24-hr Ambulatory Blood Pressure Research Articles

Fluid State and Blood Pressure Control

The aim of this study was to compare fluid state, ambulatory blood pressure, and sodium removal in automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). This observational, cross-sectional study comprised 20 APD and 24 CAPD patients with a mean duration on peritoneal dialysis of 30 ± 26 and 21 ± 23 months, respectively. Sixty-four percent of the patients were treated with icodextrin. The methods used were 24 hr dialysate and urine collections, standardized 3.86% glucose peritoneal equilibration test (PET), bioimpedance analysis, and 24 hr ambulatory blood pressure monitoring. Extracellular water (ECW) corrected for body weight was 0.23 6 0.03 L/kg both in APD and CAPD patients. The slope normovolemia value according to Chamney was 0.0 6 0.2 L/kg in APD patients and 0.0 6 0.05 L/kg in CAPD patients (not significant [NS]). Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were respectively, 132 ± 25 and 79 ± 8 mm Hg in APD and 129 ± 16 and 76 ± 11 mm Hg in CAPD patients (NS). Sodium concentration in dialysate was respectively, 129.5 ± 3.5 mmol/L in APD and 132.4 ± 4.1 mmol/L in CAPD (p= 0.017). Dialysate sodium removal was 80.6 ± 78.4 mmol/24 hr in APD and 108.7 ± 96.8 mmol/24 hr in CAPD patients (NS). Natriuresis was respectively, in APD 76.6 ± 65.5 mmol/24 hr and in CAPD 93.5 ± 61.7 mmol/24 hr (NS). Total sodium removal was 149.5 ± 76.6 mmol/24 hr in APD and 198.4 ± 75.0 mmol/24 hr in CAPD (p= .039). Despite a higher daily sodium removal in CAPD patients, fluid state and blood pressure were not different between APD and CAPD. In general, volume status and blood pressure appeared to be reasonably controlled in this unselected population.

N-003 HIGH L-CITRULLINE TO L-ARGININE RATIO RELATES TO BLOOD PRESSURE ABNORMALITIS IN CHILDREN WITH CHRONIC KIDNEY DISEASE

Background Cardiovascular disease is a major cause of death in children with chronic kidney disease (CKD). The 24-hr ambulatory blood pressure monitoring (ABPM) is a superior predictor of cardiovascular outcome when compared to clinic BP measurement. In the kidney, L-citrulline (Cit) can be converted to L-arginine (Arg) to generate NO. We found that restoration of renal Arg availability is associated with lowering BP in young SHR. Thus we hypothesize that plasma Cit-to-Arg ratio reflects renal Arg availability, which relates to BP abnormalities in children with early chronic kidney disease (CKD). Methods The CKD staging is defined by the K/DOQI guideline. The eGFR was calculated by the Schwartz formula on the basis of height and serum creatinine. Plasma Arg and Cit levels were measured by HPLC. Subjects wore a 24-hr ABPM. Results We totally enrolled 22 children with stages 1–2 CKD. Approximately 80% (18/22) of children with early CKD had BP abnormalities. We found plasma levels of Cit and Arg, and Cit-to-Arg ratio were not different between children with CKD 1 (n = 8) and those with CKD 2 (n = 14). However, plasma Cit level and Cit-to-Arg ratio both were significantly higher in patients with abnormal ABPM profile than those with normal profile, including BP load and nocturnal BP-dipping. In addition, we found that plasma Cit level showed a significantly positive correlation with nighttime systolic (r = 0.464, P = 0.029) and diastolic BP (r = 0.479, P = 0.024), and diastolic BP load (r = 0.608, P = 0.003). Similarly, plasma Cit-to-Arg ratio was positively correlated with nighttime systolic (r = 0.52, P = 0.013) and diastolic BP (r = 0.564, P = 0.006), and diastolic BP load (r = 0.704, P < 0.001). Conclusions In conclusion, high Cit level and Cit-to-Arg ratio in the plasma are associated with BP abnormalitis on ABPM in children with CKD. Plasma Cit-to-Arg ratio may serve as a marker of cardiovascular outcome in children and adolescents with early CKD.

027 The prevalence of resistant hypertension in a large outpatient 24 hour ABPM population

Resistant hypertension is a common problem faced by Physicians. The exact prevalence of resistant hypertension is unknown, but clinical trials suggest a prevalence of anywhere from 20% to 30%. The purpose of our study was to determine the prevalence of resistant hypertension in patients presenting to the Kingston Heart Clinic for 24hr ambulatory blood pressure monitoring (ABPM).

Effect of Soy Protein on Blood Pressure in Prehypertensive/Stage 1 Hypertensive Adults

Research is mixed on the BP lowering effect of soy protein. However, even if such effects are modest, reductions in hypertension‐related mortality and morbidity in the population could be significant. Thus, the aims were to determine if daily intake of soy milk made from whole soy beans (WSB) or soy protein isolate (SPI) for 8 weeks reduces BP compared to cow's milk (CM) and if the nature of soymilk, WSB (Silk) or SPI (8th Continent) has a bearing on the degree of effect in pre‐/Stage I hypertensives. Participants (n=68) consumed the randomly assigned beverage equal to 21 g of protein/d in this single‐blind study. BP was measured in‐house using the recommended office assessment and with a 24‐hr ambulatory BP monitor at baseline, 4 and 8 weeks. Data analysis shows that while baseline BP did not differ across groups, responses to treatment differed based on the method used to assess BP. In‐house data showed significant improvements in systolic BP (SBP) for all groups and in diastolic BP (DBP) for only the CM group. Ambulatory data showed a significant improvement in DBP for only the CM group. Ambulatory BP likely provides more insight about overall BP because 1) measures are taken every 15 min for 24 h and 2) it also overcomes “whitecoat syndrome” (inflation of BP due to testing environment). Overall, soy protein did not have a greater effect in lowering BP compared to milk protein, and no difference between WSB and SPI was noted.

3. Clinical Implication of 24-hr Ambulatory Blood Pressure Monitoring.

3. Clinical Implication of 24-hr Ambulatory Blood Pressure Monitoring.

IMPROVEMENT ON INSULIN SENSITIVITY AND MUSCLE BLOOD FLOW IN AEROBIC TRAINED OVERWEIGHT-OBESE HYPERTENSIVES IS NOT ASSOCIATED WITH AMBULATORY BLOOD PRESSURE: PP.37.504

Background: The effects aerobic training on ambulatory blood pressure (ABP) and vascular function in essential hypertension was not fully investigated and is still poorly understood. Objective: The aim of this randomized controlled trial was to investigate effects of a supervised aerobic training program on ABP, vascular function, and hormonal profile in essential hypertension. Methods: Sedentary non-medicated hypertensive subjects were randomized to an aerobic training (n = 55, electronic treadmill, intensity 50–75% VO2max, 3–5 45-min sessions per week) program or a postural protocol (n = 24, control group), on a 2/1 proportion. Prescribed exercise intensity was controlled in every aerobic session through Polar A3 monitor. At the beginning and after 3 months of intervention, subjects were evaluated for 24-hr ABP (SpaceLabs 90207 monitor, USA), arterial compliance (radial tonometry, CR 2000, HDI, USA), forearm blood flow and flow-mediated vasodilation (EC6 venous occlusion pletysmograph, Hokanson, USA), and hormonal profile including HOMA-RI calculation. Results: The aerobic training was effective to promote a 12% increase in VO2max (p = 0.0001), while no significant variation was observed in the control group. In both groups, ambulatory blood pressure did not significantly modify, as well as arterial compliance, plasma renin, aldosterone, C-peptide, and urine metanephrines. In the aerobic, but not in the control group, was observed a decrease in insulin resistance (HOMA-RI, p = 0.039), a decrease in plasma cortisol (p = 0.006), an increase in flow-mediated vasodilation (p = 0.002), and an increase in forearm blood flow (p = 0.001). Conclusion: The 3-month supervised aerobic training did not significantly modify the blood pressure profile of hypertensive subjects when compared to a postural control protocol. Nevertheless, the results suggest that fitness gain can promote a decrease in cardiovascular risk of hypertensive subjects, improving endothelial function and insulin resistance.

Abstract 5146: Pre-diabetes is Associated With Masked Hypertension

Background: Masked hypertension, a condition where awake ambulatory blood pressure (BP) is elevated (≥135/85 mmHg) while office BP is within the normal range (&lt;140/90 mmHg), is associated with an increased risk of cardiovascular events; however, mechanisms causing masked hypertension remain unclear. We evaluated whether increased glucose within the non-diabetic range (fasting glucose &lt;126 mg/dl) and/or presence of pre-diabetes (fasting glucose 100 –125 mg/dl) is associated with masked hypertension. Methods: We performed office BP measurements (3 readings/visit, at 3 visits), a single 24-hr ambulatory BP (ABP) monitoring and a fasting blood glucose test in 475 healthy, employed volunteers who did not have either office hypertension or diabetes. Results: The average age was 44.7±11.1 years (male; 37.5%). The subjects with masked hypertension (N=76) were older (47.5±8.9 vs. 44.2±10.2 years, P=0.009), more likely to be male (53.9 vs. 34.3%, P=0.001) and pre-diabetic (32.9 vs. 11.8 %, P&lt;0.001); they had higher fasting glucose (94±12 vs. 88±11 mg/dl, P&lt;0.001), body mass index (29.0±5.7 vs. 27.1±5.2 kg/m 2 , P=0.004), serum creatinine (0.87±0.15 vs. 0.82±0.15 mg/dl, P=0.009), office SBP (123±8 vs. 112±9 mmHg, P&lt;0.001) and office DBP (81±5 vs. 73±7 mmHg, P&lt;0.001) than those with normal ABP (&lt;135/85 mmHg). In a logistic regression analysis, fasting glucose level was significantly associated with masked hypertension [odds ratio (OR) per 10 mg/dl, 1.35, 95% confidence interval (CI) 1.01–1.80, P=0.044], controlling for the confounding factors. In a parallel analysis, presence of pre-diabetes was also associated with masked hypertension (OR=2.68, 95%CI 1.42–5.09, P=0.002). Prevalence of masked hypertension was 51.2% among those with both pre-hypertension and pre-diabetes, 34.5% among those with pre-hypertension alone, 10.3% among those with pre-diabetes alone, and 3.8% among those without either of them. Conclusion : Both pre-diabetes status and fasting glucose (measured on a continuum) in non-diabetic individuals are associated with presence of masked hypertension, suggesting that ambulatory BP monitoring can improve CV risk stratification (over and above office BP) in persons with pre-diabetes in addition to pre-hypertension.

Blood pressure variation in the Kazakhs of Xinjiang, China, and its frequency analysis: Non-dipper type hypertension and ultradian rhythm

s from the Japanese Journal: The autonomic nervous system #1 Japanese herbal medicine goshuyuto prevents migraine and reduces cutaneous electro-conductivity: Two case reports Keishi Fujita, Tetsuya Yamamoto, Takao Kamezaki, Akira Matsumura Department of Neurosurgery, Ibaraki Seinan Medical Center Hospital, Ibaraki 306-0433, Japan Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Ibaraki 305-8575, Japan Background: We investigated the relationship between sympathetic nerve activity and migraine, and the effect of goshuyuto, a Japanese herbal (kampo) medicine for migraine used in Japan. Some of the ingredients of goshuyuto have been shown to inhibit sympathetic activity. In this paper, we discuss the possibility of goshuyuto preventing migraine by inhibiting sympathetic activity, on the basis of the evidence of two cases. Patients and Methods: Subjects were two patients, a 25-year-old man (Case 1) and a 27-year-old woman (Case 2), diagnosed with migraine based on International Headache Society (2nd edition) criteria. Goshuyuto was prescribed at 7.5 g/day in Case 1 and 5.0 g/ day in Case 2 for 8 weeks. To assess the effectiveness of goshuyuto, we assessed the impact of migraine on patient's quality of life during the last 4 weeks of treatment via the measurements obtained with the Headache Impact Test (HIT-6). To assess the influence of goshuyuto on sympathetic activity, we recorded the cutaneous electro-conductivity at 24 representative measuring points; the data used were the averages, based on the Ryodoraku method. Examinations were conducted before and at 4 and 8 weeks after the start of administration of goshuyuto. Results: The HIT-6 score in the two patients decreased in parallel with a decrease in cutaneous electro-conductivity after administration of goshuyuto, a result implying that sympathetic inhibition resulted in migraine prevention. Conclusions: Our observations on two patients suggest that goshuyuto is a potential preventive drug for migraine and that its effect may be due to sympathetic inhibition. (The Autonomic Nervous System, 45: 148–152, 2008) doi:10.1016/j.autneu.2009.09.004 #2 Blood pressure variation in the Kazakhs of Xinjiang, China, and its frequency analysis: Non-dipper type hypertension and ultradian rhythm Hiroshi Kawamura, Hiromi Mitsubayashi, Yukio Ozawa, Yoichi Izumi, YujiKasamaki,AtsushiShinndo,MasakatsuOhta,HiroakiShimabukuro, Tomohiro Nakayama, Zuhen Cheng, MasumMahamut Department of Medicine, Nippon Dental University, School of Life Dentistry, Tokyo 102-8158, Japan Departments of Cardiovascular, Renal and Endocrine Medicines, Research Center and Cardiovascular Function, Nihon University, School of Medicine, Tokyo 173-8610, Japan Department of Medicine, Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China Non-dipper-type variation of systolic blood pressure (SBP) and hypertension were more prevalent than the dipper-type variation among the Kazakhs of the province of Xinjiang, China, in a crosssectional survey of the population. To analyze the time structure and causes of the non-dipper-type of the SBP variation, we examined how it differed in the Kazakhs and the Hans. All subjects of both ethnic groups were admitted to local healthcare facilities for 24-hr ambulatory blood pressure monitoring and spectral analysis of the heart rate variability (HRV). The circadian variation of the SBP was analyzed using the maximum entropy method. We also obtained the frequency domain of the HRV. The peak spectral densities for the mean SBP occurred with 27.932-hr and 11.75 periodicity in the Hans, and with 27.437-hr and 12.72-hr periodicity in the Kazakhs. In regard to the HRV, there was no difference between the two groups in either the low frequency/high frequency [LF/HF] or the high frequency/(low frequency+high frequency) [HF/(LF+HF)] values. The only difference observed was in the spectral density in HF/(LF+HF), which was lower in the Kazakhs than in the Hans. These differences may be at the origin of ultradian rhythms in the non-dipper-type of SBP variation among the Kazakhs. (The Autonomic Nervous System, 45: 153–161, 2008) doi:10.1016/j.autneu.2009.09.005 pii:S1566-0702(09)00473-1 Autonomic Neuroscience: Basic and Clinical 151 (2009) 189–192

Methylated arginine derivatives in children and adolescents with chronic kidney disease

Asymmetric dimethylarginine (ADMA), a methylated L: -arginine (Arg) derivative is associated with endothelial dysfunction, vasoconstriction, and hypertension in animals and humans. We examined the relationship between these derivatives, estimated glomerular filtration rate (eGFR), and awake (AW) and asleep (AS) blood pressure (BP) load in children and adolescents (n = 28) with stage 2-3 chronic kidney disease (CKD) and in matched intra-familial controls (n = 10). Plasma L: -Arg, ADMA, and symmetric dimethylarginine (SDMA) levels were measured by high-performance liquid chromatography-tandem mass spectrometry. Subjects wore a 24-hr ambulatory BP monitor with BP load >95th percentile. ADMA, SDMA/ADMA ratio and SDMA were 38-200% higher in CKD patients while L: -Arg/ADMA and L: -Arg/SDMA ratios and the L: -Arg level were 11-64% lower. The eGFR explained 42-60% of L: -Arg/SDMA, SDMA/ADMA, and SDMA variability (n = 38). Using linear regression, SDMA and SDMA/ADMA separately explained 15-38% of AW and AS systolic (S) BP and diastolic (D) BP load variability (p < 0.001-0.022). Using multivariate stepwise regression with eGFR held constant, SDMA/ADMA was a significant independent variable for AW DBP load (p = 0.03). In conclusion, BP load and a disproportionate elevation of SDMA are seen in children and adolescents with stage 2-3 (mild-moderate) CKD. SDMA is a strong marker for reduced eGFR and serves as a moderate but significant indicator of 24-hr BP load variability.

MASKED AND WHITE-COAT HYPERTENSION IN TWO COHORTS OF ELDERLY SUBJECTS, AMBULATORY AND HOSPITALIZED PATIENTS

Blood pressure (BP) measurement in clinical assessment by means of a mercury sphygmomanometer (MS) has numerous drawbacks. It has been proposed that non-invasive, 24-hr ambulatory blood pressure monitoring (NIABPM) should provide more appropriate BP values for both the diagnosis of hypertension and for its subsequent monitoring during treatment. The aim of the present study was to investigate, in 100 ambulatory and 250 hospitalized elderly subjects, the prevalence of white coat hypertension (WCH) and masked hypertension (MH) in a cohort of older subjects, by using both clinical readings (MS) and NIABPM. The results of our analyses indicate that a higher prevalence of old-old subjects regarded as normotensive at anamnesis or with normal BP values at MS are true hypertensive (50% of ambulatory patients and 17.1% of hospitalized patients) or masked hypertensive (10.3% of ambulatory patients and 28.6% of hospitalized patients), and consequently at higher risk of cardiovascular morbidity and mortality.

THE TREATMENT OF HYPERTENSION WITH TELMISARTAN IN THE SPHERE OF CIRCADIAN RHYTHM IN METABOLIC SYNDROME IN THE ELDERLY

This study compares the efficacy of telmisartan with that of valsartan and ramipril in reducing blood pressure (BP) over 24 hrs in the elderly patients with metabolic syndrome (MS). This prospective and open label study analyzed a sample of 60 patients over 65 years of age with hypertension and with MS. At the beginning the BP was monitored by a 24-hr ambulatory blood pressure monitoring (AMBP). Following this, the 60 patients were divided into 3 groups of 20, to each of which was prescribed, respectively, telmisartan, valsartan and ramipril to take for 12 weeks. The drugs were to be taken at 9.00 a.m. Later on the doses were increased. After 12 weeks of therapy, BP was monitored by a 24-hr AMBP. The use of telmisartan caused a greater reduction of the BP in the final 4–6 hours of the period between the 1st administration of the drug and the next one, these last 4–6 hours being those when cardiovascular and cerebrovascular accidents are more frequent (between 6.00 and 10.00 a.m.). Comparing to valsartan and ramipril, telmisartan results in excellent pressure control during the last 4–6 hours between the 1st administration of the drug and the next one.

A Prospective Observational Study of Changes in Renal Function and Cardiovascular Risk Following Living Kidney Donation

The effect of unilateral nephrectomy on the cardiovascular risk profile of living kidney donors has not been prospectively studied. We performed an observational cohort study of 58 living donors to 6 months postdonation for changes in 24-hr ambulatory blood pressure profiles, renal function, urine protein excretion, body mass index, glucose tolerance, and fasting lipid profiles. The 24-hr systolic blood pressure average and night-day ratio were unchanged from pre- to postdonation (118.9+/-11 vs. 118.1+/-14 mm Hg, P=0.77; 0.87+/-0.07 vs. 0.87+/-0.09, P=0.68, respectively). Estimated glomerular filtration rate declined from 91.9+/-16 to 61.6+/-12 mL/min/1.73 m2 (P<0.0001). Protein excretion, body mass index, glucose, and lipids were unchanged. No significant differences were noted between dippers and nondippers either pre- or postdonation. In summary, living kidney donation in the short term is safe. We suggest further observation of individuals with lower glomerular filtration rate for possible increased cardiovascular risk factors in the future.

The use of non‐linear analyses in the characterization of hypertension and associated autonomic dysfunction

To assess the relative merits of linear vs non‐linear analysis methods for detecting early autonomic changes in prehypertensive (PHT) subjects, we compared 24hr ambulatory blood pressure (BP) recordings for 6 PHT and 6 matched normotensive (NT) subjects. Along with linear techniques (BP variability, heart rate variability and baroreflex using the alpha method), we used non‐linear techniques (approximate entropy, detrended fluctuation analysis and return map/Poincare plot). Analysis was blinded. RESULTS: While standard linear methods did not discriminate between PHT and NT, non‐linear techniques showed significant differences. Approximate entropy analysis of systolic BP data exhibited higher values throughout the 24hr period (p &lt; 0.05). Detrended fluctuation analysis of the daytime BP revealed elevated alpha‐1 of systolic BP in the PHT subjects (p &lt; 0.05). The return map/Poincare plot of the 2 groups failed to reveal any clearly statistically significant changes. In summary, non‐linear analysis tools appeared superior to linear analyses in detecting PHT from NT subjects, and should be considered when dealing with non stationary and difficult data sets. Support: VIDDA foundation.

Ambulatory Blood Pressure Variability Is Increased in Diabetic Hypertensives

The purpose of this study was to examine the possible difference in the 24-hr BP profile—including short-term BP variability, assessed as the standard deviation—between diabetic and non-diabetic hypertensives. We measured 24-hr ambulatory BP in 11 diabetic hypertensives (diabetic HT) and 10 non-diabetic hypertensives (non-diabetic HT) who were hospitalized for the educational program in our hospital and were under stable salt intake. Renal function and sleep apnea were also estimated. There were no significant differences in 24-hr systolic BP (141 mmHg vs. 135 mmHg, ns), daytime systolic BP (143 mmHg vs. 138 mmHg, ns), and nighttime systolic BP (135 mmHg vs. 130 mmHg, ns) between diabetic HT and non-diabetic HT. The values of 24‐hr HR (69.7 beats/min vs. 65.2 beats/min, ns) and 24-hr HR variability (9.9 beats/min vs. 10.1 beats/min, ns) were also similar between the groups. Interestingly, diabetic HT had a significantly greater 24-hr systolic and diastolic BP variability than non-diabetic HT (18.2 mmHg vs. 14.5 mmHg, p < 0.05; 11.5 mmHg vs. 9.6 mmHg, p < 0.05, respectively). The values for creatinine clearance, urinary protein excretion, and apnea-hypopnea index were similar between the groups. Bivariate linear regression analysis demonstrated that fasting blood glucose was the primary determinant of 24-hr diastolic BP variability (r = 0.661, p < 0.01). Multiple stepwise regression analysis revealed that fasting blood glucose was a significant and independent contributor to 24-hr systolic BP variability (r = 0.501, p < 0.05). Taken together, these results demonstrate that BP variability is increased in diabetic hypertensives. Furthermore, it is possible that an elevation of fasting blood glucose may contribute to the enhanced BP variability in hypertensives.

The impact of perceived hypertension status on anxiety and the white coat effect

The white coat effect can lead to overdiagnosis of hypertension and unnecessary pharmacologic treatment. Mechanisms underlying the white coat effect remain poorly understood but are critical to improving the accuracy of clinic blood pressure measurement. This study investigated whether perceived hypertension status was associated with state anxiety levels during a clinic visit and the magnitude of the white coat effect, independent of true blood pressure status. This observational study included 214 normotensive and mildly hypertensive participants who were 18 to 80 years old, had no cardiac history, and were willing to discontinue antihypertensive medications for 8 weeks. Participants underwent 36 hr ambulatory blood pressure monitoring and physician blood pressure measurement. Outcome measures were state anxiety reported during the clinic visit and the white coat effect. An analysis of covariance indicated that participants who perceived themselves as hypertensive reported greater state anxiety (p<.001) and showed larger white coat effects (ps<.01) compared with those who perceived themselves as normotensive. True hypertension status based on ambulatory blood pressure was not related to either outcome. Anxiety accounted for approximately 19% of the association between perceived hypertension status and the white coat effect. These findings suggest that the perception of being hypertensive is associated with greater anxiety during clinic blood pressure measurement and a larger white coat effect, independent of the true blood pressure level. Anxiety appears to be a mechanism by which perceived hypertension status contributes to the white coat effect.

Psychosocial and Physiological Stress Among Women Leaving Welfare

Women receiving Temporary Assistance for Needy Families (TANF) report more stress and have poorer health than women in the general population. Studies suggest chronic stress may contribute to poor health via physiological mechanisms, yet little is known about these mechanisms in this population. This study examined psychosocial stress, salivary cortisol, 24-hr ambulatory blood pressure and heart rate, and health among 40 single mothers before and after exiting TANF. As a group, perceived stress decreased after leaving TANF (p = .02), with other measures of psychosocial and physiological stress remaining unchanged. Within participants, changes in psychosocial stress predicted depression and general health over time (adjusted R(2) = .30 and .22; p = .006 and .004, respectively). These findings indicate psychosocial stress is positively associated with depression and negatively associated with general health as women exit welfare. Psychosocial stress was not associated with changes in physiologic indicators of stress.

Cognitive function by brain event-related potentials (ERP) in elderly with borderline isolated systolic HYPERTENSION (BISH)

Several studies have shown a relationship between BISH and cerebrovascular events, but no studies have investigated a relationship with cognitive function. The aim was to assess the cognitive function in the elderly with recent BISH. According to WHO Guidelines (1999), we selected 10 elderly normotensives, 10 elderly with recently diagnosed (<2 years) BISH, and 10 elderly with recently diagnosed (<2 years) isolated systolic hypertension (ISH). They were submitted to 24-hr ambulatory blood pressure (BP) monitoring (ABPM) and to cognitive assessment by mini mental state examination (MMSE) and the recording of brain ERP, of type N2 and P300. The elderly with BISH, compared to normotensives, showed N2 wave latency values significantly higher, but similar P300 potential latency values and MMSE scores. The elderly with ISH showed N2 and P300 latency significantly higher than the normotensives. The gradual increase of the ERP latency values of the BISH and ISH elderly, in comparison to the normotensives, seems to indicate a gradual alteration of the cognitive processes related to the increase of BP.

White Coat Hypertension Is Associated with a Greater All-cause Mortality

Background: Prognostic significance of white coat hypertension (WCH) remains controversial and most of the studies have just focused on the progression to hypertension (HT) or whether or not it already causes target organ damage. Methods: We studied consecutive adults and eldelies with sustained normotension (NT), WCH, and HT applying to the Internal Medicine Polyclinic. A 10 day twice daily measurement of blood pressure at home (HBP) was obtained in all cases, and a 24 hr ambulatory blood pressure monitoring (ABPM) was performed just for the cases with higher office and/or HBP measurements. Prevalences of smoking, overweight, obesity, impaired glucose tolerance, type II diabetes mellitus, hyperbetalipoproteinemia, hypertriglyceridemia, and dyslipidemia were calculated in each group and results were compared in between. Comparison of proportions was used as the statistical analysis method. Results: The study totally included 169 cases, 54 with sustained NT, 66 with WCH, and 49 with HT. The 115 patients with WCH and HT were both diagnosed via HBP and ABPM, and no difference was observed between the two methods for the diagnosis of WCH and masked or obvious HT. Except the smoking and overweight, almost all of the above disorders showed a stepwise and significant progression in frequencies from sustained NT toward WCH and HT. Conclusions: WCH should preferentially be accepted as a disorder associated with a greater all-cause mortality, rather than a predisposing factor of HT or atherosclerosis alone, and its management should be focused on the above comorbid disorders.

Randomised, Controlled, Cross-Over Trial of Soy Protein with Isoflavones on Blood Pressure and Arterial Function in Hypertensive Subjects

Objective: To examine the effects of dietary soy/isoflavones on 24 hr blood pressure profiles and arterial function [systemic arterial compliance (SAC), pulse wave velocity (PWV) and brachial arterial flow mediated vasodilation (FMD)] compared to non legume-based plant protein without isoflavones, in hypertensive subjects.Design: In a 6 month double-blind, placebo controlled, cross-over trial, 41 hypertensive subjects (26 men, 15 postmenopausal women), 30–75 years, received soy cereal (40 g soy protein, 118 mg isoflavones) and gluten placebo cereal, each for 3 months.Results: Thirty-eight subjects completed protocol with results expressed as mean or mean change (±SEM) with each intervention. Soy increased urinary isoflavones (daidzein: 8-fold; genistein: 8-fold; equol: 9-fold; ODMA: 18-fold) with no change during gluten placebo. There was no difference in the change in individual 24 hr ambulatory BP parameters (SBP: 2 ± 2 vs −1 ± 1 mmHg, p = 0.21; DBP: 1 ± 1 vs −1 ± 1 mmHg, p = 0.06) central BP (cSBP: −4 ± 2 vs 0 ± 2 mmHg, p = 0.2) or the change in arterial function (FMD: 0.3 ± 0.5 vs −0.2 ± 0.5%, p = NS; SAC: 0.02 ± 0.02 vs −0.02 ± 0.02 U/mmHg, p = NS; PWV central: −0.2 ± 0.2 vs 0.0 ± 0.2 m/sec, p = NS; PWV peripheral: 0.01 ± 0.3 vs −0.4 ± 0.4 m/sec, p = NS) noted between interventions. Analysis of the area under curve of 24 hr BP outputs demonstrated that soy protein compared to gluten protein resulted in higher 24 hr systolic BP by 2.3 mmHg (p = 0.003), a higher daytime systolic BP by 3.4 mmHg (p = 0.0002) and a higher daytime diastolic BP by 1.4 mmHg (p = 0.008). Overall 24 hr diastolic BP, night systolic BP and night diastolic BP were not significantly different between groups. Furthermore, soy protein compared to gluten protein resulted in higher 24 hr heart rates by 3.5 bpm (p < 0.0001).Conclusions: In hypertensive subjects, compared to gluten placebo, soy dietary supplementation containing isoflavones had no effect on arterial function, on average 24 hr ambulatory blood pressure parameters or central blood pressure in men and women with hypertension. Area under the curve of 24 hr profiles demonstrated that daytime BP was higher after soy compared to gluten.

Salt Sensitivity, Anxiety, and Irritability Predict Blood Pressure Increase over Five Years inHealthy Males

Salt sensitivity and psychological factors are thought to be associated with a higher risk for the development of hypertension but data on the relation between age-related blood pressure increase and salt sensitivity or psychological factors are scarce. A total of 31 healthy young males who were previously classified with respect to salt sensitivity, mental stress reactivity, trait-anxiety, trait-anger, and irritability were followed up 4.8 years later by 24 hr ambulatory blood pressure monitoring (ABP). Our results showed anxiety and irritability correlated significantly with 24-hr ABP 4.8 years later (p < 0.05). The increase of diastolic blood pressure over 4.8 years was higher in salt-sensitive than salt-resistant subjects (p < 0.07). Heart rate and diastolic blood pressure correlated significantly with systolic and diastolic 24-hr ABP and blood pressure reactivity under mental stress with diastolic 24-hr ABP. A regression analysis that included cardiovascular and psychological factors yielded 34% (systolic ABP, p < 0.009) and 58% (diastolic ABP, p < 0.0001) of variance. We concluded that anxiety and irritability are important predictors of blood pressure increase over time in healthy males.