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The New England Journal of Medicine Apr 1997It is known that obesity, sodium intake, and alcohol consumption factors influence blood pressure. In this clinical trial, Dietary Approaches to Stop Hypertension, we... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
It is known that obesity, sodium intake, and alcohol consumption factors influence blood pressure. In this clinical trial, Dietary Approaches to Stop Hypertension, we assessed the effects of dietary patterns on blood pressure.
METHODS
We enrolled 459 adults with systolic blood pressures of less than 160 mm Hg and diastolic blood pressures of 80 to 95 mm Hg. For three weeks, the subjects were fed a control diet that was low in fruits, vegetables, and dairy products, with a fat content typical of the average diet in the United States. They were then randomly assigned to receive for eight weeks the control diet, a diet rich in fruits and vegetables, or a "combination" diet rich in fruits, vegetables, and low-fat dairy products and with reduced saturated and total fat. Sodium intake and body weight were maintained at constant levels.
RESULTS
At base line, the mean (+/-SD) systolic and diastolic blood pressures were 131.3+/-10.8 mm Hg and 84.7+/-4.7 mm Hg, respectively. The combination diet reduced systolic and diastolic blood pressure by 5.5 and 3.0 mm Hg more, respectively, than the control diet (P<0.001 for each); the fruits-and-vegetables diet reduced systolic blood pressure by 2.8 mm Hg more (P<0.001) and diastolic blood pressure by 1.1 mm Hg more than the control diet (P=0.07). Among the 133 subjects with hypertension (systolic pressure, > or =140 mm Hg; diastolic pressure, > or =90 mm Hg; or both), the combination diet reduced systolic and diastolic blood pressure by 11.4 and 5.5 mm Hg more, respectively, than the control diet (P<0.001 for each); among the 326 subjects without hypertension, the corresponding reductions were 3.5 mm Hg (P<0.001) and 2.1 mm Hg (P=0.003).
CONCLUSIONS
A diet rich in fruits, vegetables, and low-fat dairy foods and with reduced saturated and total fat can substantially lower blood pressure. This diet offers an additional nutritional approach to preventing and treating hypertension.
Topics: Adult; Blood Pressure; Dairy Products; Diet; Dietary Fats; Feeding Behavior; Fruit; Humans; Hypertension; Meat; Treatment Outcome; Vegetables
PubMed: 9099655
DOI: 10.1056/NEJM199704173361601 -
Journal of the American College of... Mar 2021Standard blood pressure control metrics may not account for fluctuations in blood pressure over time. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Standard blood pressure control metrics may not account for fluctuations in blood pressure over time.
OBJECTIVES
This study sought to estimate the independent association between time in systolic blood pressure target range and major adverse cardiovascular events among adults with hypertension.
METHODS
This study was a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a randomized clinical trial that compared intensive (<120 mm Hg) and standard (<140 mm Hg) systolic blood pressure treatment interventions in adults with hypertension and high cardiovascular risk. Target range was defined as 110 to 130 mm Hg and 120 to 140 mm Hg for the intensive and standard arms, respectively. Time in target range was estimated over the first 3 months of follow-up using linear interpolation. The association between time in target range with major adverse cardiovascular events was estimated using adjusted Cox proportional hazards regression models.
RESULTS
Participants with greater time in target range were younger, had lower 10-year cardiovascular risk and lower baseline systolic blood pressure, and were more likely women and statin users. Each 1-SD increase in time in target range was significantly associated with a decreased risk of first major adverse cardiovascular event in fully adjusted models. Time in target range remained significantly associated with major adverse cardiovascular events despite adjustment for mean systolic blood pressure or systolic blood pressure variability. Among participants with mean systolic blood pressure at or below target, time in target range remained associated with major adverse cardiovascular events.
CONCLUSIONS
Time in systolic blood pressure target range independently predicts major adverse cardiovascular event risk.
Topics: Aged; Antihypertensive Agents; Blood Pressure; Female; Humans; Hypertension; Male; Middle Aged; Retrospective Studies
PubMed: 33706870
DOI: 10.1016/j.jacc.2021.01.014 -
Progress in Biophysics and Molecular... Jan 2021Well over a century ago, Otto Frank, working at Carl Ludwig's Institute of Physiology in Munich, studying the isolated, blood-perfused, frog heart preparation,... (Review)
Review
Well over a century ago, Otto Frank, working at Carl Ludwig's Institute of Physiology in Munich, studying the isolated, blood-perfused, frog heart preparation, demonstrated that there are two distinct pressure-volume relations in the heart: one for isovolumic twitches and a second (located inferiorly) for afterloaded twitches. Whereas Starling, working at UCL two decades later, referenced Frank's publication (to the extent of re-printing its seminal Figure), he appeared not to have tested Frank's finding. Hence, he remained silent with respect to Franks' contention that cardiac pressure-volume relations are contraction-mode-dependent. Instead, he concluded that "The energy of contraction, however measured, is a function of the length of the muscle fibre" - a conclusion that has become known (at least in the English-speaking world) as 'Starling's Law of the Heart'. This provides us with at least three conundra: (i) why did Starling present only one pressure-volume relation whereas Frank had previously found two, (ii) why, then, do we speak of The Frank-Starling relation, and (iii) how did Frank become largely forgotten for twelve decades among English speakers? This review will attempt to address and comment on these conundra.
Topics: Blood Pressure; Cardiac Output; Cardiac Volume; Heart; History, 19th Century; History, 20th Century; Humans; Models, Cardiovascular; Myocardial Contraction
PubMed: 32407748
DOI: 10.1016/j.pbiomolbio.2020.04.003 -
Nature Communications Apr 2023Multiple studies have reported a link between mental health and high blood pressure with mixed or even contradictory findings. Here, we resolve those contradictions and...
Multiple studies have reported a link between mental health and high blood pressure with mixed or even contradictory findings. Here, we resolve those contradictions and further dissect the cross-sectional and longitudinal relationship between mental health, systolic blood pressure, and hypertension using extensive psychological, medical and neuroimaging data from the UK Biobank. We show that higher systolic blood pressure is associated with fewer depressive symptoms, greater well-being, and lower emotion-related brain activity. Interestingly, impending hypertension is associated with poorer mental health years before HTN is diagnosed. In addition, a stronger baseline association between systolic blood pressure and better mental health was observed in individuals who develop hypertension until follow-up. Overall, our findings offer insights on the complex relationship between mental health, blood pressure, and hypertension, suggesting that-via baroreceptor mechanisms and reinforcement learning-the association of higher blood pressure with better mental health may ultimately contribute to the development of hypertension.
Topics: Humans; Blood Pressure; Mental Health; Cross-Sectional Studies; Hypertension
PubMed: 37029103
DOI: 10.1038/s41467-023-37579-6 -
Journal of Healthcare Engineering 2022Patients with masked hypertension are at an elevated risk of cardiovascular events and all-cause death. This risk is close to that of sustained hypertension. The mean...
BACKGROUND
Patients with masked hypertension are at an elevated risk of cardiovascular events and all-cause death. This risk is close to that of sustained hypertension. The mean value and short-term variability of systolic blood pressure are considered to be risk factors for organ damage in hypertension.
OBJECTIVE
To investigate the mean value and short-term variability of systolic blood pressure in patients with masked hypertension.
METHODS
According to the results of in-clinic and ambulatory blood pressure measurement, participants were divided into four groups: normotension group, controlled hypertension group, masked hypertension group, and sustained hypertension group. The mean value and short-term variability of systolic blood pressure of masked hypertension group were evaluated by comparison with the other three groups.
RESULTS
A total of 250 subjects were enrolled, with an average age of 65.46 ± 8.76 years, and 166 (66.4%) were male, including 62 in the normotension group, 78 in the controlled hypertension group, 69 in the masked hypertension group, and 41 in the sustained hypertension group. Compared with the normotension group and controlled hypertension group, the mean value, blood pressure load, standard deviation, and coefficient of variation of systolic blood pressure over 24 hours and during the day and night, were all higher in the masked hypertension group ( < 0.05), while the rate of the nocturnal systolic blood pressure decline was lower ( < 0.05). There were no statistically significant differences in the above indexes between the masked hypertension group and sustained hypertension group ( > 0.05).
CONCLUSION
There are higher mean value of systolic blood pressure and greater short-term variability in masked hypertension patients. Identification of masked hypertension is an important challenge in the clinic.
Topics: Aged; Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Female; Humans; Hypertension; Male; Masked Hypertension; Middle Aged; Pregnancy
PubMed: 35437462
DOI: 10.1155/2022/8016893 -
Journal of Clinical Hypertension... Nov 2023The epidemiology of elevations in blood pressure is incompletely characterized, particularly in Australia. Given the lack of evidence regarding the frequency and the...
The epidemiology of elevations in blood pressure is incompletely characterized, particularly in Australia. Given the lack of evidence regarding the frequency and the optimal management of in-hospital hypertension, the authors performed a multicenter retrospective cohort study of consecutive medical admissions in South Australia over a 2-year period to investigate systolic blood pressure levels and their association with in-hospital mortality. Among 16 896 inpatients, 76% had at least one systolic blood pressure reading of ≥140 mmHg and 11.7% of ≥180 mmHg during hospitalization. A statistically significant negative relationship was observed between having at least one reading ≥140 mmHg and a likelihood of in-hospital mortality (odds ratio 0.41, 95% CI: 0.35 to 0.49, P < .001). Our results suggest that elevations in systolic blood pressure are common in Australian medical inpatients. However, the inverse association observed between systolic blood pressure values ≥140 mmHg and in-hospital mortality warrants further research to determine the clinical significance and optimal management of blood pressure elevations in this group.
Topics: Humans; Blood Pressure; Hypertension; Retrospective Studies; Inpatients; Australia
PubMed: 37787074
DOI: 10.1111/jch.14735 -
Scientific Reports Oct 2022Cuffless blood pressure measurement enables unobtrusive and continuous monitoring that can be integrated with wearable devices to extend healthcare to non-hospital...
Cuffless blood pressure measurement enables unobtrusive and continuous monitoring that can be integrated with wearable devices to extend healthcare to non-hospital settings. Most of the current research has focused on the estimation of blood pressure based on pulse transit time or pulse arrival time using ECG or peripheral cardiac pulse signals as proximal time references. This study proposed the use of a phonocardiogram (PCG) and ballistocardiogram (BCG), two signals detected noninvasively, to estimate systolic blood pressure (SBP). For this, the PCG and the BCG were simultaneously measured in 21 volunteers in the rest, activity, and post-activity conditions. Different features were considered based on the relationships between these signals. The intervals between S1 and S2 of the PCG and the I, J, and K waves of the BCG were statistically analyzed. The IJ and JK slopes were also estimated as additional features to train the machine-learning algorithm. The intervals S1-J, S1-K, S1-I, J-S2, and I-S2 were negatively correlated with changes in SBP (p-val < 0.01). The features were used as explanatory variables for a regressor based on the Random Forest. It was possible to estimate the systolic blood pressure with a mean error of 3.3 mmHg with a standard deviation of ± 5 mmHg. Therefore, we foresee that this proposal has potential applications for wearable devices that use low-cost embedded systems.
Topics: Humans; Ballistocardiography; Blood Pressure; Blood Pressure Determination; Heart Sounds; Pulse Wave Analysis
PubMed: 36229644
DOI: 10.1038/s41598-022-22205-0 -
Heart Rate Recovery, Central Systolic Pressure, and Augmentation Index in Young Healthy Individuals.Vascular Health and Risk Management 2022Measuring heart rate recovery (HRR) holds valuable cardiovascular information and requires minimal technical skill and cost. Understanding the associations between HRR...
PURPOSE
Measuring heart rate recovery (HRR) holds valuable cardiovascular information and requires minimal technical skill and cost. Understanding the associations between HRR and more robust cardiovascular indicators, such as central systolic blood pressure (CSBP), can provide valuable cardiovascular information with less involvement. CSBP is a strong predictor of certain cardiovascular diseases. The study aims to examine the association between measures of HRR and CSBP and the augmentation index (AIx) in a group of young, healthy individuals and based on sex.
PARTICIPANTS AND METHODS
One-hundred and seven participants (men - 55, women - 52) were measured for HRR at one minute (HRR) and two minutes (HRR) after maximum oxygen consumption (VO) testing, CSBP, and the AIx at a heart rate of 75 beats∙min (AIx@75).
RESULTS
The Pearson correlation indicated no association between HRR, HRR, and CSBP in men and women combined: r = 0.06, P = 0.53; r = 0.05, P = 0.59, respectively, or based on sex: men = r = 0.01, P = 0.95; r = 0.04, P = 0.79, respectively, and women = r = -0.05, P = 0.75; r = -0.09, P = 0.52, respectively. However, there were associations between HRR and AIx@75 in men and women combined: r = -0.37, P < 0.001, and based on sex: men = r = -0.31, P = 0.02, and women = r = -0.38, P < 0.01.
CONCLUSION
Measures of HRR were not associated with CSBP in a combined group of young men and women or based on sex. Most measures of HRR, especially those established by parasympathetic nervous activity, were associated with lower AIx@75. Though measures of HRR might be good indicators of cardiovascular disease, they might not be good indicators of CSBP in young, healthy individuals.
Topics: Blood Pressure; Cardiovascular Diseases; Cardiovascular System; Female; Heart Rate; Humans; Male
PubMed: 35173435
DOI: 10.2147/VHRM.S340483 -
European Heart Journal Jul 2014Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular risk. However, systolic pressure... (Review)
Review
Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular risk. However, systolic pressure varies throughout the arterial tree, such that aortic (central) systolic pressure is actually lower than corresponding brachial values, although this difference is highly variable between individuals. Emerging evidence now suggests that central pressure is better related to future cardiovascular events than is brachial pressure. Moreover, anti-hypertensive drugs can exert differential effects on brachial and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure.
Topics: Antihypertensive Agents; Aorta; Blood Pressure; Blood Pressure Determination; Brachial Artery; Cardiovascular Diseases; Humans; Hypertension; Risk Assessment; Sphygmomanometers
PubMed: 24459197
DOI: 10.1093/eurheartj/eht565 -
Internal Medicine Journal Jan 2021Despite multiple studies, it has not been possible to account for the normal changes of blood pressure that occur from infancy to old age. We sought a comprehensive... (Review)
Review
Despite multiple studies, it has not been possible to account for the normal changes of blood pressure that occur from infancy to old age. We sought a comprehensive explanation, by linking brachial pressure with the well documented changes in the arterial pulse waveform, whose peak and nadir determine systolic, diastolic and pulse pressure in brachial arteries. Changes in humans arterial pulse wave contour from birth to old age can be readily explained on (i) growth, with increasing length of the body from birth to adolescence, and adult height maintained thereafter, and (ii) degeneration and dilation of the aorta from elastic fibre fracture throughout life, causing progressive increase in aortic pressure wave amplitude from early return of wave reflection, and summation of incident with reflected waves in systole. These changes throughout life complement arterial pulse waveform analysis and explain brachial cuff pressure values, with optimal pulse wave pattern for cardiac interaction apparent in adolescence.
Topics: Adult; Aorta; Arterial Pressure; Blood Pressure; Brachial Artery; Humans; Longevity; Systole
PubMed: 32175664
DOI: 10.1111/imj.14815