar to that of commonly used antihypertensive medications. Generalisability of these findings to real-world clinical settings should be further evaluated.
Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Blood Pressure; Calcium Channel Blockers; Diuretics; Exercise; Humans; Hypertension; Network Meta-Analysis
PubMed: 30563873
DOI: 10.1136/bjsports-2018-099921 -
Current Hypertension Reports Jul 2023Accumulating data on the consumption of plant-based diets and their impact on blood pressure indicate a consensus that plant-based diets are linked to reduced blood... (Review)
Review
PURPOSE OF REVIEW
Accumulating data on the consumption of plant-based diets and their impact on blood pressure indicate a consensus that plant-based diets are linked to reduced blood pressure. The suggested mechanisms of action are manifold, and, in this systematic review, we provide a summary of the most recent findings on plant-based diets and their impact on blood pressure, along with an analysis of the molecules accountable for the observed effects.
RECENT FINDINGS
The overwhelming majority of intervention studies demonstrate that plant-based diets result in lower blood pressure readings when compared to diets that are based on animal products. The various mechanisms of action are being clarified. The data discussed in this systematic review allow us to conclude that plant-based diets are associated with lower blood pressure and overall better health outcomes (namely, on the cardiovascular system) when compared to animal-based diets. The mechanisms of action are being actively investigated and involve many macro- and micronutrients plentiful in plants and the dishes prepared with them.
Topics: Animals; Humans; Blood Pressure; Hypertension; Diet; Cardiovascular System; Diet, Vegetarian
PubMed: 37178356
DOI: 10.1007/s11906-023-01243-7 -
PloS One 2023Whether food source or energy mediates the effect of fructose-containing sugars on blood pressure (BP) is unclear. We conducted a systematic review and meta-analysis of... (Meta-Analysis)
Meta-Analysis
Whether food source or energy mediates the effect of fructose-containing sugars on blood pressure (BP) is unclear. We conducted a systematic review and meta-analysis of the effect of different food sources of fructose-containing sugars at different levels of energy control on BP. We searched MEDLINE, Embase and the Cochrane Library through June 2021 for controlled trials ≥7-days. We prespecified 4 trial designs: substitution (energy matched substitution of sugars); addition (excess energy from sugars added); subtraction (excess energy from sugars subtracted); and ad libitum (energy from sugars freely replaced). Outcomes were systolic and diastolic BP. Independent reviewers extracted data. GRADE assessed the certainty of evidence. We included 93 reports (147 trial comparisons, N = 5,213) assessing 12 different food sources across 4 energy control levels in adults with and without hypertension or at risk for hypertension. Total fructose-containing sugars had no effect in substitution, subtraction, or ad libitum trials but decreased systolic and diastolic BP in addition trials (P<0.05). There was evidence of interaction/influence by food source: fruit and 100% fruit juice decreased and mixed sources (with sugar-sweetened beverages [SSBs]) increased BP in addition trials and the removal of SSBs (linear dose response gradient) and mixed sources (with SSBs) decreased BP in subtraction trials. The certainty of evidence was generally moderate. Food source and energy control appear to mediate the effect of fructose-containing sugars on BP. The evidence provides a good indication that fruit and 100% fruit juice at low doses (up to or less than the public health threshold of ~10% E) lead to small, but important reductions in BP, while the addition of excess energy of mixed sources (with SSBs) at high doses (up to 23%) leads to moderate increases and their removal or the removal of SSBs alone (up to ~20% E) leads to small, but important decreases in BP in adults with and without hypertension or at risk for hypertension. Trial registration: Clinicaltrials.gov: NCT02716870.
Topics: Adult; Humans; Fructose; Blood Pressure; Fruit; Sugars; Hypertension
PubMed: 37582096
DOI: 10.1371/journal.pone.0264802 -
The Science of the Total Environment Apr 2022Many studies have investigated the association between greenspaces and blood pressure (BP), but the results remain mixed. We conducted a systematic review and... (Meta-Analysis)
Meta-Analysis Review
Many studies have investigated the association between greenspaces and blood pressure (BP), but the results remain mixed. We conducted a systematic review and meta-analysis to comprehensively evaluate the evidence concerning greenspaces with BP levels and prevalent hypertension. Systematic literature searches were performed in Web of Science, PubMed, and Embase up to 25 April 2021. Combined effect estimates were calculated using random-effect models for each greenspace exposure assessment method that had been examined in ≥3 studies. Sensitivity analysis, subgroup analysis, and publication bias were also conducted. Of 38 articles (including 52 analyses, 5.2 million participants in total) examining the effects of normalized difference vegetation index (NDVI) (n = 23), proportion of greenspace (n = 11), distance to greenspace (n = 9), and others (n = 9) were identified. Most studies (65%) reported beneficial associations between greenspaces and BP levels/hypertension. Our results of meta-analyses showed that higher NDVI was significantly associated with lower levels of systolic blood pressure (SBP = -0.77 mmHg, 95%CI: -1.23 to -0.32) and diastolic blood pressure (DBP = -0.32 mmHg, 95%CI: -0.57 to -0.07). We also found that NDVI in different buffers and the proportion of greenspaces were significantly associated with lower odds (1-9%) of hypertension. However, no significant effect was found for distance to greenspaces. In summary, our results indicate the beneficial effects of greenspace exposure on BP and hypertension. However, future better-designed studies, preferably longitudinal, are needed to confirm and better quantify the observed benefits in BP and/or hypertension.
Topics: Blood Pressure; Humans; Hypertension; Parks, Recreational
PubMed: 35016929
DOI: 10.1016/j.scitotenv.2021.152513 -
Clinical Research in Cardiology :... Aug 2016Recent evidence suggests that pulse pressure (PP) is a strong cardiovascular diseases' risk factor. We systematically evaluated all relevant studies to determine whether... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recent evidence suggests that pulse pressure (PP) is a strong cardiovascular diseases' risk factor. We systematically evaluated all relevant studies to determine whether PP can be used as an independent predictor of stroke and mortality.
METHODS AND RESULTS
A meta-analysis was performed by searching the published literature using MEDLINE, Cochrane and Google Scholar databases up to December 15, 2015. We measured the effect size expressed by hazard ratio (HR) and 95 % confidence interval (95 % CI). Eleven publications were included in the analysis. Pooled results demonstrated that 10 mmHg increase in PP was associated with increased risk of stroke occurrence (pooled HR 1.046, 95 % CI 1.025-1.068, P < 0.001). Additionally, systolic blood pressure (SBP) (pooled HR 1.053, 95 % CI 1.033-1.073, P < 0.001) and diastolic blood pressure (DPB) (pooled HR 1.056, 95 % CI 1.038-1.074, P < 0.001) were found to be significant predictors for stroke. We did not find a significant association between PP and all-cause mortality (pooled HR 1.022, 95 % CI 0.983-1.063, P = 0.270). We found SBP (pooled HR 1.008, 95 % CI 1.002-1.014, P = 0.012), but not DBP (pooled HR 1.023, 95 % CI 0.964-1.085, P = 0.451) to be significantly associated with all-cause mortality.
CONCLUSIONS
Current data confirms that PP is an independent risk factor for stroke but is not a predictor of mortality.
Topics: Adult; Aged; Aged, 80 and over; Blood Pressure; Female; Humans; Hypertension; Male; Middle Aged; Prognosis; Risk Assessment; Risk Factors; Stroke
PubMed: 26902972
DOI: 10.1007/s00392-016-0972-2 -
Sleep Medicine Reviews Oct 2018Insomnia is a prevalent sleep disorder that is associated with a multitude of health consequences. Particularly, insomnia has been associated with cardiovascular disease... (Review)
Review
Insomnia is a prevalent sleep disorder that is associated with a multitude of health consequences. Particularly, insomnia has been associated with cardiovascular disease and its precursors, such as hypertension and blood pressure (BP) non-dipping. The present systematic review aimed to summarize the evidence on the concurrent and prospective associations between insomnia and hypertension and/or BP. Using electronic search engines (PubMed, SCOPUS, PsycINFO), 5,618 articles published from January 1970 to December 2017 were identified, and 64 met the inclusion criteria (26 to 162,121 participants; age range: 18-100; 46.4% male). Insomnia was based on diagnostic or non-diagnostic criteria. Hypertension was based on self-or physician-reports, antihypertensive medication use, and/or measured BP. Findings indicate that when insomnia is frequent, chronic, and/or accompanied with short sleep duration or objective markers of arousal, there is a strong association with hypertension/BP. Based on limited studies, hypertension did not significantly predict future insomnia in middle-aged adults, but did in older adults. Based on a majority of case-control studies, no differences in BP were found between participants with and without insomnia. Further research is needed to identify putative pathophysiological mechanisms underlying the link between insomnia and hypertension. The impact of insomnia therapy on BP should also be further examined in the future.
Topics: Antihypertensive Agents; Blood Pressure; Humans; Hypertension; Risk Factors; Sleep Initiation and Maintenance Disorders; Time Factors
PubMed: 29576408
DOI: 10.1016/j.smrv.2018.02.003 -
Journal of Alternative and... Sep 2017To introduce research that presents scientific evidence regarding the effects of mantra and mindfulness meditation techniques and yoga on decreasing blood pressure (BP)... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To introduce research that presents scientific evidence regarding the effects of mantra and mindfulness meditation techniques and yoga on decreasing blood pressure (BP) in patients who have hypertension.
METHODS
A literature search was performed to identify all studies published between 1946 and 2014 from periodicals indexed in Ovid Medline, EMBASE, CINAHL, PsycINFO, KoreaMed, and NDSL by using the following keywords: "hypertension," "blood pressure," "psychotherapy," "relaxation therapy," "meditation," "yoga," and "mind-body therapy." The Cochrane's Risk of Bias was applied to assess the internal validity of the randomized controlled trial studies. Thirteen studies were analyzed in this meta-analysis by using Review Manager 5.3.
RESULTS
Among 510 possible studies, 13 met the selection criteria. Seven examined meditation, and six examined yoga. The meta-analysis indicated that meditation and yoga appeared to decrease both systolic and diastolic BP, which were within similar baseline ranges, and the reduction was statistically significant; however, some results showed little difference. After an in-depth analysis of those results, BP range and patient age were revealed as the factors that affected the different results in some reports. In particular, meditation played a noticeable role in decreasing the BP of subjects older than 60 years of age, whereas yoga seemed to contribute to the decrease of subjects aged less than 60 years.
CONCLUSIONS
While acknowledging the limitations of this research due to the differences in BP and the participants' ages, meditation and yoga are demonstrated to be effective alternatives to pharmacotherapy. Given that BP decreased with the use of meditation and yoga, and this effect varied in different age groups, scientifically measured outcomes indicate that these practices are safe alternatives in some cases.
Topics: Adult; Aged; Aged, 80 and over; Blood Pressure; Female; Humans; Hypertension; Male; Meditation; Middle Aged; Relaxation Therapy; Yoga; Young Adult
PubMed: 28384004
DOI: 10.1089/acm.2016.0234