Stress system dysfunction revealed by integrating reactivity of stress pathways to psychological stress in lean and overweight/obese men

While the patterns of response within the sympatho-adrenal medullary (SAM) system and hypothalamo-pituitary adrenal (HPA) axis are interesting and important in their own accord, the overall response to acute psychological stress involves reactivity of both pathways We tested the hypothesis that consideration of the integrated response of these pathways may reveal dysregulation of the stress systems that is not evident when considering either system alone. Age matched lean and overweight/obese men were subjected to a Trier Social Stress Test and reactivity of the SAM system (salivary alpha amylase, systolic blood pressure, diastolic blood pressure and heart rate) and the HPA axis (salivary cortisol) were measured. Relative reactivity of SAM system and HPA axis was calculated as the ratio between the measures from each pathway. While analysis of reactivity of individual stress pathways showed no evidence of dysfunction in overweight/obese compared with lean men, analysis of HPA/SAM reactivity revealed significantly lower cortisol over systolic blood pressure (CoSBP) and cortisol over diastolic blood pressure (CoDBP) reactivity in overweight/obese compared with lean men. Other measures of HPA/SAM reactivity and all measures of SAM/HPA reactivity were unaltered in overweight/obese compared with lean men. These findings suggest that the cortisol response per unit of blood pressure response is blunted in men with elevated adiposity. Further, these findings support a notion of a coordinated overall approach to activation of the stress pathways with the degree of activation in one pathway being related to the degree of activation of the other.

Factors Associated With an Abnormal Blood Pressure Response During Exercise After Coarctation Repair

Background Although resting blood pressures following aortic arch repair or the extended end-to-end anastomosis (EEA) repair for coarctation can be physiologic, factors associated with an abnormal blood pressure response after exercise are unknown. We measured blood pressure gradients following exercise in children who had undergone previous repair in accordance with a surgical selection algorithm and sought to identify factors associated with an abnormal blood pressure response. Methods In accordance with our practice's surgical algorithm for repair of coarctation, infants were stratified to aortic arch repair when the distal transverse arch-to-left carotid artery ratio (DTA:LCA) ≤ 1.0, or when a brachiocephalic trunk or intra-cardiac lesion requiring repair was present. A thoracotomy and EEA were otherwise used. A follow-up exercise stress test (EST) measured the arm:leg blood pressure gradient after exercise, and a gradient ≥ 20 mm Hg was defined as an abnormal blood pressure response. Results Thirty-seven infants who had previously undergone coarctation repair (aortic arch repair-19, EEA-18) completed an EST at 12.3 ± 2.2 years of age. Thirteen (35%) children (aortic arch repair-5, EEA-8; p = .3) exhibited an abnormal blood pressure response. Factors associated with an abnormal blood pressure response included: smaller DTA:LCA ratios prior to repair (1.0 ± .2 vs. 1.2 ± .3; p = .04) and greater body weight at the time of EST (57.5 ± 19.1 vs. 40.9 ± 15.6 kg; p = .03). Conclusion An abnormal blood pressure response following exercise is associated with smaller DTA:LCA ratios at the time of repair and increased weight during follow-up suggesting that patients with these factors warrant close observation.

Expert opinion. Spironolactone: a new twist on an old story

The article presents recent data on possibilities of a broader use of mineralocorticoid receptor antagonists for existing indications and of expanding indications for the use of this pharmaceutical group in the context of the novel coronavirus infection COVID-19. The authors discussed prospects for expanded detection of aldosteronism using a new diagnostic approach, including an additional evaluation of blood pressure response to spironolactone.

Comparison of Long‐Term Outcomes for Responders Versus Non‐Responders Following Renal Denervation in Resistant Hypertension

Background Recent trial results support the efficacy of renal sympathetic denervation in lowering blood pressure (BP). While BP reduction in general is associated with a clinically meaningful reduction in cardiovascular events and mortality, such a relationship has not been described for patients undergoing renal sympathetic denervation. Methods and Results Clinical events were assessed in patients who underwent renal sympathetic denervation at our center using telephone‐ and clinical follow‐up, interviews with general practitioners, as well as review of hospital databases. Event rates were compared between BP responders (≥5 mm Hg 24‐hour ambulatory BP reduction) and non‐responders; 296 patients were included. Compared with baseline, 24‐hour systolic ambulatory BP was reduced by 8.3±12.2 mm Hg and diastolic BP by 4.8±7.0 mm Hg ( P <0.001 for both) after 3 months. One hundred eighty patients were classified as BP responders and 116 as non‐responders. During a median follow‐up time of 48 months, significantly less major adverse cardiovascular events (cardiovascular death, stroke, myocardial infarction, critical limb ischemia, renal failure) occurred in responders than in non‐responders (22 versus 23 events, hazard ratio [HR], 0.53 [95% CI, 0.28 to 0.97], P =0.041). This was consistent after adjustment for potential confounders as well as confirmed by propensity‐score matching. A proportional relationship was found between BP reduction after 3 months and frequency of major adverse cardiovascular events (HR, 0.75 [95% CI, 0.58 to 0.97] per 10 mm Hg 24‐hour systolic ambulatory BP reduction). Conclusions Based on these observational data, blood pressure response to renal sympathetic denervation is associated with improved long‐term clinical outcome.

Electroacupuncture for Hypertension in Adults: Study Protocol of a Systematic Review and Meta-Analysis

Introduction: Hypertension is a common, prevalent cardiovascular disease that requires multidisciplinary treatments. In Asian countries, electroacupuncture (EA) is often used as an adjunct to antihypertensive drugs for lowering blood pressure and relieving related symptoms. However, till now the effects of EA for hypertension are not fully evaluated. This study aims to assess the efficacy and safety of EA in patients with hypertension through a systematic review and meta-analysis of randomized controlled trials.Methods and analysis: Seven electronic databases including Medline, EMBASE, CENTRAL, CNKI, CBM, Wanfang, and VIP Database will be searched from inception to May 30, 2021, to identify clinical trials of EA treating hypertension in adults. Eligible comparisons will be limited to 1) EA versus valid comparators including placebo, antihypertensives, waiting list and 2) EA as an adjunct to antihypertensives versus antihypertensives. Clinical outcomes include blood pressure, response rate, somatic symptom relief, quality of life, and safety from baseline to post-treatment. The Cochrane Risk of Bias assessment tool will be used to evaluate the quality of the included studies and the GRADE system will be employed to summarize the overall quality of evidence. Random-effects model will be performed, where efficacy data will be reported with mean difference (continuous data) or risk ratio (dichotomous data). In addition, heterogeneity and publication bias will be tested with the I2 statistic and the Egger’s test/funnel plot. Ethics and dissemination: As a secondary literature study, this systematic review doesn’t require ethical approval. The study results will be disseminated via peer-review publication or conference presentation. Registration: PROSPERO registration ID CRD42019133937.