Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the american heart association

Use of Mind-Body Therapies Among Young Adults Aged 18-24 Years: Findings From the 2012 National Health Interview Survey

PURPOSE

To investigate the prevalence, patterns, and satisfaction of use of mind-body therapies (MBTs) in a nationally representative sample of young adults (ages 18-24 years).

METHODS

Young adults interviewed in the 2012 National Health Interview Survey were analyzed (n = 3,286). Individual types (e.g., mindfulness) and a combined measure of use of any MBT were assessed. Reasons for and satisfaction with use was also investigated. Design-based F tests and logistic regression were used; all analyses were weighted and stratified by gender.

RESULTS

Overall, 14.6% of young adults used MBT in the past year (9.6% of men and 19.1% of women, p < .001). Among men, higher levels of education, greater numbers of health conditions, and healthy behaviors were associated with greater odds of MBT use. Among women, Latina and black women had lower odds of use (vs. white). Higher education, greater mental distress, and greater numbers of health conditions and healthy behaviors were associated with greater odds of use. While both men and women reported stress reduction and general wellness as top reasons for use, men also reported the use to improve athletic performance.

CONCLUSIONS

Young adulthood is a critical period in the life course when individuals are establishing lifestyle and health behaviors that can be enduring. Because stress is a persistent problem, and many MBTs can be helpful with management of stress and anxiety, young adult may be underutilizing these modalities. Public health and educational strategies for greater engagement in MBT among young adults are warranted.

Pilot Trial of an Acceptance-Based Behavioral Intervention to Promote Physical Activity Among Adolescents

Prior interventions have shown limited efficacy in increasing the number of adolescents engaging in adequate physical activity (PA). Preliminary evidence suggests acceptance-based behavioral treatments (ABTs) may increase PA; however, this approach has not been tested in adolescents. This was a nonrandomized experimental pilot study that examined feasibility, acceptability, and treatment outcomes of a school-based, acceptance-based behavioral intervention for PA. Adolescents (n = 20) with low activity received a PA tracking device and were allocated to device use only or device use plus 10-weeks of ABT. PA, cardiovascular fitness, and physiological outcomes were measured pre- and postintervention. The intervention was found to be feasible and acceptable. PA, cardiovascular fitness, and physiological outcomes improved over time in the intervention group, but not in the comparison condition. This study demonstrated feasibility, acceptability, and preliminary treatment efficacy based on effect sizes for an acceptance-based behavioral intervention to increase PA in adolescents.

Association of baseline level of physical activity and its temporal changes with incident hypertension and diabetes mellitus

Background The association between baseline and temporal changes in physical activity and incident hypertension or diabetes mellitus in initially non-hypertensive or non-diabetic subjects is rarely known. Methods Among individuals who underwent consecutive comprehensive health screenings, their physical activity level was measured using a self-reported international physical activity questionnaire. First, subjects were classified into four categories: no regular physical activity with a sedentary lifestyle; minimal physical activity (<75 min/week); insufficient physical activity (≥75 min but <150 min/week); and sufficient physical activity (≥150 min/week). Second, subjects were sub-grouped, based on temporal changes in physical activity level between baseline and consecutive follow-up: increase, no change, and decrease. Results Finally, among 174,314 subjects (mean age 36.7 ± 6.9 years), 5544 (3.18%) and 21,276 (12.2%) developed incident diabetes mellitus and arterial hypertension, respectively. After a multivariate adjustment, sufficient baseline physical activity was associated with significantly lower risk for incident hypertension (hazard ratio 0.89; 95% confidence interval (CI) 0.81 to 0.97), but the difference was not significant, and showed a lower trend in diabetes mellitus incidence (hazard ratio 0.87; 95% CI 0.69 to 1.04) in reference to no regular physical activity group. Regardless of the baseline physical activity level, subjects with a temporal increase in physical activity showed significantly decreased risk for incident hypertension (hazard ratio 0.93; 95% CI 0.87 to 0.99) and diabetes mellitus (hazard ratio 0.83; 95% CI 0.74 to 0.92) compared with those with a temporal decrease in their physical activity level. Conclusion Both sufficient baseline physical activity level and its temporal increase were associated with a lower risk of incident hypertension and diabetes mellitus in a large, relatively healthy, cohort.

Characterizing and Comparing Acute Responses of Blood Pressure, Heart Rate, and Forearm Blood Flow to 2 Handgrip Protocols

PURPOSE

Growing evidence supports handgrip exercise training for reducing resting blood pressure (BP), with inconsistent exercise protocols reported throughout the literature. To verify safety of such protocols, real-time cardiovascular responses must be assessed. Consequently, this research sought to evaluate the acute impact of dissimilar handgrip protocols on the cardiovascular responses of BP, heart rate (HR), and forearm blood flow.

METHODS

Using a randomized intraindividual crossover design, 20 post-menopausal women completed 2 distinct handgrip protocols compared with a nonexercise control: 4 × 2-min sustained grips at 30% moderate intensity with 1-min rest between sets (ZONA), and 32 × 5-sec intermittent grips at maximal intensity with 5-sec rest between sets (MINT). Cardiovascular responses were measured throughout exercise and post-exercise recovery.

RESULTS

Compared to ZONA, the MINT protocol required less time and less exercise effort, yet caused greater average BP perturbations (systolic, MINT: 16.9 ± 12.9 mm Hg, ZONA: 7.9 ± 11.6 mm Hg; diastolic, MINT: 8.7 ± 7.2 mm Hg, ZONA: 4.5 ± 4.9 mm Hg) (P < .05), with peak BP changes far below published safety guidelines. Average HR responses were similarly elevated between protocols (MINT: 5.4 ± 4.9 beats/min, ZONA: 3.4 ± 3.6 beats/min). Post-exercise recovery of BP and HR occurred swiftly following MINT while remaining elevated following ZONA.

CONCLUSIONS

Handgrip exercise protocols with distinct design features (ie, grip intensity, grip strategy, and exercise duration) cause dissimilar acute cardiovascular responses. Careful and controlled attention should be directed toward determining how such acute dissimilarities influence corresponding training outcomes. Given the confirmed safety of acute BP perturbations, future researchers can have confidence in prescribing even the high-intensity MINT protocol for at-home, unsupervised activity.

Blood-Letting Therapy for Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

To evaluate the efficacy and safety of blood-letting therapy (BLT) in treatment of hypertension.

METHODS

A comprehensive electronic and manual bibliographic searches were performed in Cochrane Central Register of Controlled Trials, Excerpt Medica Database (EMBASE), PubMed, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, and Wanfang Database to identify randomized controlled trials (RCTs) in which hypertensive patients were treated with BLT or BLT plus antihypertensive drugs (BPAD) against placebo, no treatment or antihypertensive drugs. The Cochrane Risk Assessment Tool was used to assess the methodological quality of trials. The Review Manager 5.3 software was used for meta-analysis.

RESULTS

A total of 7 RCTs with 637 hypertensive patients from 1989 to 2017 were identified. Compared with antihypertensive drugs, blood pressure was significantly reduced by BLT (RR=1.21, 95% CI: 1.01 to 1.44, P=0.03; heterogeneity: P=0.06, I²=60%) and BPAD (RR=1.25, 95% CI, 1.02 to 1.53, P=0.03; heterogeneity: P= 0.01, I²=71%). Moreover, a significant improvement in Chinese medicine syndrome by BLT (RR=1.32; 95% CI: 1.14 to 1.53, P=0.0002; heterogeneity: P=0.53, I²=0%) and BPAD (RR=1.47; 95% CI: 1.06 to 2.04, P=0.02; heterogeneity: P=0.13, I²=56%) was identified. The reported adverse effects were well tolerated.

CONCLUSION

Although some positive findings were identified, no definite conclusions regarding the efficacy and safety of BLT as complementary and alternative approach for treatment of hypertension could be drew due to the generally poor methodological design, significant heterogeneity, and insufficient clinical data. Further rigorously designed trials are warranted to confirm the results.

Effect of religion on hypertension in adult Buddhists and residents in China: A cross-sectional study

Correlation between religion and hypertension is worth investigating since they both influence many people. Compared to studies which quantify religion with indicators representing only restricted dimensions of religion, researches assessing religion as an integral is preferable while lacking. Moreover, religious behaviors have great potential to be generalized if they are proved to be mediator through which religion exerts effect. However, relevant evidence is limited. Therefore, this cross-sectional study recruited 1384 adult Tibetan Buddhists from two Buddhist institutes in the Sichuan Province of China, and enrolled 798 adult Tibetan residents from nearby villages/towns. Each participant received a questionnaire, physical examination, and blood biochemistry tests. Buddhist effect on hypertension was investigated. The effects of uniquely Buddhist behaviors on hypertension were analyzed. The hypertensive risk of the Tibetan Buddhists is significantly decreased by 38% than Tibetan residents. As a Buddhist behavior, vegetarian diet highly approximates to be protective for Tibetan hypertension. As another Buddhist behavior, longer Buddhist activity participation time is associated with decreased prevalence of hypertension as well as lower blood pressure (BP) by analyzing subgroup of 570 Buddhists. Therefore, the protective role of religion on hypertension is suggested, and the religious behaviors are mediators which may be applied to general population.

Adenosine 5'-Triphosphate Metabolism in Red Blood Cells as a Potential Biomarker for Post-Exercise Hypotension and a Drug Target for Cardiovascular Protection

The importance of adenosine and ATP in regulating many biological functions has long been recognized, especially for their effects on the cardiovascular system, which may be used for management of hypertension and cardiometabolic diseases. In response to ischemia and cardiovascular injury, ATP is broken down to release adenosine. The effect of adenosine is very short lived because it is rapidly taken up by erythrocytes (RBCs), myocardial and endothelial cells, and also rapidly catabolized to oxypurine metabolites. Intracellular adenosine is phosphorylated back to adenine nucleotides via a salvage pathway. Extracellular and intracellular ATP is broken down rapidly to ADP and AMP, and finally to adenosine by 5′-nucleotidase. These metabolic events are known to occur in the myocardium, endothelium as well as in RBCs. Exercise has been shown to increase metabolism of ATP in RBCs, which may be an important mechanism for post-exercise hypotension and cardiovascular protection. The post-exercise effect was greater in hypertensive than in normotensive rats. The review summarizes current evidence in support of ATP metabolism in the RBC as a potential surrogate biomarker for cardiovascular protection and toxicities. It also discusses the opportunities, challenges, and obstacles of exploiting ATP metabolism in RBCs as a target for drug development and precision medicine.

Mind-Body Interactions and Mindfulness Meditation in Diabetes

Diabetes is associated with significant psychological distress. It is, therefore, important to ensure the physical and emotional as well as psychosocial wellbeing of individuals living with diabetes. Meditation-based strategies have been evaluated for their complementary role in several chronic disorders including depression, anxiety, obesity, hypertension, cardiovascular disease and diabetes. The practice of meditation is associated with reduction in stress and negative emotions and improvements in patient attitude, health-related behaviour and coping skills. There is increased parasympathetic activity with reduction in sympathetic vascular tone, stress hormones and inflammatory markers. Additionally, several studies evaluated the role of mindfulness-based stress reduction in diabetic individuals and demonstrated modest improvements in body weight, glycaemic control and blood pressure. Thus, mindfulness meditation-based intervention can lead to improvements across all domains of holistic care – biological, psychological and social. Though most of these studies have been of short duration and included small numbers of patients, meditation strategies can be useful adjunctive techniques to lifestyle modification and pharmacological management of diabetes and help improve patient wellbeing.

Handgrip strength is positively related to blood pressure and hypertension risk: results from the National Health and nutrition examination survey

Background

Isometric handgrip resistance exercise, a nonpharmacological lifestyle modification, has been recommended as a first-line treatment for hypertension. This study aimed to examine the relationship of handgrip strength to blood pressure and the risk of hypertension.

Methods

The responses and examination of 4597 participants in the National Health and Nutrition Examination Survey (NHANES) were analyzed in this study. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were transformed to age- and sex-specific z-scores. Handgrip strength was adjusted by weight (kg) and converted to an age- and sex-specific z-score. The relationships of SBP and DBP to handgrip strength were analyzed by Pearson correlation test and multivariable linear regression. Binary logistic regression was used to analyze the association between handgrip strength and prevalence of hypertension.

Results

Handgrip strength was positively related to higher DBP in men and women. In men, logistic regression models revealed that increased handgrip strength was associated with higher risk of hypertension after adjusting for age, BMI, smoking and drinking status; OR was 1.24 (95%CI: 1.04–1.48). After stratifying on BMI, handgrip strength was significantly associated with higher risk of hypertensions after adjusting for age, BMI, smoking and drinking status in overweight and obese men; OR was 1.31 (95%CI: 1.05–1.63). No significant associations were observed in women.

Conclusions

Increased handgrip strength is associated with higher DBP in men and women. In men, especially overweight and obese men, strong handgrip strength may be associated with higher risk of hypertension.

Electronic supplementary material

The online version of this article (10.1186/s12944-018-0734-4) contains supplementary material, which is available to authorized users.

Hipertensão arterial autorreferida em adultos residentes em Campinas, São Paulo, Brasil: prevalência, fatores associados e práticas de controle em estudo de base populacional

Resumo O objetivo deste artigo é avaliar a prevalência de hipertensão arterial autorreferida em adultos de 20-59 anos, identificar os fatores associados, o uso dos serviços de saúde e as práticas de controle da doença segundo posse ou não de plano de saúde. Estudo transversal de base populacional realizado em Campinas-SP, em que foram analisados 957 adultos. A prevalência de hipertensão arterial autorreferida foi de 14,1%, revelando-se mais elevada em mulheres, em indivíduos com ≥ 40 anos, nos que se declararam de cor preta, com menor escolaridade, nos inativos no lazer, ex-fumantes, naqueles com sobrepeso ou obesidade, nos que relataram duas ou mais doenças e que autoavaliaram a saúde como não sendo excelente/muito boa. Não foram detectadas desigualdades entre hipertensos cobertos por planos de saúde e os SUS dependentes quanto ao acesso ao serviço, uso de medicamentos para controle da doença e ser orientado sobre os cuidados com a doença, mas houve diferenças quanto a prática de atividade física e o uso de dieta. Apesar da equidade revelada quanto ao acesso à atenção à saúde, é incipiente a proporção de adultos que adota mudanças no estilo de vida para o controle da doença, reafirmando o papel central da gestão das políticas de saúde, que precisam trabalhar intersetorialmente

Role of MicroRNA in Endothelial Dysfunction and Hypertension

Purpose of Review

Hypertension is either a cause or a consequence of the endothelial dysfunction and a major risk factor for cardiovascular disease (CVD). In vitro and in vivo studies established that microRNAs (miRNAs) are decisive for endothelial cell gene expression and function in various pathological conditions associated with CVD.

This review provides an overview of the miRNA role in controlling the key connections between endothelial dysfunction and hypertension.

Recent Findings

Herein we summarize the present understanding of mechanisms underlying hypertension and its associated endothelial dysfunction as well as the miRNA role in endothelial cells with accent on the modulation of renin-angiotensin-aldosterone-system, nitric oxide, oxidative stress and on the control of vascular inflammation and angiogenesis in relation to endothelial dysfunction in hypertension. In particular, latest insights in the identification of endothelial-specific microRNAs and their targets are added to the understanding of miRNA significance in hypertension.

Summary

This comprehensive knowledge of the role of miRNAs in endothelial dysfunction and hypertension and of molecular mechanisms proposed for miRNA actions may offer novel diagnostic biomarkers and therapeutic targets for controlling hypertension-associated endothelial dysfunction and other cardiovascular complications.

The safety of isometric exercise: Rethinking the exercise prescription paradigm for those with stage 1 hypertension

Few studies have investigated the relative safety of prescribing isometric exercise (IE) to reduce resting blood pressure (BP). This study aimed to ascertain the safety of the hemodynamic response during an IE wall squat protocol.Twenty-six hypertensive (BP of 120-139 mm Hg systolic and/or 80-90 mm Hg diastolic) males (45 ± 8 years; 1.78 ± 0.07 m; 89.7 ± 12.3 kg; mean ± SD), visited the laboratory on 2 separate occasions. Heart rate (HR) and BP were measured at rest and continuously throughout exercise. In visit 1, participants completed a continuous incremental isometric wall squat exercise test, starting at 135° of knee flexion, decreasing by 10° every 2 minutes until 95° (final stage). Exercise was terminated upon completion of the test or volitional fatigue. The relationship between knee joint angle and mean HR was used to calculate the participant-specific knee joint angle required to elicit a target HR of 95% HRpeak. This angle was used to determine exercise intensity for a wall squat training session consisting of 4 × 2 minute bouts (visit 2).Systolic BPs during the exercise test and training were 173 ± 21 mm Hg and 171 ± 19 mm Hg, respectively, (P > .05) and were positively related (r = 0.73, P < .05) with ratio limits of agreement (LoA) of 0.995 ×/÷ 1.077. Diastolic BPs were 116 ± 14 mm Hg and 113 ± 11 mm Hg, respectively, (P > .05) and were positively related (r = 0.42, P < .05) with ratio LoA of 0.99 ×/÷ 1.107. No participant recorded a systolic BP > 250 mm Hg. Diastolic BP values > 115 mm Hg were recorded in 12 participants during the incremental test and 6 participants during the training session. Peak rate pressure product was 20681 ± 3911 mm Hg bpm during the IE test and was lower (18074 ± 3209 mm Hg bpm) during the IE session (P = .002). No adverse effects were reported.Based on the current ACSM guidelines for aerobic exercise termination, systolic BP does not reach the upper limit during IE in this population. Diastolic BP exceeds 115 mm Hg in some during the IE protocol, which may suggest the need to individualise IE training prescription in some with suboptimal BP control. Future research is required to ascertain if IE requires modified BP termination guidelines.

Effects of ninety minutes per week of continuous aerobic exercise on blood pressure in hypertensive obese humans

The main objective of this study was to examine the effect of continuous aerobic training (CAT) in hypertensive, obese people. Seven patients of average age (45.3±3.9 years), height (1.63±0.1 m), body weight (89.09±22.0 kg), and body mass index (33.44±8.6 kg/m2) were subjected to the training. CAT was performed in thrice-weekly nonconsecutive sessions (90 min per week) with intervals of 48 hr between each session. The training sessions entailed 30 min of walking at an intensity of 70%–80% of the maximum heart rate (MHR) on a treadmill over a period of eight weeks, giving a total of 24 sessions. Through correlation analyses, we found significant improvement in the systolic pressure (R=0.5675, P=0.0253) and diastolic pressure (R=0.7083, P=0.0088) when the last session was compared to the first session of training. We found no differences in the diastolic pressure and systolic pressure before, during and after 15 min of the protocol exercise. The program showed a large effect size (ES) for systolic pressure (ES=0.85) and a small ES for diastolic pressure (ES=0.33). We found no differences in the blood pressure (BP) and heart rate (HR) during and after the training of obese hypertensive humans, but we found a positively significant correlation between HR and BP in the last session and a large ES, suggesting that this protocol exercise might have significance effect in the long term.

Use of physician-recommended non-pharmacological strategies for hypertension control among hypertensive patients

This study aims to evaluate the 4 non-pharmacological strategies adopted by patients for hypertension control and patient characteristics that affect the choice of strategies. Four thousand hypertensive patients aged ≥18 years were selected from the National Health and Nutrition Examination Survey. Odds ratios of the choice of strategies were analyzed using weighted logistic models. Clinical recommendations of non-pharmacological strategies for hypertension control were relatively low. More exercise was the least frequent strategy used for hypertension control. More patients reported using ≥3 strategies than using ≤2 strategies (79.1% vs 20.9%, P < .0001). Non-Hispanic blacks were more likely to use each individual strategy and to use ≥3 strategies simultaneously. Patients with obesity and diabetes were less likely to attempt weight control or more exercise, but more likely to use ≥3 strategies than peers. Educational programs should be developed to enhance physician's advice for lifestyle modifications and to increase patient's acceptance of physical activity.

High-intensity handgrip training lowers blood pressure and increases heart rate complexity among postmenopausal women: a pilot study

OBJECTIVE

Handgrip exercise is an emerging strategy for resting blood pressure (BP) reduction requiring minimal time and exercise effort. However, the research literature is currently limited to handgrip protocol designs predominantly prescribing sustained grip contractions, with little assessment of alternative options. Furthermore, our understanding of the utility of handgrip exercise would be strengthened by an evaluation of the physiological mechanisms driving BP reductions and an assessment of the interindividual response variability. As such, this research was designed to perform an initial evaluation of the pragmatic effectiveness of a novel at-home, high-intensity, unilateral (nondominant) handgrip exercise training program in reducing resting BP, while simultaneously exploring mediators of BP change including a neurocardiac index of autonomic nervous control [heart rate (HR) variability], measures of arterial stiffness (radial augmentation index and carotid-radial pulse wave velocity), and cardiovascular reactivity to psychophysiological stressors.

METHODS

Postmenopausal women were recruited to complete 8 weeks of handgrip exercise training. Aforementioned measures of resting BP and mediators of BP change were acquired at the midway point and end of training.

RESULTS

All participants (n=17) completed training with high self-reported adherence (96.9%) and improvement in grip strength (2.7±2.4kg, P<0.05). Handgrip training reduced resting systolic BP (-5.1±7.7 mmHg, P<0.05) and improved HR complexity (sample entropy: 0.24±0.31, P<0.05), without significant changes to resting diastolic BP, HR, or arterial stiffness (all P>0.05).

CONCLUSION

This pilot study successfully shows the potential utility of high-intensity intermittent handgrip exercise for improvements in cardiovascular health among postmenopausal women, with additional research required to further explore the underlying physiological mechanisms driving such improvements.

Interaction between physical activity and television time on blood pressure level: cross-sectional data from 45 000 individuals

OBJECTIVES

The aim was to investigate if there is an interaction between sitting time and leisure time physical activity on blood pressure and if there are age differences and sex differences in this respect.

METHODS

Linear regression analysis on cross-sectional data was performed in more than 45 000 men and women from two Swedish cohort studies, EpiHealth (45-75 years) and LifeGene (18-45 years). Self-reported leisure time physical activity was given in five levels from low (level 1) to vigorous physical activity (level 5) and television time was used as a proxy measure of sitting time.

RESULTS

High physical activity was associated with lower DBP (P = 0.001), but not SBP. Active middle-aged men had lower DBP (-1.1 mmHg; 95% CI -1.7 to -0.4) compared with inactive participants. Prolonged television time was associated with higher SBP (P < 0.001) and DBP (P = 0.011) in both sexes and in most age groups. Watching 3 h instead of 1 h television per day was associated with higher SBP in middle-aged women (SBP: 1.1 mmHg; 95% CI 0.7-1.4) and men (SBP: 1.2 mmHg; 95% CI 0.8-1.6). Only in young men, a high physical activity (level 4 instead of level 1) could compensate for a prolonged television time (3 h per day) in terms of DBP.

CONCLUSION

Prolonged television time was associated with higher SBP and DBP in both sexes and at most ages, whereas an increased physical activity was mainly associated with a lower DBP. Only in young men, a high physical activity could compensate for prolonged television time regarding DBP.

Thoughts modulate the expression of inflammatory genes and may improve the coronary blood flow in patients after a myocardial infarction

BACKGROUND

Mental stress is one of the main risk factors for cardiovascular disease. Meditation and music listening are two techniques that are able to counteract it through the activation of specific brain areas, eliciting the so-called Relaxing Response (RR). Epidemiological evidence reveals that the RR practice has a beneficial prognostic impact on patients after myocardial infarction. We aimed to study the possible molecular mechanisms of RR underlying these findings.

METHODS

We enrolled 30 consecutive patients after myocardial infarction and 10 healthy controls. 10 patients were taught to meditate, 10 to appreciate music and 10 did not carry out any intervention and served as controls. After training, and after 60 days of RR practice, we studied the individual variations, before and after the relaxation sessions, of the vital signs, the electrocardiographic and echocardiographic parameters along with coronary flow reserve (CFR) and the carotid's intima media thickness (IMT). Neuro-endocrine-immune (NEI) messengers and the expression of inflammatory genes (p53, Nuclear factor Kappa B (NfKB), and toll like receptor 4 (TLR4)) in circulating peripheral blood mononuclear cells were also all observed.

RESULTS

The RR results in a reduction of NEI molecules (p < 0.05) and oxidative stress (p < 0.001). The expression of the genes p53, NFkB and TLR4 is reduced after the RR and also at 60 days (p < 0.001). The CFR increases with the relaxation (p < 0.001) and the IMT regressed significantly (p < 0.001) after 6 months of RR practice.

CONCLUSIONS

The RR helps to advantageously modulate the expression of inflammatory genes through a cascade of NEI messengers improving, over time, microvascular function and the arteriosclerotic process.

Modifiable lifestyle risk factors for stroke among a high risk hypertensive population in Greater Kampala, Uganda; a cross-sectional study

OBJECTIVE

To describe the modifiable lifestyle risk factors for stroke among a high risk population for stroke. Africa suffers from rapid population growth, adoption of harmful western diets, and increased prevalence of hypertension and obesity.

RESULTS

A total of 440 study participants were screened and 87 individuals with hypertension plus at least one other known stroke risk factor were enrolled. The prevalence of hypertension and diabetes mellitus in the screened population was 19.7 and 1.8%, respectively. Among those with hypertension only 2.3% (2/87) had ever had serum lipid assessment. Seventy-two percent (68/87) had very high serum LDL-cholesterol, while 33.3% (29/87) had low levels of HDL-cholesterol, and 67.8% had mean blood pressures greater than 160/100 mmHg and 40% (35/87) were obese, with a BMI ≥30. Targeting individuals with modifiable stroke risk factors and implementing self-management programs may be a way to reduce stroke burden in Uganda.

The Nitrate-Independent Blood Pressure-Lowering Effect of Beetroot Juice: A Systematic Review and Meta-Analysis

Beetroot is considered a complementary treatment for hypertension because of its high content of inorganic NO₃ This systematic review and meta-analysis aimed to clarify several aspects of beetroot juice supplementation on systolic blood pressure (SBP) and diastolic blood pressure (DBP). We searched PubMed, Scopus, and Embase databases, and the reference lists of previous reviews. Randomized clinical trials that investigated the effects of beetroot juice on resting blood pressure in humans were recruited for quality assessment, meta-analyses, subgroup analyses, and meta-regressions; of these, 22 were conducted between 2009 and 2017 and included a total of 47 intervention (n = 650) and 43 control (n = 598) groups. Overall, SBP (-3.55 mm Hg; 95% CI: -4.55, -2.54 mm Hg) and DBP (-1.32 mm Hg; 95% CI: -1.97, -0.68 mm Hg) were significantly lower in the beetroot juice-supplemented groups than in the control groups. The mean difference of SBP was larger between beetroot juice-supplemented and control groups in the longer than in the shorter (≥14 compared with <14 d) study durations (-5.11 compared with -2.67 mm Hg) and the highest compared with the lowest (500 compared with 70 and 140 mL/d) doses of beetroot juice (-4.78 compared with -2.37 mm Hg). A positive correlation was observed between beetroot juice doses and the mean differences of blood pressures. In contrast, a smaller effect size of blood pressures was observed after supplementation with higher NO₃ (milligrams per 100 mL beetroot juice). A weak effect size was observed in a meta-analysis of trials that used NO₃-depleted beetroot juice as a placebo compared with other interventions (-3.09 compared with -4.51 mm Hg for SBP and -0.81 compared with -2.01 mm Hg for DBP). Our results demonstrate the blood pressure-lowering effects of beetroot juice and highlight its potential NO₃-independent effects.

Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association

Despite numerous advances in the prevention and treatment of atherosclerosis, cardiovascular disease remains a leading cause of morbidity and mortality. Novel and inexpensive interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of interest. Numerous studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may thus be a potential attractive cost-effective adjunct to more traditional medical therapies. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk. Neurophysiological and neuroanatomical studies demonstrate that meditation can have long-standing effects on the brain, which provide some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. Studies of the effects of meditation on cardiovascular risk have included those investigating physiological response to stress, smoking cessation, blood pressure reduction, insulin resistance and metabolic syndrome, endothelial function, inducible myocardial ischemia, and primary and secondary prevention of cardiovascular disease. Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest. Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline-directed cardiovascular risk reduction by those interested in this lifestyle modification, with the understanding that the benefits of such intervention remain to be better established. Further research on meditation and cardiovascular risk is warranted. Such studies, to the degree possible, should utilize randomized study design, be adequately powered to meet the primary study outcome, strive to achieve low drop-out rates, include long-term follow-up, and be performed by those without inherent bias in outcome.

The antihypertensive effects of aerobic versus isometric handgrip resistance exercise

BACKGROUND

Aerobic exercise reduces blood pressure (BP) on average 5-7 mmHg among those with hypertension; limited evidence suggests similar or even greater BP benefits may result from isometric handgrip (IHG) resistance exercise.

METHOD

We conducted a randomized controlled trial investigating the antihypertensive effects of an acute bout of aerobic compared with IHG exercise in the same individuals. Middle-aged adults (n = 27) with prehypertension and obesity randomly completed three experiments: aerobic (60% peak oxygen uptake, 30 min); IHG (30% maximum voluntary contraction, 4 × 2 min bilateral); and nonexercise control. Study participants were assessed for carotid-femoral pulse wave velocity pre and post exercise, and left the laboratory wearing an ambulatory BP monitor.

RESULTS

SBP and DBP were lower after aerobic versus IHG (4.8 ± 1.8/3.1 ± 1.3 mmHg, P = 0.01/0.04) and control (5.6 ± 1.8/3.6 ± 1.3 mmHg, P = 0.02/0.04) over the awake hours, with no difference between IHG versus control (P = 0.80/0.83). Pulse wave velocity changes following acute exercise did not differ by modality (aerobic increased 0.01 ± 0.21 ms, IHG decreased 0.06 ± 0.15 ms, control increased 0.25 ± 0.17 ms, P > 0.05). A subset of participants then completed either 8 weeks of aerobic or IHG training. Awake SBP was lower after versus before aerobic training (7.6 ± 3.1 mmHg, P = 0.02), whereas sleep DBP was higher after IHG training (7.7 ± 2.3 mmHg, P = 0.02).

CONCLUSION

Our findings did not support IHG as antihypertensive therapy but that aerobic exercise should continue to be recommended as the primary exercise modality for its immediate and sustained BP benefits.

Acute and Chronic Effects of Isometric Handgrip Exercise on Cardiovascular Variables in Hypertensive Patients: A Systematic Review

The aim of this study was to describe, through a systematic review, the acute and chronic effects of isometric handgrip exercise on cardiovascular variables in hypertensive individuals. In this systematic review, we included studies that analyzed whether a single bout or a program with isometric exercises affect cardiovascular variables in hypertensive adults. The electronic database PubMed/Medline was searched for relevant studies published until May 2017. Of the 2927 studies initially identified, 2916 were excluded based on title and abstract and five on the basis of full-text assessment, leaving six studies remaining. In addition, one further study cited in the references of the included articles was included in this review, totaling seven studies included (five studies on the chronic effects of isometric handgrip exercise on cardiovascular parameters). None of the acute studies observed post-exercise hypotension. The majority of the chronic studies found decreases in office blood pressure after isometric handgrip training, with training ranging from 6 to 10 weeks, while heart rate variability parameters were improved in one study and did not change in another. Reduction in oxidative stress was observed; however, this variable was only analyzed in one study. In hypertensives, acute responses to isometric handgrip exercise are very limited due to the small number of studies, therefore more research is required. Furthermore, chronic isometric handgrip training reduces blood pressure; however, there is still a gap in the knowledge on the effects of this modality of exercise on other cardiovascular variables—such as endothelial function, oxidative stress, and cardiac autonomic modulation—which should be addressed in future studies.

Cardiovascular responses during resistance exercise after an aerobic session

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Diastolic and mean BP were higher during resistance exercise after aerobic exercise.

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Peak heart rate values were higher during resistance exercise after aerobic exercise.

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Aerobic exercise before resistance exercise promoted higher cardiovascular work.

Objective

To analyze the influence of previous aerobic exercise on cardiovascular responses during resistance exercise.

Methods

This is a crossover observational study. The sample included 19 normotensive men aged between 19 and 39 years. Subjects performed two experimental sessions in random order: resistance exercise (R: three sets of knee extension exercises with 40% of one repetition maximum) and aerobic exercise + resistance exercise (A + R: 30 min of aerobic exercise followed by R protocol). In both sessions, blood pressure (BP) and heart rate were monitored beat-by-beat by finger photoplethysmography.

Results

After aerobic exercise in the A + R session, there was a maintenance of systolic BP −2 (95% CI: −6; 2) mmHg (P = 0.35), diastolic 1 (95% CI: −2; 5) mmHg (P = 0.40) and mean BP 0 (95% CI: −4; 4) mmHg (P = 0.91) and an increase in heart rate 11 (95% CI: 7; 16) bpm (P < 0.001). Diastolic and mean BP increased and peak heart rate was higher during resistance exercise in the A + R session compared to the R session. Differences between sessions: diastolic BP 7 (95% CI: 2; 12) mmHg (P = 0.03); mean BP 8 (95% CI: 2; 13) mmHg (P = 0.05); and peak heart rate 18 (95% CI: 13; 23) bpm (P < 0.001). The increases in systolic BP during resistance exercise were similar between sessions 16 (95% CI: 6; 26) mmHg (P = 0.43).

Conclusion

Aerobic exercise before resistance exercise increased diastolic and mean BP and heart rate. However, due to the sample size of 19 individuals, the results must be interpreted with caution.

Effects of long term device-guided slow breathing on sympathetic nervous activity in hypertensive patients: a randomized open-label clinical trial

PURPOSE

Device-guided slow breathing (DGB) is indicated as nonpharmacological treatment for hypertension. The sympathetic nerve activity (SNA) reduction may be one of the mechanisms involved in blood pressure (BP) decrease. The aim of this study is to evaluate the long-term use of DGB in BP and SNA.

SUBJECTS AND METHODS

Hypertensive patients were randomized to listen music (Control Group-CG) or DGB (aim to reduce respiratory rate to less than 10 breaths/minute during 15 minutes/day for 8 weeks). Before and after intervention ambulatory blood pressure monitoring (ABPM), catecholamines and muscle sympathetic nerve activity (MSNA) by microneurography were performed.

RESULTS

17 volunteers in the DGB and 15 in the CG completed the study. There was no change in office BP before and after intervention in both groups. There was a reduction in systolic and diastolic BP in the awake period by ABPM only in the CG (131 ± 10/92 ± 9 vs 128 ± 10/88 ± 8mmHg, p < 0.05). In relation to SNA, no difference in catecholamines was observed. In the volunteers who had a microneurography record, there was no change the MSNA (bursts/minute): DGB (17(15-28) vs 19(13-22), p = 0.08) and CG (22(17-23) vs 22(18-24), p = 0.52).

CONCLUSION

Long-term DGB did not reduce BP, catecholamines levels or MSNA in hypertensive patients. ClinicalTrials.gov identifier: NCT01390727.

Measure accurately, Act rapidly, and Partner with patients: An intuitive and practical three-part framework to guide efforts to improve hypertension control

Hypertension is the leading cause of cardiovascular disease in the United States and worldwide. It also provides a useful model for team-based chronic disease management. This article describes the M.A.P. checklists: a framework to help practice teams summarize best practices for providing coordinated, evidence-based care to patients with hypertension. Consisting of three domains-Measure Accurately; Act Rapidly; and Partner With Patients, Families, and Communities-the checklists were developed by a team of clinicians, hypertension experts, and quality improvement experts through a multistep process that combined literature review, iterative feedback from a panel of internationally recognized experts, and pilot testing among a convenience sample of primary care practices in two states. In contrast to many guidelines, the M.A.P. checklists specifically target practice teams, instead of individual clinicians, and are designed to be brief, cognitively easy to consume and recall, and accessible to healthcare workers from a range of professional backgrounds.

microRNA in Cardiovascular Aging and Age-Related Cardiovascular Diseases

Over the last decades, life expectancy has significantly increased although several chronic diseases persist in the population, with aging as the leading risk factor. Despite improvements in diagnosis and treatment, many elderlies suffer from cardiovascular problems that are much more frequent in an older, more fragile organism. In the long term, age-related cardiovascular diseases (CVDs) contribute to the decline of quality of life and ability to perform normal activities of daily living. microRNAs (miRNAs) are a class of small non-coding RNAs that regulate gene expression at the posttranscriptional level in both physiological and pathological conditions. In this review, we will focus on the role of miRNAs in aging and age-related CVDs as heart failure, hypertension, atherosclerosis, atrial fibrillation, and diabetes mellitus. miRNAs are key regulators of complex biological mechanisms, representing an exciting potential therapeutic target in CVDs. Moreover, one major challenge in geriatric medicine is to find reliable biomarkers for diagnosis, prognosis, and prediction of the response to specific drugs. miRNAs represent a very promising tool due to their stability in the circulation and unique signature in CVDs. However, further studies are needed to investigate their translational potential in the real clinical practice.

Isometric Handgrip as an Adjunct for Blood Pressure Control: a Primer for Clinicians

Considered a global health crisis by the World Health Organization, hypertension (HTN) is the leading risk factor for death and disability. The majority of treated patients do not attain evidence-based clinical targets, which increases the risk of potentially fatal complications. HTN is the most common chronic condition seen in primary care; thus, implementing therapies that lower and maintain BP to within-target ranges is of tremendous public health importance. Isometric handgrip (IHG) training is a simple intervention endorsed by the American Heart Association as a potential adjuvant BP-lowering treatment. With larger reductions noted in HTN patients, IHG training may be especially beneficial for those who (a) have difficulties continuing or increasing drug-based treatment; (b) are unable to attain BP control despite optimal treatment; (c) have pre-HTN or low-risk stage I mild HTN; and (d) wish to avoid medications or have less pill burden. IHG training is not routinely prescribed in clinical practice. To shift this paradigm, we focus on (1) the challenges of current HTN management strategies; (2) the effect of IHG training; (3) IHG prescription; (4) characterizing the population for whom it works best; (5) clinical relevance; and (6) important next steps to foster broader implementation by clinical practitioners.

Evidence in the human of a hypotensive and a bradycardic effect after mouth opening maintained for 10 min

PURPOSE

We have recently shown that in humans submaximal mouth opening associated with partial masticatory movements for 10 min is followed by a small but significant and prolonged reduction of blood pressure and heart rate. We here report the effects of a fixed mouth opener.

METHODS

In 22 seated normotensive volunteers the effect on blood pressure and heart rate was studied in randomized order after fixed mandibular extension and after a control procedure consisting in keeping a stick between the incisor teeth (both for 10 min). Automated recordings every 10 min were done for 40 min before and 120 min following the procedure.

RESULTS

Two-way ANOVA for repeated measures on absolute values (actual recordings) and on changes from baseline revealed that, compared to controls, systolic, diastolic and mean blood pressure and heart rate were significantly lower after mandibular extension. Compared to controls, mandibular extension induced an average blood pressure drop of 2.88 mmHg (systolic), 2.55 mmHg (diastolic) and 2.42 mmHg (mean) over the entire observation period. The average decline over the central part of the observation period (30th to 80th min) was, respectively, of 3.62, 3.70 and 3.61 mmHg. The decrements of heart rate were of 2.11 and 2.66 beats per min. All these differences were statistically significant. The hypotensive and bradycardic responses persisted for 70-120 min.

CONCLUSIONS

This study shows that, in normotensives, a single fixed submaximal mouth opening for 10 min is followed by prolonged albeit small reductions of blood pressure and heart rate.

Psychosocial Factors and Hypertension: A Review of the Literature

Black people have the highest prevalence of hypertension in the United States. Evidence suggests that psychosocial factors increase the risks for hypertension and help to account for racial differences in this condition. This article reviews research on psychosocial factors and hypertension, and contextualizes the findings within a health disparities framework. A wide range of psychosocial factors contribute to hypertension but understanding remains limited about how these factors relate to each other and accumulate to contribute to hypertension disparities. Future research on psychosocial factors and hypertension needs to enhance the effectiveness of interventions to reduce hypertension risk in ethnic minority communities.

Recognition and Management of Resistant Hypertension

Despite improvements in hypertension awareness and treatment, 30%-60% of hypertensive patients do not achieve BP targets and subsequently remain at risk for target organ damage. This therapeutic gap is particularly important to nephrologists, who frequently encounter treatment-resistant hypertension in patients with CKD. Data are limited on how best to treat patients with CKD and resistant hypertension, because patients with CKD have historically been excluded from hypertension treatment trials. First, we propose a consistent definition of resistant hypertension as BP levels confirmed by both in-office and out-of-office measurements that exceed appropriate targets while the patient is receiving treatment with at least three antihypertensive medications, including a diuretic, at dosages optimized to provide maximum benefit in the absence of intolerable side effects. Second, we recommend that each patient undergo a standardized, stepwise evaluation to assess adherence to dietary and lifestyle modifications and antihypertensive medications to identify and reduce barriers and discontinue use of substances that may exacerbate hypertension. Patients in whom there is high clinical suspicion should be evaluated for potential secondary causes of hypertension. Evidence-based management of resistant hypertension is discussed with special considerations of the differences in approach to patients with and without CKD, including the specific roles of diuretics and mineralocorticoid receptor antagonists and the current place of emerging therapies, such as renal denervation and baroreceptor stimulation. We endorse use of such a systematic approach to improve recognition and care for this vulnerable patient group that is at high risk for future kidney and cardiovascular events.