Blood Pressure Classifications Research Articles

Randomized Controlled Trial of Lifestyle Walking for African American Women: Blood Pressure Outcomes.

The aim of this study was to test the effects of a lifestyle physical activity intervention (group meetings alone vs supplemented by personal or automated calls) on changes in systolic/diastolic blood pressures from baseline to 24 and 48 weeks among African American women. This was a randomized controlled trial with intervention conditions randomly assigned across 6 community health care sites. Participants were 288 sedentary African American women without major signs/symptoms of cardiovascular disease. Each intervention had 6 group meetings over 48 weeks, with 1 of 3 options between meetings: (1) no calls, (2) personal motivational calls, or (3) automated motivational calls. Blood pressures were taken at baseline, 24 weeks, and 48 weeks. Separate analyses were conducted using blood pressure classifications from the 2003 and 2017 high blood pressure guidelines. Average blood pressures decreased approximately 3 mm Hg for systolic and 2 mm Hg for diastolic from baseline to 48 weeks, with no differences between conditions. For both 2003 and 2017 blood pressure classifications, the risk ratio (odds of moving to a lower classification) was 1.44 for each assessment (P < .001). This lifestyle walking intervention appears beneficial in lowering blood pressure across blood pressure classifications in midlife African American women.

Inflammation and Healthy Lifestyle Choices Influence Cardiometabolic Risks in African American Women.

Individuals of African origin in Europe and the Caribbean have a lower prevalence of coronary heart disease (CHD) than do Europeans and European Americans; however, African Americans, especially women, do not possess the same low CHD prevalence as Africans. As such, this study was designed to determine whether highly sensitive C-reactive protein (hsCRP) and fitness (V˙O2max) cluster with other cardiometabolic risks (CMRs) or whether their influence is independent of other CMRs in African American women. Fifty African American women were compared on fasting glucose, triglyceride, high-density lipoprotein cholesterol, blood pressure, and adiposity-based hsCRP classifications (low <1, group 1; moderate >1, group 2). Participants were obese but metabolically healthy. Oxygen uptake (V˙O2max) was correlated with systolic blood pressure, and percentage of fat in group 1. V˙O2max was related to systolic blood pressure, diastolic blood pressure, low-density lipoprotein-cholesterol, and percentage of fat, and hsCRP was related to triglycerides, and percentage of fat was related to diastolic blood pressure in group 2. These data indicate that CMRs are inversely related to V˙O2max at moderate hsCRP values in African American women. Inflammation and obesity are relatively independent of other CMRs. Inflammation along with sedentary lifestyles may contribute to the disparity observed for CHD morbidity and mortality in African American women. Adding the CMR profile may improve the prediction of CHD in African American women.

Functional paradox of leptin and adiponectin in diabetes patients and controls in the Cape Coast Metropolis of Ghana

Aim: To investigate the concept of obesity paradox in diabetes patients and nondiabetic control in the Cape Coast Metropolis of Ghana. Materials and Methods: Levels of leptin, adiponectin, total antioxidant power (TAP), lipid peroxides, and C-reactive protein (CRP) were assessed in 115 diabetics and an equal number of control respondents. Furthermore, various anthropometric indices and blood pressure were measured using standard methods. Levels of biomarkers were compared between groups based on body mass index or blood pressure classifications. Results: Control respondents exhibited higher (P 0.05) mean levels of the various biomarkers, except TAP level which was higher (P 0.05) levels of the other biomarkers between diabetes patients and their control counterpart. Irrespective of diabetes, obesity, or hypertensive status, leptin associated positively with various measures of adiposity. Adiponectin correlated positively with leptin (R > 0.38; P< 0.05) only in the control respondents, suggesting a possible functional paradox of the adipocytokines in this group of respondents. Conclusion: Overweight/obese respondents appear metabolically healthier than their normal-weight counterparts. However, further studies are needed for proper understanding of this concept in the Ghanaian context.

CSM 2017 Sports Physical Therapy Section Poster Presentations (Abstracts SPO1–SPO152)

CSM 2017 Sports Physical Therapy Section Poster Presentations (Abstracts SPO1–SPO152)

Correlation Between Sleep Quality and Blood Pressure Changes in Iranian Children

Background: Hypertension has a growing trend all around the world among children. Evidences imply that inadequate sleep duration and its poor quality are related to hypertension. But there are only few studies to show this relationship in children. Objectives: The aim of this study was to investigate the correlation between sleep quality parameters and blood pressure (BP) changes in children. Patients and Methods: Eighty six patients aged 5-15 years old with the history of urinary tract infection were included in this study. They underwent 24-hour BP monitoring. In addition, the Pittsburg Sleep Quality index questionnaire was filled out and the data were compared with BP records. Results: After excluding duplicate cases and those with insufficient data, 76 children entered into study. Overall sleep quality was good in 48 and poor in 28 children. Mean diastolic BP load (P = 0.019), diastolic load Awake-Time (P = 0.045), mean systolic Sleep-Time (P = 0.022), Non-Dipper state (P = 0.009) were statistically different among groups. By dividing the children into two groups of good and poor sleeper, the parameters of BP were not different. In addition, there was no correlation between BP classifications and sleep latency, duration of sleep, sleep efficiency, sleep disturbance, day dysfunction due to sleepiness, and overall sleep quality score. Conclusions: Our study could not show any correlation between sleep quality and ambulatory BP monitoring parameters in children with abnormal BP. © 2015, Iranian Society of Pediatrics.

New-onset hypertension and risk for chronic kidney disease in the Japanese general population.

Our aims were to assess the progression rate of normotension and prehypertension to hypertension in Japan, and the effect of the new-onset hypertension on chronic kidney disease (CKD). This was a nationwide study of 45 378 Japanese aged 40-74 years (mean age 60 years, 37% men) without hypertension or cardiovascular disease at baseline. At baseline and 3-year follow-up, blood pressure (BP) and kidney function were assessed. CKD was defined as an estimated glomerular filtration rate (eGFR) below 60 ml/min per 1.73 m² or the presence of proteinuria (≥1+ by a dipstick). At 3-year follow-up, the incidence rates of hypertension among participants with optimal BP (<120/80 mmHg, n = 18,724), normal BP (120-129/80-84 mmHg, n = 15,017) and high-normal BP (130-139/85-89 mmHg, n = 11,637) were 8, 23, and 39% in men, and 6, 20, and 37% in women, respectively. Among those without CKD at baseline (n = 42,625), 2142 participants (5%) had developed CKD during follow-up. Irrespective of the baseline BP classifications, participants with new-onset hypertension had a higher risk for proteinuria [odds ratio (95% confidence interval) 1.7 (1.3-2.3) in men and 1.6 (1.2-2.2) in women], but not for eGFR below 60 ml/min per 1.73 m², compared with those who maintained optimal BP during follow-up. Men who remained in the high-normal BP range during follow-up showed higher risk for proteinuria [odds ratio (95% confidence interval) 1.6 (1.1-2.3)], but not for eGFR below 60 ml/min per 1.73 m². This nationwide longitudinal study suggests that, over 3 years of follow-up, women and men with new-onset hypertension and men with high-normal BP were at higher risk of newly developing proteinuria.

Perioperative acute hypertension-role of Clevidipine butyrate.

Arterial hypertension (AH) is one of the most common pathological conditions affecting the general population which contributes to pathogenesis of various diseases and worsens the treatment outcome (James et al., 2014). It increases the perioperative morbidity and mortality, frequently result in cancelation of surgical procedures and increases treatment-associated costs (Handler, 2006). Perioperative hypertension may occur in patients with pre-existing arterial hypertension or manifest as a de novo phenomenon (Vuylsteke et al., 2000; Varon and Marik, 2008). Induction of general anesthesia is related with significant stress and sympathetic over-activation. The systolic blood pressure (SBP) in normotensive patients may increase by up to 20–30 mm Hg, while hypertensive patients may have an exaggerated reaction—SBP in these patients may increase up to 90 mm Hg (Ahuja and Charap, 2010). On the other hand, anesthesia-induced sympathetic suppression with diminished baroreceptor reflex takes place during the maintenance phase which frequently causes sustained arterial hypotension. Postoperatively, these patients present with labile BP, frequent and rebound hypertension, and have an increased risk of postoperative complications (Goldman and Caldera, 1979; Wolfsthal, 1993). Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7 and JNC-8) classifications and guidelines are currently applicable to perioperative patients as well (James et al., 2014; Chobanian et al., 2003). According to JNC-7 guidelines for evaluation and treatment of hypertensive emergencies, an immediate intervention is required in cases of hypertensive emergencies to reduce the SBP by 10–15% (no more than 25%) within the first hour. Reduction of the absolute BP to 160/110 mmHg should be done gradually over the following 2–6 h (Aggarwal and Khan, 2006; Flanigan and Vitberg, 2006; Pollack and Varon, 2008; Varon, 2008; De Gaudio et al., 2009; Hays and Wilkerson, 2010; Kuppasani and Reddi, 2010; Smithburger et al., 2010; Polly et al., 2011). Only in patients with aortic dissection, the SBP should be reduced to less than 120 mmHg within 20 min. In hypertensive emergencies associated with ischemic stroke, BP must be decreased to less than 180/110 before thrombolytic therapy may be administered (Pollack and Varon, 2008; Varon, 2008; De Gaudio et al., 2009; Hays and Wilkerson, 2010; Polly et al., 2011). Abrupt BP reduction should be avoided as it can result in critical blood flow reduction and ischemic end organ damage (Varon, 2008; De Gaudio et al., 2009; Smithburger et al., 2010; Polly et al., 2011). Since overshooting a target BP in hypertensive patients is associated with worse outcome, many treatment protocols require invasive arterial blood pressure monitoring during anesthesia in high risk cases (Pollack and Varon, 2008; Rhoney and Peacock, 2009). Hypertensive emergencies should be treated aggressively, using quick-onset intravenous medications, whereas hypertensive urgencies do not always require such aggressive treatment. Longer acting oral medications (labetalol, clonidine, etc.) may be more appropriate in situations of hypertensive urgency. However, caution should be exercised when using antihypertensive agents in the acute setting. An overly aggressive treatment approach may lead to organ hypoperfusion (Rodriguez et al., 2010). Once the immediate threat of organ damage is diminished, BP should be gradually brought to baseline level within a period of 24–48 h (Peacock et al., 2009). Characteristics of an ideal intravenous hypertensive agent are rapid onset and offset of action, low risk of hypotension, minimal drug interaction with other medications, lack of adverse reactions, wide therapeutic window, ease of titration, preservation of renal and hepatic functions, selectivity, low cost, possibility of easy transition to oral therapy, predictable response, and lack of effects on intracranial pressure (Levy, 1999; Oparil et al., 1999). Multiple intravenous medications are currently used to control the BP in the perioperative period, and all these medications have specific advantages and limitations (Kurnutala et al., 2013). Selection of an optimal antihypertensive therapy for the perioperative period depends on the patient’s individual characteristics and locally adopted guidelines (Pollack and Varon, 2008; Belsha, 2013). Clevidipine butyrate is a Ca2+-channel antagonist that acts on the L-type Ca2+

I Brazilian position paper on prehypertension, white coat hypertension and masked hypertension: diagnosis and management.

Arterial blood pressure (BP) is a very useful variable in clinical practice. Its measurement is simple, inexpensive and easy; it is worth noting that BP should be accurately obtained, following the recommendations of the VI Brazilian Guidelines on Hypertension (DBH VI)1. Office BP measurement is the central parameter for the diagnosis, treatment and follow-up of systemic arterial hypertension (SAH), being directly, continuously and independently related to the risk of fatal and non-fatal cardiovascular (CV) events1-3. Thus, the consideration of BP values closer to the upper limits of normality, the so-called prehypertension (PH)2, and intervention on those values have been emphasized over the last decade, because PH represents an important opportunity to prevent established SAH, contributing to reduce the associated CV risk. Repeated BP measurement at the office allows the diagnosis of hypertension and normotension. To better assess BP behavior, there are methods that analyze BP by using a higher number of measurements, minimizing interferences of the environment, situation and observer. Those alternatives are as follows: 24-hour ambulatory BP monitoring (ABPM); and dwelling BP measurement [home BP monitoring (HBPM) and BP self-measurement (BPSM)]. Based on those methods, two other BP classifications were adopted: white coat hypertension (WCH) and masked hypertension (MH)1,3-5 (Figure 1). Figure 1 Classification of blood pressure behavior considering office BP, ABPM and home BP measurements1. ABPM: ambulatory blood pressure monitoring; BP: blood pressure. Epidemiological and clinical studies on those conditions are still limited; however, they deserve attention because of their higher CV risk as compared with normotension6,7. This document represents the position of the Brazilian Society of Cardiology Arterial Hypertension Department (DHA/SBC) on the diagnosis and non-drug and drug therapy for PH, WCH and MH, aiming at contributing to a better clinical practice.

Weight Loss and Blood Pressure Control (Pro)

Overweight is an increasingly prevalent condition throughout the world. Current estimates, which are probably conservative, indicate that at least 500 000 000 people worldwide are overweight as defined by a body mass index (BMI) of between 25.0 and 29.9 and an additional 250 000 000 are obese with a BMI of 30.0 or higher.1 In the United States, recent data indicate that as much as 66% of the adult population is overweight or obese.2 Overweight and obesity are established risk factors for cardiovascular disease (CVD), stroke, noninsulin dependent diabetes (NIDDM), certain cancers, and numerous other disorders.3,4,5,6,7 It is also a risk factor for hypertension.8 Hypertension, defined as a systolic blood pressure in excess of 140 mm Hg or a diastolic blood pressure higher than 90 mm Hg, is also a globally increasing public health concern. Roughly 1 billion individuals worldwide are estimated to exhibit clinically significant elevated blood pressure with about 50 million of those residing in the United States.8 Hypertension, in turn, is associated with increased risk for CVD, stroke, renal disease, and all-cause mortality.9,10,11,12 The JNC VII report defines Stage 1 hypertension as blood pressure levels between 140 and 159 mm Hg systolic and 90 and 99 diastolic. Additionally, the report establishes a category of Prehypertension (Systolic blood pressure between 120 and 140 mm Hg or diastolic between 80 and 89 mm Hg). These 2 blood pressure classifications are deemed to be appropriate primary targets for lifestyle modification interventions, including weight loss. Higher levels of blood pressure, or stage 1 hypertension that is maintained over a long period, should be addressed primarily with medications or other physician directed treatments. There is a positive relationship between overweight or obesity and blood pressure and risk for hypertension. As early as the 1920s, a significant …

The role of gender, environmental and psychosocial factors in non-dipping status for blood pressure

Environmental and psychosocial factors are recognized as important determinants of disease state expression. This is particularly so in African-Americans and is apparent during early developmental stages. Moreover, gender status provides an additional modifier of response to environmental and psychosocial factors particularly as relates to 24-hour hemodynamic patterns. This study examined the relationship between sex, social support, daily hassles, and ambulatory blood pressure non-dipping status (<10% decrease in blood pressure from awake to asleep), a risk factor for stroke and left ventricular hypertrophy. 151 normotensive, non-obese (BMI below 25), African-American adolescents (79 males, 72 females; ages 11-18 years) completed measures of social support (emotional) and daily hassles; and wore a 24-hr ambulatory blood pressure monitor on a single occasion. Adolescents were classified as dippers (≥10% decrease in blood pressure from awake to asleep) or non-dippers (<10% decrease in blood pressure from awake to asleep). 69 % and 74% of girls and boys, had a family history of hypertension, respectively. A greater percentage of boys than girls were identified as non-dippers based on diastolic blood pressure (19% vs. 4%, p<.004) and mean (M) blood pressure classifications (25% vs. 10%, p<.05). Daily hassles were correlated with mean blood pressure dipping status (r=.20, p<.03); however, boys showed a stronger correlation between daily hassles and dipping status (r=.31, p<.03) than girls (r=.06, p=ns). A significant sex by dipping status interaction (F=3.9; p=.050) indicated that girls who were classified as non-dippers (10.6 ± 5.1) reported lower levels of social support from family members than girls who were classified as dippers (15.5 ± 4.2). Boys reported similar levels of social support across dippers (15.3 ± 3.2) and non-dippers (14.5 ± 4.4). These findings suggest that non-dipping status is more prevalent among African-American boys and is associated with greater reports of daily hassles; and that girls may show a greater health benefit from receiving emotional social support than boys. These data suggest that gender issues enter into the cardiovascular risk profile of African-Americans at as early a juncture as adolescence if not sooner.