scholarly journals Effects of menopausal hormone therapy on ambulatory blood pressure and arterial stiffness in postmenopausal Korean women with grade 1 hypertension: a randomized, placebo-controlled trial

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Byung-Koo Yoon ◽  
Jidong Sung ◽  
Yun-Mi Song ◽  
Soo-Min Kim ◽  
Kyung-A Son ◽  
...  

Abstract Background Estrogen therapy in early menopausal women decreases the risk of coronary heart disease and parenteral, but not oral, estrogen is reported to reduce blood pressure (BP). Progestogens are typically added to estrogens to prevent unopposed endometrial stimulation. The effects of progestogen on BP have been less well studied to date. This study was conducted to explore the impacts of micronized progesterone (MP4) combined with percutaneous estradiol gel (PEG) on hemodynamics in postmenopausal Korean women with grade 1 hypertension. Methods Fifty-two postmenopausal women (aged 49–75 years) with systolic BP (SBP) of 140–160 mmHg or diastolic BP (DBP) of 90–100 mmHg were randomly assigned for 12 weeks to placebo (n = 16), estrogen therapy (ET) (n = 19) with PEG (0.1 %, 1 g./d), or estrogen + progestogen therapy (EPT, n = 17) with PEG and MP4 (100 mg/d). The primary endpoint was ambulatory BP and the secondary endpoints were arterial stiffness as brachial–ankle pulse-wave velocity (baPWV) and aortic parameters on applanation tonometry. Results One woman in the ET group dropped out, so 51 participants were finally analyzed. Outcome measures for ambulatory BP and arterial stiffness were not different between groups. Within-group comparisons showed that EPT significantly decreased daytime heart rate and baPWV: the changes from baseline (mean ± standard deviation) were − 2.5 ± 5.7 bpm (P = 0.03) and − 0.6 ± 1.4 m/s (P = 0.04), respectively. After adjusting for baseline, linear regression analysis revealed a significant difference in the relationship between baseline and 12-week baPWV among groups (P = 0.02). The relationship was significantly different between placebo and ET (P = 0.03) and EPT (P = 0.01), respectively, but not between ET and EPT. Additionally, pooled results of active treatments disclosed that SBP, DBP, PWV, and augmentation index at the aorta were significantly reduced relative to baseline. Conclusions There was no difference in ambulatory BP between ET and EPT in postmenopausal Korean women with grade 1 hypertension. Further, ET and EPT similarly decreased baPWV from baseline as compared with placebo. MP4 might not adversely influence estrogen effects on ambulatory BP and arterial stiffness. Trial registration Clinical Research Information Registry, KCT0005405, Registered 22 September 2020 - Retrospectively registered, https://cris.nih.go.kr/cris/search/detailSearch.do?all_type=Y&search_page=L&pageSize=10&page=1&seq=17608&search_lang=E.

Author(s):  
Seok-Hee KIM ◽  
Jooyoung KIM

Background: The risk factors of metabolic syndrome (MetS) in menopausal women are potential causes of osteoporosis. However, there is no consensus on this. We aimed to determine the relationship between risk factors of MetS and bone mineral density (BMD) in menopausal Korean women. Methods: We enrolled 205 menopausal Korean women who visited a health promotion center in Seoul in 2015 and divided them into the following two groups according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria with modified waist-circumference criteria: the non-MetS group (Group 1, n=90) and the MetS group (Group 2, n=115). Anthropometric parameters and clinical parameters, including blood pressure, blood lipid profile (cholesterol, triglycerides), and fasting blood sugar levels were recorded for all participants. BMD at the lumbar spine was determined using dual-energy X-ray absorptiometry (DEXA). The relationship between the risk factors of MetS and bone mineral density was analyzed by statistical methods. Results: There was no significant difference in risk factors of MetS between the groups. In correlation tests, waist circumference showed a significant association with body surface area (BSA) (r = -0.242, P < 0.001). Diastolic blood pressure was correlated with BSA (r = 0.186, P < 0.01) and bone mineral content (BMC) (r = 0.161, P < 0.05). However, multiple regression analysis showed no significant relationship between MetS risk factors and BMD. Conclusion: The risk factors of MetS did not affect BMD in menopausal Korean women. Follow-up studies with a larger study population are necessary size to allow the investigation of other research variables.


2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Maria Schoina ◽  
Charalampos Loutradis ◽  
Evangelos Memmos ◽  
Rafael Papadopoulos ◽  
Eleni Intzevidou ◽  
...  

Abstract Background and Aims Arterial stiffness is associated with increased risk for target-organ damage, cardiovascular events and overall mortality in the general population, patients with diabetes mellitus and patients with chronic kidney disease (CKD) of all stages. This is the first study to evaluate in comparison arterial stiffness and arterial wave reflections in diabetic and non-diabetic patients with CKD. Method This study included 48 diabetic and 48 non-diabetic adult patients (&gt;18 years) with CKD (eGFR: &lt;90 και ≥15mL/min/1.73m2), matched in a 1:1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent carotid-femoral pulse wave velocity (PWV), central blood pressure (BP), and wave reflections measurement with applanation tonometry (Sphygmocor, Atcor Medical, Australia). Results Office systolic and diastolic blood pressure was similar between diabetic and non-diabetic subjects with CKD in total and across CKD stages. Office brachial pulse pressure (PP) was significantly lower in non-diabetics (49.00±8.0 vs 52.67±8.7 mmHg, p= 0.034). Office PWV was marginally higher in diabetics compared with non-diabetics (10.89±2.0 vs 10.06±2.2 m/sec, p=0.056). In CKD stages 2 and 4, no significant difference in PWV between the two groups was noted, but PWV was higher for diabetics in CKD stages 3a (11.28±1.4 vs 9.83±1.5 m/sec, p=0.023) and 3b (11.13±1.9 vs 9.46±1.2 m/sec, p=0.016). Heart-rate-adjusted augmentation index [AIx(HR75)] was higher in diabetic compared with non-diabetic subjects only in CKD stage 4 (32.08±4.2 vs 25.92±6.6%, p=0.013). Conclusion Diabetic CKD patients present higher arterial stiffness than non-diabetic counterparts. The additional contribution of diabetes towards increased arterial stiffness is more prominent in patients with moderately impaired renal function (CKD stage 3a and 3b), whereas at stage 4, PWV was increased independent of diabetes presence.


2021 ◽  
pp. 448-456
Author(s):  
Yen-Yu Liu ◽  
Chung-Lieh Hung ◽  
Fang-Ju Sun ◽  
Po-Han Huang ◽  
Yu-Fan Cheng ◽  
...  

Sweating during exercise is regulated by objective parameters, body weight, and endothelial function, among other factors. However, the relationship between vascular arterial stiffness and sweat volume in young adults remains unclear. This study aimed to identify hemodynamic parameters before exercise that can predict sweat volume during exercise, and post-exercise parameters that can be predicted by the sweat volume. Eighty-nine young healthy subjects (aged 21.9 ± 1.7 years, 51 males) were recruited to each perform a 3-km run on a treadmill. Demographic and anthropometric data were collected and hemodynamic data were obtained, including heart rate, blood pressure and pulse wave analysis using non-invasive tonometry. Sweat volume was defined as pre-exercise body weight minus post-exercise body weight. Post-exercise hemodynamic parameters were also collected. Sweat volume was significantly associated with gender, body surface area (BSA) (b = 0.288, p = 0.010), peripheral systolic blood pressure (SBP), peripheral and central pulse pressure (PP), and was inversely associated with augmentation index at an HR of 75 beats/min (AIx@HR75) (b = -0.005, p = 0.019) and ejection duration. While BSA appeared to predict central PP (B = 19.271, p ≤ 0.001), central PP plus AIx@HR75 further predicted sweat volume (B = 0.008, p = 0.025; B = -0.009, p = 0.003 respectively). Sweat volume was associated with peripheral SBP change (B = -17.560, p = 0.031). Sweat volume during a 3-km run appears to be influenced by hemodynamic parameters, including vascular arterial stiffness and central pulse pressure. Results of the present study suggest that vascular arterial stiffness likely regulates sweat volume during exercise.


Cardiology ◽  
2021 ◽  
pp. 1-6
Author(s):  
John Michael Cochran ◽  
Vincent R. Siebert ◽  
Jeffrey Bates ◽  
Djenita Butulija ◽  
Anna Kolpakchi ◽  
...  

Background: Identification and modification of cardiovascular risk factors is paramount to reducing cardiovascular disease morbidity and mortality. Hypertension is a major risk factor for cardiovascular disease, but its association with height remains largely underrecognized. Objectives: The objective of this manuscript is to review the evidence examining the association between blood pressure and human stature and to summarize the plausible pathophysiological mechanisms behind such an association. Methods: A systematic review of adult human height and its association with hypertension and coronary artery disease was undertaken. The literature evidence is summarized and tabulated, and an overview of the pathophysiological basis for this association is presented. Results: Shorter arterial lengths found in shorter individuals may predispose to hypertension in a complex hemodynamic interplay, which is explained predominantly by summated arterial wave reflections and an elevated augmentation index. Our systemic review suggests that an inverse relationship between adult height and blood pressure exists. However, differences in the studied populations and heterogeneity in the methods applied across the various studies limit the generalizability of these findings and their clinical application. Conclusion: Physiological studies and epidemiological data suggest a potential inverse association between adult height and blood pressure. Further research is required to define the relationship more clearly between adult height and blood pressure and to assess whether antihypertensive therapeutic approaches and goals should be modified according to patients’ heights.


2020 ◽  
Vol 15 (5) ◽  
pp. 877-886
Author(s):  
İsa Kaya

This study aimed to investigate the relationship between children's prosocial behavior and self-regulation skills. To collect the data of the study, demographic information form developed by the researcher was used for the demographic information of children, the prosocial behavior sub-dimension of the social behavior scale was used for the prosocial behavior, and the self-regulation skills scale was used for the self-regulation skills of the children. The collected data were analyzed by independent sample t-test, Pearson’s product moment correlation analysis and simple linear regression analysis in a computer package software. As a result of the research, while the self-regulation and prosocial behaviors of children differed according to gender and age of children, the situation of the children whether they have siblings and duration of the pre-school education did not make any significant difference. According to these results, girls' self-regulation and prosocial behavior scores were higher than that of boys and 6 years of age children’s scores were higher than that of 5 years of age children. While there was a moderate positive significant relationship between self-regulation skills and prosocial behavior, it was concluded that the prosocial behavior of children predicted self-regulation skills at the level of 11%.   Keywords: Prosocial behavior, self-regulation skills, early childhood, preschool


2009 ◽  
Vol 15 (3) ◽  
pp. 290-295 ◽  
Author(s):  
V. V. Ivanenko ◽  
O. P. Rotar ◽  
A. Konradi

Objective. To assess relation between central blood pressure and arterial stiffness with cardiovascular risk factors. Design and methods. 116 subjects considering themselves healthy were examined. 63 showed blood pressure elevation. Anthropometry was performed and fasting blood specimens were obtained from all patients. Plasma glucose and lipids levels were measured. Pulse wave velocity (PWV) and augmentation index (AI) were measured by Sphygmocor Px device (Australia). Results. Parameters of arterial stiffness were strongly associated with hypertension, increased waist circumference, age, cholesterol level, and metaboloc syndrome. Females had higher AI as compared to males. Conclusion. Central blood pressure and arterial stiffness are determined not only by age and peripheral blood pressure but by cholesterol level and anthropometric parameters as well.


2018 ◽  
Vol 41 (7) ◽  
pp. 378-384 ◽  
Author(s):  
Alper Erdan ◽  
Abdullah Ozkok ◽  
Nadir Alpay ◽  
Vakur Akkaya ◽  
Alaattin Yildiz

Background: Arterial stiffness is a strong predictor of mortality in hemodialysis patients. In this study, we aimed to investigate possible relations of arterial stiffness with volume status determined by bioimpedance analysis and aortic blood pressure parameters. Also, effects of a single hemodialysis session on these parameters were studied. Methods: A total of 75 hemodialysis patients (M/F: 43/32; mean age: 53 ± 17) were enrolled. Carotid-femoral pulse wave velocity, augmentation index, and aortic pulse pressure were measured by applanation tonometry before and after hemodialysis. Extracellular fluid and total body fluid volumes were determined by bioimpedance analysis. Results: Carotid-femoral pulse wave velocity (9.30 ± 3.30 vs 7.59 ± 2.66 m/s, p < 0.001), augmentation index (24.52 ± 9.42 vs 20.28 ± 10.19, p < 0.001), and aortic pulse pressure (38 ± 14 vs 29 ± 8 mmHg, p < 0.001) significantly decreased after hemodialysis. Pre-dialysis carotid-femoral pulse wave velocity was associated with age (r2 = 0.15, p = 0.01), total cholesterol (r2 = 0.06, p = 0.02), peripheral mean blood pressure (r2 = 0.10, p = 0.005), aortic-mean blood pressure (r2 = 0.06, p = 0.02), aortic pulse pressure (r2 = 0.14, p = 0.001), and extracellular fluid/total body fluid (r2 = 0.30, p < 0.0001). Pre-dialysis augmentation index was associated with total cholesterol (r2 = 0.06, p = 0,02), aortic-mean blood pressure (r2 = 0.16, p < 0.001), and aortic pulse pressure (r2 = 0.22, p < 0.001). Δcarotid-femoral pulse wave velocity was associated with Δaortic-mean blood pressure (r2 = 0.06, p = 0.02) and inversely correlated with baseline carotid-femoral pulse wave velocity (r2 = 0.29, p < 0.001). Pre-dialysis Δaugmentation index was significantly associated with Δaortic-mean blood pressure (r2 = 0.09, p = 0.009) and Δaortic pulse pressure (r2 = 0.06, p = 0.03) and inversely associated with baseline augmentation index (r2 = 0.14, p = 0.001). In multiple linear regression analysis (adjusted R2 = 0.46, p < 0.001) to determine the factors predicting Log carotid-femoral pulse wave velocity, extracellular fluid/total body fluid and peripheral mean blood pressure significantly predicted Log carotid-femoral pulse wave velocity (p = 0.001 and p = 0.006, respectively). Conclusion: Carotid-femoral pulse wave velocity, augmentation index, and aortic pulse pressure significantly decreased after hemodialysis. Arterial stiffness was associated with both peripheral and aortic blood pressure. Furthermore, reduction in arterial stiffness parameters was related to reduction in aortic blood pressure. Pre-dialysis carotid-femoral pulse wave velocity was associated with volume status determined by bioimpedance analysis. Volume control may improve not only the aortic blood pressure measurements but also arterial stiffness in hemodialysis patients.


2021 ◽  
Vol 27 (4) ◽  
pp. 427-435
Author(s):  
V. E. Gumerova ◽  
S. A. Sayganov ◽  
V. V. Gomonova

Objective. To assess the relationship between arterial stiffness parameters in hypertensive patients with and without atherosclerotic lesions.Design and methods. We included 127 subjects who were divided into 3 groups: patients with hypertension (HTN) without atherosclerosis (n = 42); patients with HTN and subclinical atherosclerosis (SА) (n = 52) and control group which consisted of individuals without HTN, SA, or coronary artery disease (n = 33). All groups matched by age and gender. All subjects underwent following examinations: ultrasonography of extracranial segments of carotid arteries, 24-hour blood pressure monitoring with the assessment of arterial stiffness parameters.Results. In subjects with HTN compared to controls, pulse wave velocity in aorta (PWVao) was significantly higher (11,3 ± 1,5; 12,3 ± 1,8 vs 10,4 ± 1,3 m/s; p < 0,05), as well as pulse pressure (PP) (46,4 ± 9,8; 45,6 ± 10,6 vs 39,9 ± 6,5 mmHg; p < 0,05), central pulse pressure (PPао) (35,5 ± 8,5; 34,9 ± 8,5 vs 30,9 ± 5,4 mmHg; p < 0,05), and arterial stiffness index (ASI) (141 (127, 159); 139 (128,5, 160,5) vs 126 (118, 138) mmHg; p < 0,05). In subjects with HTN and SA, PWVao was significantly higher compared to other groups (p < 0,05). No significant difference in augmentation index was found (–32,5 (–45, –12); –22 (–36, –12); –37 (–50, –17); p = 0,25). Аmbulatory arterial stiffness index was higher in controls (0,5 ± 0,2) compared to HTN group (0,4 ± 0,2; p = 0,05), while HTN and SA group did not differ significantly (0,5 ± 0,2; p = 0,3). PWVao above 11,15 m/s is associated with 4,3 (2,3–8,2) times higher rate of atherosclerosis plaque detection.Conclusions. In HTN patients, arterial stiffness is changed compared to healthy individuals. PWVao above 11,15 m/s is associated with 4,3 (2,3–8,2) times higher rate of atherosclerosis plaque detection. In patients with HTN and SA arterial stiffness is higher, which might have additional predictive value in risk stratification.


Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Seung-Hyun Lee ◽  
Kihyuk Shin ◽  
Sungha Park ◽  
Seok-Min Kang ◽  
Seung-Hyo Lee ◽  
...  

Objectives: Elastin is a major structural protein of arteries and elastin derived peptide is known to be related to arterial change. We previously reported a novel assay for anti-aortic elastin antibody, but its clinical implication has not been clearly shown. The aim of this study was to check if anti-aortic elastin antibody titers may reflect the risk of coronary artery disease (CAD) or its detail characteristics. Methods: This study included 174 CAD patients and 171 age-, sex-matched control subjects. In all subjects, anti-aortic elastin antibody titer was quantified by ELISA. Parameters of arterial stiffness including augmentation index (AI) and heart to femoral pulse wave velocity (hfPWV) were measured non-invasively. In patients with CAD, clinical and angiographic characteristics were evaluated. Associations between anti-aortic elastin and vascular characteristics were identified by linear regression analysis. Results: Median blood level of anti-aortic elastin was significantly lower in the CAD group than that of the control group (197 a.u. vs. 63 a.u., p<0.001). Levels of anti-aortic elastin were significantly lower in males, subjects with hypertension, diabetes mellitus, hyperlipidemia, or hfPWV (Figure). However, the levels were not dependent of atherothrombotic events or angiographic severity of CAD (Figure). In multivariate analysis, male (β=-0.38, p<0.001), diabetes mellitus (β=-0.62, p<0.001), hyperlipidemia (β=-0.29, p<0.001), and AI (β=-0.006, p=0.02) were finally identified as determinants for anti-aortic elastin levels (Table). Conclusions: Taken together, lower levels of anti-aortic elastin are related to CAD. The association between antibody titer and CAD is linked to arterial stiffness rather than advancement of atherosclerosis.


Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Chisa Matsumoto ◽  
Susanne Rautiainen ◽  
Elise Roche ◽  
JoAnn E Manson ◽  
Howard D Sesso

Introduction: A multivitamin (MV) is the most commonly taken supplement in older U.S. adults. Arterial stiffness is an important intermediate marker of cardiovascular disease (CVD). However, few studies have examined the association of MV use and arterial stiffness. Hypothesis: Regular multivitamin use is associated with lower levels of arterial stiffness. Methods: A subcohort of participants enrolled in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS), a large scale randomized clinical trial testing a MV and a cocoa extract supplement on CVD and cancer, completed baseline measurement of arterial stiffness assessed by pulse wave velocity (PWV), augmentation index (AI), and central blood pressure (CBP). Frequency and duration of MV use was assessed via self-report questionnaire at baseline. The cross-sectional association of MV use and arterial stiffness was evaluated by multivariate linear regression with adjustment for conventional CVD risk factors. We also performed subgroup analyses to evaluate effect modification between MV use and sex, age, body mass index (BMI), and hypertension. Results: A total of 470 (229 women and 241 men) COSMOS participants were included in this study, with mean age 69.1±5.2 years, of whom 150 (32%) reported current MV use at baseline. Multivariate linear regression analysis revealed that current MV use (yes versus no) was significantly associated with lower PWV (β:-0.59±1.02, p=0.004) but not associated with other measures of arterial stiffness, including AI or CBP. There were also no consistent associations between frequency and duration of MV use with any of the measures of arterial stiffness. Also, there was no effect modification by sex, age, BMI, or hypertension on the association between MV use and arterial stiffness. Conclusions: MV use was associated with lower PWV in older subjects. Further results from the COSMOS trial on randomized MV supplementation and changes in arterial stiffness over 2 years will further elucidate the effects of MV on arterial stiffness.


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