scholarly journals Twenty-Four–Hour Central (Aortic) Systolic Blood Pressure: Reference Values and Dipping Patterns in Untreated Individuals

Hypertension ◽  
2021 ◽  
Author(s):  
Thomas Weber ◽  
Athanase D. Protogerou ◽  
Mohsen Agharazii ◽  
Antonis Argyris ◽  
Sola Aoun Bahous ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Systolic Blood Pressure ◽  
Reference Values ◽  
Normal Limit ◽  
Organ Damage ◽  
Age Group ◽  
Hypertension Diagnosis ◽  
Untreated Individuals ◽  
The Brain

Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18–94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBP MAP/DBPcal ), or bSBP/diastolic blood pressure (cSBP SBP/DBPcal ), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBP MAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBP SBP/DBPcal , respectively. We pragmatically propose as upper normal limit for 24-hour cSBP MAP/DBPcal 135 mm Hg and for 24-hour cSBP SBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was −10.6 % in young participants and decreased with increasing age. Central SBP SBP/DBPcal dipping was less pronounced (−8.7% in young participants). In contrast, cSBP MAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation.

scholarly journals Age-specific associations of blood pressure variability with cardiovascular disease and mortality: 10-year Diabetes cohort study

2020 ◽  
Author(s):  
Eric Yuk Fai WAN ◽  
Esther Yee Tak Yu ◽  
Weng Yee Chin ◽  
Jessica K. Barrett ◽  
Ian Chi Kei Wong ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cohort Study ◽  
Systolic Blood Pressure ◽  
Mortality Risk ◽  
Blood Pressure Variability ◽  
Hazard Ratio ◽  
Diabetic Patients ◽  
Age Group ◽  
Systolic Blood Pressure Variability

Abstract Background: This study evaluated the age-specific association of systolic blood pressure variability with cardiovascular disease and mortality in Type-2 diabetic patients. The detrimental effects of increased systolic blood pressure variability on cardiovascular disease and mortality risk in diabetic patients remains unclear. Methods: A retrospective cohort study investigated 155,982 diabetic patients aged from 45 to 84 years old without prior history of cardiovascular disease at baseline from 2008 to 2010). systolic blood pressure variability was estimated using systolic blood pressure standard deviation from mixed effects model to reduce regression dilution bias. Age-specific associations (45-54; 55-64; 65-74; 75-84 years) between systolic blood pressure variability, cardiovascular disease and mortality risk were assessed by Cox regression adjusted for patient characteristics with subgroups stratified by subject baseline characteristics. Results: After a median follow-up of 9.7 years (16.4 million person-years), 49,816 events (including 34,039 events with and 29,211 mortalities) were identified. Elevated and independent systolic blood pressure variability was positively and log-linearly associated with higher risk on cardiovascular disease and mortality among all age groups, without evidence of a specific threshold. The cardiovascular disease and mortality risk per 5mmHg increase in systolic blood pressure variability within 45-54 years age group is over three times higher than the 70-79 years age group [Hazard Ratio: 1.66 (1.49, 1.85) vs. Hazard Ratio: 1.19 (1.15, 1.23)]. The significant associations remained consistent among all subgroups. Patients with younger age, lower systolic blood pressure and comorbidity with more types of anti-hypertensive prescription drug users had higher hazard ratios. Conclusions: The findings suggest that systolic blood pressure variability was strongly associated with cardiovascular disease and mortality risk without evidence of a specific threshold in diabetic population. In addition to optimize blood pressure control, the systolic blood pressure variability particularly for younger patients should be monitored and evaluated in routine practice.

Prevalence, Biochemical and Clinical Characteristics of Resistant Hypertension

2018 ◽  
Vol 69 (10) ◽  
pp. 2845-2849
Author(s):  
Daniela Gurgus ◽  
Elena Ardeleanu ◽  
Carmen Gadau ◽  
Roxana Folescu ◽  
Ioan Tilea ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Resistant Hypertension ◽  
Clinical Characteristics ◽  
Salt Intake ◽  
Target Organ Damage ◽  
Multivariate Logistic Regression Analysis ◽  
Organ Damage ◽  
Left Ventricular ◽  
High Salt Intake

The objectives of the present study were to evaluate the prevalence of resistant hypertension (RH) in primary care setting and to analyse its biochemical and clinical characteristics. After 3 months of treatment and evaluation, 721 (14.01%) of 5,146 patients with hypertension did not reach target office blood pressure of [ 140/90 mmHg. After exclusion of �white-coat effect� with ambulatory blood pressure, of secondary and pseudo- resistant hypertension, prevalence of RH was 6.74%. Lifestyle factors associated with RH were physical inactivity, obesity, high salt intake, smoking and excessive alcohol ingestion. Compared to controlled hypertension, RH patients presented higher incidence of family history of cardiovascular disease (38.90% vs 25.94%), diabetes mellitus (34.87% vs 19.01%), impaired fasting glucose (21.91% vs 19.07%), target organ damage (29.1% vs 15.95%), and cardiovascular disease (27.09% vs 17.06%). Dyslipidaemia (52.90% vs 42.03%), fasting plasma glucose (116.10�38.9 vs 107.80�37.2), HbA1c (6.41�1.42 vs 5.96�0.94), serum creatinine (1.09�0.27 vs 1.03�0.24) and microalbuminuria (21.90% vs 10.95%) were significantly higher in RH. Predictors of RH, determined by a multivariate logistic regression analysis were left ventricular hypertrophy (OD 2.14, 95% CI 1.32-3.69), renal impairment expressed as eGFR [ 60 ml/min/1.73m2 (OD 1.62, 95% CI 1.21-2.21) and the presence of cardiovascular disease (OD 1.48, 95% CI 1.02-2.16).

Reno-protective mechanisms of epoxyeicosatrienoic acids in cardiovascular disease

2012 ◽  
Vol 302 (3) ◽  
pp. R321-R330 ◽  
Author(s):  
Ahmed A. Elmarakby
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Animal Models ◽  
Vascular Function ◽  
Organ Damage ◽  
Reduce Blood Pressure ◽  
Experimental Models ◽  
Epoxyeicosatrienoic Acids ◽  
Protective Effects ◽  
Protective Mechanisms

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and it is well known that end-stage renal disease (ESRD) is a profound consequence of the progression of CVD. Present treatments only slow CVD progression to ESRD, and it is imperative that new therapeutic strategies are developed to prevent the incidence of ESRD. Because epoxyeicosatrienoic acids (EETs) have been shown to elicit reno-protective effects in hypertensive animal models, the current review will focus on addressing the reno-protective mechanisms of EETs in CVD. The cytochrome P-450 epoxygenase catalyzes the oxidation of arachidonic acid to EETs. EETs have been identified as endothelium-derived hyperpolarizing factors (EDHFs) with vasodilatory, anti-inflammatory, antihypertensive, and antiplatelet aggregation properties. EETs also have profound effects on vascular migration and proliferation and promote angiogenesis. The progression of CVD has been linked to decreased EETs levels, leading to the concept that EETs should be therapeutically targeted to prevent end-organ damage associated with CVD. However, EETs are quickly degraded by the enzyme soluble epoxide hydrolase (sEH) to their less active diols, dihydroxyeicosatrienoic acids (DHETs). As such, one way to increase EETs level is to inhibit their degradation to DHETs by using sEH inhibitors. Inhibition of sEH has been shown to effectively reduce blood pressure and organ damage in experimental models of CVD. Another approach to target EETs is to develop EET analogs with improved solubility and resistance to auto-oxidation and metabolism by sEH. For example, stable ether EET analogs dilate afferent arterioles and lower blood pressure in hypertensive rodent animal models. EET agonists also improve insulin signaling and vascular function in animal models of metabolic syndrome.

scholarly journals Effects of Cranberry Juice Supplementation on Cardiovascular Disease Risk Factors in Adults with Elevated Blood Pressure: A Randomized Controlled Trial

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2618
Author(s):  
Chesney K. Richter ◽  
Ann C. Skulas-Ray ◽  
Trent L. Gaugler ◽  
Stacey Meily ◽  
Kristina S. Petersen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Systolic Blood Pressure ◽  
Vascular Function ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Lipoprotein Profile ◽  
Cranberry Juice ◽  
Central Systolic Blood Pressure

Emerging cardiovascular disease (CVD) risk factors, including central vascular function and HDL efflux, may be modifiable with food-based interventions such as cranberry juice. A randomized, placebo-controlled, crossover trial was conducted in middle-aged adults with overweight/obesity (n = 40; mean BMI: 28.7 ± 0.8 kg/m2; mean age: 47 ± 2 years) and elevated brachial blood pressure (mean systolic/diastolic BP: 124 ± 2/81 ± 1 mm Hg). Study participants consumed 500 mL/d of cranberry juice (~16 fl oz; 27% cranberry juice) or a matched placebo juice in a randomized order (8-week supplementation periods; 8-week compliance break), with blood samples and vascular measurements obtained at study entry and following each supplementation period. There was no significant treatment effect of cranberry juice supplementation on the primary endpoint of central systolic blood pressure or central or brachial diastolic pressure. Cranberry juice significantly reduced 24-h diastolic ambulatory BP by ~2 mm Hg compared to the placebo (p = 0.05) during daytime hours. Cranberry juice supplementation did not alter LDL-C but significantly changed the composition of the lipoprotein profile compared to the placebo, increasing the concentration of large LDL-C particles (+29.5 vs. −6.7 nmol/L; p = 0.02) and LDL size (+0.073 vs. −0.068 nm; p = 0.001). There was no effect of treatment on ex vivo HDL efflux in the total population, but exploratory subgroup analyses identified an interaction between BMI and global HDL efflux (p = 0.02), with greater effect of cranberry juice in participants who were overweight. Exploratory analyses indicate that baseline C-reactive protein (CRP) values may moderate treatment effects. In this population of adults with elevated blood pressure, cranberry juice supplementation had no significant effect on central systolic blood pressure but did have modest effects on 24-hr diastolic ambulatory BP and the lipoprotein profile. Future studies are needed to verify these findings and the results of our exploratory analyses related to baseline health moderators.

scholarly journals SAT-558 A Dedicated Endocrine Hypertension Service Increases the Timely Diagnosis of Primary Aldosteronism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jun Yang ◽  
Yin Y Lim ◽  
Renata Libianto ◽  
Jimmy Shen ◽  
Morag Jennifer Young ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Primary Aldosteronism ◽  
Pressure Control ◽  
Organ Damage ◽  
Antihypertensive Medications ◽  
Endocrine Hypertension ◽  
Treatment Naïve ◽  
Hypertension Diagnosis ◽  
The Impact

Abstract Background: Primary aldosteronism (PA) accounts for 3.2-12.7% of hypertension in primary care but is often diagnosed late, if at all. A delayed or missed diagnosis leads to poor blood pressure control and greater cardiovascular risk that could be averted with targeted treatment. An Endocrine Hypertension Service (EHS), encompassing an education program, streamlined diagnostic tests and dedicated PA clinic, was developed to address this issue. Aims: To analyse the impact of Victoria’s first dedicated EHS on the pattern of PA diagnoses. Methods: Socio-demographic and clinical data from all patients who attended the EHS since July 2016 (N=267) was collected prospectively. Patients were divided into Year 1 (Y1), Year 2 (Y2), and Year 3 (Y3), based on their first visit. Results: The proportion of referrals from primary care increased (20% in Y1 to 52% in Y3) with more referrals being made for treatment-naive hypertension (3% in Y1 to 19% in Y3). Patients with a hypertension diagnosis of 5 years or less at the time of referral to EHS increased from 34% in Y1 to 45% in Y3 whilst the percentage of patients with a hypertension diagnosis of more than 10 years decreased from 50% in Y1 to 35% in Y3. Consistent with an earlier presentation, the proportion of patients with end-organ damage at the time of referral decreased from 44% in Y1 to 29% in Y3. Almost a third of the PA patients had unilateral disease; all of those who underwent adrenalectomy had biochemical cure. Patients with bilateral PA were treated with spironolactone. Their systolic/diastolic blood pressure decreased by 15/12 mmHg in Y1, 17/13 mmHg in Y2 and 23/11 mmHg in Y3; while the mean number of antihypertensive medications decreased from 2.9 to 1.8 in Y1, 2.7 to 2.0 in Y2 and 2.2 to 1.6 in Y3 Conclusion: The EHS has facilitated an increase in referrals for PA screening from primary care, resulting in the earlier diagnosis of PA, when less complications are present, and optimised patient outcomes. A broader uptake of such a clinical service, integrated with education outreach, will bridge the gap between the reported high prevalence of PA and the actual low diagnostic rates.

scholarly journals Plasma S1P links to hypertension and biomarkers of inflammation, metabolism and cardiovascular disease – findings from a translational investigation

2020 ◽  
Author(s):  
Amra Jujic ◽  
Frank Matthes ◽  
Lotte Vanherle ◽  
Henning Petzka ◽  
Marju Orho-Melander ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Systolic Blood Pressure ◽  
Immune Cell ◽  
Vascular Dysfunction ◽  
Plasma Concentrations ◽  
Human Study ◽  
Experimental Hypertension ◽  
Study Cohort ◽  
Markers Of Inflammation

Recent studies identified sphingosine-1-phosphate (S1P) as an important player in immune cell trafficking and vascular dysfunction contributing to the development and progression of overt hypertension. Although targeting S1P signaling revealed therapeutic potential in different experimental hypertension studies, validations of S1P-blood pressure associations in humans are lacking. In a translational approach, we explored the associations between plasma S1P, quantified using LC-MS, and blood pressure in a family-based study cohort (MOS) study, and in a longitudinally conducted murine hypertension cohort. In MOS, linear multivariate regression analyses showed that plasma S1P associates with increased systolic blood pressure. Study subjects with systolic blood pressure ≥ 140 mmHg presented with significantly higher S1P plasma concentrations compared to subjects with blood pressure ≤ 120 mmHg independent of age and sex. The S1P-blood pressure association was validated in a murine model where plasma S1P increased with systolic blood pressure. In a sub-sample of the human study population, proteomic profiling for markers of inflammation, metabolism and cardiovascular disease was carried out using proximity Extension Assays. Testing S1P associations revealed multiple significant interactions, some of them with marked sex-specificity. Amongst them, interleukin 18, which exerts apparent vascular and immune responses during hypertension and associates to adverse cardiovascular events, strongly correlates with plasma S1P concentrations in females but not males in both humans and mice. In vitro and ex vivo validation of S1P effects on endothelial and monocytic cells of murine or human origin and resistance arteries isolated from mice disclosed augmented expression of different vascular dysfunction and inflammation markers in response to exogenously added S1P. Taken together, our translational findings strongly suggest a link between plasma S1P and systolic blood pressure as well as several inflammation and cardiovascular disease biomarkers in humans, encouraging further studies to investigate S1Ps potential as a therapeutic target in hypertensive disease.

Feline blood pressure measurement: when is it needed?

2021 ◽  
Vol 26 (11) ◽  
pp. 222-228
Author(s):  
Sarah Caney
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Systemic Hypertension ◽  
Ophthalmological Examination ◽  
Target Organs

Systemic hypertension is a common disorder, primarily affecting older cats. Most cases are secondary to underlying medical conditions, such as chronic kidney disease. If left untreated, systemic hypertension has the potential to cause serious damage to certain target organs and can be fatal. Target organs include the nervous system, cardiovascular system, eyes and kidneys. Target organ damage to the eyes is often pathognomonic and is detected on ophthalmological examination in up to 80% of cats with systemic hypertension. Blood pressure measurement is essential in confirming a diagnosis and should be prioritised in cats showing evidence of target organ damage. Blood pressure screening of apparently healthy older cats is justified, since the risk of hypertension increases with age. Systemic hypertension is diagnosed in cats with persistent elevation in their systolic blood pressure of 160 mmHg or higher. Stress and anxiety can cause a transient increase in systolic blood pressure so measurements should be collected in a manner that is as calm and ‘cat friendly’ as possible. In the presence of confirmed target organ damage, a single high systolic blood pressure reading confirms systemic hypertension. Where no target organ damage is detectable, evidence of elevated systolic blood pressure on two or more occasions is needed to confirm the diagnosis.

Essential hypertension: Diagnosis, assessment, and treatment

2020 ◽  
pp. 3753-3778
Author(s):  
Bryan Williams ◽  
John D. Firth
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Severe Hypertension ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Elevated Blood ◽  
Hypertensive Patients ◽  
Assessment And Treatment ◽  
Hypertension Diagnosis

Essential hypertension is invariably symptomless and usually detected by routine screening or opportunistic measurement of blood pressure. However, once a patient has been labelled as ‘hypertensive’ it is not uncommon for them to associate preceding symptoms to their elevated blood pressure. Some patients will claim that they can recognize when their blood pressure is elevated, usually on the basis of symptoms such as plethoric features, palpitations, dizziness, or a feeling of tension. Screening surveys have demonstrated that these symptoms occur no more commonly in untreated hypertensive patients than they do in the normotensive population. However, there are two important caveats to the symptomless nature of essential hypertension: (1) symptoms may develop as a consequence of target organ damage, (2) headache may be a feature of severe hypertension.

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