P1693The longitudinal associations between telomere attrition and the effects of blood pressure lowering and antihypertensive treatment

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Y Zhang ◽  
R X Li ◽  
Y Y Yang ◽  
Y Chen ◽  
S J Yang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Telomere Length ◽  
Antihypertensive Treatment ◽  
Attrition Rate ◽  
Leukocyte Telomere Length ◽  
Blood Pressure Lowering ◽  
Blood Samples ◽  
Telomere Attrition ◽  
Pressure Lowering

Abstract Background Leukocyte telomere length, as an emerging marker of biological age, has been shown to associate with hypertension. However, it has not been studied whether telomere attrition rate in patients with hypertension is related to the heterogeneity of blood pressure (BP) response to antihypertensive therapy. Purpose Our aim is to investigate the relationship between telomere attrition rate and BP lowering in a longitudinal Chinese hypertensive cohort. We also aim to explore the potential association between telomere attrition rate and the differences in antihypertensive treatment response. Methods A community-based, prospective study was conducted at BenXi county, Liaoning province, in the northern China. A total of 3,671 hypertensive patients were recruited from 2013 t 2015 and of whom 1,382 provided blood samples at baseline. After a median follow-up period of 2.2 (range 1.5–2.4) years, the blood samples were collected from 1,197 patients again in 2016, and 185 patients were not reached to obtain blood sample because of immigration. In addition, 89 blood samples were excluded due to insufficient quality. Finally, 1,108 patients who are available for blood samples both at baseline and at follow-up, were included in the analysis for telomeres change. Annual telomere attrition rate was calculated as (follow-up telomere length-baseline telomere length)/follow-up year, and then categorized into two groups: the shorten (annual telomere attrition rate <0) and the lengthen (annual telomere attrition rate >0). Multivariable linear regression model was used to examine the association of annual telomere attrition rate with blood pressure lowering and antihypertensive treatment. Cox Proportional Hazards model was used to examine the association between annual telomere attrition rate and cardiovascular disease risk. Results In multivariable linear regression models, the telomere lengthening was significantly associated with decrease in systolic blood pressure (SBP) (β: −4.13; p=0.006) and pulse pressure (PP) (β: −3.22; p=0.007) during the follow-up, but not associated with diastolic blood pressure (DBP) change. And the associations were observed age- and gender-specific difference. The lengthen was significantly associated with ΔSBP and ΔPP in women and younger patients (age ≤60 years old). Furthermore, the associations were observed in patients who treated with calcium channel blocker (CCB) and angiotensin receptor blocker (ARB), but not in diuretics. Then we found no significant association between annual telomere attrition rate and incident cardiovascular events during the follow-up. Conclusion(s) Our data showed that the increasing of leukocyte telomere length is associated with the decreasing of SBP and PP, particularly for the patients who received CCB and ARB therapy. These data showed that annual telomere attrition rate could be a marker of treatment response and will help in clinical management. Acknowledgement/Funding the National Science and Technology Pillar Program during the Twelfth Five-year Plan Period (No. 2011BAI11B04)

scholarly journals Intensive blood-pressure lowering in patients with acute cerebral hemorrhage

CJEM ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 256-259 ◽  
Author(s):  
Sufyan Alrahbi ◽  
Rashid Alaraimi ◽  
Abdalla Alzaabi ◽  
Sophie Gosselin
Keyword(s):  
Blood Pressure ◽  
Cerebral Hemorrhage ◽  
Antihypertensive Treatment ◽  
Therapeutic Benefit ◽  
Blood Pressure Lowering ◽  
Pressure Lowering ◽  
Acute Intracerebral Hemorrhage ◽  
Better Than ◽  
Intensive Blood Pressure

Clinical questionIs intensive blood pressure (BP) treatment (systolic BP target 110-139 mm Hg) better than standard antihypertensive treatment (systolic BP target 140-179 mm Hg) in reducing mortality and disability in patients with acute intracerebral hemorrhage (ICH)?Article chosenQureshi AI, Palesch YY, Barsan WG, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med 2016;375(11):1033-43.ObjectiveTo determine the therapeutic benefit of intensive BP treatment compared to standard BP treatment in reducing death and disability after 3 months of follow-up among patients with ICH treated within 4.5 hours from onset of symptoms.

scholarly journals High blood pressure in older subjects with cognitive impairment

2016 ◽  
Vol 84 (1-2) ◽  
Author(s):  
Enrico Mossello ◽  
David Simoni
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Old Age ◽  
High Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Cognitively Impaired ◽  
Blood Pressure Lowering ◽  
Pressure Lowering ◽  
Older Subjects

<p>High blood pressure and cognitive impairment often coexist in old age, but their pathophysiological association is complex. Several longitudinal studies have shown that high blood pressure at midlife is a risk factor for cognitive impairment and dementia, although this association is much less clear in old age. The effect of blood pressure lowering in reducing the risk of dementia is only borderline significant in clinical trials of older subjects, partly due to the insufficient follow-up time. Conversely, dementia onset is associated with a decrease of blood pressure values, probably secondary to neurodegeneration. Prognostic effect of blood pressure values in cognitively impaired older subjects is still unclear, with aggressive blood pressure lowering being potentially harmful in this patients category. Brief cognitive screening, coupled with simple motor assessment, are warranted to identify frail older subjects who need a more cautious approach to antihypertensive treatment. Values obtained with ambulatory blood pressure monitoring seem more useful than clinical ones to predict the outcome of cognitively impaired older subjects. Future studies should identify the most appropriate blood pressure targets in older subjects with cognitive impairment. </p><p><strong>Riassunto</strong></p><p>Ipertensione arteriosa e decadimento cognitivo spesso coesistono in età avanzata, sebbene la loro associazione sia complessa dal punto di vista fisiopatologico. Diversi studi longitudinali hanno mostrato che elevati valori pressori in età adulta rappresentano un fattore di rischio per decadimento cognitivo e demenza, sebbene tale associazione sia molto meno chiara in età avanzata. L’effetto della terapia antiipertensiva è risultato ai limiti della significatività statistica nel ridurre il rischio di demenza negli studi di intervento su soggetti anziani, in parte a causa della durata insufficiente del follow-up. D’altra parte, l’insorgenza di demenza è associata con una riduzione dei valori pressori, probabilmente secondaria alla neurodegenerazione. L’effetto prognostico dei valori pressori in anziani con decadimento cognitivo non è stato ancora chiarito, in presenza di un possibile effetto dannoso di un trattamento antiipertensivo aggressivo in questa categoria di pazienti. Un breve screening cognitivo, associato con una semplice valutazione motoria, è raccomandato per identificare gli anziani fragili, che necessitano di un approccio più cauto alla terapia antiipertensiva. I risultati del monitoraggio della pressione arteriosa nelle 24 ore sembrano più utili della misurazione clinica per predire la prognosi degli anziani cognitivamente compromessi. Studi futuri dovrebbero identificare gli obiettivi pressori più appropriati nel trattamento di anziani con decadimento cognitivo.</p>

scholarly journals Adherence to Antihypertensive Treatment and the Blood Pressure–Lowering Effects of Renal Denervation in the Renal Denervation for Hypertension (DENERHTN) Trial

Circulation ◽  
2016 ◽  
Vol 134 (12) ◽  
pp. 847-857 ◽  
Author(s):  
Michel Azizi ◽  
Helena Pereira ◽  
Idir Hamdidouche ◽  
Philippe Gosse ◽  
Matthieu Monge ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Treatment ◽  
Renal Denervation ◽  
Blood Pressure Lowering ◽  
Pressure Lowering

scholarly journals Night- Time Chronotherapy With Diuretics: Effect On Sleep Quality And Duration In Patients With Hypertension In Lusaka, Zambia

2020 ◽  
Vol 4 (3) ◽  
pp. 1-9
Author(s):  
David Band ◽  
◽  
Tyson L. Muungo ◽  
Nason Lambwe ◽  
◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sleep Quality ◽  
Blood Pressure Level ◽  
Poor Sleep ◽  
Blood Pressure Lowering ◽  
Quality Of Sleep ◽  
Night Time ◽  
Pressure Lowering

Poor sleep plays an important role in the prevalence of hypertension. It increases the prevalence rate to 60%. The night-time dosing of blood pressure-lowering drugs has yielded positive results. Scholars have rarely investigated the relationship between night-time dosing of diuretics and the quality of sleep. The study aimed at evaluating the quality and duration of sleep while on night-time dosing of diuretics and determine the commonly used blood pressure-lowering medication at University Teaching Hospital. The study was a Prospective Cohort Study with 12 weeks of follow-up. The sample consisted of 46 patients with hypertension and on a diuretic, 25 of whom were taking their medication in the evening at 10 PM (study group), and 18 were in the 10 AM dosing schedule as a control. Overall, 43 were included in the analysis. Baseline and follow-up at 2, 8 and 12 Sleep quality and duration, and blood pressure level were available for 43 (93.5%) individuals. The study recruited more women (76.1%) and the majority were on hydrochlorothiazide and amiloride combination (65.2%). The 10 PM dosing showed better quality of sleep and duration, and blood pressure-lowering as the follow-up continued with a p-value of less than 0.05 for Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and for the blood pressure-lowering at 12 weeks. The study showed beneficial effects of 10 PM dosing of diuretics in hypertensive patients and the diuretic effect does not affect the quality and duration of sleep. Further, 10 PM dosing lowers the blood pressure significantly compared with 10 AM.

Abstract WP347: Early Achievement of Blood Pressure Lowering on Hematoma Growth in Hyperacute Intracerebral Hemorrhage: the SAMURAI-ICH Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Yoshitaka Yamaguchi ◽  
Masatoshi Koga ◽  
Kenichi Todo ◽  
Shoichiro Sato ◽  
Hiroshi Yamagami ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Antihypertensive Treatment ◽  
Blood Pressure Lowering ◽  
Acute Hypertension ◽  
Negatively Associated ◽  
Significant Difference ◽  
Pressure Lowering ◽  
Hematoma Growth ◽  
Multicenter Prospective Observational Study

Background: Little has been investigated about associations between timing of blood pressure lowering and clinical outcome of intracerebral hemorrhage (ICH). Methods: The Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-ICH Study is a multicenter, prospective, observational study investigating the safety and feasibility of early (within 3 hours from symptom onset) systolic blood pressure (SBP) reduction to less than 160 mmHg with intravenous nicardipine for acute hypertension in patients with spontaneous ICH. We retrospectively examined the relationship between time from onset, CT imaging, and initiation of antihypertensive treatment to target SBP achievement and hematoma growth in ICH patients. Hematoma growth was defined as an absolute growth of ≥ 6 ml from baseline to second imaging at 24 (±6) hours after the initiation of antihypertensive treatment. Results: Among 211 patients (81 women (38.4%), mean age 66 years), mean baseline hematoma volume was 13 ml and hematoma growth was seen in 36 (17.1%) patients. Time from image to target SBP and time from treatment to target SBP were significantly shorter in patients without hematoma growth than those with ( P = 0.043 and P = 0.032, respectively), whereas there was not significant difference in time from onset to target SBP between the two groups ( P = 0.177). Lower quartiles of time from image to target SBP and time from treatment to target SBP had lower incidences of hematoma growth (P trend = 0.023 and 0.037, respectively, Cochran-Armitage test), whereas there was not significant trend in time from onset to target SBP ( P = 0.074). The lowest quartile of time from image to target SBP was negatively associated with hematoma growth on multivariate logistic regression (odds ratio 0.182, 95% confidential interval 0.038-0.867, P = 0.032). Conclusions: Early achievement to target SBP <160 mmHg was negatively associated with hematoma growth in ICH patients.

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