24-h Blood Pressure Research Articles

AUGMENTED BLOOD PRESSURE VARIABILITY FOLLOWING CONTINUOUS INFUSION OF NORADRENALINE IN RATS

Objective: Augmented blood pressure (BP) variability has been shown to be an independent cardiovascular risk factor. Activity of the sympathetic nervous system is an important determinant factor of the 24-h profile of BP variability, although it is unknown whether persistent adrenergic activation causes augmented BP variability or not. Here we report that continuous infusion of noradrenalin augments 24-h BP variability in rats, and our efforts were also made to explore the mechanism of action through which noradrenalin exerted this effect. Design and method: Nine-week-old male Wistar rats maintained under a 12-h light and 12-h dark cycle were continuously infused with subcutaneous 30 mg/h noradrenalin, 150 mg/h of the a1-adrenergic agonist phenylephrine, or 30 mg/h of the non-selective b-agonist isoproterenol, for 14 days. Noradrenalin-infused rats were also administered either oral 5 mg/day prazosin, an a1-blocker, or 50 mg/day atenolol, a b1-blocker, during the infusion period. BP variability was evaluated before and after 7 and 14 days of the infusion, using a coefficient of variation (CV) of BP recorded every 15 min under an unrestrained condition via an abdominal aortic catheter by a radiotelemetry system. Results: Continuous infusion of noradrenalin significantly increased BP variability at 7 and 14 days, slightly elevating BP levels, and this increase was observed similarly in the light and dark cycles. Noradrenalin-induced augmentation of BP variability was partially attenuated by oral administration of prazosin, but not by atenolol. This action of noradrenalin was mimicked by continuous infusion of phenylephrine, while isoproterenol failed to affect the BP variability. Conclusions: Continuous infusion of noradrenalin increased BP variability in rats through an a1-adrenergic receptor-mediated mechanism, suggesting that the noradrenalin-infused rat is an animal model of augmented BP variability induced by persistent adrenergic activation. This model could be useful in pharmacological screening of the suppressive action of candidate drugs on augmented BP variability in vivo.

URINE METABOLITES OF CORTISOL CORRELATES WITH AMBULATORY BLOOD PRESSURE VALUES IN OBESE CHILDREN

Abstract Objective: Obesity is considered a pseudo-Cushing state and often elevated levels of cortisol and its metabolites can be found; however, the relationship between cortisol metabolites and blood pressure (BP) in obese children is understudied. 11b-hydroxysteroid dehydrogenase type 2 (11b-HSD-2) catalyses the reversible conversion of physiological glucocorticoids (tetrahydrocortisol, THF and allo-tetrahydrocortisol, allo-THF) to inactive products (tetrahydrocortisone, THE). An increase in the THFs/THE ratio reflects 11b-HSD-2 impairment and has been associated with BP elevation. Ambulatory blood pressure monitoring (ABPM) provides an accurate measurement of BP during 24 hours. We aimed to investigate the relationship between BP measured by ABPM, urinary cortisol and its metabolites, in a sample of obese children. Design and method: 50 obese children aged between 8 and 17 years (mean age 11.5 ± 3.3 years, 66% males), were included in the present study. Children underwent ABPM. Cortisol, sodium, THF, allo-THF and THE were measured on urinary 24-hour collection. Cortisol urinary metabolites were quantified by liquid chromatography tandem mass spectrometry (Nexera Shimadzu, 4500 MD Sciex). Results: The THF + alloTHF/THE ratio negatively correlates with 24-hours urinary sodium excretion (p = -0.346; r = 0.015) and to SBP and DBP load (% of measure of PAS > 130mmHg or % of PAD > 80mmHg) (respectively r = 0.283 p = 0.047 and r = 0,284; p = 0.046). No correlation between THFs/THE ratio and daytime or nighttime SPB or DBP were found. The sum of urinary cortisol and its metabolites, a gross index of relative excess of cortisol, is directly correlated with SBP load (r = 0.355; p = 0.029). Conclusions: In our sample of obese children, both the impaired activity of the 11b-HSD-2 and the amount of cortisol and its metabolites excreted by urine are associated with an excessive 24-h BP load. Reduced urinary sodium excretion mediated by increasing of THF/THE ratio could be involved.

Multiple Myeloma Patients Undergoing Carfilzomib: Development and Validation of a Risk Score for Cardiovascular Adverse Events Prediction

Simple SummaryDespite the relationship between Carfilzomib (CFZ) therapy in multiple myeloma (MM) and cardiovascular adverse events (CVAEs), no specific validated protocols on cardiovascular risk assessment are available. In this prospective study, we investigated major predictors of CVAEs prior to starting CFZ, applying the European Myeloma Network management protocol (EMN). Five predictors were identified: office systolic blood pressure, 24-h blood pressure variability, left ventricular hypertrophy, pulse wave velocity value and global longitudinal strain. The resulting ‘CVAEs risk score’ defined a low- and a high-risk group (negative predicting value for the high-risk group of 90%). 62 patients experienced one or more CVAEs: 17 major and 45 hypertension-related events. In conclusion, CVAEs are frequent and a specific management protocol is required. The EMN protocol and ‘CFZ risk score’ proved to be effective in estimating the baseline risk of CVAEs during CFZ therapy in MM patients, targeting the appropriate follow-up.Cardiovascular adverse events (CVAEs) are linked to Carfilzomib (CFZ) therapy in multiple myeloma (MM); however, no validated protocols on cardiovascular risk assessment are available. In this prospective study, the effectiveness of the European Myeloma Network protocol (EMN) in cardiovascular risk assessment was investigated, identifying major predictors of CVAEs. From January 2015 to March 2020, 116 MM patients who had indication for CFZ therapy underwent a baseline evaluation (including blood pressure measurements, echocardiography and arterial stiffness estimation) and were prospectively followed. The median age was 64.53 ± 8.42 years old, 56% male. Five baseline independent predictors of CVAEs were identified: office systolic blood pressure, 24-h blood pressure variability, left ventricular hypertrophy, pulse wave velocity value and global longitudinal strain. The resulting ‘CVAEs risk score’ distinguished a low- and a high-risk group, obtaining a negative predicting value for the high-risk group of 90%. 52 patients (44.9%) experienced one or more CVAEs: 17 (14.7%) had major and 45 (38.7%) had hypertension-related events. In conclusion, CVAEs are frequent and a specific management protocol is crucial. The EMN protocol and the risk score proved to be useful to estimate the baseline risk for CVAEs during CFZ therapy, allowing the identification of higher-risk patients.

Positive effects of renal denervation on markers of cardiovascular inflammation and left ventricular mass. 24-months follow-up

Aim. To study the long-term effect of renal denervation (RDN) on left ventricular mass (LVM) and inflammatory markers in resistant hypertensive patients.Material and methods. Forty-one patients with resistant hypertension and 24-h blood pressure (BP) 158,7±15,8/87,3+14,6 mmHg, aged 56,6+10,2 years, were enrolled in the study and undergone RDN. Mean 24-h BP, left ventricular mass (transthoracic echocardiography), high sensitivity C-reactive protein (hsCRP), interleukin- 1β (IL­1β), IL-6, IL-10) and tumor necrosis factor alpha (TNF- α) were assessed at baseline and 2 years after the RDN.Results. A baseline prevalence of left ventricular hypertrophy (LVH) was 90,2%. Two years after RDN LVM and interventricular septum (IVS) decreased significantly (p<0.05 for both). Decrease in myocardial mass (∆LVM >0 g) was documented in 24 patients. The regression of LVM was accompanied by a significant decrease in levels of inflammatory markers — hsCRP by 38,3% (p=0,031), TNF-α by 60,7% (p=0,009), IL- 1β — by 71,1% (p=0,001), and IL-10 by 58,2% (p=0,001). In patients in the absence of LVM regression only TNF-α decreased significantly (-68,8%, p=0,001). There was no correlation between changes of LVM and the inflammatory markers at 24 months after RDN.Conclusion. The RDN in RH patients may have long-term cardioprotective effect in terms of significant regress of LVH, which may be partly attributed to the regress in systemic or myocardial inflammation.

Prolonged Post-Exercise Hypotension: Effects of Different Exercise Modalities and Training Statuses in Elderly Patients with Hypertension.

Background: In this study, we aimed at comparing the effects of three different exercise modalities on post-exercise hypotension (PEH) in elderly hypertensive patients and at investigating whether PEH responses to the same exercises are affected by their training status. Methods: Thirty-six male sedentary hypertensive patients over 60 years old, were included. They were divided into three groups each one corresponding to a different exercise modality, i.e., aerobic continuous exercise (ACE), high-intensive interval exercise (HIIE), and combined (aerobic and resistance) exercise (CE). PEH was assessed in each group by ambulatory blood pressure monitoring (ABPM) in two different conditions as follows: (1) sedentary status and (2) trained status, at the end of a 12 week of ACE training program. A cardiopulmonary test was performed before and at the end of the training program. Results: In the sedentary status, 24-h and nocturnal systolic and diastolic blood pressure (BP) decreased in all groups as compared with top pre-exercise, with a greater but not significant reduction in the ACE and CE groups as compared with HIIE. ACE and HIIE groups presented a more sustained PEH than CE. In the trained status, 24-h and nighttime systolic and diastolic BP decreased significantly only after HIIE, but were unchanged as compared with pre-exercise in the ACE and CE groups. Conclusions: ACE and CE produced greater PEH than HIIE in sedentary elderly hypertensive patients. However, after training, HIIE produced the greater and more sustained PEH. The training status appears to exert significant effects on PEH produced by different exercise modalities.

Sex-Dependent Association Between Early Morning Ambulatory Blood Pressure Variations and Acute Mountain Sickness.

BackgroundAcute high altitude (HA) exposure elicits blood pressure (BP) responses in most subjects, and some of them suffer from acute mountain sickness (AMS). However, a 24-h ambulatory BP (ABP) change and the correlation with the occurrence of AMS in different sexes are still unclear.ObjectivesThis prospective study aimed to investigate HA induced BP responses in males and females and the relationship between AMS and 24-h ABP.MethodsForty-six subjects were matched according to demographic parameters by propensity score matching with a ratio of 1:1. All the subjects were monitored by a 24-h ABP device; the measurement was one period of 24 h BP. 2018 Lake Louise questionnaire was used to evaluate AMS.ResultsBoth the incidence of AMS (14 [60.9%] vs. 5 [21.7%], P = 0.007) and headache (18 [78.3%] vs. 8 [34.8%], P = 0.003) were higher in females than in males. All subjects showed an elevated BP in the early morning [morning systolic BP (SBP), 114.72 ± 13.57 vs. 120.67 ± 11.10, P = 0.013]. The elevation of morning SBP variation was more significant in females than in males (11.95 ± 13.19 vs. −0.05 ± 14.49, P = 0.005), and a higher morning BP surge increase (4.69 ± 18.09 vs. −9.66 ± 16.96, P = 0.005) was observed after acute HA exposure in the female group. The increase of morning SBP was associated with AMS occurrence (R = 0.662, P < 0.001) and AMS score (R = 0.664, P = 0.001). Among the AMS symptoms, we further revealed that the incidence (R = 0.786, P < 0.001) and the severity of headache (R = 0.864, P < 0.001) are closely correlated to morning SBP.ConclusionsOur study demonstrates that females are more likely to suffer from AMS than males. AMS is closely associated with elevated BP in the early morning period, which may be correlated to higher headache incidence in subjects with higher morning SBP.

Clinical and central hemodynamic characteristics of early adulthood isolated diastolic hypertension: a comparison with isolated systolic hypertension.

Knowledge on early adulthood isolated diastolic hypertension (IDH) is limited. We compared the clinical and central hemodynamic characteristics of early adulthood IDH, isolated systolic hypertension (ISH) and normotension. A total of 509 untreated young adults (18-35 years) who underwent ambulatory blood pressure monitoring (ABPM; ABPM cohort), 148 who underwent both ABPM and applanation tonometry (ABPM-tonometry cohort) and 26 newly recruited normotensives were analyzed. Their pulse wave images were analyzed after categorizing them into type A vs. B vs. C. In the ABPM cohort (men, 86.6%), systolic-diastolic hypertension was the most common subtype (68.0%), while IDH was the rarest (5.1%). The subtype composition showed age-dependency; the proportion of IDH and systolic-diastolic hypertension increased across the age tertiles, while that of ISH declined. Patients with IDH were significantly older and shorter than those with ISH. Despite having a significantly lower 24-h average systolic blood pressure (SBP), patients with IDH exhibited discordantly high central systolic blood pressures at levels comparable to those of patients with ISH. Pulse pressure amplification was the lowest in patients with IDH and highest in those with ISH (P < 0.001), accounting for the discordance. Augmentation index differed significantly between them (P < 0.016). The waveform composition differed across the subtypes (type A vs. B/C: IDH = 61.5 vs. 38.5%; ISH = 3.0 vs. 97.0%; normotension = 30.8 vs. 69.2%, P < 0.001); the averaged waveform plots demonstrated a clear morphological disparity between IDH (type A) and ISH (type B/C). Early adulthood IDH is a unique entity clearly distinguishable from ISH in terms of clinical and central hemodynamic characteristics.

Light therapy improves diurnal blood pressure control in night shift workers via reduction of catecholamines: the EuRhythDia study.

Night shift work is associated with high rates of hypertension and cardiometabolic disease, which are linked to disrupted circadian rhythms. We hypothesized that timed light therapy might improve disrupted circadian rhythms and stabilize diurnal control of blood pressure and glucose in night shift workers. We randomized 24 rotating night shift workers (mean age, 36 ± 13 years, 7 men) who had spent a median of 6 years on rotating night shifts (median, six night shifts per month) to 12 weeks of light therapy or no intervention and compared them with 12 daytime workers (37 ± 11 years, 6 men). We measured oral glucose tolerance (OGTT), 24-h blood pressure and arterial stiffness, and the circadian profiles of melatonin, cortisol, metanephrine and nor-metanephrine at baseline, after 12 weeks of intervention, and 12 weeks after the end of intervention. At baseline, fewer night shift workers showed dipper status as compared with daytime workers (29 vs. 58%; P < 0.001). After 12 weeks of light therapy, there was a highly significant increase in the proportion of dippers (to 58%; P < 0.0001). We also observed a significant decrease in serum glucose during OGTT in the light therapy group (-22%; P < 0.05) with no change in serum insulin. Whilst circadian profiles of melatonin and cortisol were unchanged, plasma metanephrine and nor-metanephrine levels were significantly reduced in the light therapy group (P < 0.01). Timed light therapy improves diurnal blood pressure control and glucose tolerance in rotating night shift workers. This effect is unrelated to melatonin and cortisol but is paralleled by reduced catecholamine levels.

A comparative analysis of ambulatory BP profile and arterial stiffness between CAPD and APD

Prior studies have associated automated peritoneal dialysis (APD) with less effective volume and blood pressure (BP) control as compared with continuous ambulatory peritoneal dialysis (CAPD). Our study aimed to compare the volume status, ambulatory BP profile and severity of arterial stiffness between patients treated with CAPD versus APD. In a case-control design, 28 CAPD patients were matched in 1:1 ratio with 28 controls receiving APD for age, gender and diabetic status. Body composition was assessed with the method of bioimpendence spectroscopy. Twenty-four hours ambulatory BP monitoring with the Mobil-O-Graph device (IEM, Germany) was performed to determine peripheral and central hemodynamic parameters, heart rate-adjusted augmentation index (AIx75) and pulse wave velocity (PWV). Standardized office BP, antihypertensive medication use and extracellular-to-total body water ratio did not differ between CAPD and APD groups. Twenty-four hours brachial systolic BP (129.0 ± 17.3 vs. 128.1 ± 14.2 mmHg, P = 0.83) and 24-h aortic systolic BP (116.9 ± 16.4 vs. 116.4 ± 11.6 mmHg, P = 0.87) were similar in patients treated with CAPD versus APD. Similarly, there was no significant difference between PD modalities in severity of arterial stiffness, as assessed with 24-h AIx75 (24.8 ± 8.9 vs. 22.5 ± 9.1, P = 0.36) and 24-h PWV (9.1 ± 2.4 vs. 8.8 ± 2.1 m/s, P = 0.61). The present study suggests that there is no difference in peripheral and central hemodynamic parameters as well as in the severity of arterial stiffness between CAPD and APD. However, these observations should be interpreted within the context of clinical characteristics of patients included in this case-control study. The comparative effectiveness of these 2 PD modalities warrants further investigation in larger longitudinal studies.

Blood pressure and left ventricular function changes in different ambulatory blood pressure patterns at high altitude.

Acute high‐altitude (HA) exposure induces physiological responses of the heart and blood pressure (BP). However, few studies have investigated the responses associated with dipper and non‐dipper BP patterns. In this prospective study, 72 patients underwent echocardiography and 24‐h ambulatory BP testing at sea level and HA. Patients were divided into dipper and non‐dipper groups according to BP at sea level. Acute HA exposure elevated 24‐h systolic and diastolic BP and increased BP variability, particularly in the morning. Moreover, acute exposure increased left ventricular torsion, end‐systolic elastance, effective arterial elastance, and untwisting rate, but reduced peak early diastolic velocity/late diastolic velocity and peak early diastolic velocity/early diastolic velocity, implying enhanced left ventricular systolic function but impaired filling. Dippers showed pronounced increases in night‐time BP, while non‐dippers showed significant elevation in day‐time BP, which blunted differences in nocturnal BP fall, and lowest night‐time and evening BP. Dippers had higher global longitudinal strain, torsion, and untwisting rates after acute HA exposure. Variations in night‐time systolic BP correlated with variations in torsion and global longitudinal strain. Our study firstly demonstrates BP and cardiac function variations during acute HA exposure in different BP patterns and BP increases in dippers at night, while non‐dippers showed day‐time increases. Furthermore, enhanced left ventricular torsion and global longitudinal strain are associated with BP changes. Non‐dippers showed poor cardiac compensatory and maladaptive to acute HA exposure. However, the exact mechanisms involved need further illumination.

Age dependence of brachial cuff-based ambulatory PWV in end-stage kidney disease patients undergoing long-term peritoneal dialysis.

The newly introduced device Mobil-O-Graph (IEM, Stolberg, Germany) combines brachial cuff oscillometry and pulse wave analysis, enabling the determination of pulse wave velocity (PWV) via complex mathematic algorithms during 24-h ambulatory blood pressure monitoring (ABPM). However, the determinants of oscillometric PWV in the end-stage kidney disease (ESKD) population remain poorly understood. In this study, 81 ESKD patients undergoing long-term peritoneal dialysis underwent 24-h ABPM with the Mobil-O-Graph device. The association of 24-h oscillometric PWV with several demographic, clinical and haemodynamic parameters was explored using linear regression analysis. In univariate analysis, among 21 risk factors, 24-h PWV exhibited a positive relationship with age, body mass index, overhydration assessed via bioimpedance spectroscopy, diabetic status, history of dyslipidaemia and coronary heart disease, and it had a negative relationship with female sex and 24-h heart rate. In stepwise multivariate analysis, age (β: 0.883), 24-h systolic blood pressure (BP) (β: 0.217) and 24-h heart rate (β: -0.083) were the only three factors that remained as independent determinants of 24-h PWV (adjusted R 2 = 0.929). These associations were not modified when all 21 risk factors were analysed conjointly or when the model included only variables shown to be significant in univariate comparisons. The present study shows that age together with simultaneously assessed oscillometric BP and heart rate are the major determinants of Mobil-O-Graph-derived PWV, explaining >90% of the total variation of this marker. This age dependence of oscillometric PWV limits the validity of this marker to detect the premature vascular ageing, a unique characteristic of vascular remodelling in ESKD.

Effects of testosterone treatment, with and without exercise training, on ambulatory blood pressure in middle-aged and older men.

With age, testosterone (T) and physical activity levels often decline in parallel. The effect of combining T treatment and exercise training on ambulatory blood pressure (ABP) is unclear. To assess T and exercise effects, alone and in combination, on ABP in men aged 50-70years, waist circumference≥95cm and low-normal serum T (6-14nmol/L), without organic hypogonadism. A 2 × 2 factorial randomised, placebo-controlled study. Randomization to daily transdermal AndroForte5® (Testosterone 5.0%w/v, 100mg in 2ml) cream (T), or matching placebo (P) (double-blind), and to supervised exercise (Ex) or no additional exercise (NEx), for 12weeks. Average 24-h systolic blood pressure (SBP) increased with T treatment (testosterone*time, p=.035). Average 24-h SBP increased in T+Ex (T+Ex:+3.0 vs. P+NEx: -3.0mmHg, p=.026) driven by day-time changes (T+Ex:+3.5 vs. P+NEx: -3.0mmHg, p=.026). There was an effect of T for 24-h average diastolic blood pressure (DBP, testosterone*time, p=.044) driven by the decrease in P+Ex (P+Ex: -3.9 vs. T+NEx: -0.5mmHg, p=.015). Night-time DBP was lower with exercise (P+Ex: -4.0 vs. P+NEx: +0.7mmHg, p=.032). The effect of exercise to lower night-time DBP was not apparent in the presence of T (T+Ex: -0.4 vs. P+NEx: +0.7mmHg, p>.05). Ex increased average 24-h pulse pressure (PP, exercise*time, p=.022), largely during daytime hours (exercise*time, p=.013). There was a main effect of T to increase 24-h SBP, primarily seen when T was combined with Ex. Exercise alone decreased 24-h and night-time DBP; an effect attenuated by T. BP should be carefully assessed and monitored, when prescribing T treatment to middle-aged and older men, especially when combined with exercise training.

Associations of circulating irisin with 24-h blood pressure, total and visceral fat, and metabolic parameters in young adult hypertensives.

Some experimental and clinical studies suggest a possible role of irisin in central and peripheral regulation of blood pressure. The purpose of the study was to assess the associations between serum irisin levels, total and visceral fat, metabolic parameters, and blood pressure pattern during 24-h monitoring (ABPM). In 206 patients with essential hypertension receiving standard antihypertensive treatments, we assessed anthropometric indices; serum irisin, blood lipids (total cholesterol, LDL-C, HDL-C, and triglycerides), glucose and insulin; body composition including lean mass and total, visceral, android and gynoid fat using a dual-energy x-ray absorptiometry; ABPM; and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR). Baseline irisin levels were within normal reference ranges and comparable between the genders. There were no significant correlations of irisin with age, anthropometric variables, lipids, HOMA-IR, body composition, as well as 24-h blood pressure and dipping status. In univariate analysis, age, fat mass and distribution, lipids and glucose, HOMA-IR, and nocturnal blood pressure fall were poor predictors of irisin levels. These neutral associations were not affected by age, gender, and treatment modality. In young adult hypertensives, serum concentration of irisin was within a normal range and not associated with total and regional fat, blood lipids, insulin resistance, as well as 24-h blood pressure and the magnitude of its nocturnal fall.

Hemodiafiltration maintains a sustained improvement in blood pressure compared to conventional hemodialysis in children-the HDF, heart and height (3H) study.

Hypertension is prevalent in children on dialysis and associated with cardiovascular disease. We studied the blood pressure (BP) trends and the evolution of BP over 1year in children on conventional hemodialysis (HD) vs. hemodiafiltration (HDF). This is a post hoc analysis of the "3H - HDF-Hearts-Height" dataset, a multicenter, parallel-arm observational study. Seventy-eight children on HD and 55 on HDF who had three 24-h ambulatory BP monitoring (ABPM) measures over 1year were included. Mean arterial pressure (MAP) was calculated and hypertension defined as 24-h MAP standard deviation score (SDS) ≥95th percentile. Poor agreement between pre-dialysis systolic BP-SDS and 24-h MAP was found (mean difference - 0.6; 95% limits of agreement -4.9-3.8). At baseline, 82% on HD and 44% on HDF were hypertensive, with uncontrolled hypertension in 88% vs. 25% respectively; p < 0.001. At 12months, children on HDF had consistently lower MAP-SDS compared to those on HD (p < 0.001). Over 1-year follow-up, the HD group had mean MAP-SDS increase of +0.98 (95%CI 0.77-1.20; p < 0.0001), whereas the HDF group had a non-significant increase of +0.15 (95%CI -0.10-0.40; p = 0.23). Significant predictors of MAP-SDS were dialysis modality (β = +0.83 [95%CI +0.51 - +1.15] HD vs. HDF, p < 0.0001) and higher inter-dialytic-weight-gain (IDWG)% (β = 0.13 [95%CI 0.06-0.19]; p = 0.0003). Children on HD had a significant and sustained increase in BP over 1year compared to a stable BP in those on HDF, despite an equivalent dialysis dose. Higher IDWG% was associated with higher 24-h MAP-SDS in both groups.

Vascular Inflammation and Cardiovascular Burden in Metastatic Breast Cancer Female Patients Receiving Hormonal Treatment and CDK 4/6 Inhibitors or Everolimus

Background: Chemotherapy regimens for breast cancer treatment can promote vascular dysfunction and lead to high cardiovascular risk.Purpose: To investigate the cardiovascular burden and vascular inflammation in metastatic breast cancer patients receiving CDK 4/6 inhibitors or everolimus in addition to standard hormonal treatment.Methods: 22 consecutive female patients with metastatic breast cancer were enrolled. Relative wall thickness (RWT) and left ventricle mass (LVM) measurements by transthoracic echocardiography were obtained followed by 24-h ambulatory blood pressure monitoring, and 18F-fluorodeoxyglucose positron-emission tomography/computed tomography imaging. Uptake of the radiotracer in the aortic wall was estimated as tissue-to-background ratio (TBR). Each patient was assessed for the aforementioned parameters before the initiation and after 6 months of treatment.Results: At follow up, patients assigned to CDK 4/6 treatment demonstrated increased 24-h systolic blood pressure (SBP) (p = 0.004), daytime SBP (p = 0.004) and night time SBP (p = 0.012) (Group effect). The 24-h mean arterial pressure measurements were also higher in CDK 4/6 population, in comparison to everolimus that displayed firm values (Group effect- p = 0.035, Interaction effect-p = 0.023). Additionally, 24 h diastolic blood pressure recordings in CDK 4/6 therapy were higher opposed to everolimus that remained consistent (Interaction effect- p = 0.010). In CDK 4/6 group, TBR aorta also increased significantly, whereas TBR values in everolimus remained stable (Interaction effect-p = 0.049). Both therapeutic regimens displayed statistically significant damaging effect to RWT and LVM.Conclusion: CDK 4/6 inhibitors and hormonal treatment can lead to increased vascular inflammation, and higher blood pressure compared to the combination of everolimus and hormonal treatment. Moreover, both treatment strategies promoted left ventricle remodeling.

Recreational beach tennis reduces 24-h blood pressure in adults with hypertension: a randomized crossover trial

To evaluate the effect of a beach tennis session on 24-h ambulatory blood pressure in adults with hypertension. In this randomized crossover trial, 24 participants (12 men and 12 women) randomly performed two experimental sessions: a beach tennis session and a non-exercise control session. The beach tennis session started with a standardized 5-min warm-up consisting of basic techniques, followed by three 12-min beach tennis matches with 2-min intervals between them. Heart rate was continuously recorded and rating of perceived exertion was assessed in the middle and at the end of each set during the beach tennis session. Enjoyment was also assessed after the beach tennis session. The control session was performed in seated rest. Both experimental sessions lasted 45min. Ambulatory blood pressure was measured continuously for 24 h after sessions. Systolic blood pressure (24-h: 6mmHg, P = 0.008; daytime: 6mmHg, P = 0.031; nighttime: 6mmHg, P = 0.042) and diastolic blood pressure (24-h: 3mmHg, P = 0.021; daytime: 3mmHg, P = 0.036; nighttime: 4mmHg, P = 0.076) decreased after beach tennis when compared with control. The participants presented a reserve heart rate of 59-68%, and a rating of perceived exertion score of 3.4-4.7 using Borg's CR10 Scale. The enjoyment scores after beach tennis session were higher than 90%. A single session of recreational beach tennis reduces 24-h ambulatory blood pressure in adults with hypertension. Additionally, the participants can achieve a high physiological stress but perceive less effort during the practice. Date: April 10, 2019; identifier number NCT03909308 (Clinicaltrials.gov).

The long-term impact of expansion sphincter pharyngoplasty treatment on blood pressure control and health-related quality of life in patients with obstructive sleep apnea and hypertension

To assess how expansion sphincter pharyngoplasty (ESP) impacts blood pressure (BP) and health-related quality of life (HRQOL) in hypertensive patients with obstructive sleep apnea (OSA). Patients were separated into two groups based upon whether or not they adhered to antihypertensive drug regimens. Patients underwent 24-h ambulatory BP monitoring before and at 6 months post-ESP, while clinical BP measurements and HRQOL questionnaires (SF-36) were conducted over the course of 24 months post-surgery. We enrolled 62 patients, with 25 and 37 in the medicated and non-medicated groups, respectively. Mean 24-h BP differed significantly, with systolic and diastolic BP (SBP and DBP) decreases of 5.3 mmHg and 2.5 mmHg, respectively (P <0.01). Mean 24-h SBP and DBP decreases in the medicated group were 10.2 mmHg and 4.6 mmHg, respectively (P < 0.001), with significant decreases during the daytime of8.6 mmHg, 3.0 mmHg, and nighttime of12.3 mmHg, 7.7 mmHg (P <0.001). In the non-medicated treatment group, 24-h SBP and DBP decreases were 1.9 mmHg and 1.1 mmHg (P < 0.005) with significant decreases in mean nighttime BP values of 3.2 mmHg and 1.9 mmHg (P < 0.001). While pre- and postoperative SF-36 results differed significantly, no differences were observed between the two groups. ESP decreases BP and improves HRQOL in OSA patients with hypertension, particularly in combination with antihypertensive drugs.

Should reduction of increased short-term blood pressure variability be a target of antihypertensive therapy?

It has long been known that blood pressure (BP) is characterized by marked short‐term fluctuations occurring within a 24‐h period and also by long‐term oscillations occurring over more prolonged periods of time. An increased short‐term blood pressure variability (BPV) appears to importantly contribute to target organ damage and to the enhanced cardiovascular risk of hypertensive patients, over and above the effect of an increase in mean BP levels. Reducing 24‐h mean BP is the main aim of antihypertensive therapy, but initial data are available that additional cardiovascular protection can be achieved by reducing BPV. However, to definitively prove the prognostic role of short‐term BPV and the need for its control by treatment, evidence is still needed from intervention trials aimed at demonstrating that by reducing BPV through administration of antihypertensive drugs, a reduction in organ damage and in the rate of cardiovascular events can be obtained.

Impact of cortisol on blood pressure and hypertension-mediated organ damage in hypertensive patients.

Patients with overt and subclinical Cushing's syndrome frequently develop hypertension, metabolism disorders, and atherosclerotic lesions. The aim of the present study was to test the association between cortisol and blood pressure (BP), organ damage, and metabolic parameters in hypertensive patients without hypercortisolism. After exclusion of patients treated with corticosteroids or with Cushing's syndrome, the cohort included 623 hypertensive patients (mean ± SD age 50.3 ± 15.4 years, 50.9% men, median 24-h BP 146/88 mmHg) with an extended work-up (lipid profile, hypertension-mediated organ damage). Cortisol secretion was assessed by plasma cortisol at 0800 and 1600 h, and by 24-h urinary free cortisol (24 h UFC) normalized if required to urine creatinine (UFC/U creat). Plasma cortisol at 1600 h, 24 h-UFC, and UFC/U creat were significantly and positively correlated with daytime, night-time, and 24-h SBP; plasma cortisol at 0800 h was not associated with BP. The strongest correlations were observed in the subgroup of aged more than 50 years (correlation coefficients between 0.23 and 0.28). These correlations remained after adjustment on plasma aldosterone. Metabolic parameters were weakly associated with cortisol. Arterial stiffness (central pulse pressure and pulse wave velocity), plasma NT-proBNP, and microalbuminuria were significantly correlated with 24 h UFC, UFC/U creat, and plasma cortisol at 1600 h. Cortisol influences weakly the level of BP independently from plasma aldosterone in hypertensive patients, particularly in older patients, and that there was weak association with HMOD. It may, therefore, be of interest to test specific treatments targeting cortisol excess in selected hypertensive patients.

Sex May Modulate the Effects of Combined Polyphenol Extract and L-citrulline Supplementation on Ambulatory Blood Pressure in Adults with Prehypertension: A Randomized Controlled Trial.

Increased blood pressure (BP), vascular dysfunction and inflammation are involved in the etiology of cardiovascular disease (CVD). Although several dietary components such as polyphenols and L-citrulline may help to control BP, their combined impact on ambulatory BP in individuals at risk of CVD remains unknown. The objective of this research was to investigate the short-term impact of supplementation with a combination of polyphenol extract and L-citrulline on ambulatory BP, endothelial function and inflammation. In a randomized double-blind parallel trial, 73 men and women with prehypertension were supplemented with a placebo (cellulose, n = 34, Plac) or 548 mg/day of polyphenols and 2 g/day of L-citrulline (n = 35, Suppl) for 6 weeks. The primary outcome of this study was the difference between groups in 24-h ambulatory diastolic BP (DBP) at week six. Secondary outcomes were a difference between groups at week six in ambulatory systolic BP (SBP), casual BP, serum lipids and high-sensitivity C-reactive protein (hs-CRP) concentrations and skin advanced glycation end products (AGEs). Potential interaction of treatment with sex was examined. Suppl had no impact on mean ambulatory SBP and DBP (p > 0.10 vs. placebo). Daytime and 24-h SBP were reduced with Suppl in women (p ≤ 0.01), but not in men (p ≥ 0.27). A non-significant reduction in AGEs was observed after Suppl compared to Plac among all participants (p = 0.07) and there was no difference in the concentrations of blood lipids (p > 0.20) or CRP (p = 0.36) between treatments at week six. Therefore, supplementation with polyphenol extract and L-citrulline for 6 weeks has no impact on ambulatory BP, blood lipids and CRP in adults with prehypertension. However, the polyphenol extract/L-citrulline supplement may reduce ambulatory SBP in women, but not in men. These preliminary results need further research efforts towards further documenting this sex-dependent BP response to supplementation with polyphenols and L-citrulline.