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Al Haddad N, Costanian C, Zibara V, Bilen Y, Kilani H, Tohme F, Bahous SA. The association between sleep disturbances and blood pressure variability: a review of the literature. J Clin Sleep Med 2023; 19:1533-1544. [PMID: 37078190 PMCID: PMC10394351 DOI: 10.5664/jcsm.10566] [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: 08/05/2022] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/21/2023]
Abstract
STUDY OBJECTIVES Sleep disturbances are an underrecognized public health issue that results in various adverse outcomes and disturbed quality of life. Blood pressure variability (BPV) is an emerging entity in assessing cardiovascular disease risk and accumulating evidence suggests that BPV is closely associated with end-organ damage. This review aims to explore the association between sleep disturbances and BPV. METHODS A comprehensive systematic literature search was conducted electronically using Web of Science, Ovid MEDLINE, , and SCOPUS. The electronic search was restricted to relevant English-language studies published between 1985 and August 2020. Most studies were prospective cohorts in design. After applying eligibility criteria, 29 articles were included for synthesis. RESULTS This review shows that sleep disturbances are linked to short-term, midterm, and long-term BPV. Restless legs syndrome, shift work, insomnia, short sleep, long sleep, obstructive sleep apnea, and sleep deprivation were all positively associated with systolic blood pressure or diastolic blood pressure fluctuations. CONCLUSIONS Given the prognostic implications of BPV and sleep disturbances on cardiovascular mortality, recognizing and treating both disorders is essential. More research is needed to examine the impact of sleep disorder treatment on BPV and cardiovascular mortality. CITATION Al Haddad N, Costanian C, Zibara V, et al. The association between sleep disturbances and blood pressure variability: a review of the literature. J Clin Sleep Med. 2023;19(8):1533-1544.
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Affiliation(s)
- Nadia Al Haddad
- Lebanese American University School of Medicine, Byblos, Lebanon
| | | | - Victor Zibara
- Department of Internal Medicine, Lebanese American University Medical Center—Rizk Hospital, Beirut, Lebanon
| | - Yara Bilen
- Department of Internal Medicine, Lebanese American University Medical Center—Rizk Hospital, Beirut, Lebanon
| | - Hala Kilani
- Department of Internal Medicine, Lebanese American University Medical Center—Rizk Hospital, Beirut, Lebanon
| | - Fadi Tohme
- Department of Internal Medicine, Lebanese American University Medical Center—Rizk Hospital, Beirut, Lebanon
| | - Sola Aoun Bahous
- Lebanese American University School of Medicine, Byblos, Lebanon
- Department of Internal Medicine, Lebanese American University Medical Center—Rizk Hospital, Beirut, Lebanon
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2
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Gamboa Madeira S, Fernandes C, Paiva T, Santos Moreira C, Caldeira D. The Impact of Different Types of Shift Work on Blood Pressure and Hypertension: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136738. [PMID: 34201492 PMCID: PMC8269039 DOI: 10.3390/ijerph18136738] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022]
Abstract
Shift work (SW) encompasses 20% of the European workforce. Moreover, high blood pressure (BP) remains a leading cause of death globally. This review aimed to synthesize the magnitude of the potential impact of SW on systolic blood pressure (SBP), diastolic blood pressure (DBP) and hypertension (HTN). MEDLINE, EMBASE and CENTRAL databases were searched for epidemiological studies evaluating BP and/or HTN diagnosis among shift workers, compared with day workers. Random-effects meta-analyses were performed and the results were expressed as pooled mean differences or odds ratios and 95% confidence intervals (95% CI). The Newcastle-Ottawa Scale was used to assess the risk of bias. Forty-five studies were included, involving 117,252 workers. We found a significant increase in both SBD and DBP among permanent night workers (2.52 mmHg, 95% CI 0.75-4.29 and 1.76 mmHg, 95% CI 0.41-3.12, respectively). For rotational shift workers, both with and without night work, we found a significant increase but only for SBP (0.65 mmHg, 95% CI 0.07-1.22 and 1.28 mmHg, 95% CI 0.18-2.39, respectively). No differences were found for HTN. Our findings suggest that SW is associated with an increase of BP, mainly for permanent night workers and for SBP. This is of special interest given the large number of susceptible workers exposed over time.
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Affiliation(s)
- Sara Gamboa Madeira
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisbon, Portugal
- Family Health Unit Mactamã, Administração Regional de Saúde de Lisboa e Vale do Tejo, 2745-862 Lisbon, Portugal
- Correspondence:
| | - Carina Fernandes
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, 1600-560 Lisbon, Portugal;
- Neurology Department, Hospital das Forças Armadas, 1649-020 Lisbon, Portugal
| | - Teresa Paiva
- Sleep Medicine Center (CENC), 1070-068 Lisbon, Portugal;
- Comprehensive Health Research Center (CHRC), Nova Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Carlos Santos Moreira
- Medicine Clinic I, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal;
| | - Daniel Caldeira
- Cardiology Department, Hospital de Santa Maria/Santa Maria University Hospital—Centro Hospitalar Universitário Lisboa Norte (CHULN), 1649-028 Lisbon, Portugal;
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
- Centro Cardiovascular da Universidade de Lisboa (CCUL), CAML, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
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Solymanzadeh F, Rokhafroz D, Asadizaker M, Dastoorpoor M. The relationship between rotating shift work and blood pressure among nurses working in hospitals of Abadan, Iran. Chronobiol Int 2021; 38:1569-1574. [PMID: 34096425 DOI: 10.1080/07420528.2021.1936542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hypertension is a major risk factor for developing cardiovascular disease. Various factors such as occupational and environmental risk factors affect blood pressure. Shift work is considered to be an occupational stressor. The aim of this study was to determine the relationship between rotating shift work and blood pressure among nurses working in hospitals associated with faculty of medical science. This cross-sectional and descriptive-analytic study was conducted on nurses who worked in three hospitals associated with faculty of medical science, located in Abadan, southwest of Iran from September until December 2019. The sample size was 120 participants and divided into 60 rotating shift workers and 60 day workers (non-shift workers). The nurses were selected through the stratified random sampling technique. Demographic data, smoking status, and medical and occupational history were collected through a check list and interviews. Blood pressure was measured using a digital sphygmomanometer. Data were analyzed by the Mann-Whitney U, chi-square, Pearson's correlation coefficient and logistic regression by using SPSS software version 22. There was statistically significant difference in blood pressure between day workers and rotating shift workers (p ≤ 0.001). By logistic regression analyses, and even after adjusting for confounding variables, rotating shift work was associated with a higher prevalence of hypertension (OR: 1.76 [95%CI: 1.11-2.80]). The findings of this study showed that rotating shift workers have a higher incidence of hypertension than day workers. Therefore, a particular follow-up of rotating shift workers should be recommended to screen workers for hypertension.
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Affiliation(s)
- Farhad Solymanzadeh
- Chronic Diseases Research Center, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Dariush Rokhafroz
- Medical Education, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Marziyeh Asadizaker
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences Ahvaz, Ahvaz, Iran
| | - Maryam Dastoorpoor
- Department of Epidemiology and Biostatistics, Menopause & Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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4
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Chang WP, Jen HJ. BMI differences between different genders working fixed day shifts and rotating shifts: a literature review and meta-analysis. Chronobiol Int 2020; 37:1754-1765. [PMID: 32873091 DOI: 10.1080/07420528.2020.1800027] [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: 01/29/2023]
Abstract
The objective of this study was to perform a systematic literature review and meta-analysis to understand the BMI differences between different genders working fixed day shifts and rotating shifts. The Pubmed, Medline, and Embase databases were searched using set keywords, thereby producing 42 studies. Study quality was assessed using appraisal criteria from the Joanna Briggs Institute (JBI), and meta-analysis was performed using Comprehensive Meta-Analysis Software (CMA) version 3. The indices were the means and standard deviations of BMI values from different genders working fixed day shifts and rotating shifts. The participants of the studies included a total of 43,193 individuals working rotating shifts and 185,875 individuals working fixed day shifts. The pooling effect size (SMD, standardized mean difference) presented was 0.19. The 95% confidence interval ranged from 0.10 to 0.281. The meta-regression analysis results showed that women had higher BMI values than men, the difference was statistically significant (p <.001). The heterogeneity test indicated statistically significant differences (p <.05), and the percentage of heterogeneity (I square) was 97.91%, which indicates that a high degree of heterogeneity exists among studies. A subgroup analysis by gender was conducted. For women, the pooling effect size was 0.25, and the 95% confidence interval ranged from 0.20 to 0.30. For men, the pooling effect size was 0.19, and the 95% confidence interval ranged from 0.05 to 0.33. This meta-analysis found that both women and men working rotating shifts have significantly higher BMI values than those working fixed day shifts. Finally, we divided the data into a cross-sectional group and a cohort group based on study design, and a meta-regression analysis conducted after controlling for age and nature of work variables revealed that in the cohort study, women presented higher BMI values than men, and the difference was statistically significant (p =.010). Thus, in terms of long-term effects, these results indicate that working rotating shifts exerts a greater impact on the BMI of women.
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Affiliation(s)
- Wen-Pei Chang
- School of Nursing, College of Nursing, Taipei Medical University , Taipei, Taiwan.,Department of Nursing, Shuang Ho Hospital, Taipei Medical University , New Taipei City, Taiwan
| | - Hsiu-Ju Jen
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University , New Taipei City, Taiwan
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5
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Impact of shift work on blood pressure among emergency medical services clinicians and related shift workers: A systematic review and meta-analysis. Sleep Health 2020; 6:387-398. [DOI: 10.1016/j.sleh.2020.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/21/2020] [Accepted: 03/11/2020] [Indexed: 01/29/2023]
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6
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Karelius S, Vahtera J, Pentti J, Lindroos AS, Jousilahti P, Heinonen OJ, Stenholm S, Niiranen TJ. The relation of work-related factors with ambulatory blood pressure and nocturnal blood pressure dipping among aging workers. Int Arch Occup Environ Health 2020; 93:563-570. [PMID: 31893291 PMCID: PMC7260250 DOI: 10.1007/s00420-019-01510-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022]
Abstract
Objectives Individuals with reduced nocturnal blood pressure (BP) dipping are at increased risk of cardiovascular disease compared to persons with normal BP dipping. Although the relation of work-related factors and BP has been studied extensively, very little is known of the association between work-related factors and 24-h BP patterns in aging workers. We examined the cross-sectional relation of work-related risk factors, including occupational status, work-time mode, job demands and job control, with ambulatory BP in aging workers, focusing on nocturnal BP dipping. Methods 208 workers (mean age 62 ± 3 years; 75% women) from two Finnish population-based cohort studies underwent 24-h ambulatory BP monitoring. Work-related factors were inquired using a questionnaire. Nocturnal BP dipping was calculated as [1 − (asleep BP/awake BP)] × 100. Results Shift workers demonstrated a higher nocturnal diastolic BP dipping than regular day workers (19% vs. 17%, p = 0.03) and had a significantly higher systolic awake BP than regular day workers (136.5 mmHg vs. 132.5 mmHg, p = 0.03). Participants with high job demands demonstrated a smaller nocturnal systolic BP dipping than participants with low job demands (14% vs. 16%, p = 0.04). We did not observe significant differences in nocturnal systolic or diastolic BP dipping between groups categorized by occupational status or job control. Conclusions Although shift workers have a higher daytime BP than regular daytime workers, they exhibit greater nighttime BP dipping. Participants with high job demand had smaller nighttime BP dipping than participants with low job demand. Job control or occupation did not affect the 24-h ambulatory BP profile of aging workers.
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Affiliation(s)
- Saana Karelius
- Department of Internal Medicine, University of Turku, Turku, Finland.
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.,Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Annika S Lindroos
- Department of Internal Medicine, University of Turku, Turku, Finland
| | - Pekka Jousilahti
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Olli J Heinonen
- Paavo Nurmi Centre & Department of Health and Physical Activity, University of Turku, Turku, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Teemu J Niiranen
- Department of Internal Medicine, University of Turku, Turku, Finland.,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
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7
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Słomko J, Zawadka-Kunikowska M, Kozakiewicz M, Klawe JJ, Tafil-Klawe M, Newton JL, Zalewski P. Hemodynamic, Autonomic, and Vascular Function Changes after Sleep Deprivation for 24, 28, and 32 Hours in Healthy Men. Yonsei Med J 2018; 59:1138-1142. [PMID: 30328330 PMCID: PMC6192892 DOI: 10.3349/ymj.2018.59.9.1138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/02/2018] [Accepted: 09/11/2018] [Indexed: 11/27/2022] Open
Abstract
This study aimed to analyze the impact of sleep deprivation (SD) on cardiac, hemodynamic, and endothelial parameters and to determine whether these are sustained with increased periods of SD. The study included 60 healthy men (mean: age 31.2±6.3 years; body mass index 24.6±2.6 kg/m²). Hemodynamic parameters, parameters of myocardial contractility, spectral analysis of heart rate (HR) and blood pressure (BP) variability, and the sensitivity of arterial baroreflex function were evaluated. Biochemical tests were performed to assess L-arginine (L-Arg) and asymmetric dimethylarginine (ADMA) levels in reflection of endothelial nitric oxide synthase ability. Measurements of cardiovascular system parameters were obtained at 9 a.m. (baseline) on the first day of the study and 9 a.m. (24-h SD), 1 p.m. (28-h SD), and 5 p.m. (32-h SD) on the second day. Blood samples for evaluating biochemical parameters were obtained at baseline and after 24-h SD. ANOVA Friedman's test revealed a significant effect for time in relation to HR (χ²=26.04, df=5, p=0.000), systolic BP (χ²=35.98, df=5, p=0.000), diastolic BP (χ²=18.01, df=5, p=0.003), and mean BP (χ²=28.32, df=5, p=0.000). L-Arg and ADMA levels changed from 78.2±12.9 and 0.3±0.1 at baseline to 68.8±10.2 and 0.4±0.1 after 24-hr SD, respectively (p=0.001, p=0.004). SD in healthy men is associated with increases in BP, which appear to occur after 24 hours of SD and are maintained over increasing periods of SD. The observed hemodynamic changes may have resulted due to disordered vascular endothelial function, as reflected in alterations in L-Arg and ADMA levels.
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Affiliation(s)
- Joanna Słomko
- Department of Hygiene, Epidemiology and Ergonomics, Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland.
| | - Monika Zawadka-Kunikowska
- Department of Hygiene, Epidemiology and Ergonomics, Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Mariusz Kozakiewicz
- Department of Food Chemistry, Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Jacek J Klawe
- Department of Hygiene, Epidemiology and Ergonomics, Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Małgorzata Tafil-Klawe
- Department of Human Physiology, Faculty of Medicine, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Julia L Newton
- Institute for Cellular Medicine, The Medical School, Newcastle University, Newcastle-upon-Tyne, UK
| | - Paweł Zalewski
- Department of Hygiene, Epidemiology and Ergonomics, Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
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8
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Clinical significance of stress-related increase in blood pressure: current evidence in office and out-of-office settings. Hypertens Res 2018; 41:553-569. [DOI: 10.1038/s41440-018-0053-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 12/26/2022]
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10
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Choi B, Schnall P, Dobson M. Twenty-four-hour work shifts, increased job demands, and elevated blood pressure in professional firefighters. Int Arch Occup Environ Health 2016; 89:1111-25. [PMID: 27368424 DOI: 10.1007/s00420-016-1151-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate whether working conditions (number of 24-h shifts, number of calls, sedentary work, job strain, effort-reward imbalance, and physical demands) are associated with elevated blood pressure and hypertension among professional firefighters. METHODS A total of 330 (321 males and 9 females) firefighters were chosen for this study among the Southern California firefighters who participated in a work and obesity project. Working conditions were measured with a firefighter-specific occupational health questionnaire. Blood pressure was clinically assessed, and hypertension was defined according to the contemporary standard classification. RESULTS About 11 % of the firefighters had hypertension. Fifty percent of the hypertensive firefighters (mostly mild hypertensive) had uncontrolled high blood pressure. Hypertension was more prevalent in male, older, and high-rank firefighters and firefighter who reported low numbers of daily calls. In male firefighters who were normotensive or hypertensive without taking anti-hypertensive medication, additional 24-h shifts in the past month increased the risk of elevated diastolic blood pressure (DBP) than those who reported a standard work schedule (eight to eleven 24-h shifts). Particularly, firefighters who reported sixteen 24-h shifts had 5.0 mmHg higher DBP (p < 0.01). Body mass index attenuated the association between number of shifts and blood pressure to some extent. Firefighters who reported "increased job demands over the past years" had 3.0 mmHg (p = 0.06) higher systolic blood pressure. Other working conditions were not associated with elevated blood pressure and hypertension. CONCLUSIONS Many additional 24-h shifts and increased job demands were risk factors for elevated blood pressure in male firefighters. Optimal collective and individual workload and improved hypertension management are warranted for enhancing the cardiovascular health of firefighters.
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Affiliation(s)
- BongKyoo Choi
- Center for Occupational and Environmental Health, University of California, Irvine, 100 Theory, Suite 100, Irvine, CA, 92617, USA. .,Program in Public Health, University of California, Irvine, Irvine, CA, USA.
| | - Peter Schnall
- Center for Occupational and Environmental Health, University of California, Irvine, 100 Theory, Suite 100, Irvine, CA, 92617, USA.,Center for Social Epidemiology, Marina del Rey, CA, USA
| | - Marnie Dobson
- Center for Occupational and Environmental Health, University of California, Irvine, 100 Theory, Suite 100, Irvine, CA, 92617, USA.,Center for Social Epidemiology, Marina del Rey, CA, USA
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11
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Blood Pressure Modifications during Shift Work among Workers in Isfahan City, Iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.30092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Sohail S, Yu L, Bennett DA, Buchman AS, Lim AS. Irregular 24-hour activity rhythms and the metabolic syndrome in older adults. Chronobiol Int 2015; 32:802-13. [PMID: 26061588 PMCID: PMC4542004 DOI: 10.3109/07420528.2015.1041597] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Circadian rhythms - near 24 h intrinsic biological rhythms - modulate many aspects of human physiology and hence disruption of circadian rhythms may have an important impact on human health. Experimental work supports a potential link between irregular circadian rhythms and several key risk factors for cardiovascular disease including hypertension, obesity, diabetes and dyslipidemia, collectively termed the metabolic syndrome. While several epidemiological studies have demonstrated an association between shift-work and the components of the metabolic syndrome in working-age adults, there is a relative paucity of data concerning the impact of non-occupational circadian irregularity in older women and men. To address this question, we studied 7 days of actigraphic data from 1137 older woman and men participating in the Rush Memory and Aging Project, a community-based cohort study of the chronic conditions of aging. The regularity of activity rhythms was quantified using the nonparametric interdaily stability metric, and was related to the metabolic syndrome and its components obesity, hypertension, diabetes and dyslipidemia. More regular activity rhythms were associated with a lower odds of having the metabolic syndrome (OR = 0.69, 95% CI = 0.60-0.80, p = 5.8 × 10(-7)), being obese (OR = 0.73, 95% CI = 0.63-0.85, p = 2.5 × 10(-5)), diabetic (OR = 0.76, 95% CI = 0.65-0.90, p = 9.3 × 10(-4)), hypertensive (OR = 0.78, 95% CI = 0.66-0.91, p = 2.0 × 10(-3)) or dyslipidemic (OR = 0.82, 95% CI = 0.72-0.92, p = 1.2 × 10(-3)). These associations were independent of differences in objectively measured total daily physical activity or rest, and were not accounted for by prevalent coronary artery disease, stroke or peripheral artery disease. Moreover, more regular activity rhythms were associated with lower odds of having cardiovascular disease (OR = 0.83; 95% CI = 0.73-0.95, p = 5.7 × 10(-3)), an effect that was statistically mediated by the metabolic syndrome. We conclude that irregular activity rhythms are associated with several key components of the metabolic syndrome in older community-dwelling adults, and that the metabolic syndrome statistically partially mediates the association between activity rhythms and prevalent cardiovascular disease. Although additional longitudinal and experimental studies are needed to conclusively delineate the causal relationships underlying these associations, these findings are consistent with preclinical data, and add further support for investigations of the irregularity of activity rhythms as a potential therapeutic target to decrease the burden of cardiovascular disease in older adults.
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Affiliation(s)
- Shahmir Sohail
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; 2075 Bayview Ave M1-600, Toronto, Ontario, Canada, M4N 1X2
| | - Lei Yu
- Rush Alzheimer Disease Center and Department of Neurological Sciences, Rush University, Chicago, IL; 600 S Paulina St Suite 1026, Chicago IL, 60612
| | - David A. Bennett
- Rush Alzheimer Disease Center and Department of Neurological Sciences, Rush University, Chicago, IL; 600 S Paulina St Suite 1026, Chicago IL, 60612
| | - Aron S. Buchman
- Rush Alzheimer Disease Center and Department of Neurological Sciences, Rush University, Chicago, IL; 600 S Paulina St Suite 1026, Chicago IL, 60612
| | - Andrew S.P. Lim
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; 2075 Bayview Ave M1-600, Toronto, Ontario, Canada, M4N 1X2
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13
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Gholami Fesharaki M, Kazemnejad A, Zayeri F, Rowzati M, Akbari H. Historical cohort study of shift work and blood pressure. Occup Med (Lond) 2014; 64:109-12. [PMID: 24526704 DOI: 10.1093/occmed/kqt156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND It has been suggested that shift work (SW) is associated with changes in blood pressure (BP). However, studies have reported contradictory results. AIMS To prospectively examine the association between SW and BP among male workers. METHODS A historical cohort study, involving workers of Esfahan's Mobarakeh Steel Company, in Iran, was conducted over 14 years. The association between SW, systolic BP (SBP) and diastolic BP (DBP) was investigated after adjusting for body mass index, age, work experience, marriage, smoking and education based on the Bayesian multilevel modelling approach. RESULTS The study sample included 5331 male workers. The mean age (standard deviation, SD) was 34.8 (6.6) years and mean work (SD) experience was 9.4 (6.1) years. Among these subjects, 2348 (44%), 340 (6%) and 2643 (50%) were day workers, weekly rotating shift workers and routinely rotating shift workers, respectively. The mean SBP (SD) and DBP (SD) of these workers were 118.7 (8.1) and 73.1 (6.7) mmHg, respectively. After controlling for several confounding variables, there was no significant relationship between SBP and DBP and SW. CONCLUSIONS No significant association between SW and BP was observed among these three groups (day workers, weekly rotating shift workers and routinely rotating shift workers). Prospective studies, which control for confounding factors, such as the healthy worker effect, occupational history, family history and psychological factors (e.g. occupational stress and job satisfaction), are required to evaluate this further.
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Affiliation(s)
- M Gholami Fesharaki
- Biostatistics Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 1411713116, Iran
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14
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Hermida RC, Ayala DE, Smolensky MH, Mojón A, Fernández JR, Crespo JJ, Moyá A, Ríos MT, Portaluppi F. Chronotherapy improves blood pressure control and reduces vascular risk in CKD. Nat Rev Nephrol 2013; 9:358-68. [PMID: 23609565 DOI: 10.1038/nrneph.2013.79] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In patients with chronic kidney disease (CKD), the prevalence of increased blood pressure during sleep and blunted sleep-time-relative blood pressure decline (a nondipper pattern) is very high and increases substantially with disease severity. Elevated blood pressure during sleep is the major criterion for the diagnoses of hypertension and inadequate therapeutic ambulatory blood pressure control in these patients. Substantial, clinically meaningful ingestion-time-dependent differences in the safety, efficacy, duration of action and/or effects on the 24 h blood pressure pattern of six different classes of hypertension medications and their combinations have been substantiated. For example, bedtime ingestion of angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers is more effective than morning ingestion in reducing blood pressure during sleep and converting the 24 h blood pressure profile into a dipper pattern. We have identified a progressive reduction in blood pressure during sleep--a novel therapeutic target best achieved by ingestion of one or more hypertension medications at bedtime--as the most significant predictor of decreased cardiovascular risk in patients with and without CKD. Recent findings suggest that in patients with CKD, ambulatory blood pressure monitoring should be used for the diagnosis of hypertension and assessment of cardiovascular disease risk, and that therapeutic strategies given at bedtime rather than on awakening are preferable for the management of hypertension.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo 36310, Spain.
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Melatonin in the afternoons of a gradually advancing sleep schedule enhances the circadian rhythm phase advance. Psychopharmacology (Berl) 2013; 225:825-37. [PMID: 23001190 PMCID: PMC3558560 DOI: 10.1007/s00213-012-2869-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022]
Abstract
RATIONALE We test methods to advance (shift earlier) circadian rhythms without producing misalignment between rhythms and sleep. We previously tested (1) a gradually advancing sleep/dark schedule plus morning bright light and afternoon/evening melatonin and (2) the same sleep schedule with only morning bright light. Now we report on the same sleep schedule with only afternoon/evening melatonin. OBJECTIVES This study aims to examine phase advances, sleepiness, and performance in response to melatonin compared to placebo. METHODS Twelve adults (five female individuals) aged 20-45 years (mean ± SD = 28.3 ± 7.3 years) completed this within-subjects placebo-controlled counterbalanced study. The participants slept on fixed 8-h sleep schedules for nine days. Then, sleep/dark was advanced by 1 h/day for three consecutive days of treatment. The participants took 3 mg of melatonin or placebo 11 h before baseline sleep midpoint (the optimal time to produce phase advances) on the first treatment day and 1 h earlier on each subsequent day. We measured the dim light melatonin onset before and after treatment. The participants rated subjective symptoms throughout the study. They completed the Psychomotor Vigilance Task and rated sleepiness from 1 h before pill ingestion until bedtime on each treatment day. RESULTS Melatonin produced significantly larger advances (1.3 ± 0.7 h) compared to placebo (0.7 ± 0.7 h); however, in the hours between melatonin ingestion and bed, melatonin caused sleepiness and performance decrements. CONCLUSIONS Adding afternoon/evening melatonin to the gradually advancing sleep schedule increased the phase advance, but given the side effects, like sleepiness, it is better to use morning bright light and perhaps a lower dose of melatonin.
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Evans JA, Davidson AJ. Health consequences of circadian disruption in humans and animal models. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2013; 119:283-323. [PMID: 23899601 DOI: 10.1016/b978-0-12-396971-2.00010-5] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Daily rhythms in behavior and physiology are programmed by a hierarchical collection of biological clocks located throughout the brain and body, known as the circadian system. Mounting evidence indicates that disruption of circadian regulation is associated with a wide variety of adverse health consequences, including increased risk for premature death, cancer, metabolic syndrome, cardiovascular dysfunction, immune dysregulation, reproductive problems, mood disorders, and learning deficits. Here we review the evidence for the pervasive effects of circadian disruption in humans and animal models, drawing from both environmental and genetic studies, and identify questions for future research.
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Affiliation(s)
- Jennifer A Evans
- Department of Neurobiology, Morehouse School of Medicine, Atlanta, Georgia, USA
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Smith MR, Eastman CI. Shift work: health, performance and safety problems, traditional countermeasures, and innovative management strategies to reduce circadian misalignment. Nat Sci Sleep 2012; 4:111-32. [PMID: 23620685 PMCID: PMC3630978 DOI: 10.2147/nss.s10372] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
There are three mechanisms that may contribute to the health, performance, and safety problems associated with night-shift work: (1) circadian misalignment between the internal circadian clock and activities such as work, sleep, and eating, (2) chronic, partial sleep deprivation, and (3) melatonin suppression by light at night. The typical countermeasures, such as caffeine, naps, and melatonin (for its sleep-promoting effect), along with education about sleep and circadian rhythms, are the components of most fatigue risk-management plans. We contend that these, while better than nothing, are not enough because they do not address the underlying cause of the problems, which is circadian misalignment. We explain how to reset (phase-shift) the circadian clock to partially align with the night-work, day-sleep schedule, and thus reduce circadian misalignment while preserving sleep and functioning on days off. This involves controlling light and dark using outdoor light exposure, sunglasses, sleep in the dark, and a little bright light during night work. We present a diagram of a sleep-and-light schedule to reduce circadian misalignment in permanent night work, or a rotation between evenings and nights, and give practical advice on how to implement this type of plan.
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Affiliation(s)
- Mark R Smith
- Biological Rhythms Research Laboratory, Rush University Medical Center, Chicago, IL, USA
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Shift work and cardiovascular risk factors: new knowledge from the past decade. Arch Cardiovasc Dis 2011; 104:636-68. [PMID: 22152516 DOI: 10.1016/j.acvd.2011.09.004] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 09/09/2011] [Accepted: 09/12/2011] [Indexed: 01/07/2023]
Abstract
Cardiovascular diseases remain a major public health problem. The involvement of several occupational factors has recently been discussed, notably the organization of work schedules, e.g. shift work. To analyse the progress of knowledge on the relationship between cardiovascular risk factors and shift work. A review of English-language literature dealing with the link between cardiovascular factors and shift workers (published during 2000-2010) was conducted. Studies published in the past 10 years tend to document an impact of shift work on blood pressure, lipid profile (triglyceride levels), metabolic syndrome and, possibly, body mass index. However, the consequences on glucose metabolism are unclear. These results are not yet firmly established, but are supported by strong hypotheses. Some advice could reasonably be proposed to guide the clinical practitioner.
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Job strain, effort-reward imbalance and ambulatory blood pressure: results of a cross-sectional study in call handler operators. Int Arch Occup Environ Health 2010; 84:383-91. [DOI: 10.1007/s00420-010-0576-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 08/27/2010] [Indexed: 11/26/2022]
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KANTERMANN T, JUDA M, VETTER C, ROENNEBERG T. Shift-work research: Where do we stand, where should we go? Sleep Biol Rhythms 2010. [DOI: 10.1111/j.1479-8425.2010.00432.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Lo SH, Liau CS, Hwang JS, Wang JD. Dynamic blood pressure changes and recovery under different work shifts in young women. Am J Hypertens 2008; 21:759-64. [PMID: 18451805 DOI: 10.1038/ajh.2008.186] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Some studies have reported that shift work can affect blood pressure (BP), but few have studied recovery from BP changes occurring during different shifts. METHODS We recruited 16 young female nurses working rotating shifts and six working the regular day shift. All received repeated ambulatory BP monitoring (ABPM) during their workdays and following day off. RESULTS Our linear mixed-effect model showed that both systolic and diastolic BPs were significantly decreased during sleeping period and significantly increased while on working period, on a work day, but increased during sleeping period after a night shift or evening shift. BP measurements that changed after evening shift usually returned to baseline on consecutive off-duty day after day shift, but they did not completely return to baseline after a night shift (P < 0.05). We also found 69% of those working rotating shifts had at least changed once in dipper/nondipper status. The rates of change in dipper/nondipper status between work day and off-duty day were 33, 44, 50, and 38% for nurses worked in outpatient clinic, night shift, evening shift, and day shift, respectively. CONCLUSION Shift work is significantly associated with BP and possibly dipper/nondipper status in young female nurses. Except for those working night shifts, BP levels returned to baseline the off-duty day after day shift. We recommend that potential influence of shift work be considered when evaluating a person's BP.
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Tamagawa R, Lobb B, Booth R. Tolerance of shift work. APPLIED ERGONOMICS 2007; 38:635-42. [PMID: 16996472 DOI: 10.1016/j.apergo.2006.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 01/31/2006] [Accepted: 05/29/2006] [Indexed: 05/11/2023]
Abstract
This study aimed to explore criteria for shift work tolerance and to investigate the relationships between personality traits and states and shift work tolerance. Eighty-nine policemen and police women completed a questionnaire, once during consecutive night shifts and again during rotating shifts, and their responses were used to assess anxiety, emotional control, positive and negative affect, health complaints, sleep quality, difficulties in social and domestic life, and perceptions about shift work. Both the criteria for tolerance and the relationship between tolerance and personality varied according to shift type. Night shift tolerance involved four factors--somatic health, flexibility, sleep and sleep need--while rotating shift tolerance involved three factors--somatic health, flexibility and fatigue. Tolerance of shift work was associated with anxiety, repressive emotional style and mood. During night shifts, anxiety was the most influential personality factor for the somatic health and sleep dimensions of shift tolerance. During rotating shifts, positive and negative moods, rather than trait personality factors, were important predictors of the somatic health and fatigue shift tolerance dimensions. These results suggest a mechanism for more effective matching of workers to suitable shift schedules.
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Affiliation(s)
- Rie Tamagawa
- Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Auckland, New Zealand
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Brondolo E, Rieppi R, Erickson SA, Bagiella E, Shapiro PA, McKinley P, Sloan RP. Hostility, interpersonal interactions, and ambulatory blood pressure. Psychosom Med 2003; 65:1003-11. [PMID: 14645779 DOI: 10.1097/01.psy.0000097329.53585.a1] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined aspects of the transactional model of hostility and health by investigating relationships among hostility, interpersonal interactions, and ambulatory blood pressure in a healthy community sample. MATERIALS AND METHODS Participants included 65 female and 39 male healthy adults between the ages of 18 and 46 years. Ambulatory blood pressure (ABP) and diary data on mood and social interactions were obtained every 20 minutes for 1 day. Mixed models regression analyses were used to evaluate the relationships among hostility, interpersonal interactions, and ABP. RESULTS Trait hostility was positively associated with the frequency and intensity of negative interactions and was negatively associated with the frequency and intensity of positive interactions. Interacting with others was associated with increases in systolic blood pressure (SBP) and diastolic blood pressure (DBP). The magnitude of the increase in blood pressure was positively associated with the degree to which the interaction was perceived as negative. Hostility was not directly associated with ABP/heart rate (HR) or ABP/HR responses during any interactions or negative interactions. However, there was an interaction between hostility and negative interaction intensity for DBP, suggesting that hostility moderates the effects of negative interactions on DBP. Specifically, increases in the intensity of negative interactions were associated with increases in DBP for participants with high, but not low, hostility. CONCLUSIONS The results provide partial support for the notion that hostility may be associated with risk for cardiovascular disease through its effects on interpersonal interactions and their cardiovascular correlates.
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Amamoto K, Okamura T, Tamaki S, Kita Y, Tsujita Y, Kadowaki T, Nakamura Y, Ueshima H. Epidemiologic study of the association of low-Km mitochondrial acetaldehyde dehydrogenase genotypes with blood pressure level and the prevalence of hypertension in a general population. Hypertens Res 2002; 25:857-64. [PMID: 12484509 DOI: 10.1291/hypres.25.857] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Japanese and other Asians, the prevalence of genetically decreased mitochondrial aldehyde dehydrogenase (ALDH2) activity is higher than in Caucasians. The aim of this study was to elucidate the relation between ALDH2 genotypes and blood pressure levels or hypertension in Japanese. After obtaining informed consent for genetic analysis from 917 men and 1,478 women who lived in a mountainous farming region near Kyoto and who were free from cardiovascular disease and liver dysfunction, the authors identified the ALDH2 genotype in all subjects. Differences in blood pressure level among genotypes were then compared by analysis of covariance, and the relation between genotypes and hypertension was also analyzed by logistic regression analysis. The frequencies of genotypes *1/*1, *1/*2, and *2/*2 were 44.7%, 46.9% and 8.4% in men, and 50.1%, 43.2% and 6.8% in women, respectively. In men, systolic and diastolic blood pressures tended to decrease in the order of *1/*1>*1/*2>*2/*2. However, adjustment for confounding factors including alcohol consumption resulted in the disappearance of significance. Logistic regression analysis adjusted for the same confounding factors for men showed that the odds ratios (OR) of being hypertensive in the *2 allele to not having *2 allele were 0.67 (95% confidence interval (CI): 0.47-0.96). However, in the subgroup analyses, this relation was not observed in the group having a below-median level of alcohol consumption (OR = 0.92; 95% CI: 0.53-1.62) or in the group not taking antihypertensive agents (OR = 0.77; 95% CI: 0.52-1.15). Furthermore, we did not observe any relation between the ALDH2/*2 allele and hypertension in women (OR = 1.07; 95% CI: 0.80-1.42). The results suggest that there may be no causal relation between hypertension and the ALDH2 genotype per se, after excluding for some confounding factors, especially for alcohol drinking.
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Affiliation(s)
- Kenji Amamoto
- Department of Health Science, Shiga University of Medical Science, Otsu, Japan.
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Abstract
Ambulatory measurements are increasingly used to evaluate the effects of different aspects of lifestyle on blood pressure. Such measurements provide greater statistical power than casual measurements and are particularly useful for assessing diurnal variations, 24-hour load and variability, and both acute and sustained effects of common behaviours. Concomitant heart rate and biochemical and genetic measurements can provide clues as to the mechanisms underlying the effects of lifestyle on blood pressure in different target populations. The information obtained is proving helpful in evaluating actions and interactions of smoking, alcohol, physical activity, caffeine consumption, various types of psychological stress, obesity, and dietary habits.
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Affiliation(s)
- Lawrence J Beilin
- Department of Medicine, University of Western Australia, West Australian Institute for Medical Research and HeartSearch, Perth, Australia.
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