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Reddin C, Murphy R, Hankey GJ, Wang X, Langhorne P, Oveisgharan S, Xavier D, Judge C, Rosengren A, Iversen HK, Czlonkowska A, Lanas F, Oguz A, Ryglewicz D, Wasay M, Smyth A, Yusuf S, O'Donnell M. Blood pressure variability in acute stroke: Risk factors and association with functional outcomes at 1 month. Eur J Neurol 2024; 31:e16314. [PMID: 38738545 PMCID: PMC11235980 DOI: 10.1111/ene.16314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND AND PURPOSE Blood pressure variability, in acute stroke, may be an important modifiable determinant of functional outcome after stroke. In a large international cohort of participants with acute stroke, it was sought to determine the association of blood pressure variability (in the early period of admission) and functional outcomes, and to explore risk factors for increased blood pressure variability. PATIENTS AND METHODS INTERSTROKE is an international case-control study of risk factors for first acute stroke. Blood pressure was recorded at the time of admission, the morning after admission and the time of interview in cases (median time from admission 36.7 h). Multivariable ordinal regression analysis was employed to determine the association of blood pressure variability (standard deviation [SD] and coefficient of variance) with modified Rankin score at 1-month follow-up, and logistic regression was used to identify risk factors for blood pressure variability. RESULTS Amongst 13,206 participants, the mean age was 62.19 ± 13.58 years. When measured by SD, both systolic blood pressure variability (odds ratio 1.13; 95% confidence interval 1.03-1.24 for SD ≥20 mmHg) and diastolic blood pressure variability (odds ratio 1.15; 95% confidence interval 1.04-1.26 for SD ≥10 mmHg) were associated with a significant increase in the odds of poor functional outcome. The highest coefficient of variance category was not associated with a significant increase in risk of higher modified Rankin score at 1 month. Increasing age, female sex, high body mass index, history of hypertension, alcohol use, and high urinary potassium and low urinary sodium excretion were associated with increased blood pressure variability. CONCLUSION Increased blood pressure variability in acute stroke, measured by SD, is associated with an increased risk of poor functional outcome at 1 month. Potentially modifiable risk factors for increased blood pressure variability include low urinary sodium excretion.
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Affiliation(s)
- Catriona Reddin
- HRB Clinical Research Facility Galway, School of MedicineUniversity of GalwayGalwayIreland
- Wellcome Trust‐HRB, Irish Clinical Academic TrainingDublinIreland
| | - Robert Murphy
- HRB Clinical Research Facility Galway, School of MedicineUniversity of GalwayGalwayIreland
| | - Graeme J. Hankey
- Perron Institute Chair in Stroke Research, Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Perron Institute for Neurological and Translational SciencePerthWestern AustraliaAustralia
| | - Xingyu Wang
- Beijing Hypertension League InstituteBeijingChina
| | - Peter Langhorne
- Academic Section of Geriatric Medicine, Glasgow Royal InfirmaryUniversity of GlasgowGlasgowUK
| | - Shahram Oveisgharan
- Rush Alzheimer Disease Research CenterRush University Medical CenterChicagoIllinoisUSA
| | - Denis Xavier
- St Johns Medical CollegeBangaloreIndia
- St Johns Research InstituteBangaloreIndia
| | - Conor Judge
- HRB Clinical Research Facility Galway, School of MedicineUniversity of GalwayGalwayIreland
| | - Annika Rosengren
- Sahlgrenska University Hospital and Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Helle K. Iversen
- Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | | | - Fernando Lanas
- Faculty of MedicineUniversidad de La FronteraTemucoChile
| | - Aytekin Oguz
- Department of Internal Medicine, Faculty of MedicineIstanbul Medeniyet University, Dumlupinar MahallesiIstanbulTurkey
- Faculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | | | - Mohammad Wasay
- Department of MedicineAga Khan UniversityKarachiPakistan
| | - Andrew Smyth
- HRB Clinical Research Facility Galway, School of MedicineUniversity of GalwayGalwayIreland
| | - Salim Yusuf
- Population Health Research InstituteHamilton Health Sciences and McMaster UniversityHamiltonOntarioCanada
| | - Martin O'Donnell
- HRB Clinical Research Facility Galway, School of MedicineUniversity of GalwayGalwayIreland
- Population Health Research InstituteHamilton Health Sciences and McMaster UniversityHamiltonOntarioCanada
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Mancia G, Schumacher H, Böhm M, Grassi G, Teo KK, Mahfoud F, Parati G, Redon J, Yusuf S. Impact of seasonal blood pressure changes on visit-to-visit blood pressure variability and related cardiovascular outcomes. J Hypertens 2024; 42:1269-1281. [PMID: 38690947 PMCID: PMC11198955 DOI: 10.1097/hjh.0000000000003759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/21/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Visit-to-visit blood pressure (BP) variability associates with an increased risk of cardiovascular events. We investigated the role of seasonal BP modifications on the magnitude of BP variability and its impact on cardiovascular risk. METHODS In 25 390 patients included in the ONTARGET and TRANSCEND trials, the on-treatment systolic (S) BP values obtained by five visits during the first two years of the trials were grouped according to the month in which they were obtained. SBP differences between winter and summer months were calculated for BP variability quintiles (Qs), as quantified by the coefficient of variation (CV) of on-treatment mean SBP from the five visits. The relationship of BP variability with the risk of cardiovascular events and mortality was assessed by the Cox regression model. RESULTS SBP was approximately 4 mmHg lower in summer than in winter regardless of confounders. Winter/summer SBP differences contributed significantly to each SBP-CV quintile. Increase of SBP-CV from Q1 to Q5 was associated with a progressive increase in the adjusted hazard ratio (HR) of the primary endpoint of the trials, i.e. morbid and fatal cardiovascular events. This association was even stronger after removal of the effect of seasonality from the calculation of SBP-CV. A similar trend was observed for secondary endpoints. CONCLUSIONS Winter/summer SBP differences significantly contribute to visit-to-visit BP variability. However, this contribution does not participate in the adverse prognostic significance of visit-to-visit BP variations, which seems to be more evident after removal of the BP effects of seasonality from visit-to-visit BP variations.
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Affiliation(s)
| | | | - Michael Böhm
- Universitätsklinikum des Saarlandes, Homburg, Germany
| | | | - Koon K. Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Felix Mahfoud
- Universitätsklinikum des Saarlandes, Homburg, Germany
| | | | - Josep Redon
- Department of Medicine, INCLIVA Research Institute, University of Valencia, Valencia, Spain
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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3
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Parati G, Croce A, Bilo G. Blood pressure variability: no longer a mASCOT for research nerds. Eur Heart J 2024; 45:1170-1172. [PMID: 38315171 DOI: 10.1093/eurheartj/ehae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Affiliation(s)
- Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 2, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessandro Croce
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 2, 20149 Milan, Italy
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 2, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Jiang D, Matsuzaki M, Ida T, Kitamura K, Kato J. Effects of vasodilators on beat-to-beat and every fifteen minutes blood pressure variability induced by noradrenaline infusion in rats. Hypertens Res 2024; 47:1017-1023. [PMID: 38337004 PMCID: PMC10994831 DOI: 10.1038/s41440-024-01595-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/20/2023] [Accepted: 01/13/2024] [Indexed: 02/12/2024]
Abstract
Increased blood pressure variability (BPV) was shown to be associated with cardiovascular morbidities and/or mortalities. There are various types of BPV depending on time intervals of BP measurements, ranging from beat-to-beat to visit-to-visit or year-to-year. We previously found that continuous infusion of noradrenaline (NA) for 14 days increased short-term BPV every 15 min in rats. The aims of this study were to examine (1) whether NA infusion increases very short-term beat-to-beat BPV, (2) the effects of azelnidipine and hydralazine on NA-induced BPV, and (3) whether baroreceptor reflex sensitivity (BRS) is affected by NA or NA plus those vasodilators. Nine-week-old Wistar rats infused subcutaneously with 30 μg/h NA were orally treated with or without 9.7 mg/day azelnidipine or 5.9 mg/day hydralazine over 14 days. BP levels were continuously monitored via abdominal aortic catheter with a telemetry system in an unrestrained condition. Standard deviations (SDs) were used to evaluate beat-to-beat BPV and BPV every 15 min which was obtained by averaging BP levels for 10-s segment at each time point. BRS was determined by a sequence analysis. Continuous NA infusion over 14 days increased average BP, beat-to-beat BPV, and BPV every 15 min, lowering BRS. Comparing the two vasodilators, hydralazine reduced BP elevation by NA; meanwhile, azelnidipine alleviated BPV augmentation, preserving BRS, despite a smaller BP reduction. Thus, NA infusion increased both very short- and short-term BPV concomitantly with impaired BRS, while azelnidipine had an inhibitory effect, possibly independent of BP-lowering, on those types of BPV and impairment of BRS.
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Affiliation(s)
- Danfeng Jiang
- Frontier Science Research Center, University of Miyazaki Faculty of Medicine, Miyazaki, 889-1692, Japan
| | - Minami Matsuzaki
- Frontier Science Research Center, University of Miyazaki Faculty of Medicine, Miyazaki, 889-1692, Japan
| | - Takanori Ida
- Frontier Science Research Center, University of Miyazaki Faculty of Medicine, Miyazaki, 889-1692, Japan
| | - Kazuo Kitamura
- Frontier Science Research Center, University of Miyazaki Faculty of Medicine, Miyazaki, 889-1692, Japan
| | - Johji Kato
- Frontier Science Research Center, University of Miyazaki Faculty of Medicine, Miyazaki, 889-1692, Japan.
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Sible IJ, Jang JY, Blanken AE, Alitin JPM, Engstrom A, Dutt S, Marshall AJ, Kapoor A, Shenasa F, Gaubert A, Nguyen A, Ferrer F, Bradford DR, Rodgers KE, Mather M, Duke Han S, Nation DA. Short-term blood pressure variability and brain functional network connectivity in older adults. NEUROIMAGE. REPORTS 2024; 4:100198. [PMID: 38699510 PMCID: PMC11064972 DOI: 10.1016/j.ynirp.2024.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background Blood pressure variability is increasingly linked with cerebrovascular disease and Alzheimer's disease, independent of mean blood pressure levels. Elevated blood pressure variability is also associated with attenuated cerebrovascular reactivity, which may have implications for functional hyperemia underpinning brain network connectivity. It remains unclear whether blood pressure variability is related to functional network connectivity. We examined relationships between beat-to-beat blood pressure variability and functional connectivity in brain networks vulnerable to aging and Alzheimer's disease. Methods 53 community-dwelling older adults (mean [SD] age = 69.9 [7.5] years, 62.3% female) without history of dementia or clinical stroke underwent continuous blood pressure monitoring and resting state fMRI scan. Blood pressure variability was calculated as variability independent of mean. Functional connectivity was determined by resting state fMRI for several brain networks: default, salience, dorsal attention, fronto-parietal, and language. Multiple linear regression examined relationships between short-term blood pressure variability and functional network connectivity. Results Elevated short-term blood pressure variability was associated with lower functional connectivity in the default network (systolic: standardized ß = -0.30 [95% CI -0.59, -0.01], p = .04). There were no significant associations between blood pressure variability and connectivity in other functional networks or between mean blood pressure and functional connectivity in any network. Discussion Older adults with elevated short-term blood pressure variability exhibit lower resting state functional connectivity in the default network. Findings support the role of blood pressure variability in neurovascular dysfunction and Alzheimer's disease. Blood pressure variability may represent an understudied early vascular risk factor for neurovascular dysfunction relevant to Alzheimer's disease, with potential therapeutic implications.
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Affiliation(s)
- Isabel J. Sible
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
| | - Jung Yun Jang
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA 92697, USA
| | - Anna E. Blanken
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, 94121, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, 94158, USA
| | - John Paul M. Alitin
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Allie Engstrom
- Department of Psychological Science, University of California Irvine, Irvine, CA 92697, USA
| | - Shubir Dutt
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, 94158, USA
| | - Anisa J. Marshall
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
| | - Arunima Kapoor
- Department of Psychological Science, University of California Irvine, Irvine, CA 92697, USA
| | - Fatemah Shenasa
- Department of Psychological Science, University of California Irvine, Irvine, CA 92697, USA
| | - Aimée Gaubert
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Amy Nguyen
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Farrah Ferrer
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - David R. Bradford
- Center for Innovation in Brain Science, Department of Pharmacology, The University of Arizona, Tucson, AZ, 85721, USA
| | - Kathleen E. Rodgers
- Center for Innovation in Brain Science, Department of Pharmacology, The University of Arizona, Tucson, AZ, 85721, USA
| | - Mara Mather
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - S. Duke Han
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
- Department of Family Medicine, Keck School of Medicine of University of Southern California, Alhambra, CA 91803, USA
| | - Daniel A. Nation
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
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Parati G, Bilo G, Kollias A, Pengo M, Ochoa JE, Castiglioni P, Stergiou GS, Mancia G, Asayama K, Asmar R, Avolio A, Caiani EG, De La Sierra A, Dolan E, Grillo A, Guzik P, Hoshide S, Head GA, Imai Y, Juhanoja E, Kahan T, Kario K, Kotsis V, Kreutz R, Kyriakoulis KG, Li Y, Manios E, Mihailidou AS, Modesti PA, Omboni S, Palatini P, Persu A, Protogerou AD, Saladini F, Salvi P, Sarafidis P, Torlasco C, Veglio F, Vlachopoulos C, Zhang Y. Blood pressure variability: methodological aspects, clinical relevance and practical indications for management - a European Society of Hypertension position paper ∗. J Hypertens 2023; 41:527-544. [PMID: 36723481 DOI: 10.1097/hjh.0000000000003363] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Blood pressure is not a static parameter, but rather undergoes continuous fluctuations over time, as a result of the interaction between environmental and behavioural factors on one side and intrinsic cardiovascular regulatory mechanisms on the other side. Increased blood pressure variability (BPV) may indicate an impaired cardiovascular regulation and may represent a cardiovascular risk factor itself, having been associated with increased all-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease, and dementia incidence. Nonetheless, BPV was considered only a research issue in previous hypertension management guidelines, because the available evidence on its clinical relevance presents several gaps and is based on heterogeneous studies with limited standardization of methods for BPV assessment. The aim of this position paper, with contributions from members of the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability and from a number of international experts, is to summarize the available evidence in the field of BPV assessment methodology and clinical applications and to provide practical indications on how to measure and interpret BPV in research and clinical settings based on currently available data. Pending issues and clinical and methodological recommendations supported by available evidence are also reported. The information provided by this paper should contribute to a better standardization of future studies on BPV, but should also provide clinicians with some indications on how BPV can be managed based on currently available data.
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Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Martino Pengo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Paolo Castiglioni
- IRCCS Fondazione Don Carlo Gnocchi, Milan
- Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | | | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Department of Cardiovascular Sciences, University of Leuven, and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Belgium
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Roland Asmar
- Foundation-Medical Research Institutes, Geneva, Switzerland
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Enrico G Caiani
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Italy
| | - Alejandro De La Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | | | - Andrea Grillo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
| | - Przemysław Guzik
- Department of Cardiology -Intensive Therapy, University School of Medicine in Poznan, Poznan, Poland
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Geoffrey A Head
- Baker Heart and Diabetes Institute, Melbourne Victoria Australia
| | - Yutaka Imai
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Eeva Juhanoja
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Turku
- Department of Oncology; Division of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Thomas Kahan
- Karolinska Institute, Department of Clinical Sciences, Division of Cardiovascular Medicine, Department of Cardiology, Danderyd University Hospital Corporation, Stockholm, Sweden
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | | | | | - Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension and Medical Genomics, National Research Centre for Translational Medicine
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital Athens, Greece
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Paolo Palatini
- Department of Medicine. University of Padova, Padua, Italy
| | - Alexandre Persu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Athanasios D Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Francesca Saladini
- Department of Medicine. University of Padova, Padua, Italy
- Cardiology Unit, Cittadella Town Hospital, Padova, Italy
| | - Paolo Salvi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Franco Veglio
- Internal Medicine Division and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Charalambos Vlachopoulos
- Hypertension and Cardiometabolic Syndrome Unit, 1 Department of Cardiology, Medical School, National & Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Yuqing Zhang
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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7
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Short- to long-term blood pressure variability: Current evidence and new evaluations. Hypertens Res 2023; 46:950-958. [PMID: 36759660 DOI: 10.1038/s41440-023-01199-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/05/2023] [Accepted: 01/19/2023] [Indexed: 02/11/2023]
Abstract
Increased blood pressure (BP) variability and the BP surge have been reported to be associated with increased cardiovascular risk independently of BP levels and can also be a trigger of cardiovascular events. There are multiple types of BP variation: beat-to-beat variations related to breathing and the autonomic nervous system, diurnal BP variation and nocturnal dipping related to sleep and physical activity over a 24-hr period, day-to-day BP variability with anomalous readings within a several-day period, visit-to-visit BP variability between outpatient visits, and seasonal variations. BP variability is also associated with the progression to hypertension from prehypertension and the progression of chronic kidney disease and cognitive impairments. Our research group proposed the "resonance hypothesis of blood pressure surge" as a new etiological hypothesis of BP variability and surges; i.e., the concept that when the time phases of surges and hypertension-inducing environmental influences coincide, resonance occurs and is amplified into a larger "dynamic surge" that triggers the onset of cardiovascular disease. New devices to assess BP variability as well as new therapeutic interventions to reduce BP variability are being developed. Although there are still issues to be addressed (including measurement accuracy), cuffless devices and information and communication technology (ICT)-based BP monitoring devices have been developed and validated. These new devices will be useful for the individualized optimal management of BP. However, evidence regarding the usefulness of therapeutic interventions to control BP variability is still lacking.
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8
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Yousufuddin M, Murad MH, Peters JL, Ambriz TJ, Blocker KR, Khandelwal K, Pagali SR, Nanda S, Abdalrhim A, Patel U, Dugani S, Arumaithurai K, Takahashi PY, Kashani KB. Within-Person Blood Pressure Variability During Hospitalization and Clinical Outcomes Following First-Ever Acute Ischemic Stroke. Am J Hypertens 2023; 36:23-32. [PMID: 36130108 PMCID: PMC11301580 DOI: 10.1093/ajh/hpac106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/19/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Uncertainty remains over the relationship between blood pressure (BP) variability (BPV), measured in hospital settings, and clinical outcomes following acute ischemic stroke (AIS). We examined the association between within-person systolic blood pressure (SBP) variability (SBPV) during hospitalization and readmission-free survival, all-cause readmission, or all-cause mortality 1 year after AIS. METHODS In a cohort of 862 consecutive patients (age [mean ± SD] 75 ± 15 years, 55% women) with AIS (2005-2018, follow-up through 2019), we measured SBPV as quartiles of standard deviations (SD) and coefficient of variation (CV) from a median of 16 SBP readings obtained throughout hospitalization. RESULTS In the cumulative cohort, the measured SD and CV of SBP in mmHg were 16 ± 6 and 10 ± 5, respectively. The hazard ratios (HR) for readmission-free survival between the highest vs. lowest quartiles were 1.44 (95% confidence interval [CI] 1.04-1.81) for SD and 1.29 (95% CI 0.94-1.78) for CV after adjustment for demographics and comorbidities. Similarly, incident readmission or mortality remained consistent between the highest vs. lowest quartiles of SD and CV (readmission: HR 1.29 [95% CI 0.90-1.78] for SD, HR 1.29 [95% CI 0.94-1.78] for CV; mortality: HR 1.15 [95% CI 0.71-1.87] for SD, HR 0.86 [95% CI 0.55-1.36] for CV). CONCULSIONS In patients with first AIS, SBPV measured as quartiles of SD or CV based on multiple readings throughout hospitalization has no independent prognostic implications for the readmission-free survival, readmission, or mortality. This underscores the importance of overall patient care rather than a specific focus on BP parameters during hospitalization for AIS.
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Affiliation(s)
- Mohammed Yousufuddin
- Department of Hospital Internal Medicine, Mayo Clinic Health
System, Austin, Minnesota, USA
| | - M H Murad
- Robert D. and Patricia E. Kern Center for the Science of Healthcare
Delivery, Mayo Clinic, Rochester, Minnesota,
USA
- Division of Public Health, Infectious Diseases, and Occupational Medicine,
Mayo Clinic, Rochester, Minnesota, USA
| | - Jessica L Peters
- Department of Hospital Internal Medicine, Mayo Clinic Health
System, Austin, Minnesota, USA
| | - Taylor J Ambriz
- Department of Hospital Internal Medicine, Mayo Clinic Health
System, Austin, Minnesota, USA
| | - Katherine R Blocker
- Department of Hospital Internal Medicine, Mayo Clinic Health
System, Austin, Minnesota, USA
| | - Kanika Khandelwal
- Department of Hospital Internal Medicine, Mayo Clinic Health
System, Austin, Minnesota, USA
| | - Sandeep R Pagali
- Division of Hospital Internal Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Sanjeev Nanda
- Division of Internal Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Ahmed Abdalrhim
- Division of Internal Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Urvish Patel
- Icahn School of Medicine, Mount Sinai,
New York, USA
| | - Sagar Dugani
- Division of Hospital Internal Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | | | - Paul Y Takahashi
- Division of Community Internal Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Mayo Clinic,
Rochester, Minnesota, USA
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Blood pressure variability and plasma Alzheimer's disease biomarkers in older adults. Sci Rep 2022; 12:17197. [PMID: 36229634 PMCID: PMC9561652 DOI: 10.1038/s41598-022-20627-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/15/2022] [Indexed: 01/06/2023] Open
Abstract
Blood pressure variability is an emerging risk factor for Alzheimer's disease in older adults, independent of average blood pressure levels. Growing evidence suggests increased blood pressure variability is linked to Alzheimer's disease pathophysiology indexed by cerebrospinal fluid and positron emission tomography markers, but relationships with plasma Alzheimer's disease markers have not been investigated. In this cross-sectional study of 54 community-dwelling older adults (aged 55-88, mean age 69.9 [8.2 SD]), elevated blood pressure variability over 5 min was associated with lower levels of plasma Aβ1-42 (standardized ß = - 0.36 [95% CI - 0.61, - 0.12]; p = 0.005; adjusted R2 = 0.28) and Aβ1-42: Aβ1-40 ratio (ß = - 0.49 [95% CI - 0.71, - 0.22]; p < 0.001; adjusted R2 = 0.28), and higher levels of total tau (ß = 0.27 [95% CI 0.01, 0.54]; p = 0.04; adjusted R2 = 0.19) and Ptau181:Aβ1-42 ratio (ß = 0.26 [95% CI 0.02, 0.51]; p = 0.04; adjusted R2 = 0.22). Findings suggest higher blood pressure variability is linked to plasma biomarkers of increased Alzheimer's disease pathophysiology.
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10
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Sible IJ, Nation DA. Visit-to-Visit Blood Pressure Variability and CSF Alzheimer Disease Biomarkers in Cognitively Unimpaired and Mildly Impaired Older Adults. Neurology 2022; 98:e2446-e2453. [PMID: 35418462 PMCID: PMC9231834 DOI: 10.1212/wnl.0000000000200302] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Blood pressure variability is an emerging risk factor for cognitive decline and dementia, but mechanisms remain unclear. The current study examined whether visit-to-visit blood pressure variability is related to CSF Alzheimer disease biomarker levels over time and whether associations differed by APOE ε4 carrier status. METHODS In this retrospective analysis of a prospective cohort study, cognitively unimpaired or mildly impaired older adults from the Alzheimer's Disease Neuroimaging Initiative underwent 3 to 4 blood pressure measurements over a 12-month period and ≥1 lumbar puncture for evaluation of CSF phosphorylated tau, total tau, and β-amyloid levels at follow-up (6-108 months later). APOE ε4 carriers were defined as having ≥1 ε4 allele. Visit-to-visit blood pressure variability was determined over 12 months as variability independent of mean. Only CSF samples collected after the final blood pressure measurement were analyzed. Bayesian linear growth modeling investigated the role of blood pressure variability, APOE ε4, and the passage of time on CSF biomarker levels after controlling for several variables, including average blood pressure and baseline hypertension. RESULTS Four hundred sixty-six participants (mean 76.7 [SD 7.1] years of age) were included in the study. Elevated blood pressure variability was associated with increased CSF phosphorylated tau (β = 0.81 [95% CI 0.74, 0.97]), increased total tau (β = 0.98 [95% CI 0.71, 1.31]), and decreased β-amyloid levels (β = -1.52 [95% CI -3.55, -0.34]) at follow-up. APOE ε4 carriers with elevated blood pressure variability had the fastest increase in phosphorylated tau levels (β = 9.03 [95% CI 1.67, 16.36]). Blood pressure variability was not significantly related to total tau or β-amyloid levels over time according to APOE ε4 carrier status. DISCUSSION Older adults with elevated blood pressure variability exhibit increased CSF phosphorylated tau, increased total tau, and decreased β-amyloid over time, suggesting that blood pressure variability may correlate with alterations in Alzheimer disease biomarkers. Findings warrant further study of the relationship between blood pressure variability and the development of Alzheimer disease. APOE ε4 carrier status moderated relationships between blood pressure variability and CSF phosphorylated tau but not total tau or β-amyloid, consistent with other studies relating hemodynamic factors to tau changes.
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Affiliation(s)
- Isabel J Sible
- From the Department of Psychology (I.J.S.), University of Southern California, Los Angeles; and Institute for Memory Impairments and Neurological Disorders (D.A.N.) and Department of Psychological Science (D.A.N.), University of California Irvine
| | - Daniel A Nation
- From the Department of Psychology (I.J.S.), University of Southern California, Los Angeles; and Institute for Memory Impairments and Neurological Disorders (D.A.N.) and Department of Psychological Science (D.A.N.), University of California Irvine.
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11
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Liu M, Chen X, Zhang S, Lin J, Wang L, Liao X, Zhuang X. Assessment of Visit-to-Visit Blood Pressure Variability in Adults With Optimal Blood Pressure: A New Player in the Evaluation of Residual Cardiovascular Risk? J Am Heart Assoc 2022; 11:e022716. [PMID: 35470678 PMCID: PMC9238602 DOI: 10.1161/jaha.121.022716] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background There is a paucity of evidence regarding the association between visit‐to‐visit blood pressure variability and residual cardiovascular risk. We aimed to provide relevant evidence by determining whether high systolic blood pressure (SBP) variability in the optimal SBP levels still influences the risk of cardiovascular disease. Methods and Results We studied 7065 participants (aged 59.3±5.6 years; 44.3% men; and 82.9% White) in the ARIC (Atherosclerosis Risk in Communities) study with optimal SBP levels from visit 1 to visit 3. Visit‐to‐visit SBP variability was measured by variability independent of the mean in the primary analysis. The primary outcome was the major adverse cardiovascular event (MACE), defined as the first occurrence of all‐cause mortality, coronary heart disease, stroke, and heart failure. During a median follow‐up of 19.6 years, 2691 participants developed MACEs. After multivariable adjustment, the MACE risk was higher by 21% in participants with the highest SBP variability (variability independent of the mean quartile 4) compared with the lowest SBP variability participants (variability independent of the mean quartile 1) (hazard ratio, 1.21; 95% CI, 1.09–1.35). The restricted cubic spline showed that the hazard ratio for MACE was relatively linear, with a higher variability independent of the mean being associated with higher risk. These association were also found in the stratified analyses of participants with or without hypertension. Conclusions In adults with optimal SBP levels, higher visit‐to‐visit SBP variability was significantly associated with a higher risk of MACE regardless of whether they had hypertension. Therefore, it may be necessary to further focus on the visit‐to‐visit SBP variability even at the guideline‐recommended optimal blood pressure levels.
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Affiliation(s)
- Menghui Liu
- Department of Cardiology The First Affiliated Hospital of Sun Yat-Sen University Guangzhou People's Republic of China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) Guangzhou People's Republic of China
| | - Xiaohong Chen
- Department of Otorhinolaryngology The Third Affiliated Hospital of Sun Yat-Sen University Guangzhou People's Republic of China
| | - Shaozhao Zhang
- Department of Cardiology The First Affiliated Hospital of Sun Yat-Sen University Guangzhou People's Republic of China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) Guangzhou People's Republic of China
| | - Junfan Lin
- Sun Yat-sen University School of Medicine Guangzhou People's Republic of China
| | - Lichun Wang
- Department of Cardiology The First Affiliated Hospital of Sun Yat-Sen University Guangzhou People's Republic of China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) Guangzhou People's Republic of China
| | - Xinxue Liao
- Department of Cardiology The First Affiliated Hospital of Sun Yat-Sen University Guangzhou People's Republic of China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) Guangzhou People's Republic of China
| | - Xiaodong Zhuang
- Department of Cardiology The First Affiliated Hospital of Sun Yat-Sen University Guangzhou People's Republic of China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) Guangzhou People's Republic of China
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12
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Abstract
Current hypertension guidelines recommend using the average values of several blood pressure (BP) readings obtained both in and out of the office for the diagnosis and management of hypertension. In-office BP measurement using an upper-arm cuff constitutes the evidence-based reference method for current BP classification and treatment targets. However, out-of-office BP evaluation using 24 h ambulatory or home BP monitoring is recommended by all major medical associations for obtaining further insights into the BP profile of an individual and how it relates to their daily activities. Importantly, the highly variable nature of office and out-of-office BP readings has been widely acknowledged, including the association of BP variability with cardiovascular outcomes. However, to date, the implications of BP variability on cardiovascular outcomes have largely been ignored, with limited application in clinical practice. Novel cuffless wearable technologies might provide a detailed assessment of the 24 h BP profile and behaviour over weeks or months. These devices offer many advantages for researchers and patients compared with traditional BP monitors, but their accuracy and utility remain uncertain. In this Review, we outline and compare conventional and novel methods and techniques for assessing average BP levels and BP variability, and reflect on the utility and potential of these methods for improving the treatment and management of patients with hypertension. The most commonly available blood pressure (BP) monitoring devices are useful for capturing a snapshot BP value, but most have limited utility in measuring BP variability. In this Review, Schutte and colleagues outline the advantages and disadvantages of conventional and novel techniques to measure average BP levels and BP variability. Although the dynamic nature of blood pressure (BP) is well-known, hypertension guidelines recommend using the average values of static BP readings (office or out-of-office), specifically aiming to level the fluctuations and peaks in BP readings. All current BP measurement methods have imperfect reproducibility owing to the continuous fluctuation in BP readings, making it difficult to accurately diagnose hypertension. Accumulating evidence from clinical trials, large registries and meta-analyses shows that increased BP variability predicts cardiovascular outcome, independently of the average BP values. To date, BP variability is overlooked, with limited application in clinical practice, probably owing to a variety of complex non-standardized BP variability assessment methods and indices, and uncertain thresholds and clinical usefulness. Novel cuffless wearable BP technologies can provide very large numbers of readings for days and months without the discomfort of traditional BP monitoring devices, and have the potential to replace current BP methods, once accuracy issues are resolved and their clinical usefulness is proved.
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13
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de Havenon A, Petersen N, Wolcott Z, Goldstein E, Delic A, Sheibani N, Anadani M, Sheth KN, Lansberg M, Turan T, Prabhakaran S. Effect of dihydropyridine calcium channel blockers on blood pressure variability in the SPRINT trial: a treatment effects approach. J Hypertens 2022; 40:462-469. [PMID: 34694261 PMCID: PMC11284837 DOI: 10.1097/hjh.0000000000003033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Increased visit-to-visit blood pressure variability (vvBPV) has negative effects on multiple organ systems. Prior research has suggested that dihydropyridine calcium channel blockers (CCB) may reduce vvBPV, which we attempted to verify in a high-quality dataset with robust statistical methodology. METHODS We performed a post hoc analysis of the SPRINT trial and included participants who were on a dihydropyridine CCB either 0 or 100% of follow-up study visits. The primary outcome was vvBPV, defined as residual standard deviation (rSD) of SBP from month 6 until study completion. We estimated the average treatment effect of the treated (ATET) after augmented inverse-probability-weighting (AIPW) matching. RESULTS Of the 9361 participants enrolled in SPRINT, we included 5020, of whom 1959 were on a dihydropyridine CCB and 3061 were not; mean age was 67.4 ± 9.2 years, 34.5% were men, 65.9% were white, 49.4% were randomized to intensive blood pressure control, and the rSD was 10.1 ± 4.0 mmHg. Amlodipine represented greater than 95% of dihydropyridine CCB use. After AIPW matching of demographics and other antihypertensive medications, the ATET estimation for participants on a dihydropyridine CCB was an rSD that was 2.05 mmHg lower (95% CI -3.19 to -0.91). We did not find that other antihypertensive medications classes decreased vvBPV, and several increased it. CONCLUSION In the SPRINT trial, consistent use of a dihydropyridine CCB was associated with a 2 mmHg reduction in vvBPV. The implication of this hypothesis-generating finding in a high-quality dataset is that future trials to reduce vvBPV could consider using dihydropyridine CCBs.
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Affiliation(s)
- Adam de Havenon
- Departments of Neurology at: University of Utah (AdH, AD, ZW, NS, EG), Washington University (MA), Yale University (NP, KS), Stanford University (ML), Medical University of South Carolina (TT), University of Chicago (SP)
| | - Nils Petersen
- Departments of Neurology at: University of Utah (AdH, AD, ZW, NS, EG), Washington University (MA), Yale University (NP, KS), Stanford University (ML), Medical University of South Carolina (TT), University of Chicago (SP)
| | - Zoe Wolcott
- Departments of Neurology at: University of Utah (AdH, AD, ZW, NS, EG), Washington University (MA), Yale University (NP, KS), Stanford University (ML), Medical University of South Carolina (TT), University of Chicago (SP)
| | - Eric Goldstein
- Departments of Neurology at: University of Utah (AdH, AD, ZW, NS, EG), Washington University (MA), Yale University (NP, KS), Stanford University (ML), Medical University of South Carolina (TT), University of Chicago (SP)
| | - Alen Delic
- Departments of Neurology at: University of Utah (AdH, AD, ZW, NS, EG), Washington University (MA), Yale University (NP, KS), Stanford University (ML), Medical University of South Carolina (TT), University of Chicago (SP)
| | - Nazanin Sheibani
- Departments of Neurology at: University of Utah (AdH, AD, ZW, NS, EG), Washington University (MA), Yale University (NP, KS), Stanford University (ML), Medical University of South Carolina (TT), University of Chicago (SP)
| | - Mohammad Anadani
- Departments of Neurology at: University of Utah (AdH, AD, ZW, NS, EG), Washington University (MA), Yale University (NP, KS), Stanford University (ML), Medical University of South Carolina (TT), University of Chicago (SP)
| | - Kevin N. Sheth
- Departments of Neurology at: University of Utah (AdH, AD, ZW, NS, EG), Washington University (MA), Yale University (NP, KS), Stanford University (ML), Medical University of South Carolina (TT), University of Chicago (SP)
| | - Maarten Lansberg
- Departments of Neurology at: University of Utah (AdH, AD, ZW, NS, EG), Washington University (MA), Yale University (NP, KS), Stanford University (ML), Medical University of South Carolina (TT), University of Chicago (SP)
| | - Tanya Turan
- Departments of Neurology at: University of Utah (AdH, AD, ZW, NS, EG), Washington University (MA), Yale University (NP, KS), Stanford University (ML), Medical University of South Carolina (TT), University of Chicago (SP)
| | - Shyam Prabhakaran
- Departments of Neurology at: University of Utah (AdH, AD, ZW, NS, EG), Washington University (MA), Yale University (NP, KS), Stanford University (ML), Medical University of South Carolina (TT), University of Chicago (SP)
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14
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Yang J, Huang J, Yu B, Zhang Q, Zhang S, Wu L, Luo L, Li L, Li L, Han F, Lai EY, Yang Y. Long-term predialysis blood pressure variability and outcomes in hemodialysis patients. J Clin Hypertens (Greenwich) 2022; 24:148-155. [PMID: 35089648 PMCID: PMC8845477 DOI: 10.1111/jch.14398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022]
Abstract
Blood pressure variability (BPV) is significantly associated with cardiovascular diseases (CVD) and mortality in hemodialysis patients. However, the relationship between blood pressure and CVD in hemodialysis patients is complex and affected by many factors. The present study aimed to assess the association of long‐term predialysis BPV with all‐cause mortality and major adverse cardiovascular events (MACE). One thousand seven hundred twenty‐seven patients receiving maintenance hemodialysis were recruited in nine hemodialysis centers. Predialysis BPV was assessed over 1‐year intervals. Outcomes included all‐cause mortality and MACE during follow‐up periods. The mean age of the final cohort was 59 years, of which 57% were males. Greater predialysis systolic BPV was associated with an increased risk of all‐cause mortality (adjusted hazard ratio, 1.101; 95% confidence intervals 1.064–1.140) and MACE (adjusted hazard ratio, 1.091; 95% confidence intervals 1.059–1.125). Results were similar when systolic BPV was stratified by baseline systolic blood pressure. In conclusion, greater predialysis BPV among hemodialysis patients was associated with all‐cause mortality and MACE. Strategies to reduce blood pressure variability might be beneficial for hemodialysis patients.
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Affiliation(s)
- Jingjuan Yang
- Department of Nephrology, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Jian Huang
- Department of Nephrology, Central Hospital of Jinhua, Jinhua, China.,Hemodialysis Quality Control Center of Jinhua, Jinhua, China
| | - Biying Yu
- Department of Nephrology, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Qian Zhang
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shanshan Zhang
- Department of Nephrology, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Longlong Wu
- Department of Nephrology, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Lin Luo
- Department of Nephrology, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Lizhu Li
- Department of Nephrology, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Li Li
- Department of Nephrology, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Fei Han
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - En Yin Lai
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Physiology, School of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Yang
- Department of Nephrology, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China.,Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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15
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Xia HS, Liu Y, Li JX, Su H, Wu YQ. Long-term amlodipine-based combination therapy attenuates seasonal variation of blood pressure in hypertensive patients. Clin Exp Hypertens 2021; 43:742-749. [PMID: 34338579 DOI: 10.1080/10641963.2021.1960363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: This study was to investigate whether long-term amlodipine-based combination therapy attenuates seasonal variation of office blood pressure (BP) in hypertensive patients. Methods: The data of 206 patients recruited in the Nanchang site of CHIEF trial were retrospectively analyzed. All patients received an amlodipine-based therapy for three years after reaching target BP with a 12-week titration treatment. Among them, 106 patients received amlodipine plus amiloride/hydrochlorothiazide (AA group) and 100 received amlodipine plus telmisartan (AT group) therapies. These patients were followed up every three months . The difference between the highest and lowest values of outdoor temperature in each three months was calculated as the seasonal temperature difference (T-d) and seasonal BP difference was calculated in the similar way. BP control rates in each season were calculated. Results: In the three years, the highest SBP and DBP values occurred in winter and the lowest values in summer. As a result, the BP control rate in summer was the highest and that in winter was the lowest, especially for SBP. Although T-d levels were similar during three following-up years, the seasonal SBP/DBP differences in 2011 were significantly lower than 2009 (10.03 ± 5.74/6.96 ± 3.72 vs 14.36 ± 8.19/9.78 ± 5.21 mmHg, P < .05), suggesting seasonal variation in BP was obviously reduced. Meanwhile, similar change was observed in AA and AT groups. Conclusions: Besides lower BP effectively, long-term amlodipine-based combination therapy could alleviate the seasonal BP variation in high-risk hypertensive patients.
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Affiliation(s)
- Hua-Song Xia
- Department of cardiology, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
| | - Yue Liu
- Department of cardiology, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
| | - Ju-Xiang Li
- Department of cardiology, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
| | - Hai Su
- Department of cardiology, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
| | - Yan-Qing Wu
- Department of cardiology, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
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16
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Basson MD, Newman WE, Klug MG. Correlations Among Visit-to-Visit Blood Pressure Variability and Treatment With Antihypertensive Medication With Long-Term Adverse Outcomes in a Large Veteran Cohort. Am J Hypertens 2021; 34:1092-1099. [PMID: 34115112 DOI: 10.1093/ajh/hpab087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/13/2021] [Accepted: 06/07/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Blood pressure variability (BPV) is associated with adverse events (AEs) independently of hypertension. It has been suggested that calcium channel blockers (CCBs) may reduce BPV, and thus be particularly valuable in hypertensives with high BPV. We sought to investigate how CCB affect BPV progression and whether long-term adverse effects of BPV differ after CCB treatment than after treatment with other antihypertensives. METHODS We retrospectively analyzed 25,268 US veterans who had been followed for 3 years without hypertensive therapy, started on a single class of antihypertensive agents (thiazides, CCBs, ACE inhibitors, or beta blockers [BBs]), treated for 6 years, and then followed for 3 additional years. BPV was calculated as SD of systolic or diastolic blood pressures from at least 10 measurements over each 3-year period. A combined AE endpoint included hospitalization, coronary artery bypass grafting, carotid endarterectomy, angioplasty, amputation, arteriovenous fistula creation, and mortality was assessed in years 9-12. RESULTS Post-medication high BPV and BB or thiazide use were associated with increased AE risk. Medication type also affected mean post-medication BPV. The effects of medications except for BBs on AE and mortality was independent of the patient BPV. CONCLUSIONS The possible deleterious effects of thiazides should be considered within the context of the study population, who were mostly male and received only a single class of hypertensives. While CCB may ameliorate BPV over time, this study does not support choosing CCB over other agents specifically to lessen BPV-associated risk.
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Affiliation(s)
- Marc D Basson
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
- Department of Research Service, Fargo VA Medical Center, Fargo, North Dakota, USA
| | - William E Newman
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
- Department of Internal Medicine Service, Fargo VA Medical Center, Fargo, North Dakota, USA
| | - Marilyn G Klug
- Department of Population Health, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
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Boubouchairopoulou N, Ntineri A, Kollias A, Destounis A, Stergiou GS. Blood pressure variability assessed by office, home, and ambulatory measurements: comparison, agreement, and determinants. Hypertens Res 2021; 44:1617-1624. [PMID: 34599293 DOI: 10.1038/s41440-021-00736-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/15/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022]
Abstract
The present study compared the blood pressure variability (BPV) among office (OBP), home (HBP), and ambulatory blood pressure (ABP) measurements and assessed their determinants, as well as their agreement in identifying individuals with high BPV. Individuals attending a hypertension clinic had OBP measurements (2-3 visits) and underwent HBP monitoring (3-7 days, duplicate morning and evening measurements) and ABP monitoring (24 h, 20-min intervals). BPV was quantified using the standard deviation (SD), coefficient of variation (CV), and variability independent of the mean (VIM) using all BP readings obtained by each method. A total of 626 participants were analyzed (age 52.8 ± 12.0 years, 57.7% males, 33.1% treated). Systolic BPV was usually higher than diastolic BPV, and out-of-office BPV was higher than office BPV, with ambulatory BPV giving the highest values. BPV was higher in women than men, yet it was not different between untreated and treated individuals. Associations among BPV indices assessed using different measurement methods were weak (r 0.1-0.3) but were stronger between out-of-office BPV indices. The agreement between methods in detecting individuals with high BPV was low (30-40%) but was higher between out-of-office BPV indices. Older age was an independent determinant of increased OBP variability. Older age, female sex, smoking, and overweight/obesity were determinants of increased out-of-office BPV. These data suggest that BPV differs with different BP measurement methods, reflecting different pathophysiological phenomena, whereas the selection of the BPV index is less important. Office and out-of-office BP measurements appear to be complementary methods in assessing BPV.
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Affiliation(s)
- Nadia Boubouchairopoulou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Antonios Destounis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece.
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18
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Zhou Z, Chen J, Fu G, Zhuang X, Hou J, Chen S, Huang S, Yue Y, Shang L, Wang K, Lv L, Liang M, Wu Z. Association of Post-operative Systolic Blood Pressure Variability With Mortality After Coronary Artery Bypass Grafting. Front Cardiovasc Med 2021; 8:717073. [PMID: 34458342 PMCID: PMC8387866 DOI: 10.3389/fcvm.2021.717073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Blood pressure variability (BPV) has long been considered a risk factor for cardiovascular events. We aimed to investigate whether post-operative systolic BPV was associated with early and late all-cause mortality in patients undergoing coronary artery bypass grafting (CABG). Methods: Clinical variables and blood pressure records within the first 24 h in the post-operative intensive care unit stay from 4,509 patients operated on between 2001 and 2012 were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. BPV was measured as the coefficient of the variability of systolic blood pressure, and we compared patients in the highest quartile with patients in the other three quartiles. Results: After full adjustment, patients in the highest quartile of BPV were at a higher risk of intensive care unit mortality (OR = 2.02, 95% CI: 1.11–3.69), 30-day mortality (OR = 1.92, 95% CI: 1.22–3.02), and 90-day mortality (HR = 1.64, 95% CI: 1.19–2.27). For 2,892 patients with a 4-year follow-up, the association between a higher post-operative BPV and the risk of 4-year mortality was not significant (HR = 1.17, 95% CI: 0.96–1.42). The results were supported by the comparison of survival curves and remained generally consistent in the subgroup analyses and sensitivity analyses. Conclusions: Our findings demonstrated that in patients undergoing CABG, a higher post-operative BPV was associated with a higher risk of early mortality while the association was not significant for late mortality. Post-operative BPV can support doctors in identifying patients with potential hemodynamic instability and making timely clinical decisions.
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Affiliation(s)
- Zhuoming Zhou
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Jiantao Chen
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Guangguo Fu
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Xiaodong Zhuang
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China.,Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Center for Information Technology & Statistics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jian Hou
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Sida Chen
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Suiqing Huang
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Yuan Yue
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Liqun Shang
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Keke Wang
- Department of Emergency, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Linhua Lv
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Mengya Liang
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Zhongkai Wu
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
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19
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Fujiwara T, Hoshide S, Kanegae H, Kario K. Clinical Impact of the Maximum Mean Value of Home Blood Pressure on Cardiovascular Outcomes: A Novel Indicator of Home Blood Pressure Variability. Hypertension 2021; 78:840-850. [PMID: 34304579 DOI: 10.1161/hypertensionaha.121.17362] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Takeshi Fujiwara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan (T.F., S.H., H.K., K.K.)
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan (T.F., S.H., H.K., K.K.)
| | - Hiroshi Kanegae
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan (T.F., S.H., H.K., K.K.).,Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan (T.F., S.H., H.K., K.K.)
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20
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Benolken MM, Meduna AE, Klug MG, Basson MD. Preoperative and Intraoperative Blood Pressure Variability Independently Correlate with Outcomes. J Surg Res 2021; 266:387-397. [PMID: 34087623 DOI: 10.1016/j.jss.2021.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/01/2021] [Accepted: 04/16/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Blood pressure variability (BPV) describes visit-to-visit blood pressure (BP) changes independent of hypertension. Preoperative BPV and intraoperative BPV are associated with increased postoperative outcomes. We investigated the impact of both preoperative BPV and intraoperative BPV on elective surgical outcomes, specifically whether preoperative BPV and intraoperative BPV were independent risk factors for surgical complications. MATERIALS AND METHODS We investigated 600 patients undergoing elective surgery lasting more than two h and who had ≥8 outpatient BP recordings over three preoperative years. Age, sex, ethnicity, BMI, current medical problems, and medications at time of surgery were recorded. BPV was calculated as the standard deviation (SD) of systolic or diastolic BP for the 369 valid patients. Average BPV were compared between adverse outcomes of readmission, wound infection, acute kidney injury, death, myocardial infarction, and cerebral vascular accident. RESULTS Three-hundred-sixty-nine (52.6% male, 47.4% female, 98.1% non-Hispanic) patients (mean age 62.5) were included in the study. Preoperative systolic (P = 0.043) and diastolic (P = 0.009) BPV were higher for patients with the combined endpoint of all adverse events. Preoperative systolic BPV was correlated with intraoperative BPV (P = 0.010). Both systolic and diastolic preoperative BPV was found to be independent from intraoperative BPV. Otolaryngology procedures were associated with less adverse outcomes (P = 0.034), whil antimicrobials (P = 0.022), autonomic drugs (P < 0.001), or respiratory drugs (P = 0.032) was associated with an increased likelihood of adverse outcome. CONCLUSION Preoperative DBPV is associated with increased risk of readmission, wound infection and the combined endpoint of all adverse events. Intraoperative systolic blood pressure variability (SPBV) is associated with increased risk of acute kidney injury and the combined endpoint of all adverse events. Preoperative DBPV and intraoperative SBPV are independent risk factors for ninety-d postoperative outcomes. BPV should be considered in individualized risk assessment when assessing patient eligibility for elective procedures.
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Affiliation(s)
- Molly M Benolken
- University of North Dakota School and Medicine and Health Sciences, Grand Forks, North Dakota
| | | | - Marilyn G Klug
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Marc D Basson
- University of North Dakota School and Medicine and Health Sciences, Grand Forks, North Dakota; University of North Dakota, Grand Forks, North Dakota; University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota.
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21
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Impact of dietary intake of sodium and potassium on short-term blood pressure variability. J Hypertens 2021; 39:1835-1843. [PMID: 34054053 DOI: 10.1097/hjh.0000000000002856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Dietary Approaches to Stop Hypertension (DASH)-Sodium trial showed that dietary sodium and potassium affect blood pressure (BP). We aimed to investigate whether dietary sodium and potassium affect short-term BP variability (BPV) in addition to BP. METHODS A total of 343 participants from the DASH-Sodium trial (age 48.4 ± 9.7, 42.5% men) and 323 individuals from the Jackson Heart Study (JHS) (age 56.7 ± 11.2, 30.7% men) with satisfactory ambulatory BP monitoring records and 24-h urine collection were included. Average real variability (ARV) was calculated as a measure of short-term BPV. RESULTS By estimating dietary intake from urinary excretion, we observed that higher urinary sodium-to-potassium ratio was significantly associated with higher diastolic ARV in both studies. Among the DASH-Sodium trial, potassium-rich DASH diet alone had insignificant effect on both systolic (-0.1 ± 1.7 mmHg, P = 0.343) or diastolic ARV (-0.2 ± 1.5 mmHg, P = 0.164), whereas combined DASH diet and low sodium intake significantly reduced both systolic (8.5 ± 1.6 vs. 8.9 ± 1.7 mmHg, P = 0.032) and diastolic ARV (7.5 ± 1.5 vs. 7.8 ± 1.6 mmHg, P = 0.025) as compared with control diet and high sodium intake. As the reduction of systolic ARV was majorly derived from the change of mean SBP, diastolic ARV was significantly determined by urinary sodium-to-potassium ratio (β coefficient ± standard error: 0.012 ± 0.004; P = 0.006) after adjusting for age, sex, smoking, mean DBP, BMI, and race. CONCLUSION Dietary sodium and potassium can jointly modulate short-term BPV in addition to BP. Combined DASH diet and low sodium intake may reduce systolic and diastolic ARV via different mechanisms.
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22
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Yano Y, Reis JP, Lewis CE, Sidney S, Pletcher MJ, Bibbins-Domingo K, Navar AM, Peterson ED, Bancks MP, Kanegae H, Gidding SS, Muntner P, Lloyd-Jones DM. Association of Blood Pressure Patterns in Young Adulthood With Cardiovascular Disease and Mortality in Middle Age. JAMA Cardiol 2021; 5:382-389. [PMID: 31968050 DOI: 10.1001/jamacardio.2019.5682] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Determining blood pressure (BP) patterns in young adulthood that are associated with cardiovascular disease (CVD) events in later life may help to identify young adults who have an increased risk for CVD. Objective To determine whether the long-term variability of BP across clinical visits and the rate of change in BP from young adulthood to midlife are associated with CVD and all-cause mortality by middle age, independently of mean BP during young adulthood and a single BP in midlife. Design, Setting, and Participants This prospective cohort study included a community-based sample of 3394 African American and white participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, enrolled from March 1985 through June 1986. Patterns of systolic BP (SBP) were evaluated with measurements at year 0 (baseline) and 2, 5, 7, and 10 years after baseline. Visit-to-visit SBP variability was estimated as BP variability independent of the mean (VIM). Data were collected from March 1985 through August 2015 and analyzed from June through October 2019. Main Outcomes and Measures Cardiovascular disease and all-cause mortality experienced through August 2015 were adjudicated. The associations of each SBP pattern with CVD events and all-cause mortality were determined using Cox proportional hazards regression models. Results At year 10, the mean (SD) age of the 3394 participants was 35.1 (3.6) years; 1557 (45.9%) were African American; 1892 (55.7%) were women; and 103 (3.0%) were taking antihypertensive medication. During a median follow-up of 20.0 (interquartile range, 19.4-20.2) years, 162 CVD events and 181 deaths occurred. When all BP pattern measurements were entered into the same model including a single SBP measurement at the year 10 examination, the hazard ratios for CVD events for each 1-SD increase in SBP measures were 1.25 (95% CI, 0.90-1.74) for mean SBP, 1.23 (95% CI, 1.07-1.43) for VIM SBP, and 0.99 (95% CI, 0.81-1.26) for annual change of SBP. The VIM for SBP was the only BP pattern associated with all-cause mortality (hazard ratio, 1.24; 95% CI, 1.09-1.41). Conclusions and Relevance The results of this study suggest that the assessment of visit-to-visit SBP variability may help identify young adults at increased risk for CVD and all-cause mortality later in life.
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Affiliation(s)
- Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Ann Marie Navar
- Duke Clinical Research Institute, Durham, North Carolina.,Associate Editor
| | | | - Michael P Bancks
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | - Samuel S Gidding
- Nemours Cardiac Center, Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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23
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Ernst ME, Chowdhury EK, Beilin LJ, Margolis KL, Nelson MR, Wolfe R, Tonkin AM, Ryan J, Woods RL, McNeil JJ, Reid CM. Long-Term Blood Pressure Variability and Risk of Cardiovascular Disease Events Among Community-Dwelling Elderly. Hypertension 2020; 76:1945-1952. [PMID: 33131315 DOI: 10.1161/hypertensionaha.120.16209] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
High office blood pressure variability (OBPV) in midlife increases the risk of cardiovascular disease (CVD), but the impact of OBPV in older adults without previous CVD is unknown. We conducted a post hoc analysis of ASPREE trial (Aspirin in Reducing Events in the Elderly) participants aged 70-years and older (65 for US minorities) without history of CVD events at baseline, to examine risk of incident CVD associated with long-term, visit-to-visit OBPV. CVD was a prespecified, adjudicated secondary end point in ASPREE. We estimated OBPV using within-individual SD of mean systolic BP from baseline and first 2 annual visits. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% CI for associations with CVD events. In 16 475 participants who survived to year 2 without events, those in the highest tertile of OBPV had increased risk of CVD events after adjustment for multiple covariates, when compared with participants in the lowest tertile (HR, 1.36 [95% CI, 1.08-1.70]; P=0.01). Similar increased risk was observed for ischemic stroke (HR, 1.56 [95% CI, 1.04-2.33]; P=0.03), heart failure hospitalization, or death (HR, 1.73 [95% CI, 1.07-2.79]; P=0.02), and all-cause mortality (HR, 1.27 [95% CI, 1.04-1.54]; P=0.02). Findings were consistent when stratifying participants by use of antihypertensive drugs, while sensitivity analyses suggested the increased risk was especially for individuals whose BP was uncontrolled during the OBPV estimation period. Our findings support increased OBPV as a risk factor for CVD events in healthy older adults with, or without hypertension, who have not had such events previously. Registration- URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01038583; URL: https://www.isrctn.com; Unique identifiers: ISRCTN83772183.
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Affiliation(s)
- Michael E Ernst
- From the Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City (M.E.E.)
| | - Enayet K Chowdhury
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.).,School of Public Health, Curtin University, Perth, WA, Australia (E.K.C., C.M.R.)
| | - Lawrence J Beilin
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Australia (L.J.B.)
| | | | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmani, Hobart, Australia (M.R.N.)
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.).,School of Public Health, Curtin University, Perth, WA, Australia (E.K.C., C.M.R.)
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24
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Kaufmann H, Palma JA. White Matter Hyperintensities in the Synucleinopathies: Orthostatic Hypotension, Supine Hypertension, or Both? Mov Disord Clin Pract 2020; 7:595-598. [PMID: 32775503 PMCID: PMC7396862 DOI: 10.1002/mdc3.13000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Horacio Kaufmann
- Department of Neurology, Dysautonomia Center New York University School of Medicine New York New York USA
| | - Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center New York University School of Medicine New York New York USA
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25
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Blood pressure measurement in atrial fibrillation: review and meta-analysis of evidence on accuracy and clinical relevance. J Hypertens 2020; 37:2430-2441. [PMID: 31408028 DOI: 10.1097/hjh.0000000000002201] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
: Atrial fibrillation (AF) often coexists with hypertension in the elderly and multiplies the risk of stroke and death. Blood pressure (BP) measurement in patients with AF is difficult and uncertain and has been a classic exclusion criterion in hypertension clinical trials leading to limited research data. This article reviews the evidence on the accuracy of BP measurement in AF performed using different methods (office, ambulatory, home) and devices (auscultatory, oscillometric) and its clinical relevance in predicting cardiovascular damage. The current evidence suggests the following: (i) Interobserver and intra-observer variation in auscultatory BP measurement is increased in AF because of increased beat-to-beat BP variability and triplicate measurement is required; (ii) Data from validation studies of automated electronic BP monitors in AF are limited and methodologically heterogeneous and suggest reasonable accuracy in measuring SBP and a small yet consistent overestimation of DBP; (iii) 24-h ambulatory BP monitoring is feasible in AF, with similar proportion of errors as in individuals without AF; (iv) both auscultatory and automated oscillometric BP measurements appear to be clinically relevant in AF, providing similar associations with intra-arterial BP measurements and with indices of preclinical cardiac damage as in patients without AF, and predict cardiovascular events and death; (v) Screening for AF in the elderly using an AF-specific algorithm during routine automated office, home or ambulatory BP measurement has high diagnostic accuracy. In conclusion, in AF patients, BP measurement is important, reliable, and clinically relevant and should not be neglected in clinical research and in practice.
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26
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Mehlum MH, Liestøl K, Kjeldsen SE, Wyller TB, Julius S, Rothwell PM, Mancia G, Parati G, Weber MA, Berge E. Blood Pressure–Lowering Profiles and Clinical Effects of Angiotensin Receptor Blockers Versus Calcium Channel Blockers. Hypertension 2020; 75:1584-1592. [DOI: 10.1161/hypertensionaha.119.14443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Blood pressure–lowering drugs have different blood pressure–lowering profiles. We studied if differences in blood pressure mean and variability can explain the differences in risks of cardiovascular events and death among 15 245 high-risk hypertensive patients randomized to valsartan or amlodipine and followed for 4.2 years in the VALUE trial (Valsartan Antihypertensive Long-Term Use Evaluation). We selected patients with ≥3 visits and performed Cox regression analyses, defining mean blood pressure as a time-dependent covariate and visit-to-visit and within-visit blood pressure variability as the SD. Of 14 996 eligible patients, participants in the valsartan group had higher systolic mean blood pressure by 2.2 mm Hg, higher visit-to-visit systolic variability by 1.4 mm Hg, and higher within-visit systolic variability by 0.2 mm Hg (
P
values <0.0001). The higher risks of myocardial infarction and stroke in the valsartan group was attenuated after adjustment for mean and variability of systolic blood pressure, from HR 1.19 (95% CI, 1.02–1.39) to 1.11 (0.96–1.30) and from HR 1.13 (0.96–1.33) to 1.00 (0.85–1.18), respectively. The lower risk of congestive heart failure in the valsartan group was accentuated after adjustment, from HR 0.86 (0.74–1.00) to 0.76 (0.65–0.89). A smaller effect was seen on risk of death, from 1.01 (0.92–1.12) to 0.94 (0.85–1.04). In conclusion, the higher risks of myocardial infarction and stroke in patients randomized to valsartan versus amlodipine were related to the drugs’ different blood pressure modulating profiles. The risk of congestive heart failure with valsartan was lower, independent of the less favorable blood pressure modulating profile.
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Affiliation(s)
- Maria H. Mehlum
- From the Department of Geriatric Medicine (M.H.M., T.B.W.), Oslo University Hospital Ullevaal, Oslo, Norway
- Institute of Clinical Medicine (M.H.M., S.E.K., T.B.W.), University of Oslo, Norway
| | - Knut Liestøl
- Department of Informatics (K.L.), University of Oslo, Norway
| | - Sverre E. Kjeldsen
- Department of Cardiology (S.E.K., E.B.), Oslo University Hospital Ullevaal, Oslo, Norway
- Institute of Clinical Medicine (M.H.M., S.E.K., T.B.W.), University of Oslo, Norway
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (S.E.K., S.J.)
| | - Torgeir B. Wyller
- From the Department of Geriatric Medicine (M.H.M., T.B.W.), Oslo University Hospital Ullevaal, Oslo, Norway
- Institute of Clinical Medicine (M.H.M., S.E.K., T.B.W.), University of Oslo, Norway
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (S.E.K., S.J.)
| | - Peter M. Rothwell
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, University of Oxford, United Kingdom (P.M.R.)
| | - Giuseppe Mancia
- Policlinico di Monza, Monza, Italy (G.M.)
- University of Milano-Bicocca, Milan, Italy (G.M., G.P.)
| | - Gianfranco Parati
- University of Milano-Bicocca, Milan, Italy (G.M., G.P.)
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy (G.P.)
| | - Michael A. Weber
- Department of Cardiovascular Medicine, State University of New York, Downstate College of Medicine (M.A.W.)
| | - Eivind Berge
- Department of Cardiology (S.E.K., E.B.), Oslo University Hospital Ullevaal, Oslo, Norway
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27
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Rodionov AV. High Blood Pressure Variability is an Additional Cardiovascular Risk Factor. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-02-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Blood pressure (BP) is a highly variable physiological indicator. Most people have BP changes within 40-50 mmHg during the day. Various external factors (from the patient’s position during BP measurement to poor adherence to therapy and abuse of short-acting antihypertensive drugs) affect the assessed indicators. Evaluation of the average daily, intra-visit, as well as long-term ("from visit to visit") BP variability is used in clinical practice. In the past twenty years a number of major studies demonstrated that increased BP variability is an independent prognostic factor that increases the risk of cardiovascular complications. The largest meta-analysis of 41 studies showed that an increase in long-term BP variability was associated with 15% and 18% increase in total and cardiovascular mortality, respectively. According to the IDHOCO project, the threshold coefficient of variation for day-today variability is >11.0/12.8. Different groups of antihypertensive drugs have an uneven effect on BP variability. Consistent data from ASCOT-BPLA, X-CELLENT and ACCOMPLISH studies indicate that among the main groups of antihypertensive drugs, calcium antagonists, mainly amlodipine, have the greatest potential for the variability reduction. A decrease in BP variability, as shown in a post-hoc analysis of CAMELOT and PREVENT studies, has a positive effect on the incidence of major adverse cardiac events (MACE). Thus, the BP variability is an important indicator that reflects the prognosis in hypertensive patients. BP variability reduction can be considered as one of the independent goals of therapy. Calcium antagonists can be considered as first-line drugs for patients with high BP variability.
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Affiliation(s)
- A. V. Rodionov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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28
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Basson MD, Klug MG, Newman WE, Dyke C. Preoperative outpatient blood pressure variability predicts postoperative mortality, readmission and morbidity after surgery. Am J Surg 2020; 220:1083-1092. [PMID: 32139103 DOI: 10.1016/j.amjsurg.2020.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Outpatient blood pressure variability (BPV) predicts hospitalization and death in non-surgical patients independently of hypertension. We hypothesized that preoperative BPV predicts postoperative outcomes. METHODS We assessed 22,233 veterans undergoing CABG, colectomy, hip replacement, pancreatectomy, carotid endarterectomy or AV-fistula with ≥10 outpatient BP's over three preoperative years. Calculating BPV as SD of systolic or diastolic BP, we used logistic regression considering demographics, comorbidities, and pre-admission cardiovascular medications to estimate odds ratios for 90-day mortality or readmission, MI, CVA, renal failure, and wound infection, choosing the lowest 5%ile of systolic/diastolic BPV for reference. RESULTS Covariate-adjusted ORs for adverse outcomes increased as BPV increased. For instance, the highest 5%ile of systolic BPV had covariate-adjusted ORs of 2.96 and 1.78 for 90-day mortality and readmission. Systolic and diastolic BPV trended together but affected outcomes independently. CONCLUSIONS Preoperative BPV predicts postoperative outcomes. BPV should be considered in individualized risk assessment and subgroup risk stratification.
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Affiliation(s)
- Marc D Basson
- Department of Surgery, University of North Dakota School of Medicine & Health Sciences and the Fargo VAMC, USA.
| | - Marilyn G Klug
- Department of Population Health, University of North Dakota School of Medicine & Health Sciences and the Fargo VA, USA
| | - William E Newman
- Department of Internal Medicine, University of North Dakota School of Medicine & Health Sciences and the Fargo VA, USA
| | - Cornelius Dyke
- Department of Surgery, University of North Dakota School of Medicine & Health Sciences and Sanford Health, USA
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29
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Brainin M, Feigin V, Bath PM, Collantes E, Martins S, Pandian J, Sacco R, Teuschl Y. Multi-level community interventions for primary stroke prevention: A conceptual approach by the World Stroke Organization. Int J Stroke 2019; 14:818-825. [DOI: 10.1177/1747493019873706] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The increasing burden of stroke and dementia emphasizes the need for new, well-tolerated and cost-effective primary prevention strategies that can reduce the risks of stroke and dementia worldwide, and specifically in low- and middle-income countries (LMICs). This paper outlines conceptual frameworks of three primary stroke prevention strategies: (a) the “polypill” strategy; (b) a “population-wide” strategy; and (c) a “motivational population-wide” strategy. (a) A polypill containing generic low-dose ingredients of blood pressure and lipid-lowering medications (e.g. candesartan 16 mg, amlodipine 2.5 mg, and rosuvastatin 10 mg) seems a safe and cost-effective approach for primary prevention of stroke and dementia. (b) A population-wide strategy reducing cardiovascular risk factors in the whole population, regardless of the level of risk is the most effective primary prevention strategy. A motivational population-wide strategy for the modification of health behaviors (e.g. smoking, diet, physical activity) should be based on the principles of cognitive behavioral therapy. Mobile technologies, such as smartphones, offer an ideal interface for behavioral interventions (e.g. Stroke Riskometer app) even in LMICs. (c) Community health workers can improve the maintenance of lifestyle changes as well as the adherence to medication, especially in resource poor areas. An adequate training of community health workers is a key point. Conclusion An effective primary stroke prevention strategy on a global scale should integrate pharmacological (polypill) and lifestyle modifications (motivational population-wide strategy) interventions. Side effects of such an integrative approach are expected to be minimal and the benefits among individuals at low-to-moderate risk of stroke could be significant. In the future, pragmatic field trials will provide more evidence.
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Affiliation(s)
- Michael Brainin
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, School of Public Health and Psychosocial Studies, Auckland, New Zealand
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Epifania Collantes
- Department of Neurosciences, Philippine General Hospital, Manila, Philippines
| | - Sheila Martins
- Neurology and Neurosurgery Service, Hospital Moinhos de Vento, Brazil
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Ralph Sacco
- Miller School of Medicine, University of Miami, FL, USA
| | - Yvonne Teuschl
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
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Sakamoto M, Matsutani D, Kayama Y. Clinical Implications of Baroreflex Sensitivity in Type 2 Diabetes. Int Heart J 2019; 60:241-246. [PMID: 30799384 DOI: 10.1536/ihj.18-455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The evaluation of baroreflex sensitivity (BRS), which maintains systemic circulatory homeostasis, is an established tool to assess cardiovascular autonomic neuropathy in type 2 diabetes mellitus (T2DM). As BRS plays an important function in blood pressure regulation, reduced BRS leads to an increase in blood pressure variability, which further leads to reduced BRS. This sequence of events becomes a vicious cycle. The major risk factors for reduced BRS are T2DM and essential hypertension, but many other risk factors have been reported to influence BRS. In recent years, reports have indicated that glycemic variability (GV), such as short- and long-term GV that are considered important risk factors for macrovascular and microvascular complications, is involved in reductions in BRS independently of blood glucose levels. In this review, we discuss reduced BRS in T2DM, its features, and the potential for its reversal.
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Affiliation(s)
- Masaya Sakamoto
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine
| | - Daisuke Matsutani
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine
| | - Yosuke Kayama
- Department of Cardiology, Jikei University School of Medicine
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Factors associated with intra-individual visit-to-visit variability of blood pressure in four countries: the INTERMAP study. J Hum Hypertens 2018; 33:229-236. [PMID: 30420643 DOI: 10.1038/s41371-018-0129-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/02/2018] [Accepted: 09/14/2018] [Indexed: 11/08/2022]
Abstract
Several studies demonstrated that visit-to-visit variability of blood pressure (BP) predicted future events of total death, stroke and cardiovascular disease. Little is known about factors associated with visit-to-visit BP variability in different countries. We recruited participants aged 40-59 years from four countries (Japan, the People's Republic of China [PRC], the United Kingdom [UK] and the United States [US]). At each study visit, BP was measured twice by trained observers using random zero sphygmomanometers after five minutes resting. We defined visit-to-visit BP variability as variation independent of mean (VIM) by using average systolic BP of 1st and 2nd measurement across four study visits. Data on 4680 men and women were analyzed. Mean ± standard deviation of VIM values among participants in Japan, the PRC, the UK and the US were 5.44 ± 2.88, 6.85 ± 3.49, 5.65 ± 2.81 and 5.84 ± 3.01, respectively; VIM value in the PRC participants was significantly higher. Sensitivity analyses among participants without antihypertensive treatment or past history of cardiovascular disease yielded similar results. Higher VIM value was associated with older age, female gender, lower pulse rate and urinary sodium excretion and use of antihypertensive agents such as angiotensin converting enzyme inhibitors, beta blockers and calcium channel blockers. The difference of visit-to-visit BP variability between PRC and other countries remained significant after adjustment for possible confounding factors. In this large international study across four countries, visit-to-visit BP variability in the PRC was higher than in the other three countries. Reproducibility and mechanisms of these findings remain to be elucidated.
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Sierra C, Castilla-Guerra L, Masjuan J, Gil-Nuñez A, Álvarez-Sabín J, Egocheaga MI, Armario P. [Recommendations on the treatment of hypertension in the secondary prevention of ischemic stroke]. HIPERTENSION Y RIESGO VASCULAR 2018; 35:e11-e18. [PMID: 30042028 DOI: 10.1016/j.hipert.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/30/2022]
Abstract
Stroke continues to be one of the leading causes of death and disability in the world. One of the main problems with a patient who has survived from a stroke is the possibility of developing a new vascular episode again. Hypertension is the modifiable vascular risk factor with the greatest impact for both primary prevention and stroke recurrence. The Group for the study of Hypertension and Brain (GEHYC) from the Spanish Society of Hypertension aims to spread the importance of strict control of blood pressure in order to prevent cerebrovascular diseases. In this article, this multidisciplinary Group reviews the latest evidence regarding antihypertensive treatment and secondary prevention of ischemic stroke.
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Affiliation(s)
- C Sierra
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital Clinic, IDIBAPS, Universidad de Barcelona, Barcelona, España.
| | - L Castilla-Guerra
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Virgen Macarena, Sevilla, España
| | - J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá (IRYCIS), Red INVICTUS PLUS, Madrid, España
| | - A Gil-Nuñez
- Sección de Neurología Vascular-Unidad de Ictus, Hospital Gregorio Marañón, Madrid, España
| | - J Álvarez-Sabín
- Servicio de Neurología, Hospital de la Vall d́Hebrón, Barcelona, España
| | - M I Egocheaga
- Medicina de Familia, Centro de Salud de Oza, Madrid, España
| | - P Armario
- Área Atención Integrada Riesgo Vascular, Servicio de Medicina Interna, Hospital Moisés Broggi-Consorci Sanitari Integral, Universidad de Barcelona , Barcelona, España
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Parati G, Stergiou GS, Dolan E, Bilo G. Blood pressure variability: clinical relevance and application. J Clin Hypertens (Greenwich) 2018; 20:1133-1137. [DOI: 10.1111/jch.13304] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Gianfranco Parati
- Department of Medicine and Surgery; University of Milano-Bicocca; Milano Italy
- Cardiology Unit and Department of Cardiovascular; Neural and Metabolic Sciences; Istituto Auxologco Italiano; S. Luca Hospital; Milano Italy
| | - George S. Stergiou
- Hypertension Center STRIDE-7; School of Medicine; Third Department of Medicine; Sotiria Hospital, National and Kapodistrian University of Athens; Athens Greece
| | - Eamon Dolan
- Stroke and Hypertension Unit; Connolly Hospital; Dublin Ireland
| | - Grzegorz Bilo
- Department of Medicine and Surgery; University of Milano-Bicocca; Milano Italy
- Cardiology Unit and Department of Cardiovascular; Neural and Metabolic Sciences; Istituto Auxologco Italiano; S. Luca Hospital; Milano Italy
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Fujita H, Matsuoka S, Awazu M. Visit-to-visit blood pressure variability in children and adolescents with renal disease. Clin Exp Nephrol 2018. [PMID: 29536392 DOI: 10.1007/s10157-018-1557-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increase in blood pressure (BP) variability (BPV) is associated with cardiovascular events, target organ damage, and arterial stiffness in adults. We previously reported that 24-h BPV may be associated with arterial stiffness and underlie white-coat hypertension (WCH). In this study, we examined whether visit-to-visit variability (VVV) could predict WCH and whether VVV correlated with eGFR, eGFR slope, and albuminuria/proteinuria in children and adolescents with renal diseases. METHODS VVV was determined as average real variability of office BP measurements between visits, and 24-h BPV as the standard deviation of 24-h ambulatory BP. In 35 renal patients (25 boys and 10 girls, 7-18 years of age), divided into normotension (NT), WCH, and hypertension (HTN), the relationships between VVV and 24-h BPV and VVV in each BP category were studied. In separate 48 renal patients (24 boys and 24 girls, 2-18 years of age), the correlation between VVV and eGFR, eGFR slope, urine albumin or protein excretion was examined. RESULTS Systolic VVV was significantly correlated with systolic office BP index. There was no correlation between VVV and 24-h BPV or 24-h pulse pressure. In addition, VVV was not different among NT, WCH, and HTN. Systolic VVV was significantly negatively correlated with eGFR but not with eGFR slope, albuminuria, or proteinuria. A cut-off value of systolic VVV for detecting eGFR < 60 ml/min per 1.73 m2 was 8.5. CONCLUSION VVV could not predict WCH. Systolic VVV correlated with eGFR but not with eGFR slope, albuminuria/proteinuria. Increased VVV could be a marker of decreased eGFR.
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Affiliation(s)
- Hisayo Fujita
- Department of Pediatrics, Tokyo Medical Center, Tokyo, Japan
| | | | - Midori Awazu
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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