Ambulatory Blood Pressure Response Research Articles

Acute Experiences of Negative Interpersonal Interactions: Examining the Dynamics of Negative Mood and Ambulatory Blood Pressure Responses Among Black and Hispanic Urban Adults.

Negative interpersonal interactions are associated with acute increases in ambulatory blood pressure (ABP). Yet, the mechanisms underlying this relationship are unclear. This study tested whether negative interpersonal interactions predict higher ABP both in the moment and during subsequent observations, and whether increases in negative mood mediate these relations. These associations were tested among Black and Hispanic urban adults who may be at higher risk for negative interpersonal interactions as a function of discrimination. Race/ethnicity and lifetime discrimination were tested as moderators. Using a 24-hr ecological momentary assessment (EMA) design, 565 Black and Hispanic participants (aged 23-65, M = 39.06, SD = 9.35; 51.68% men) had their ABP assessed every 20 min during daytime accompanied by an assessment of negative interpersonal interactions and mood. This produced 12,171 paired assessments of ABP and self-reports of participants' interpersonal interactions, including how much the interaction made them feel left out, harassed, and treated unfairly, as well as how angry, nervous, and sad they felt. Multilevel models revealed that more intense negative interpersonal interactions predicted higher momentary ABP. Mediation analyses revealed that increased negative mood explained the relationship between negative interpersonal interactions and ABP in concurrent and lagged analyses. Discrimination was associated with more negative interpersonal interactions, but neither race/ethnicity nor lifetime discrimination moderated findings. Results provide a clearer understanding of the psychobiological mechanisms through which interpersonal interactions influence cardiovascular health and may contribute to health disparities. Implications include the potential for just-in-time interventions to provide mood restoring resources after negative interactions.

Early Life SES, Childhood Trauma Exposures, and Cardiovascular Responses to Daily Life Stressors in Middle-aged Adults.

Dysregulation in physiological responses to stress may provide a mechanism through which low socioeconomic status (SES) in childhood negatively impacts health. Evidence linking early life SES to physiological stress responses is inconsistent. Exposure to childhood trauma may be an important source of heterogeneity accounting for mixed findings. Guided by the adaptive calibration model, we examined whether childhood SES and childhood trauma jointly predict ambulatory measures of cardiovascular responses to daily life stressors. A sample of 377 healthy, middle-aged adults (62% female, 80% White, 64% college-educated, Mage = 52.59 ± 7.16) completed a 4-day ecological momentary assessment protocol that measured task strain, social conflict, and ambulatory systolic and diastolic blood pressure (SBP and DBP, respectively) at hourly intervals throughout the day. Average ambulatory blood pressure responses to stress were calculated by regressing momentary SBP and DBP on momentary measures of stress within the multilevel models. Early life SES and childhood trauma were measured retrospectively by self-report questionnaire. Multilevel models controlling for momentary influences on blood pressure and age, sex, and race showed no main effects of early life SES or childhood trauma on ambulatory measures of cardiovascular responses to daily life stress. An interaction emerged for DBP responses to social conflict, where individuals raised in middle SES families who experienced trauma showed a blunted response relative to those who did not ([Formula: see text]-0.93, 95% CI: [-1.62, -0.24], p = .008). There was no significant SES-trauma interaction in predicting SBP responses to social conflict or blood pressure responses to task strain. Results do not provide support for our predictions that were derived from the adaptive calibration model, but do suggest that the impacts of early childhood experiences on cardiovascular responses may vary by type of daily stress experience.

Cardiometabolic Biomarkers and Habitual Caffeine Consumption Associate with the Adverse Ambulatory Blood Pressure Response to Strenuous Physical Exertion among Firefighters.

Caffeine has beneficial effects on firefighter job performance reducing fatigue and improving psychomotor vigilance. However, excessive caffeine intake may raise blood pressure (BP) following a bout of acute exercise among adults with elevated BP. The influence of caffeine intake on the ambulatory BP (ABP) response to vigorous physical exertion among firefighters has not been studied. In this sub-study we conducted secondary statistical analyses from a larger clinical trial (NCT04514354) that included examining the influence of habitual caffeine intake, and cardiometabolic biomarkers shown to influence BP, on the ABP response following a bout of sudden vigorous exertion over 19 h among firefighters. Previously, we found high amounts of calcium and sodium intake raised BP following a bout of acute exercise among adults with elevated BP. Thus, other secondary aims were to examine the influence of habitual calcium and sodium intake, and cardiometabolic biomarkers have shown to influence BP, on the ABP response following sudden vigorous exertion over 19 h among firefighters. Firefighters (n = 15) completed a Food-Frequency Questionnaire assessing habitual dietary intake over the past year. They randomly completed a maximal graded exercise stress test (GEST) and non-exercise CONTROL on separate non-workdays leaving the laboratory wearing an ABP monitor for 19 h. Prior to and immediately after the GEST, fasting venous blood was collected to measure lipid-lipoproteins, c-reactive protein, and blood glucose. Height and weight were taken to calculate body mass index. Repeated measures ANCOVA tested if the ABP response differed after GEST vs. CONTROL. Linear mixed models examined the relationships among caffeine, calcium, sodium, cardiometabolic biomarkers, and the ABP response following GEST vs. CONTROL. Firefighters were middle-aged (40.2 ± 9.5 year), overweight (29.0 ± 3.9 kg/m2) men with elevated BP (124.1 ± 10.3/79.6 ± 11.5 mmHg) who consumed 542.0 ± 348.9 mg of caffeine/day, about ~50% more than the dietary reference intake. Unexpectedly, systolic ABP was higher by 18.0 ± 6.7 mmHg and diastolic ABP by 9.1 ± 5.4 mmHg (ps < 0.01) over 19 h following GEST vs. CONTROL. We found 24% of the variance in the adverse ABP response to maximal physical exertion was explained by caffeine intake, and when combined with c-reactive protein, non-high-density lipoprotein-cholesterol, body mass index, blood glucose, and resting heart rate, up to 74% of the variability in the ABP response was explained. Additionally, we found calcium (ps < 0.001) and sodium (p < 0.0001) intake each explained up to 24% of the ABP response. Further investigation is needed in a larger, more diverse sample of firefighters to better establish how caffeine contributes to the adverse BP response to strenuous physical exertion.

Acute ambulatory blood pressure response to short-term black carbon exposure: the MobiliSense sensor-based study

Acute ambulatory blood pressure response to short-term black carbon exposure: the MobiliSense sensor-based study

THE INFLUENCE OF SUDDEN VIGOROUS PHYSICAL EXERTION ON CARDIAC DEMAND UNDER AMBULATORY CONDITIONS AMONG FIREFIGHTERS

Firefighters have a high prevalence of cardiovascular disease and its risk factors compared to the general population. The poor heart health of firefighters is implicated in their increased risk of sudden cardiac death (SCD) accounting for nearly 50% of all on-duty fatalities. Exercise may confer protective benefits against SCD in part due to the immediate blood pressure (BP) reductions of 5-8 mmHg following exercise, termed postexercise hypotension (PEH). PURPOSE: To examine the time course of PEH under ambulatory conditions after a maximal cardiopulmonary graded exercise stress test (GEST) among career firefighters. METHODS: Firefighters (n = 19) completed a maximal GEST and a non-exercise control (CONTROL) in random order on separate nonwork days and left the laboratory attached to an ambulatory BP (ABP) monitor for 19 hr. Ambulatory systolic BP (ASBP), diastolic BP (ADBP), and heart rate (AHR) were recorded at hourly intervals over 19 hr. The ambulatory rate pressure product (ARPP), an indicator of cardiac demand, was calculated as ASBPxAHRx10-3 at each hourly interval over 19 hr. Repeated measures ANCOVA tested if the ABP, AHR, and ARPP responses differed after GEST vs CONTROL over 19 hr. RESULTS: Firefighters were middle-aged (39.5 ± 8.9 yr), overweight (29.2 ± 4.0 kg/m2) men with elevated resting BP (123.1 ± 9.6/79.8 ± 10.4 mmHg), while resting HR (67.7 ± 11.3 bpm) and RPP (8.4 ± 1.7 mmHg*bpm*10-3) were in normal ranges. ASBP (16.6 ± 5.7 mmHg) and ADBP (3.1 ± 4.6 mmHg) increased after the GEST vs CONTROL over 19 hr (ps < 0.01), as did AHR (9.4 ± 7.9 bpm, p = 0.02) and ARPP (2.5 ± 1.1 mmHg*bpm*10-3, p < 0.01). CONCLUSION: Unexpectedly, the firefighters exhibited postexercise hypertension rather than PEH. The increases in ABP and AHR we observed resulted in a sustained increase in cardiac demand. Further investigation is needed to confirm our findings and determine whether the adverse hemodynamic responses we observed contribute to the high prevalence of SCD that firefighters experience on the job.

Acute ambulatory blood pressure response to short-term black carbon exposure: The MobiliSense sensor-based study

Documented relationships between black carbon (BC) exposure and blood pressure (BP) have been inconsistent. Very few studies measured both BC exposure and ambulatory BP across the multiple daily environments visited in the general population, and none adjusted for personal noise exposure, a major confounder. Our study addresses these gaps by considering 245 adults living in the Grand Paris region. Personal exposure to BC was monitored for 2 days using AE51 microaethalometers. Ambulatory BP was measured every 30 min after waking up using Arteriograph 24 monitors (n = 6772). Mixed effect models with a random intercept at the individual level and time-autocorrelation structure adjusted for personal noise exposure were used to evaluate the associations between BC exposure (averaged from 5 min to 1 h before each BP measurement) and BP. To increase the robustness of findings, we eliminated confounding by unmeasured time-invariant personal variables, by modelling the associations with fixed-effect models. All models were adjusted for potential confounders and short-term time trends. Results from mixed models show that a 1-μg/m3 increase in 5-minute averaged BC exposure was associated with an increase of 0.57 mmHg in ambulatory systolic blood pressure (SBP) (95 % CI: 0.30, 0.83) and with an increase of 0.36 mmHg in diastolic blood pressure (DBP) (95 % CI: 0.14, 0.58). The slope of the exposure-response relationship gradually decreased for both SBP and DBP with the increase in the averaging period of BC exposure from 5 min to 1 h preceding each BP measurement. Findings from the fixed-effect models were consistent with these results. There was no effect modification by noise in the associations, across all exposure windows. We found evidence of a relationship between BC exposure and acute increase in ambulatory SBP and DBP after adjustment for personal noise exposure, with potential implications for the development of adverse cardiovascular outcomes.

Ambulatory blood pressure response to S-amlodipine in Korean adult patients with uncontrolled essential hypertension: A prospective, observational study.

Although amlodipine is recommended as the first‐line therapy for the treatment of hypertension, its use is limited by its potential side effects. S‐amlodipine is expected to be able to minimize side effects of amlodipine with a similar antihypertensive effect by removing the malicious R‐chiral form. However, sustainable blood pressure control with S‐amlodipine has not been well established yet. The purpose of the current study was to evaluate ambulatory blood pressure (ABP) profiles before and after a 12‐week treatment of S‐amlodipine. Patients received once‐daily S‐amlodipine 2.5 or 5 mg. ABP during 24 hr and office blood pressure were measured at baseline and after the 12‐week treatment. Primary endpoints were changes of systolic and diastolic 24 hr ABP. After 12‐week S‐amlodipine treatment, mean systolic ABP (‐15.1 ± 16.2 mmHg, p < .001) and diastolic ABP (‐8.9 ± 9.8 mmHg, p < .001) were decreased significantly. Both daytime and night‐time mean systolic BP and diastolic BP were also significantly decreased after the 12‐week treatment. Global trough‐to‐peak ratio and smoothness index after 12‐week S‐amlodipine treatment were .75 and .79 for SBP and .65 and .61 for DBP, respectively. Age ≥65 years (hazard ratio [HR]: 3.13; 95% confidence interval [CI]: 1.67–14.3) and nonalcohol drinking (HR: 3.09; 95% CI: 1.34–7.17) were independent clinical factors for target ABP achievement. Adverse drug reactions (ADR) were developed in 16 (6.4%) patients, including two (.8%) cases of peripheral edema. In conclusion, this study demonstrated the efficacy and safety of S‐amlodipine in patients with uncontrolled essential hypertension.

Acute Ambulatory Blood Pressure Response to Short-Term Black Carbon Exposure: The Mobilisense Sensor-Based Study

Acute Ambulatory Blood Pressure Response to Short-Term Black Carbon Exposure: The Mobilisense Sensor-Based Study

Influence of CYP2D6 and CYP3A5 Polymorphisms on the Pharmacokinetics and Pharmacodynamics of Bisoprolol in Hypertensive Chinese Patients

Purpose: This study was performed to investigate the effects of common polymorphisms in CYP2D6 and CYP3A5 on the plasma concentrations and antihypertensive effects of bisoprolol in hypertensive Chinese patients.Methods: One hundred patients with essential hypertension were treated with open-label bisoprolol 2.5 mg daily for 6 weeks. Clinic blood pressure (BP) and ambulatory BP (ABP) were measured after the placebo run-in and after 6 weeks treatment. Peak plasma concentrations of bisoprolol were measured at 3 h after the first dose and 3 h after the dose after 6 weeks treatment. Trough levels were measured before the dose after 6 weeks treatment. Bisoprolol plasma concentrations were measured with a validated liquid chromatography tandem mass spectrometry method. Six common polymorphisms in CYP2D6 and the CYP3A5*3 polymorphism were genotyped by TaqMan® assay.Results: After 6 weeks of treatment, clinic BP and heart rate were significantly reduced by 14.3 ± 10.9/8.4 ± 6.2 mmHg (P < 0.01) and 6.3 ± 7.6 BPM (P < 0.01), respectively. Similar reductions were seen in ABP values. Bisoprolol plasma concentration at 3 h after the first dose and 3 h post-dose after 6 weeks of treatment were significantly associated with baseline body weight (P < 0.001) but there was no significant effect of the CYP2D6 and CYP3A5 polymorphisms on these or the trough plasma concentrations. There was no significant association of the CYP2D6 and CYP3A5 polymorphisms or plasma bisoprolol concentrations with the clinic BP or ABP responses to bisoprolol.Conclusion: Bisoprolol 2.5 mg daily effectively reduced BP and HR. The common polymorphisms in CYP2D6 that were examined and the CYP3A5*3 polymorphism appear to have no benefit in predicting the hemodynamic response to bisoprolol in these patients.

The ambulatory blood pressure and heart rate variability responses following sudden vigorous physical exertion among firefighters with hypertension

The ambulatory blood pressure and heart rate variability responses following sudden vigorous physical exertion among firefighters with hypertension

Caffeine Intake Influences The Blood Pressure Response To Strenuous Physical Exertion Among Firefighters

Caffeine may diminish the immediate blood pressure (BP) reductions that occur after an exercise bout, termed post-exercise hypotension (PEH). Neither PEH nor the influence of caffeine on PEH have been studied in firefighters (FF), who have a disproportionate high risk of sudden cardiac death on the job, partially due to its strenuous nature and poor nutrition. PURPOSE: To examine the influence of caffeine intake (CAF) on PEH after a maximal graded exercise stress test (GEST) in FF. METHODS: FF (n=15) completed a non-exercise control (CONTROL) and GEST in random order on separate non-work days. They left the laboratory attached to an ambulatory BP (ABP) monitor for 19hr. CAF was assessed with the National Health and Nutrition Examination Survey food-frequency questionnaire. Repeated measures ANCOVA in SAS tested if the ABP response after GEST vs CONTROL differed by CAF group divided by the median as high (806.8+190.7mg) and low (239.3+202.9mg) with baseline ABP as a covariate. RESULTS: FF were overweight (29.0+3.9kg/m2), middle-aged (40.2+9.5yr) men with elevated resting BP (124.1+10.3/79.6+11.5mmHg). CAF tended to be positively correlated with resting SBP (r=.50, p=.06) and DBP (r=.50, p=.06). Among the total sample, the systolic ABP (ASBP) (18.0+4.8mmHg, p<.01) and diastolic ABP (ADBP) (9.1+1.5mmHg, p<.01) changes from baseline were greater after GEST vs CONTROL over 19hr, independent of CAF (Ps>0.05), but with significant interactions among ASBP, ADBP, and CAF over 19hr (Ps<0.05). These interactions revealed ASBP was consistently greater after GEST vs CONTROL over 19hr in high CAF (p<=0.01 GEST vs CONTROL); whereas in low CAF the difference in ASBP after GEST vs CONTROL was variable over 19hr (p=0.03 GEST vs CONTROL x Time). By contrast, the ADBP response after GEST vs CONTROL over 19hr tended to be greater in low (15.3+4.5mmHg, p=.08) than high CAF (4.4+2.4mmHg, p=.05). DISCUSSION: This small sample of FF exhibited post-exercise hypertension and CAF seemed to modulate this adverse response. Further study is needed in a larger sample of FF to confirm our findings and better establish the relationship of these associations. Supported by the University of Connecticut Institute for Collaboration on Health Intervention and Policy and the United States Department of Agriculture (SAES, HATCH Project No. CONS00954).

Ambulatory Blood Pressure Response to Romantic Partner Interactions and Long-Term Cardiovascular Health Outcomes.

Lower blood pressure (BP) during romantic partner interactions may underlie the association between romantic relationships and better long-term cardiovascular health. This secondary analysis examined the effect of momentary ambulatory BP (ABP) response to partner interactions on between-person changes in left ventricular mass index and mean systolic and diastolic BP over time. Participants were 538 married, working adults (mean [SD] = 46.9 [8.8] years, 56.7% female) with a screening BP of ≤160/105 mm Hg. Participants completed questionnaires, 24-hour ABP monitoring, and an echocardiogram at waves 1 and 2 (mean [SD] = 6.2 [1.0] years later). Associations between ABP response to partner (versus nonpartner) interactions and cardiovascular outcomes were examined using multilevel structural equation models. Participants with lower diastolic BP during partner interactions at wave 1 had a lesser increase in systolic BP at wave 2 (B = 1.68, SE = 0.61, p = .006; 9.84 mm Hg differential change in systolic BP for participants at +1/-1 SD diastolic ABP response to partner interactions). Participants with lower diastolic ABP during partner-specific interactions at wave 1 also had a lesser increase in diastolic BP (B = 0.83, SE = 0.42, p = .045; 4.89 mm Hg differential change in diastolic BP at +1/-1 SD). Systolic ABP response to partner-specific interactions did not predict changes in cardiovascular outcomes; diastolic ABP response did not predict changes in left ventricular mass index. Momentary diastolic ABP response to partner-specific interactions may function as a mechanism underlying the cardioprotective effect of romantic relationships on long-term BP outcomes.

Physical activity moderates the effects of daily psychosocial stressors on ambulatory blood pressure.

Previous literature has shown an inconsistent relationship between physical activity and stressor-evoked blood pressure reactivity. Use of ecological momentary assessment (EMA) may facilitate detecting such a relationship. In this study, the moderating effects of regular physical activity on the magnitude of ambulatory blood pressure (ABP) responses to psychosocial stressors experienced in daily life were examined. Four hundred seventy-seven healthy working adults (ages 30-54) provided ABP readings and recorded their daily experiences, using electronic diaries (ED), over 4 monitoring days. Measures of momentary Task Strain (high demand, low control) and Social Conflict (rating of recent social interaction quality) were used as indices of stressor exposure, and an accelerometry device was used to create 2 indices of physical activity: weekly average and recent (30 min prior to each ED interview). Multilevel models were used to examine the moderating between- and within-person effects of physical activity on ABP fluctuations corresponding with the momentary psychosocial stressors. Weekly physical activity moderated the effects of ABP responses to Task Strain (systolic blood pressure [SBP]: p = .033; diastolic blood pressure [DBP]: p = .028) and Social Conflict (DBP: p = .020), with significant increases in SBP and DBP shown for less physically active individuals but not for more physically active individuals. Similarly, recent physical activity moderated within-person DBP responses to Task Strain (p = .025), with greater DBP increases following less active periods. Our results demonstrate that weekly and recent physical activity may moderate the effects of ABP responses to daily psychosocial stress. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Post-exercise Hypotension Produced by Supramaximal Interval Exercise is Potentiated by Angiotensin Receptor Blockers.

We studied the effects of supramaximal interval exercise (SIE) with or without antihypertensive medication (AHM) on 21-hr blood pressure (BP) response. Twelve hypertensive patients chronically medicated with AHM, underwent three trials in a randomized order: a) control trial without exercise and substituting their AHM with a placebo (PLAC); b) placebo medicine and a morning bout of SIE (PLAC+SIE), and c) combining AHM and exercise (AHM+SIE). Acute and ambulatory blood pressure responses were measured for 21-hr after treatment. 20 min after treatment, systolic blood pressure (SBP) readings were reduced, similar to readings after PLAC+SIE (-9.7±6.0 mmHg, P<0.001) and AHM+SIE (-10.4±7.9 mmHg, P=0.001). 21 h after treatment, SBP remained reduced after PLAC+SIE (125±12 mmHg, P=0.022) and AHM+SIE (122±12 mmHg, P=0.013) compared to PLAC (132±16 mmHg). The BP reduction in PLAC+SIE faded out at 4 a.m., while in AHM+SIE it continued overnight. At night, BP reduction was larger in AHM+SIE than PLAC+SIE (-5.6±4.0 mmHg, P=0.006). Our data shows that a bout of supramaximal aerobic interval exercise in combination with ARB medication in the morning elicits a sustained blood pressure reduction lasting at least 21-h. Thus, the combination of exercise and angiotensin receptor blocker medication seems superior to exercise alone for acutely decreasing blood pressure.

Ambulatory Blood Pressure Reduction In Response To Supramaximal Interval Exercise; Interactions With Antihypertensive Medication.

Metabolic Syndrome (MetS) increases the risk of cardiovascular and all-cause mortality. High blood pressure is the most frequent factor of MetS. General guidelines for hypertension recommend both pharmacological and exercise treatment while their combined effects on blood pressure have not been thoroughly explored yet. PURPOSE: To compare the blood pressure (BP) response to a bout of supramaximal aerobic interval exercise (SIE) alone or in combination with antihypertensive medication in MetS hypertensive patients. METHODS: Twelve patients chronically medicated with angiotensin II receptor 1 blockade antihypertensive medicine (AHM), underwent 3 trials separated by 1 week in a randomized order: a) control trial without exercise and substituting their AHM by a placebo (PLAC); b) placebo medicine and a morning bout of SIE (PLAC+SIE) and c) combining AHM and exercise (AHM+SIE). Acute and ambulatory blood pressure responses were measured for 21-h after treatments. Repeated-measures crossover, double-blind, placebo randomized design was used. RESULTS: Acutely (i.e., 20 min after treatments), systolic blood pressure (SBP) were reduced similarly after PLAC+SIE (- 9.7 ± 6.0 mmHg, P<0.001) and AHM+SIE (-10.4 ± 7.9 mmHg, P=0.001). Chronically, (21-h following treatments) SBP remained reduced after PLAC+SIE (125 ± 12mmHg, P=0.022) and AHM+SIE (122 ± 12 mmHg, P=0.013) in comparison to PLAC (132 ± 16 mmHg). The BP reduction in PLAC+SIE faded out at 4 a.m., whilst in AHM+SIE continued over the complete measurement period (Figure 1). At nighttime BP reduction was larger in AHM+SIE than PLAC+SIE (-5.6 ± 4.0 mmHg, P=0.006). CONCLUSION: Our data show that a bout of supramaximal aerobic interval exercise in combination with antihypertensive medication in the morning elicits a sustained blood pressure reduction that lasts at least 21-h. Exercise potentiates the effects of antihypertensive medicine reducing blood pressure longer and at a larger magnitude than exercise alone.

RESISTANT ARTERIAL HYPERTENSION

Resistant hypertension is defined as a lack to lower 140 mmHg (systolic blood pressure) and 90 mmHg (diastolic blood pressure) values of ambulatory blood pressure (BP) response using 3 antihypertensive agents of different classes, one of which should be a diuretic in patients fully adherent to antihypertensive therapy. Prevalence of resistant hypertension is ranging from about 5 to 50 % in various cohorts. Initial management requires identification of true treatment resistance by out-of-office BP measurements, assessment of adherence and screening for treatable causes of uncontrolled BP. Recent studies try to indicate possible biomarkers of resistance hypertension. Treatment include lifestyle changes, enhancing treatment adherence and optimization of the doses. An invasive approach to resistant hypertension should be kept for persistently severe cases managed in a specialized hypertension center. This article aims to familiarize readers with the evaluation and management of resistant hypertension by outlining the most recent evidence-based treatment options.

Kidney protective effects of baroreflex activation therapy in patients with resistant hypertension.

Baroreflex activation therapy (BAT) is approved for the treatment of resistant hypertension. In addition to blood pressure (BP) reduction, pilot studies suggested several organoprotective effects of BAT. Thirty-two patients with resistant hypertension were prospectively treated with BAT. Besides office BP and 24-hour ambulatory BP (ABP) measurements, detection of a urinary proteome-based classifier (CKD273), which has been shown to predict chronic kidney disease (CKD) progression, was carried out at baseline and after 6months of BAT. Office BP significantly decreased from 170±25/90±18 to 149±29/82±18mmHg. Analysis of CKD273 score and eGFR with CKD-EPI equation at baseline revealed strong correlation (r=0.568, P<0.001). After 6months of BAT, there was no significant change in CKD273 score (-0.061 [95% CI: -0.262 to 0.140], P=0.601). However, by stratification of the data regarding ABP response, there was a statistically significant (P=0.0113) reduction in the CKD273 score from a mean of 0.161 [95% CI: -0.093 to 0.414] to -0.346 [95% CI: -0.632 to -0.060] after BAT in patients with systolic ABP decrease of ≥5mmHg. These data emphasized potential nephroprotective effects of BAT in patients with sufficient BP response.

Ambulatory arterial stiffness index and blood pressure response to renal denervation.

Ambulatory arterial stiffness index and blood pressure response to renal denervation.

Undergraduate training for medical students on breaking bad news in oncology: A continuation study exploring the patient perspective

Social interaction quality is related to cardiovascular functioning. Trait emotional reactivity may amplify cardiovascular responses to social interactions, but is often examined as a tendency to react to negative events. We took a broader approach by examining the joint effects of positive and negative emotional reactivity and social interaction quality on ambulatory blood pressure (ABP) and heart rate (HR) responses to daily social interactions.Participants were part of a larger study on BP and cardiovascular health (N = 805; MAge = 45.3; 40.1% male). Participants completed a measure of emotional reactivity (BIS/BAS) and 24-hour ABP monitoring accompanied by ecological momentary assessments (EMA) about just-experienced social interactions and their pleasantness. Multilevel models tested the associations of emotional reactivity, average pleasantness, and momentary pleasantness with BP and HR.Participants who reported more pleasant interactions on average had lower BP (systolic BP: B = −0.51 mmHg; diastolic BP: B = −0.46 mmHg). These effects did not depend on emotional reactivity. The effect of momentary pleasantness depended on BIS/BAS; in less reactive participants, greater pleasantness was associated with lower HR, B = −0.13 bpm; in more reactive participants, greater pleasantness was associated with increased HR, B = 0.16).Participants who had more pleasant social interactions throughout the day had lower mean ABP. The acute effect of a given social interaction on HR depended on emotional reactivity: HR increased for participants high in emotional reactivity during pleasant interactions. Thus, emotional reactivity may influence cardiovascular responses to social stimuli.

Ambulatory Blood Pressure Lower Following Aquatic Exercise than Land Treadmill Exercise

Blood pressure (BP) is an important marker of cardiovascular (CV) health. Aquatic (AQ) exercise training has been shown to reduce BP reactivity to exercise to a greater degree than land treadmill (LT) training. Furthermore, an acute bout of AQ exercise tended to elicit a greater post-exercise hypotensive response and augmentation in flow-mediated dilation (FMD). However, it is unclear how long the post-exercise hypotensive benefits last following an acute bout of AQ exercise. PURPOSE: To determine the effects of acute bouts of deep water aqua-jogging and land treadmill exercise on daytime ambulatory BP (AMBP) in pre-hypertensive, physically untrained men and women. METHODS: Following resting BP screening, 12 subjects (9 male, 29 ± 13 years, 30.4 ± 6.1 kg·m-2, 127 ± 8/ 82 ± 8 mmHg) completed acute bouts of both AQ and LT exercise at 55% heart rate reserve for a duration of 30 minutes. Exercise sessions began at 0700 hours. Immediately following the exercise bout, subjects wore an AMBP device (Oscar 2, Suntech Medical), which was programmed to take measurements every 15 minutes throughout the day until 1600 hours. Sessions occurred on separate days with 2-7 days off between sessions. The order that the modes were performed was counterbalanced among the subjects. Subjects were required to abstain from alcohol, caffeine, nicotine, and exercise on the day of the session and 24 hours prior. Comparisons between modes were made by a dependent sample t-test. RESULTS: All results are displayed in Table 1. CONCLUSION: Daytime AMBP was significantly lower following AQ than LT exercise. This is consistent with previous findings of a greater post-exercise hypotensive response in the 1-2 hours post AQ exercise. Previous research also demonstrated improved FMD and increased atrial natriuretic peptide levels following AQ exercise, which could potentially explain the reduced BP findings. These data further support the efficacy of AQ exercise for the promotion of CV health and BP regulation.Table 1: Ambulatory Blood Pressure Response