scholarly journals Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension - Con Side of the Argument

Hypertension ◽  
2021 ◽  
Vol 78 (3) ◽  
pp. 871-878
Author(s):  
Ricky D. Turgeon ◽  
Andrew D. Althouse ◽  
Jordana B. Cohen ◽  
Bogdan Enache ◽  
John B. Hogenesch ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Medications ◽  
Nighttime Blood Pressure

scholarly journals Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension—Pro Side of the Argument

Hypertension ◽  
2021 ◽  
Vol 78 (3) ◽  
pp. 879-893
Author(s):  
Ramón C. Hermida ◽  
Artemio Mojón ◽  
Michael H. Smolensky ◽  
José R. Fernández
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Medications ◽  
Nighttime Blood Pressure

scholarly journals Prognostic Value of a Riser Pattern of Nighttime Blood Pressure in Very Elderly Adults of ≥80 Years: A General Practice-Based Prospective SEARCH Study

2020 ◽  
Vol 33 (6) ◽  
pp. 520-527 ◽  
Author(s):  
Takeshi Fujiwara ◽  
Satoshi Hoshide ◽  
Hiroshi Kanegae ◽  
Kazuomi Kario
Keyword(s):  
Blood Pressure ◽  
General Practice ◽  
Very Elderly ◽  
Antihypertensive Medications ◽  
Event Risk ◽  
Practice Population ◽  
Elderly Outpatients ◽  
Nighttime Blood Pressure ◽  
Study Participants

Abstract BACKGROUND We examined our hypothesis that participants with higher mean nighttime blood pressure (BP) levels and/or those with a riser BP pattern, both measured by ambulatory blood pressure (BP) monitoring (ABPM), would show higher risk for cardiovascular disease (CVD) events compared to those with normal nighttime BP levels or a normal dipper BP pattern of circadian BP rhythm, even in very elderly participants in a general practice population. METHODS This prospective observational study enrolled 485 very elderly outpatients of ≥80 years (mean age: 83.2 ± 3.3 years; 44.7% male; 89.3% using antihypertensive medications). The prevalences of extreme dipper, dipper, nondipper, and riser status were 15.5%, 38.6%, 32.2%, and 13.8%, respectively. RESULTS During a mean follow-up of 3.9 years (1,734 person-years), 41 CVD events occurred. The participants with a riser pattern (higher nighttime systolic BP [SBP] than daytime SBP) showed a significantly higher risk for CVD events with adjustment for covariates: hazard ratio (HR), 2.61; 95% confidence interval (CI), 1.03–6.62. Even after adjusting for covariates and mean nighttime SBP level, the CVD risks in participants with a riser pattern remained significant: HR, 3.11; 95% CI, 1.10–8.88. On the other hand, all BP variables showed no significant risks for CVD events. In addition, when we divided study participants into quartiles by their ambulatory BP levels, none of the ambulatory BP variables showed a J- or U-shaped relationship with CVD event risk. CONCLUSIONS In very elderly general practice outpatients, a riser BP pattern was significantly associated with CVD events independently of mean nighttime BP.

Exposure to Chinese Famine in the Early Life, Adulthood Obesity Patterns, and the Incidence of Hypertension: A 22-Year Cohort Study

2021 ◽  
pp. 1-7
Author(s):  
Yu Wang ◽  
Jibin Jin ◽  
Yue Peng ◽  
Yongjie Chen
Keyword(s):  
Blood Pressure ◽  
Abdominal Obesity ◽  
Current Treatment ◽  
Late Childhood ◽  
Fetal Life ◽  
General Obesity ◽  
Antihypertensive Medications ◽  
Childhood Exposure ◽  
Famine Exposure ◽  
Obesity Hypertension

<b><i>Introduction:</i></b> Little is known regarding the joint associations of famine exposure and obesity patterns with the incidence of hypertension. <b><i>Methods:</i></b> We defined famine exposure cohorts as follows: nonexposure (born between 1962 and 1965), fetal life exposure (born between 1959 and 1961), early childhood exposure (born between 1956 and 1958), midchildhood exposure (born between 1953 and 1955), and late childhood exposure (born between 1949 and 1952). Obesity patterns were defined as follows: G−/A−: subjects without neither general obesity nor abdominal obesity; G+/A− or G−/A+: subjects with either general obesity or abdominal obesity; G+/A+: subjects with both general obesity and abdominal obesity. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg or current treatment with antihypertensive medications. <b><i>Results:</i></b> There were 5,235 individuals participating in this study. In the subjects with general or abdominal obesity, famine exposure was associated with a lower risk of hypertension. In males with G−/A−, famine exposures in the midchildhood (<i>p</i> = 0.048; HR: 0.700; HR 95% CI: 0.491–0.998) and late childhood (<i>p</i> = 0.002; HR: 0.560; HR 95% CI: 0.374–0.840) were associated with a lower incidence of hypertension. <b><i>Conclusion:</i></b> The coexistence of famine exposure and obesity patterns was associated with the incidence of hypertension.

scholarly journals Do the combined blood pressure effects of exercise and antihypertensive medications add up to the sum of their parts? A systematic meta-review

2021 ◽  
Vol 7 (1) ◽  
pp. e000895
Author(s):  
Linda S Pescatello ◽  
Yin Wu ◽  
Simiao Gao ◽  
Jill Livingston ◽  
Bonny Bloodgood Sheppard ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Strong Evidence ◽  
Pressure Effects ◽  
Cochrane Library ◽  
Antihypertensive Medications ◽  
Eligibility Criteria ◽  
Physical Activity Guidelines ◽  
Meta Review ◽  
Randomised Controlled ◽  
Meta Analyses

ObjectiveTo compare the blood pressure (BP) effects of exercise alone (EXalone), medication alone (MEDSalone) and combined (EX+MEDScombined) among adults with hypertension.Data sourcesPubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Cochrane Library.Eligibility criteriaRandomised controlled trails (RCTs) or meta-analyses (MAs) of controlled trials that: (1) involved healthy adults>18 year with hypertension; (2) investigated exercise and BP; (3) reported preintervention and postintervention BP and (4) were published in English. RCTs had an EX+MEDScombined arm; and an EXalone arm and/or an MEDSalone arm; and MAs performed moderator analyses.DesignA systematic network MA and meta-review with the evidence graded using the Physical Activity Guidelines for Americans Advisory Committee system.OutcomeThe BP response for EXalone, MEDSalone and EX+MEDScombined and compared with each other.ResultsTwelve RCTs qualified with 342 subjects (60% women) who were mostly physically inactive, middle-aged to older adults. There were 13 qualifying MAs with 28 468 participants (~50% women) who were mostly Caucasian or Asian. Most RCTs were aerobic (83.3%), while the MAs involved traditional (46%) and alternative (54%) exercise types. Strong evidence demonstrates EXalone, MEDSalone and EX+MEDScombined reduce BP and EX+MEDScombined elicit BP reductions less than the sum of their parts. Strong evidence indicates EX+MEDScombined potentiate the BP effects of MEDSalone. Although the evidence is stronger for alternative than traditional types of exercise, EXaloneelicits greater BP reductions than MEDSalone.ConclusionsThe combined BP effects of exercise and medications are not additive or synergistic, but when combined they bolster the antihypertensive effects of MEDSalone.PROSPERO registration numberThe protocol is registered at PROSPERO CRD42020181754.

scholarly journals Hypertension in the United States Fire Service

2021 ◽  
Vol 18 (10) ◽  
pp. 5432
Author(s):  
Saeed U. Khaja ◽  
Kevin C. Mathias ◽  
Emilie D. Bode ◽  
Donald F. Stewart ◽  
Kepra Jack ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Population ◽  
Age Groups ◽  
Total Sample ◽  
The United States ◽  
Fire Service ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cardiac Events ◽  
Antihypertensive Medications ◽  
Increased Risk

Hypertension is a major risk factor for atherosclerotic cardiovascular disease and cardiac remodeling and is associated with an increased risk of sudden cardiac events, the leading cause of duty-related death in the fire service. We assessed systemic blood pressures and prevalence of hypertension among US firefighters by decade of life. Medical records of career firefighters (5063 males and 274 females) from four geographically diverse occupational health clinics were assessed. Hypertension was defined as systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg, or taking antihypertensive medication. Results from the firefighter sample were compared to the US general population (2015–2016 and 2017–2018 National Health and Nutrition Examination Surveys). Among the total sample, 69% of firefighters met the criteria for hypertension and 17% were taking antihypertensive medications. Percentages of hypertensive male and female firefighters were 45% and 11% among 20–29 years old, respectively, and increased to 78% and 79% among 50–59 years old, respectively. Compared to the general population, male firefighters had a higher prevalence of hypertension (p < 0.05) across all age groups (11–16% higher). In order to improve firefighter health and protect against sudden incapacitation in this public safety occupational group, increased efforts are necessary to screen for and manage high blood pressure.

scholarly journals Nighttime Blood Pressure Fall in Renal Disease Patients

Renal Failure ◽  
2003 ◽  
Vol 25 (5) ◽  
pp. 829-837 ◽  
Author(s):  
Nicolás Roberto Robles ◽  
Barbara Cancho ◽  
Rosa Ruiz-Calero ◽  
Enrique Angulo ◽  
Emilio Sanchez-Casado
Keyword(s):  
Blood Pressure ◽  
Renal Disease ◽  
Blood Pressure Fall ◽  
Nighttime Blood Pressure ◽  
Pressure Fall

Abstract 57: Risk Factors For Severe Reductions In Blood Pressure After Treatment Of Severe Inpatient Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Lama Ghazi ◽  
Fan Li ◽  
Eric Chen ◽  
Michael Simonov ◽  
Yu Yamamoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cohort Study ◽  
Hospital Admission ◽  
Antihypertensive Treatment ◽  
Treatment Guidelines ◽  
P Value ◽  
Antihypertensive Medications ◽  
Black Race ◽  
Oral Medications

Background: Incident severe HTN during hospitalization is far more common than admission for HTN, however treatment guidelines are lacking. Severe inpatient HTN is poorly studied, therefore our goal is to characterize inpatients who develop severe HTN and assess BP response to antihypertensive treatment. Methods: This is a cohort study of adults admitted for reasons other than HTN and developed severe HTN within a single healthcare system. We defined severe inpatient HTN as the first documentation of BP elevation (>180 systolic or >110 diastolic) at least 1 hour after hospital admission. Treatment was defined as receiving antihypertensive medications within 6 hours of BP elevation. We studied the association between treatment and BP drop ≥30%. Results: Among 224,265 hospitalized adults, 23,147 developed severe HTN of which 40% were treated. Compared to inpatients who did not develop severe HTN, those who did were older, more commonly women and Black, and had more comorbidities. Of the treated and untreated patients, 45.5 and 46.4% had a MAP drop ≥30% (p-value= 0.2). Risk factors for severe MAP drop include older age, Black race, HTN, and diabetes. Additionally, treatment vs. no treatment and treatment with intravenous vs. oral medications were associated with greater odds of MAP drop ≥30% ( Table 1 ). Conclusion: While there was no difference in the proportion of treated and untreated patients with severe MAP reduction, after adjustment for factors independently associated with HTN we found that treatment was associated with severe BP drop. Further research is needed to phenotype inpatients with severe HTN to help establish treatment guidelines.

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