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Experimental Gerontology Jan 2023The present study aimed to compare the efficacy of different exercises on systolic blood pressure (SBP), diastolic blood pressure (DBP), and aortic pulse wave velocity... (Meta-Analysis)
Meta-Analysis Review
The present study aimed to compare the efficacy of different exercises on systolic blood pressure (SBP), diastolic blood pressure (DBP), and aortic pulse wave velocity (PWV) in postmenopausal women. We searched the China National Knowledge Infrastructure (CNKI), Wanfang database, Web of Science, PubMed, and Cochrane library databases, up to July 2022. The randomized controlled trials (RCTs) were selected following the inclusion criteria. We assessed study quality with the PEDro scale. The Stata software was used for statistical analysis. Twenty-three papers (26 RCTs) and 729 participants were included. Meta-analysis demonstrated that exercise decreased SBP (WMD = -6.74 mmHg, 95%CI: -9.08, -4.41, p = 0.000), DBP (WMD = -4.13 mmHg, 95%CI: -5.78, -2.48, p = 0.000) and aortic PWV (WMD = -0.79 m/s, 95%CI: -1.02, -0.56, p = 0.000). Aerobic exercise can significantly decrease SBP (WMD = -7.97 mmHg, 95%CI: -12.99, -2.60, p = 0.003) and DBP (WMD = -5.97 mmHg, 95%CI: -8.55, -3.39, p = 0.000). Resistance exercise can significantly decrease SBP (WMD = -5.62 mmHg, 95%CI: -9.00, -2.23, p = 0.001), DBP (WMD = -1.87 mmHg, 95%CI: -2.75, -0.99, p = 0.000) and aortic PWV (WMD = -0.67 m/s,95%CI: -0.98, -0.36, p = 0.000). Combined aerobic and resistance exercise can significantly decrease SBP (WMD = -5.42 mmHg, 95%CI: -10.17, -0.68, p = 0.025). The efficacy of mind-body exercise (Tai Chi/Yoga) on SBP, DBP, and aortic PWV were not obvious (p > 0.05). Exercise significantly improved SBP, DBP, and aortic PWV in postmenopausal women. Aerobic exercise decreased SBP and DBP. Resistance exercise decreased SBP, DBP, and aortic PWV. Additionally, further research is required to confirm the efficacy of mind-body exercise (Tai Chi/Yoga) on blood pressure and arterial stiffness.
Topics: Female; Humans; Blood Pressure; Vascular Stiffness; Pulse Wave Analysis; Exercise; Exercise Therapy; Hypertension
PubMed: 36397637
DOI: 10.1016/j.exger.2022.111990 -
International Journal of Cardiology Mar 2017Several intervention studies have investigated the relation between potassium intake and blood-pressure, particularly in hypertensive subjects. However, uncertainties... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several intervention studies have investigated the relation between potassium intake and blood-pressure, particularly in hypertensive subjects. However, uncertainties still exist about the existence and the amount of such an effect, and about the role of some potential effect-modifiers, including the baseline potassium intake and geographical area.
METHODS
We carried out a systematic review of the evidence concerning such relation in hypertensive subjects, performing a meta-analysis and a meta-regression of RCT with selective and validated long-term (≥4weeks) potassium supplementation. We also implemented 'unconventional' search strategies in order to identify all potentially interesting studies.
RESULTS
Overall, potassium supplementation decreased systolic blood pressure of 4.48mmHg (95% CI 3.07-5.90) and diastolic blood pressure of 2.96mmHg (1.10-4.82). There was little evidence of dose-response relation between blood-pressure decrease and potassium supplementation, as assessed through total achieved potassium intake in the intervention groups, difference in achieved potassium intake, and study duration. However, lower (<90mmol/day) potassium intake at baseline was associated with a higher blood-pressure lowering effect, as were higher sodium intake (particularly ≥4g/day), higher sodium-to-potassium ratio and the absence of any anti-hypertensive drug treatment. Trials conducted in Southern Europe showed the highest blood-pressure lowering effect compared with the remaining regions.
CONCLUSIONS
Potassium supplementation in hypertensives was generally associated with decreased blood pressure, particularly in high sodium consumers, subjects not on hypertensive drug treatment, and those in the lowest category of potassium intake. An adequate dietary intake of potassium, in the order of 90mmol/day, should be achieved for blood pressure control.
Topics: Blood Pressure; Dietary Supplements; Humans; Hypertension; Potassium
PubMed: 28024910
DOI: 10.1016/j.ijcard.2016.12.048 -
Hypertension (Dallas, Tex. : 1979) Nov 2023Masked hypertension (MH) occurs when office blood pressure is normal, but hypertension is confirmed using out-of-office blood pressure measures. Hypertension is a risk... (Meta-Analysis)
Meta-Analysis Review
Masked hypertension (MH) occurs when office blood pressure is normal, but hypertension is confirmed using out-of-office blood pressure measures. Hypertension is a risk factor for subclinical cardiovascular outcomes, including left ventricular hypertrophy, increased left ventricular mass index, carotid intima media thickness, and pulse wave velocity. However, the risk factors for ambulatory blood pressure monitoring defined MH and its association with subclinical cardiovascular outcomes are unclear. A systematic literature search on 9 databases included English publications from 1974 to 2023. Pediatric MH prevalence was stratified by disease comorbidities and compared with the general pediatric population. We also compared the prevalence of left ventricular hypertrophy, and mean differences in left ventricular mass index, carotid intima media thickness, and pulse wave velocity between MH versus normotensive pediatric patients. Of 2199 screened studies, 136 studies (n=28 612; ages 4-25 years) were included. The prevalence of MH in the general pediatric population was 10.4% (95% CI, 8.00-12.80). Compared with the general pediatric population, the risk ratio (RR) of MH was significantly greater in children with coarctation of the aorta (RR, 1.91), solid-organ or stem-cell transplant (RR, 2.34), chronic kidney disease (RR, 2.44), and sickle cell disease (RR, 1.33). MH patients had increased risk of subclinical cardiovascular outcomes compared with normotensive patients, including higher left ventricular mass index (mean difference, 3.86 g/m [95% CI, 2.51-5.22]), left ventricular hypertrophy (odds ratio, 2.44 [95% CI, 1.50-3.96]), and higher pulse wave velocity (mean difference, 0.30 m/s [95% CI, 0.14-0.45]). The prevalence of MH is significantly elevated among children with various comorbidities. Children with MH have evidence of subclinical cardiovascular outcomes, which increases their risk of long-term cardiovascular disease.
Topics: Humans; Child; Masked Hypertension; Hypertrophy, Left Ventricular; Blood Pressure Monitoring, Ambulatory; Carotid Intima-Media Thickness; Prevalence; Pulse Wave Analysis; Hypertension; Blood Pressure
PubMed: 37737026
DOI: 10.1161/HYPERTENSIONAHA.123.20967 -
Journal of Hypertension Nov 2014Comprehensive studies have confirmed that particulate matter air pollution could trigger myocardial infarction, heart failure and reduce heart rate variability; however,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Comprehensive studies have confirmed that particulate matter air pollution could trigger myocardial infarction, heart failure and reduce heart rate variability; however, its effect on blood pressure (BP) remains controversial. Therefore, we did a systematic review and meta-analysis to investigate the association and its magnitude between exposure to PM2.5 and BP.
METHODS
The databases of PubMed, Ovid Medline and Embase between 1948 and 15 November 2013 were searched to identify the studies exploring the association between particulate matters (diameter <2.5 μm) (PM2.5) and BP. Selection was performed by screening abstracts and titles and then reviewing the full text of potentially eligible studies. We extracted descriptive and quantitative information from each study and used a random-effects model to calculate BP change and 95% confidence interval (95% CI) for each increment of 10 μg/m in PM2.5. Meta-regression and subgroup analyses were conducted to explore the source of heterogeneity and the impact of possible confounding factors.
RESULTS
Of 1028 identified articles, after screening and reviewing in detail, 22 studies were included in our meta-analysis. The overall analysis suggested that BP was positively related to PM2.5 exposure with an elevation of 1.393 mmHg, 95% CI (0.874-1.912) and 0.895 mmHg, 95% CI (0.49-1.299) per 10 μg/m increase for SBP and DBP, respectively. Long-term exposure showed the strongest associations with BP. And for short-term effect, the largest magnitude was seen at the lag of the previous 5 days average prior to BP measurement. Subgroup analyses yielded consistent results with the overall analyses. Meta-regression of SBP did not identify any significant potential causes of heterogeneity. For DBP, study design, the method of BP monitoring, publication year, study design, study period and sample size were significant modifiers of the relationship between DBP and PM2.5.
CONCLUSION
Exposure to PM2.5 had a statistically significant impact on BP and the magnitude of this effect may have substantially clinical implication.
Topics: Air Pollution; Blood Pressure; Blood Pressure Determination; Environmental Exposure; Humans; Models, Theoretical; Particulate Matter
PubMed: 25250520
DOI: 10.1097/HJH.0000000000000342 -
BMC Geriatrics Dec 2017It remains unclear into which level the systolic blood pressure (SBP) should be lowered in order to provide the best cardiovascular protection among older people.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It remains unclear into which level the systolic blood pressure (SBP) should be lowered in order to provide the best cardiovascular protection among older people. Hypertension guidelines recommendation on attaining SBP levels <150 mmHg in this population is currently based on experts' opinion. To clarify this issue, we systematically reviewed and quantified available evidence on the impact of achieving different SBP levels <150 mmHg on various adverse outcomes in subjects aged ≥60 years old receiving antihypertensive drug treatment.
METHODS
We searched 8 databases to identify randomized controlled trials (RCTs) and post-hoc analyses or subanalyses of RCTs reporting the effects of attaining different SBP levels <150 mmHg on the risk of stroke, acute myocardial infarction, heart failure, cardiovascular mortality and all-cause mortality in participants aged ≥60 years. We performed random-effects meta-analyses stratified by study design.
RESULTS
Eleven studies (> 33,600 participants) were included. Compared with attaining SBP levels ≥140 mmHg, levels of 130 to <140 mmHg were not associated with lower risk of outcomes in the meta-analysis of RCTs, whereas there was an associated reduction of cardiovascular mortality (RR 0.72, 95% CI 0.59-0.88) and all-cause mortality (RR 0.86, 95% CI 0.75-0.99) in the meta-analysis of post-hoc analyses or subanalyses of RCTs. Limited and conflicting data were available for the SBP levels of <130 mmHg and 140 to <150 mmHg.
CONCLUSIONS
Among older people, there is suggestive evidence that achieving SBP levels of 130 to <140 mmHg is associated with lower risks of cardiovascular and all-cause mortality. Future trials are required to confirm these findings and to provide additional evidence regarding the <130 and 140 to <150 mmHg SBP levels.
Topics: Aged; Antihypertensive Agents; Blood Pressure; Cardiovascular Diseases; Humans; Hypertension; Middle Aged; Randomized Controlled Trials as Topic; Risk Reduction Behavior
PubMed: 29207946
DOI: 10.1186/s12877-017-0672-4 -
American Journal of Hypertension Jan 2009We conducted a systematic review to estimate the effect of acupuncture on blood pressure (BP) in hypertensive patients. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We conducted a systematic review to estimate the effect of acupuncture on blood pressure (BP) in hypertensive patients.
METHODS
Electronic literature searches for randomized controlled trials (RCTs) of acupuncture were performed in six electronic databases to June 2007 without language restrictions.
RESULTS
Eleven RCTs testing acupuncture either as an adjunct or an alternative met our inclusion criteria and they showed a wide variety of methodological quality, mainly due to poor reporting. Three sham-controlled trials out of 11 studies were statistically pooled: systolic BP (SBP) change was not statistically significant (mean difference -5 mm Hg, 95% CI (-12, 1), P = 0.12) and acupuncture only marginally reduced diastolic BP (DBP) by 3 mm Hg (95% CI (-6, 0), P = 0.05), but substantial heterogeneity was observed (I(2) = 92% for SBP, I(2) = 79% for DBP). When given with antihypertensive medication, acupuncture significantly reduced SBP (-8 mm Hg, 95% CI (-10, -5), P < 0.00001) and DBP (-4 mm Hg, 95% CI (-6, -2), P < 0.0001) and no heterogeneity between studies was detected. Four studies that investigated acupuncture against antihypertensive medication indicated noninferiority of acupuncture in lowering BP, albeit the quality of them was poor, and their sample sizes were not satisfactory as an equivalence study. Other studies comparing acupuncture with various control procedures had inconsistent findings and most of them were of low methodological quality.
CONCLUSIONS
Considering the limitation of the four positive noninferiority studies and the results of the meta-analysis of the three sham-controlled studies, the notion that acupuncture may lower high BP is inconclusive. More rigorous trials are warranted.
Topics: Acupuncture Therapy; Blood Pressure; Humans; Hypertension; Treatment Outcome
PubMed: 19008863
DOI: 10.1038/ajh.2008.311 -
The Journal of Pediatrics Mar 2020To identify, in children the normal rate of carotid-femoral pulse wave velocity (cfPWV) progression, and whether presence of cardiometabolic risk factors is associated... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To identify, in children the normal rate of carotid-femoral pulse wave velocity (cfPWV) progression, and whether presence of cardiometabolic risk factors is associated with cfPWV.
STUDY DESIGN
Electronic databases (PubMed, Google Scholar) were searched from inception to May 2018, for all studies which reported cfPWV in children (<19 years of age). Random effects meta-regression quantified the association between time (years) and cfPWV, and a systematic review was performed to determine whether cardiometabolic risk factors are associated with cfPWV.
RESULTS
Data from 28 articles were eligible for inclusion, including 9 reference value (n = 13 100), 5 cardiovascular risk (n = 5257), 10 metabolic risk (n = 2999), and 8 obesity-focused (n = 8760) studies. Meta-regression findings (9 studies) showed that the increase in cfPWV per year (age) was 0.12 m/second (95% CI, 0.07-0.16 m/second) per year, and when stratified by sex the CIs overlapped. Systematic review findings showed that cardiometabolic risk factors were positively associated with cfPWV, including positive associations with blood pressure, impaired glucose metabolism, and metabolic syndrome. However, obesity was not consistently associated with cfPWV.
CONCLUSIONS
Arterial stiffness in children progresses with age and is associated with cardiometabolic risk factors. Although further longitudinal studies are warranted, the presented reference data will be valuable to epidemiologists tracking children, and to scientists and clinicians prescribing therapies to mitigate risk in a population that is increasingly more vulnerable to cardiovascular disease.
Topics: Blood Flow Velocity; Blood Pressure; Cardiovascular Diseases; Carotid Arteries; Carotid-Femoral Pulse Wave Velocity; Humans; Obesity; Vascular Stiffness
PubMed: 31810627
DOI: 10.1016/j.jpeds.2019.10.065 -
Pediatric Research Feb 2022Central pulse wave velocity (cPWV) is a biomarker for cardiovascular (CV) risk and a predictor for CV events in adulthood. Alterations of arterial stiffness have also... (Meta-Analysis)
Meta-Analysis
Central pulse wave velocity (cPWV) is a biomarker for cardiovascular (CV) risk and a predictor for CV events in adulthood. Alterations of arterial stiffness have also been associated with CV risk in childhood. The study aimed to systematically review and meta-analyze the association of blood pressure (BP), body mass index (BMI), and cardiorespiratory fitness (CRF) with cPWV in children. Literature search was through the databases PubMed, Web of Science, Embase and the Cochrane Register of Controlled Trials. Twenty-two articles were included in the systematic review and eight articles in the meta-analysis. Higher systolic and diastolic BP were associated with higher cPWV (pooled estimated effect size (ES) 0.02 (95% CI: 0.012-0.027; P < 0.001), and ES 0.02 (95% CI: 0.011-0.029; P < 0.001); respectively). Higher BMI correlated with higher cPWV (ES 0.025 (95% CI: 0.013-0.038; P < 0.001)). CRF was inversely associated with cPWV (ES -0.033 (95% CI: -0.055 to -0.011; P = 0.002)). In children, higher BP and BMI are already related to increased cPWV, and enhanced CRF may be a preventive strategy to counteract development of CV disease later in life. IMPACT: This meta-analysis suggests that elevated blood pressure and body mass index in childhood correlate with increased central pulse wave velocity. Children with higher cardiorespiratory fitness appear to have favorably lower arterial stiffening. Elevated blood pressure and altered arterial stiffness originate early in life and childhood risk stratification as well as timely initiation of exercise treatment may help counteract development of manifest cardiovascular disease later in life.
Topics: Adult; Blood Pressure; Cardiovascular Diseases; Child; Exercise; Humans; Hypertension; Obesity; Pulse Wave Analysis; Vascular Stiffness
PubMed: 33824443
DOI: 10.1038/s41390-020-01278-5 -
Stroke Oct 2011Recent studies have shown that visit-to-visit blood pressure variability is a powerful risk factor for stroke, is reduced by calcium channel blockers and diuretics, and... (Review)
Review
BACKGROUND AND PURPOSE
Recent studies have shown that visit-to-visit blood pressure variability is a powerful risk factor for stroke, is reduced by calcium channel blockers and diuretics, and increased by β-blockers. However, it is unknown whether these effects are dose-dependent and persist in combination with other drugs.
METHODS
Cochrane and Medline databases were searched for systematic reviews and randomized controlled trials of antihypertensive drugs. Eligible trials randomized all patients to a combination of drug classes or different doses of the same drug. Baseline and follow-up data for mean (SD) systolic blood pressure (SBP) and diastolic blood pressure were extracted. Differences in interindividual variance (SD2) in blood pressure were expressed as a ratio (VR). Estimates were pooled by random-effects meta-analysis.
RESULTS
Calcium channel blockers reduced interindividual variability in SBP when added to another agent (VR, 0.75; 95% CI, 0.64 to 0.87; P=0.0002; 12 trials; 1565 patients) with a smaller reduction with diuretics (VR, 0.85; 0.71 to 1.01; P=0.07; 17 trials; 3217 patients). Adding other agents to calcium channel blockers did not significantly affect SBP variability (VR, 1.06; 0.83 to 1.34; P=0.65; 12 trials; 1460 patients) despite a 5.8-mm Hg reduction in mean SBP. Randomization to a higher dose of calcium channel blockers reduced SBP variability (VR, 0.84; 0.74 to 0.94; P=0.004; 25 trials; 2179 patients), whereas randomization to a higher dose of β-blockers increased SBP variability (VR, 1.31; 1.01 to 1.69; P=0.034; 6 trials; 486 patients).
CONCLUSIONS
Effects of antihypertensive drugs on SBP variability are dose-dependent and persist when used in combinations. Use of a high dose of a calcium channel blocker alone or in combination with other agents is therefore likely to be particularly effective in prevention of stroke.
Topics: Antihypertensive Agents; Blood Pressure; Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans; Hypertension
PubMed: 21817143
DOI: 10.1161/STROKEAHA.110.611566 -
Journal of the American Society of... Mar 2016Ambulatory blood pressure monitoring (ABPM) is more commonly recommended for assessing out-of-clinic blood pressure (BP) than home blood pressure monitoring (HBPM). We... (Review)
Review
Ambulatory blood pressure monitoring (ABPM) is more commonly recommended for assessing out-of-clinic blood pressure (BP) than home blood pressure monitoring (HBPM). We conducted a systematic review to examine whether ABPM or HBPM is more strongly associated with cardiovascular disease events and/or mortality. Of 1007 abstracts published through July 20, 2015, nine articles, reporting results from seven cohorts, were identified. After adjustment for BP on HBPM, BP on ABPM was associated with an increased risk of outcomes in two of four cohorts for systolic blood pressure and two of three cohorts for diastolic blood pressure. After adjustment for BP on ABPM, systolic blood pressure on HBPM was associated with outcomes in zero of three cohorts; an association was present in one of two cohorts for diastolic blood pressure on HBPM. There is a lack of strong empiric evidence supporting ABPM or HBPM over the other approach for predicting cardiovascular events or mortality.
Topics: Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiovascular Diseases; Cohort Studies; Humans; Hypertension; Observational Studies as Topic
PubMed: 26822864
DOI: 10.1016/j.jash.2015.12.013