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Pregnancy Hypertension Mar 2022Gestational hypertensive complications are preceded by deviant hemodynamic adjustments affecting blood pressure. Our objective was to determine the timing and magnitude... (Meta-Analysis)
Meta-Analysis
Gestational hypertensive complications are preceded by deviant hemodynamic adjustments affecting blood pressure. Our objective was to determine the timing and magnitude of changes in blood pressure during singleton normotensive and hypertensive pregnancies. PubMed (NCBI) and Embase (Ovid) databases were searched for relevant studies up to November 2019. Studies reporting original blood pressure measurements during pregnancy together with a non-pregnant reference measurement were included. Studies including women with a history of cardiovascular or metabolic disease, or women using antihypertensive drugs were excluded. Pooled mean differences between pregnant and non-pregnant women, and absolute blood pressure values were calculated for predefined gestational intervals in normotensive and hypertensive pregnancy, using a random-effects model. Meta-regression analysis was used to analyze group differences in adjustments. In early normotensive pregnancy, both systolic and diastolic blood pressure decreased, reaching their maximum reduction of -4 mmHg (95%CI -6 to -1 mmHg) and -4 mmHg (95%CI, -5 to -3 mmHg), respectively in the second trimester. Thereafter, blood pressure gradually increased towards non-pregnant values. All absolute blood pressure measurements throughout normotensive pregnancy were below 130/80 mmHg. In hypertensive pregnancies, only diastolic blood pressure decreased early in pregnancy. In conclusion, this meta-analysis showed a clinically moderate, but significant mid-pregnancy drop in blood pressure during normotensive pregnancy. Reference curves with absolute values underscore the current liberal cut-off limit for gestational hypertension. A lack of a mid-pregnancy systolic blood pressure drop might reflect increased vascular resistance in women destined to develop hypertensive pregnancy complications.
Topics: Blood Pressure; Female; Gestational Age; Humans; Hypertension, Pregnancy-Induced; Pregnancy; Reference Values
PubMed: 34929556
DOI: 10.1016/j.preghy.2021.12.004 -
British Journal of Clinical Pharmacology Dec 2015Sulodexide is a highly purified mixture of glycosaminoglycans that has been studied for its anti-albuminuric potential. Considering the effects of glycosaminoglycans on... (Meta-Analysis)
Meta-Analysis Review
AIMS
Sulodexide is a highly purified mixture of glycosaminoglycans that has been studied for its anti-albuminuric potential. Considering the effects of glycosaminoglycans on endothelial function and sodium homeostasis, we hypothesized that sulodexide may lower blood pressure (BP). In this meta-analysis, we therefore investigated the antihypertensive effects of sulodexide treatment.
METHODS
We selected randomized controlled trials that investigated sulodexide treatment of at least 4 weeks and measured BP at baseline and after treatment. Two reviewers independently extracted data on study design, risk of bias, population characteristics and outcome measures. In addition, we contacted authors and pharmaceutical companies to provide missing data.
RESULTS
Eight studies, totalling 3019 subjects (mean follow-up 4.4 months) were included. Mean age was 61 years and mean baseline BP was 135/75 mmHg. Compared with control treatment, sulodexide resulted in a significant systolic (2.2 mmHg [95% CI 0.3, 4.1], P = 0.02) and diastolic BP reduction (1.7 mmHg [95% CI 0.6, 2.9], P = 0.004). Hypertensive patients displayed the largest systolic BP and diastolic BP reductions (10.2/5.4 mmHg, P < 0.001). Higher baseline systolic and diastolic BP were significantly associated with larger systolic (r(2)=0.83, P < 0.001) and diastolic BP (r(2)=0.41, P = 0.02) reductions after sulodexide treatment. In addition, systolic (r(2)=0.41, P = 0.03) and diastolic BP reductions (r(2)=0.60, P = 0.005) were significantly associated with albuminuria reduction.
CONCLUSION
Our data suggest that sulodexide treatment results in a significant BP reduction, especially in hypertensive subjects. This indicates that endothelial glycosaminoglycans might be an independent therapy target in cardiovascular disease. Future studies should further address the BP lowering potential of sulodexide.
Topics: Aged; Antihypertensive Agents; Blood Pressure; Dose-Response Relationship, Drug; Endothelium, Vascular; Female; Glycosaminoglycans; Humans; Male; Middle Aged; Nitric Oxide
PubMed: 26184982
DOI: 10.1111/bcp.12722 -
Arquivos Brasileiros de Cardiologia Mar 2023Central blood pressure (cBP) is considered an independent predictor of organ damage, cardiovascular events and all-cause mortality. Evidence has shown that high... (Meta-Analysis)
Meta-Analysis
Central blood pressure (cBP) is considered an independent predictor of organ damage, cardiovascular events and all-cause mortality. Evidence has shown that high intensity interval training (HIIT) is superior to moderate-intensity continuous training (MICT) for improving cardiorespiratory fitness and vascular function. However, the effects of these aerobic training modalities on cBP have not yet been properly reviewed.This meta-analysis aims to investigate to effects of HIIT versus MICT on cBP.We conducted a meta-analysis of randomized controlled trials that compared HIIT versus MICT on cBP. Primary outcomes were measures of central systolic blood pressure (cSBP) and central diastolic blood pressure (cDBP). Peripheral systolic blood pressure (pSBP) and diastolic blood pressure (pDBP), pulse wave velocity (PWV) and maximal oxygen uptake (VO2max) were analyzed as second outcomes. Meta-analysis of mean differences (MD) was conducted using the random effects model.Our study included 163 patients enrolled in six trials. We found that HIIT was superior to MICT in reducing the cSBP (MD = -3.12 mmHg, 95% CI: -4.75 to -1.50, p = 0.0002) and SBP (MD = -2.67 mmHg, 95% CI: -5.18 to -0.16, p = 0.04), and increasing VO2max(MD = 2.49 mL/kg/min, 95% CI: 1.25 to 3.73, p = 0.001). However, no significant differences were reported for cDBP, DBP and PWV.HIIT was superior to MICT in reducing the cSBP, which suggests its potential role as a non-pharmacological therapy for high blood pressure.
Topics: Humans; Blood Pressure; High-Intensity Interval Training; Pulse Wave Analysis; Hypertension; Cardiorespiratory Fitness
PubMed: 37098987
DOI: 10.36660/abc.20220398 -
BMC Pregnancy and Childbirth Aug 2023Hypertensive disorders of pregnancy (HDP) can significantly impact maternal, neonatal, and fetal health. For controlling these disorders, frequent blood pressure... (Meta-Analysis)
Meta-Analysis Review
An evaluation of the efficacy and the safety of home blood pressure monitoring in the control of hypertensive disorders of pregnancy in both pre and postpartum periods: a systematic review and meta-analysis.
BACKGROUND
Hypertensive disorders of pregnancy (HDP) can significantly impact maternal, neonatal, and fetal health. For controlling these disorders, frequent blood pressure measurements are required. Home blood pressure monitoring (HBPM) is a suggested alternative to conventional office monitoring that requires frequent visits. This systematic review was conducted to evaluate the efficacy and safety of HBPM in the control of HDP.
METHODS
We systematically conducted databases search for relevant studies in June 2022. The relevant studies were identified, and qualitative synthesis was performed. An inverse variance quantitative synthesis was conducted using RevMan software. Continuous outcome data were pooled as means differences, whereas dichotomous ones were summarized as risk ratios. The 95% confidence interval was the measure of variance.
RESULTS
Fifteen studies were included in our review (n = 5335). Our analysis revealed a superiority of HBPM in reducing the risk of induction of labor, and postpartum readmission (P = 0.02, and 0.01 respectively). Moreover, the comparison of birth weights showed a significant variation in favor of HBPM (P = 0.02). In the analysis of other outcomes, HBPM was equally effective as office monitoring. Furthermore, HBPM did not result in an elevated risk of maternal, neonatal, and fetal adverse outcomes.
CONCLUSION
Home monitoring of blood pressure showed superiority over office monitoring in some outcomes and equal efficacy in other outcomes.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Hypertension, Pregnancy-Induced; Blood Pressure Monitoring, Ambulatory; Hypertension; Pre-Eclampsia; Blood Pressure; Postpartum Period
PubMed: 37528352
DOI: 10.1186/s12884-023-05663-w -
European Journal of Epidemiology Feb 2023Elevated blood pressure and hypertension have been associated with increased risk of atrial fibrillation in a number of epidemiological studies, however, the strength of... (Meta-Analysis)
Meta-Analysis Review
Elevated blood pressure and hypertension have been associated with increased risk of atrial fibrillation in a number of epidemiological studies, however, the strength of the association has differed between studies. We conducted a systematic review and meta-analysis of the association between blood pressure and hypertension and atrial fibrillation. PubMed and Embase databases were searched for studies of hypertension and blood pressure and atrial fibrillation up to June 6th 2022. Cohort studies reporting adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) of atrial fibrillation associated with hypertension or blood pressure were included. A random effects model was used to estimate summary RRs. Sixty eight cohort studies were included in the meta-analysis. The summary RR was 1.50 (95% CI: 1.42-1.58, I = 98.1%, n = 56 studies) for people with hypertension compared to those without hypertension (1,080,611 cases, 30,539,230 participants), 1.18 (95% CI: 1.16-1.21, I = 65.9%, n = 37 studies) per 20 mmHg increase in systolic blood pressure (346,471 cases, 14,569,396 participants), and 1.07 (95% CI: 1.03-1.11, I = 91.5%, n = 22 studies) per 10 mmHg increase in diastolic blood pressure (332,867 cases, 14,354,980 participants). There was evidence of a nonlinear association between diastolic blood pressure and atrial fibrillation with a steeper increase in risk at lower levels of diastolic blood pressure, but for systolic blood pressure the association appeared to be linear. For both systolic and diastolic blood pressure, the risk increased even within the normal range of blood pressure and persons at the high end of systolic and diastolic blood pressure around 180/110 mmHg had a 1.8-2.3 fold higher risk of atrial fibrillation compared to those with a blood pressure of 90/60 mmHg. These results suggest that elevated blood pressure and hypertension increases the risk of atrial fibrillation and there is some increase in risk even within the normal range of systolic and diastolic blood pressure.
Topics: Humans; Blood Pressure; Atrial Fibrillation; Hypertension; Cohort Studies
PubMed: 36626102
DOI: 10.1007/s10654-022-00914-0 -
The Cochrane Database of Systematic... Dec 2016Many antihypertensive agents exist today for the treatment of primary hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Many antihypertensive agents exist today for the treatment of primary hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or both). Randomised controlled trials (RCTs) have been carried out to investigate the evidence for these agents. There is, for example, strong RCT evidence that thiazides reduce mortality and morbidity. Some of those trials used reserpine as a second-line therapy. However, the dose-related blood pressure reduction with this agent is not known.
OBJECTIVES
The primary objective of this review was to quantify the dose-related efficacy of reserpine versus placebo or no treatment in reducing systolic blood pressure (SBP) or diastolic blood pressure (DBP), or both.We also aimed to evaluate the dose-related effects of reserpine on mean arterial blood pressure (MAP) and heart rate (HR), as well as the dose-related effects on withdrawals due to adverse events.
SEARCH METHODS
We searched the Cochrane Hypertension Group Specialised Register (January 1946 to October 2016), CENTRAL (2016, Issue 10), MEDLINE (January 1946 to October 2016), Embase (January 1974 to October 2016), and ClinicalTrials.gov (all dates to October 2016). We also traced citations in the reference sections of the retrieved studies.
SELECTION CRITERIA
Included studies were truly randomised controlled trials (RCTs) comparing reserpine monotherapy to placebo or no treatment in participants with primary hypertension.
DATA COLLECTION AND ANALYSIS
We assessed methods of randomisation and concealment. We extracted and analysed data on blood pressure reduction, heart rate, and withdrawal due to adverse effects.
MAIN RESULTS
We found four RCTs (with a total of 237 participants) that met the inclusion criteria, none of which we found through the 2016 update search. The overall pooled effect demonstrates a statistically significant systolic blood pressure (SBP) reduction in participants taking reserpine compared with placebo (weighted mean difference (WMD) -7.92, 95% confidence interval (CI) -14.05 to -1.78). Because of significant heterogeneity across the trials, a significant effect in diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) could not be found. A dose of reserpine 0.5 mg/day or greater achieved the SBP effects. However, we could not determine the dose-response pattern because of the small number of trials. We did not combine data from the trial that investigated Rauwiloid against placebo with reserpine data from the remaining three trials. This is because Rauwiloid is a different alkaloid extract of the plant Rauwolfia serpentina, and the dose used is not comparable to reserpine. None of the included trials reported withdrawals due to adverse effects.
AUTHORS' CONCLUSIONS
Reserpine is effective in reducing SBP roughly to the same degree as other first-line antihypertensive drugs. However, we could not make definite conclusions regarding the dose-response pattern because of the small number of included trials. More RCTs are needed to assess the effects of reserpine on blood pressure and to determine the dose-related safety profile before the role of this drug in the treatment of primary hypertension can be established.
Topics: Antihypertensive Agents; Blood Pressure; Heart Rate; Humans; Hypertension; Randomized Controlled Trials as Topic; Rauwolfia; Reserpine
PubMed: 27997978
DOI: 10.1002/14651858.CD007655.pub3 -
European Journal of Clinical Nutrition Nov 2023The effect of time-restricted eating (TRE) has been summarized in previous studies, but its benefits in combination with calorie restriction (CR) still need to be... (Meta-Analysis)
Meta-Analysis Review
The effect of time-restricted eating (TRE) has been summarized in previous studies, but its benefits in combination with calorie restriction (CR) still need to be determined. The present meta-analysis aimed to evaluate the efficacy of TRE with CR on weight loss and cardiometabolic risk. PubMed, Embase, Cochrane Library, and gray literature databases were searched from inception to October 18, 2022, for potential randomized controlled trial (RCT) studies based on predefined inclusion and exclusion criteria. Body weight and other cardiometabolic risk factors were described as weighted mean difference (WMD) with a 95% confidence interval (CI). Eight RCTs involving 579 participants were enrolled in the present analysis. The pooled results showed that TRE with CR reduced the body weight, fat mass, and waist circumference significantly (WMD: -1.40, 95% CI: -1.81 to -1.00, and I: 0%; WMD: -0.73, 95% CI: -1.39 to -0.07, and I: 0%; WMD: -1.87, 95% CI: -3.47 to -0.26, and I: 67.25%, respectively). However, compared with CR alone, TRE plus CR exhibited no significant benefit on the blood pressure, glucose profile, and lipid profile. Subgroup analysis suggested that early TRE is more effective in weight loss (WMD: -1.42, 95% CI: -1.84 to -1.01, and I: 0%) and improving fat mass (WMD: -1.06, 95% CI: -1.91 to -0.22, and I: 0%) than delayed or broader TRE when combined with CR. Although the combination of TRE and CR can effectively decrease body weight, fat mass, and waist circumference, the long-term effects, particularly those on cardiometabolic risk in participants with chronic cardiovascular disease and diabetes, remain to be explored.
Topics: Humans; Caloric Restriction; Body Weight; Weight Loss; Cardiovascular Diseases; Blood Pressure
PubMed: 37488260
DOI: 10.1038/s41430-023-01311-w -
Women's Health (London, England) 2023Regular exercise performed during pregnancy has been shown to reduce the risk of developing perinatal gestational hypertensive conditions. Further evidence on the exact... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Regular exercise performed during pregnancy has been shown to reduce the risk of developing perinatal gestational hypertensive conditions. Further evidence on the exact parameters of exercise needed to explain these beneficial responses is required, within both uncomplicated and at-risk pregnancies.
OBJECTIVE
The aim of this systematic review and meta-analysis was to investigate the effects of aerobic and resistance exercise on blood pressure during pregnancy.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES AND METHODS
An online search of six search engines was conducted up to February 2023. Randomized controlled trials, quasi-experimental, cohort, and longitudinal studies were included. Studies included an acute exercise bout or intervention of land-based aerobic and/or resistance exercise during any trimester in uncomplicated and at-risk pregnancies. Outcomes included mean arterial pressure (MAP), or systolic blood pressure (SBP) and diastolic blood pressure (DBP).
RESULTS
Following the removal of duplicates, 1538 articles were screened with 59 studies meeting the inclusion criteria for the review (randomized controlled trials (RCTs) n = 34, clinical trials n = 19, cohort n = 5 and cross-sectional n = 2), and 21 studies included in the meta-analysis. A random effects model was used with mean difference calculated in mmHg. Overall, there were no statistically significant effects of exercise on resting blood pressure (BP) outcomes in pregnant women with normal blood pressure compared to control/usual care populations following intervention (SBP mean diff -1.54 mmHg (favours intervention), p = 0.38; DBP mean diff -2.25 mmHg (favours intervention), p = 0.1; MAP mean diff -1.75 mmHg (favours intervention), p = 0.31). In at-risk pregnant women, both aerobic and combination exercise significantly reduced BP outcomes compared to control (SBP mean diff -3.91 mmHg, p < 0.01; DBP mean diff -2.9 mmHg, p = 0.01; MAP mean diff -2.38 mmHg, p = 0.01). Twenty-seven studies reported an acute increase in SBP and DBP during aerobic exercise, with no difference found between uncomplicated and at-risk pregnancies.
CONCLUSIONS
Compared to usual care, aerobic and/or resistance exercise performed throughout uncomplicated pregnancy had no influence on blood pressure. Pregnant women with no diagnosed complications should be encouraged to exercise regularly due to the multitude of known benefits. In women who are at risk of, or diagnosed, with gestational hypertensive conditions during pregnancy, moderate to vigorous exercise during pregnancy improves blood pressure outcomes. Higher risk pregnancies may reduce their risk of future cardiovascular complications through regular exercise training during pregnancy.
REGISTRATION
CRD42020159998.
Topics: Pregnancy; Female; Humans; Blood Pressure; Resistance Training; Hypertension; Exercise
PubMed: 37455490
DOI: 10.1177/17455057231183573 -
Hypertension (Dallas, Tex. : 1979) Nov 2021[Figure: see text]. (Meta-Analysis)
Meta-Analysis
[Figure: see text].
Topics: Blood Pressure; Cognitive Dysfunction; Dementia; Humans; Hypertension; Risk
PubMed: 34538105
DOI: 10.1161/HYPERTENSIONAHA.121.17797 -
Frontiers in Bioscience (Landmark... Dec 2021Both stress and hypertension (HTN) are considered major health problems that negatively impact the cerebral vasculature. In this article we summarize the possible... (Review)
Review
OBJECTIVES
Both stress and hypertension (HTN) are considered major health problems that negatively impact the cerebral vasculature. In this article we summarize the possible relationship between stress and HTN.
METHODS
We conducted a systematic review of the literature using a database search of MEDLINE, PubMed, Scopus, and Web of Science.
RESULTS
Psychological stress is known to be an important risk factor for essential hypertension. Acute stress can induce transient elevations of blood pressure in the context of the fight-or-flight response. With increased intensity and duration of a perceived harmful event, the normal physiological response is altered, resulting in a failure to return to the resting levels. These changes are responsible for the development of HTN. Genetic and behavioral factors are also very important for the pathogenesis of hypertension under chronic stress situation. In addition, HTN and chronic stress may lead to impaired auto-regulation, regional vascular remodeling, and breakdown of the blood brain barrier (BBB). The effects of both HTN and chronic stress on the cerebral blood vessels shows that both have common structural and functional effects including endothelial damage with subsequent increased wall thickness, vessel resistance, stiffness, arterial atherosclerosis, and altered hemodynamics.
CONCLUSION
Most of the above mentioned vascular effects of stress were primarily reported in animal models. Further in-vivo standardization of pathological vascular indices and imaging modalities is warranted. Radiological quantification of these cerebrovascular changes is therefore essential for in depth understanding of the healthy and diseased cerebral arteries functions, identification and stratification of patients at risk of cardiovascular and neurological adverse events, enactment of preventive measures prior to the onset of systemic HTN, and the initiation of personalized medical management.
Topics: Animals; Blood Pressure; Humans; Hypertension; Vascular Remodeling
PubMed: 34994178
DOI: 10.52586/5057