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Journal of Hypertension Sep 2023The aim was to study if children following preeclampsia (PE) develop alterations in blood pressure (BP) and arterial stiffness already early in life, and how this is... (Clinical Trial)
Clinical Trial
OBJECTIVES
The aim was to study if children following preeclampsia (PE) develop alterations in blood pressure (BP) and arterial stiffness already early in life, and how this is associated with gestational, perinatal and child cardiovascular risk profiles.
METHODS
One hundred eighty-two PE (46 early-onset with diagnosis before 34 gestational weeks, and 136 late-onset) and 85 non-PE children were assessed 8-12 years from delivery. Office and 24-h ambulatory BP, body composition, anthropometrics, lipids, glucose, inflammatory markers, and tonometry-derived pulse wave velocity (PWV) and central BPs were assessed.
RESULTS
Office BP, central BPs, 24-h systolic BP (SBP) and pulse pressure (PP) were higher in PE compared with non-PE. Early-onset PE children had the highest SBP, SBP-loads, and PP. SBP nondipping during night-time was common among PE. The higher child 24-h mean SBP among PE was explained by maternal SBP at first antenatal visit and prematurity (birth weight or gestational weeks), but child 24-h mean PP remained related with PE and child adiposity after adjustments. Central and peripheral PWVs were elevated in late-onset PE subgroup only and attributed to child age and anthropometrics, child and maternal office SBP at follow-up, but relations with maternal antenatal SBPs and prematurity were not found. There were no differences in body anthropometrics, composition, or blood parameters.
CONCLUSIONS
PE children develop an adverse BP profile and arterial stiffness early in life. PE-related BP is related with maternal gestational BP and prematurity, whereas arterial stiffness is determined by child characteristics at follow-up. The alterations in BP are pronounced in early-onset PE.Clinical Trial Registration information: https://clinicaltrials.gov/ct2/show/NCT04676295ClinicalTrials.gov Identifier: NCT04676295.
Topics: Child; Female; Humans; Pregnancy; Arterial Pressure; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiovascular Diseases; Heart Disease Risk Factors; Hypertension; Pre-Eclampsia; Pulse Wave Analysis; Risk Factors; Vascular Stiffness
PubMed: 37337860
DOI: 10.1097/HJH.0000000000003485 -
Clinical and Experimental Hypertension... Dec 2023This study aimed to explore whether circadian rhythm of blood pressure is associated with brachial-ankle pulse wave velocity (baPWV) and brachial artery flow-mediated...
OBJECTIVE
This study aimed to explore whether circadian rhythm of blood pressure is associated with brachial-ankle pulse wave velocity (baPWV) and brachial artery flow-mediated dilation (FMD) in patients with essential hypertension.
METHOD
This cross-sectional study included 4,217 patients with essential hypertension who completed 24-hour ambulatory blood pressure monitoring, baPWV, and FMD. BaPWV and FMD were measured to evaluate arterial stiffness and endothelial dysfunction. Participants were divided into dipper, non-dipper, and reverse dipping groups according to the nocturnal systolic blood pressure dipping percentage.
RESULTS
In this study, baPWV was highest in the reverse dipping groups, followed by non-dipper and dipper groups (1667.11 ± 327.90 vs. 1613.88 ± 325.11 vs. 1577.45 ± 306.15 cm/s, < .001) and FMD gradually increased (4.41 ± 2.87 vs. 4.70 ± 2.84 vs. 4.92 ± 2.79%, = .001). baPWV and FMD were significantly associated with declining nocturnal systolic blood pressure (SBP). Interestingly, FMD (β = 0.042, = .014) was only positively associated with a drop in nocturnal SBP decline in patients <65 years of age. Whereas baPWV was consistently negatively associated with nocturnal SBP decline regardless of age (β = -0.065, < .001, age <65 years; β = -0.149, = .002, age ≥ 65). Receiver operating characteristics (ROC) curves analysis showed areas under the curve (AUC) of baPWV/FMD for predicting circadian rhythm of blood pressure are 0.562/0.554 with a sensitivity of 51.7%/53.9% and specificity of 56.4%/53.4.
CONCLUSION
Impairment of baPWV and FMD were correlated with abnormal circadian rhythm of blood pressure in essential hypertension, suggesting a decrease in nighttime SBP may associate with endothelial function and arterial stiffness.
Topics: Humans; Aged; Blood Pressure; Hypertension; Ankle Brachial Index; Blood Pressure Monitoring, Ambulatory; Cross-Sectional Studies; Pulse Wave Analysis; Essential Hypertension; Circadian Rhythm; Dilatation, Pathologic; Vascular Stiffness
PubMed: 37358045
DOI: 10.1080/10641963.2023.2229535 -
Journal of Hypertension Nov 2023Low ocular perfusion pressure (OPP), which depends on the mean arterial pressure (MAP) and intraocular pressure (IOP), is associated with glaucoma. We studied 24-h MAP...
BACKGROUND
Low ocular perfusion pressure (OPP), which depends on the mean arterial pressure (MAP) and intraocular pressure (IOP), is associated with glaucoma. We studied 24-h MAP dysregulations and OPP in relation to the progression of glaucoma damage.
METHODS
We retrospectively analyzed 155 normal-tension glaucoma (NTG) and 110 primary open-angle glaucoma (POAG) patients aged 18 years old followed at the University Hospital Leuven with repeated visual field tests ( n = 7000 measures, including both eyes) who underwent 24-h ambulatory blood pressure monitoring. Twenty-four-hour MAP dysregulations were variability independent of the mean (VIM), and the five lowest dips in MAP readings over 24 h. OPP was the difference between 2/3 of the MAP and IOP. Glaucoma progression was the deterioration of the visual field, expressed as decibel (dB) changes in mean deviation analyzed by applying multivariable linear mixed regression models.
RESULTS
The mean age was 68 years (53% were women). High 24-h VIMmap was associated with glaucoma progression in POAG ( P < 0.001) independently of the 24-h MAP level. The estimated changes in mean deviation in relation to dip MAP measures ranged from -2.84 dB [95% confidence interval (CI) -4.12 to -1.57] to -2.16 dB (95% CI -3.46 to -0.85) in POAG. Reduced OPP along with high variability and dips in MAP resulted in worse mean deviation deterioration.
CONCLUSION
The progression of glaucoma damage associates with repetitive and extreme dips in MAP caused by high variability in MAP throughout 24 h. This progression exacerbates if 24-h MAP dysregulations occur along with reduced OPP.
Topics: Humans; Female; Aged; Adolescent; Male; Glaucoma, Open-Angle; Blood Pressure; Retrospective Studies; Blood Pressure Monitoring, Ambulatory; Intraocular Pressure; Perfusion
PubMed: 37694533
DOI: 10.1097/HJH.0000000000003537 -
Journal of the American Heart... Aug 2023BACKGROUND Renal denervation has proven its efficacy to lower blood pressure in comparison to sham treatment in recent randomized clinical trials. Although there is a...
BACKGROUND Renal denervation has proven its efficacy to lower blood pressure in comparison to sham treatment in recent randomized clinical trials. Although there is a large body of evidence for the durability and safety of radiofrequency-based renal denervation, there are a paucity of data for endovascular ultrasound-based renal denervation (uRDN). We aimed to assess the long-term efficacy and safety of uRDN in a single-center cohort of patients. METHODS AND RESULTS Data from 2 previous studies on uRDN were pooled. Ambulatory 24-hour blood pressure measurements were taken before as well as 3, 6, 12, and 24 months after treatment with uRDN. A total of 130 patients (mean age 63±9 years, 24% women) underwent uRDN. After 3, 6, 12, and 24 months, systolic mean 24-hour ambulatory blood pressure values were reduced by 10±12, 10±14, 8±15, and 10±15 mm Hg, respectively, when compared with baseline (<0.001). Corresponding diastolic values were reduced by 6±8, 6±8, 5±9, and 6±9 mm Hg, respectively (<0.001). Periprocedural adverse events occurred in 16 patients, and all recovered without sequelae. CONCLUSIONS In this single-center study, uRDN effectively lowered blood pressure up to 24 months after treatment.
Topics: Humans; Female; Middle Aged; Aged; Male; Hypertension; Blood Pressure; Antihypertensive Agents; Blood Pressure Monitoring, Ambulatory; Renal Artery; Treatment Outcome; Kidney; Sympathectomy; Denervation
PubMed: 37581398
DOI: 10.1161/JAHA.123.030767 -
Journal of the American Heart... Jun 2023Background Blood pressure variability (BPV) is predictive of cerebrovascular disease and dementia, possibly though cerebral hypoperfusion. Higher BPV is associated with... (Clinical Trial)
Clinical Trial
Background Blood pressure variability (BPV) is predictive of cerebrovascular disease and dementia, possibly though cerebral hypoperfusion. Higher BPV is associated with cerebral blood flow (CBF) decline in observational cohorts, but relationships in samples with strictly controlled blood pressure remain understudied. We investigated whether BPV relates to change in CBF in the context of intensive versus standard antihypertensive treatment. Methods and Results In this post hoc analysis of the SPRINT MIND (Systolic Blood Pressure Intervention Trial-Memory and Cognition in Decreased Hypertension) trial, 289 participants (mean, 67.6 [7.6 SD] years, 38.8% women) underwent 4 blood pressure measurements over a 9-month period after treatment randomization (intensive versus standard) and pseudo-continuous arterial spin labeling magnetic resonance imaging at baseline and ≈4-year follow-up. BPV was calculated as tertiles of variability independent of mean. CBF was determined for whole brain, gray matter, white matter, hippocampus, parahippocampal gyrus, and entorhinal cortex. Linear mixed models examined relationships between BPV and change in CBF under intensive versus standard antihypertensive treatment. Higher BPV in the standard treatment group was associated with CBF decline in all regions (ß comparing the first versus third tertiles of BPV in whole brain: -0.09 [95% CI, -0.17 to -0.01]; =0.03), especially in medial temporal regions. In the intensive treatment group, elevated BPV was related to CBF decline only in the hippocampus (ß, -0.10 [95% CI, -0.18, -0.01]; =0.03). Conclusions Elevated BPV is associated with CBF decline, especially under standard blood pressure-lowering strategies. Relationships were particularly robust in medial temporal regions, consistent with prior work using observational cohorts. Findings highlight the possibility that BPV remains a risk for CBF decline even in individuals with strictly controlled mean blood pressure levels. Registration URL: http://clinicaltrials.gov. Identifier: NCT01206062.
Topics: Female; Humans; Male; Antihypertensive Agents; Blood Pressure; Brain; Cerebrovascular Circulation; Hypertension
PubMed: 37301768
DOI: 10.1161/JAHA.123.029797 -
Clinical and Experimental Hypertension... Dec 2023To explore the relationship between diurnal blood pressure (BP) pattern and season.
AIMS
To explore the relationship between diurnal blood pressure (BP) pattern and season.
METHODS
A total of 6765 eligible patients (average age 57.35 ± 15.53 years; male 51.8%; hypertensives 68.8%) from 1 October 2016 to 6 April 2022 were enrolled, who were divided into four dipper groups, dipper, non-dipper, riser, and extreme-dipper, according to the diurnal BP pattern calculated using their ambulatory BP monitoring data. The season which the patient was in was determined by the time of ambulatory BP monitoring examination.
RESULTS
Among the 6765 patients, 2042 (31.18%) were grouped into dipper, 380 (5.6%) into extreme-dipper, 1498 (22.1%) into riser and 2845 (42.1%) into non-dipper. Only the dipper subjects showed age difference among seasons, with the average age significantly lower in winter. There was no seasonal difference in age for the other types. No seasonal difference was revealed in gender, BMI, hypertension or not. Diurnal BP patterns significantly differed among seasons ( < .001). Post hoc tests with Bonferroni correction indicated the significantly different diurnal BP pattern between any two seasons ( < .001), but not between spring and autumn ( = .257), and the significance of the value was assessed at 0.008 (0.05/6) after Bonferroni correction. Multinomial logistic regression suggested season as an independent contributor to diurnal BP pattern.
CONCLUSION
Diurnal BP pattern is influenced by season.
Topics: Humans; Male; Adult; Middle Aged; Aged; Blood Pressure; Seasons; Circadian Rhythm; Risk Factors; Hypertension; Blood Pressure Monitoring, Ambulatory
PubMed: 37337968
DOI: 10.1080/10641963.2023.2224952 -
European Review For Medical and... Aug 2023The increasing prevalence of obesity in children and adolescents has turned hypertension into an important public health issue. In the current literature, auscultatory...
OBJECTIVE
The increasing prevalence of obesity in children and adolescents has turned hypertension into an important public health issue. In the current literature, auscultatory blood pressure measurement is recommended for the diagnosis of hypertension. The number of studies comparing electronic blood pressure measurement and auscultatory blood pressure measurement is limited. This study aimed to compare auscultatory blood pressure measurement with electronic blood pressure measurement in the children population group aged 5-15 years.
PATIENTS AND METHODS
A total of 72 patients aged between 5-15 years without chronic disease were included in the study. Anthropometric measurements (height, weight, body mass index, wrist circumference, mid-upper arm circumference) were performed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were first measured electronically from the wrist using an Omron Rs7 Intelli It HEM-6232T device, and then auscultatory measurements were performed. Each type of measurement was performed 3 times intermittently.
RESULTS
The mean wrist circumference was 14.43±0.22 cm and the mean mid-upper arm circumference was 21.43±0.55 cm. Mean SBP, DBP and MAP measured electronically on the wrist were 104.1±1.5, 65.6±1.3 and 78.1±1.3 mmHg, respectively, and mean SBP, DBP and MAP measured via auscultation were 99.3±1, 61.4±0.7 and 73.6±0.7 mmHg, respectively. Electronically-measured wrist MAP had significantly moderate correlations with mid-upper arm and wrist circumference (r:0.547, r:0.559, p<0.01).
CONCLUSIONS
Since the differences were less than 4 mmHg in both systolic and diastolic pressures between electronic wrist blood pressure (EWBP) measurement and auscultatory measurement, it appears that electronic measurement may be important in first line of blood pressure screening. Since it is easy and practical to use in the early period, it may be an alternative approach to auscultatory measurement among non-critical pediatric patients.
Topics: Adolescent; Humans; Child; Child, Preschool; Wrist; Blood Pressure; Pediatric Obesity; Auscultation; Hypertension; Electronics; Protein Kinase Inhibitors
PubMed: 37667947
DOI: 10.26355/eurrev_202308_33423 -
Current Hypertension Reports Jan 2024Nocturnal hypertension and non-dipping are both associated with increased cardiovascular risk; however, debate remains over which is a better prognosticator of... (Review)
Review
PURPOSE OF REVIEW
Nocturnal hypertension and non-dipping are both associated with increased cardiovascular risk; however, debate remains over which is a better prognosticator of cardiovascular outcomes. This review explores current literature on nocturnal hypertension and non-dipping to assess their relationship to cardiovascular disease and implications for clinical practice.
RECENT FINDINGS
While current data remain inconclusive, some suggest that nocturnal hypertension is a more reliable and clinically significant marker of cardiovascular risk than non-dipping status. Importantly, reducing nocturnal HTN and non-dipping through chronotherapy, specifically evening dosing of antihypertensives, has not been conclusively shown to provide long-term cardiovascular benefits. Recent data suggests that non-dipping, compared to nocturnal hypertension, may be falling out of favor as a prognostic indicator for adverse cardiovascular outcomes. However, additional information is needed to understand how aberrant nighttime blood pressure patterns modulate cardiovascular risk to guide clinical management.
Topics: Humans; Hypertension; Blood Pressure; Circadian Rhythm; Blood Pressure Monitoring, Ambulatory; Antihypertensive Agents
PubMed: 37955827
DOI: 10.1007/s11906-023-01273-1 -
Hypertension Research : Official... Aug 2023Automated cuff measured blood pressure (BP) is the global standard used for diagnosing hypertension, but there are concerns regarding the accuracy of the method....
Automated cuff measured blood pressure (BP) is the global standard used for diagnosing hypertension, but there are concerns regarding the accuracy of the method. Individual variability in systolic BP (SBP) amplification from central (aorta) to peripheral (brachial) arteries could be related to the accuracy of cuff BP, but this has never been determined and was the aim of this study. Automated cuff BP and invasive brachial BP were recorded in 795 participants (74% male, aged 64 ± 11 years) receiving coronary angiography at five independent research sites (using seven different automated cuff BP devices). SBP amplification was recorded invasively by catheter and defined as brachial SBP minus aortic SBP. Compared with invasive brachial SBP, cuff SBP was significantly underestimated (130 ± 18 mmHg vs. 138 ± 22 mmHg, p < 0.001). The level of SBP amplification varied significantly among individuals (mean ± SD, 7.3 ± 9.1 mmHg) and was similar to level of difference between cuff and invasive brachial SBP (mean difference -7.6 ± 11.9 mmHg). SBP amplification explained most of the variance in accuracy of cuff SBP (R = 19%). The accuracy of cuff SBP was greatest among participants with the lowest SBP amplification (p < 0.001). After cuff BP values were corrected for SBP amplification, there was a significant improvement in the mean difference from the intra-arterial standard (p < 0.0001) and in the accuracy of hypertension classification according to 2017 ACC/AHA guideline thresholds (p = 0.005). The level of SBP amplification is a critical factor associated with the accuracy of conventional automated cuff measured BP.
Topics: Female; Humans; Male; Arterial Pressure; Blood Pressure; Blood Pressure Determination; Brachial Artery; Hypertension; Middle Aged; Aged
PubMed: 37217732
DOI: 10.1038/s41440-023-01311-0 -
Biomedical and Environmental Sciences :... Jun 2023Current clinical evidence on the effects of home blood pressure telemonitoring (HBPT) on improving blood pressure control comes entirely from developed countries. Thus,... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Current clinical evidence on the effects of home blood pressure telemonitoring (HBPT) on improving blood pressure control comes entirely from developed countries. Thus, we performed this randomized controlled trial to evaluate whether HBPT plus support (patient education and clinician remote hypertension management) improves blood pressure control more than usual care (UC) in the Chinese population.
METHODS
This single-center, randomized controlled study was conducted in Beijing, China. Patients aged 30-75 years were eligible for enrolment if they had blood pressure [systolic (SBP) ≥ 140 mmHg and/or diastolic (DBP) ≥ 90 mmHg; or SBP ≥ 130 mmHg and/or DBP ≥ 80 mmHg with diabetes]. We recruited 190 patients randomized to either the HBPT or the UC groups for 12 weeks. The primary endpoints were blood pressure reduction and the proportion of patients achieving the target blood pressure.
RESULTS
Totally, 172 patients completed the study, the HBPT plus support group ( = 84), and the UC group ( = 88). Patients in the plus support group showed a greater reduction in mean ambulatory blood pressure than those in the UC group. The plus support group had a significantly higher proportion of patients who achieved the target blood pressure and maintained a dipper blood pressure pattern at the 12th week of follow-up. Additionally, the patients in the plus support group showed lower blood pressure variability and higher drug adherence than those in the UC group.
CONCLUSION
HBPT plus additional support results in greater blood pressure reduction, better blood pressure control, a higher proportion of dipper blood pressure patterns, lower blood pressure variability, and higher drug adherence than UC. The development of telemedicine may be the cornerstone of hypertension management in primary care.
Topics: Humans; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Hypertension; Telemedicine; Hypotension
PubMed: 37424245
DOI: 10.3967/bes2023.063