Blood Pressure In Group Research Articles

Pulse pressure amplification and its determinants

Background. Pulse pressure (PP) amplification expressed as the peripheral-to-central PP ratio has gained importance in the assessment of cardiovascular phenotypes and cardiovascular risk. The aim of the present study was to assess the relationship between PP amplification, large vessel parameters and peripheral blood pressure (BP) to gain insights into the amplification phenomenon. Methods. Peripheral BP, central BP and carotid-femoral pulse wave velocity (cfPWV) were assessed using the OMRON M6, SphygmoCor and Complior devices, respectively, in 741 adults attending the hypertension outpatient clinic. Analysis of covariance, partial correlations and multiple linear regression models were performed to assess the relationship between PP amplification, peripheral BP and cfPWV. Results. PP amplification was inversely related to BP group. Women showed lower PP amplification than men (1.24 ± 0.18 and 1.35 ± 0.18, respectively, p < 0.001). Age, female gender and mean arterial pressure were inversely associated with PP amplification (p < 0.001), whereas heart rate and body mass index showed positive associations (p < 0.001 and p = 0.049, respectively). cfPWV was a predictor of PP amplification in men but not in women (p = 0.006 and p = 0.424, respectively). Conclusions. PP amplification is related to BP: the higher the BP, the lower the PP amplification. Gender, age and body composition have a significant impact on PP amplification.

Relationship of Blood Pressure With Mortality and Cardiovascular Events Among Hypertensive Patients aged ≥60 years in Rural Areas of China

The Eighth Joint National Committee (JNC-8) panel recently recommended a systolic blood pressure (BP) threshold of ≥150 mmHg for the initiation of drug therapy and a therapeutic target of <150/90 mmHg in patients ≥60 years of age. However, results from some post-hoc analysis of randomized controlled trials and observational studies did not support these recommendations.In the prospective cohort study, 5006 eligible hypertensive patients aged ≥60 years from rural areas of China were enrolled for the present analysis.The association between the average follow-up BP and outcomes (all-cause and cardiovascular death, incident coronary heart disease [CHD], and stroke), followed by a median of 4.8 years, were evaluated using Cox proportional hazards models adjusting for other potential confounders. The relationship between BP (systolic or diastolic) showed an increased or J-shaped curve association with adverse outcomes. Compared with the reference group of BP <140/90 mmHg, the risk of all-cause death (hazard ratio [HR]: 2.698; 95% confidence interval [CI]: 1.989–3.659), cardiovascular death (HR: 2.702; 95% CI: 1.855–3.935), incident CHD (HR: 3.263; 95% CI: 2.063–5.161), and stroke (HR: 2.334; 95% CI: 1.559–3.945) was still significantly increased in the group with BP of 140–149/<90 mmHg.Older hypertensive patients with BP of 140–149/<90 mmHg were at higher risk of developing adverse outcomes, implying that lenient BP control of 140–149/<90 mmHg, based on the JNC-8 guidelines, may not be appropriate for hypertensive patients aged ≥60 years in rural areas of China.

Beta-adrenergic receptor mediated inflammation control by monocytes is associated with blood pressure and risk factors for cardiovascular disease

Overwhelming data indicate that individuals with even mildly elevated blood pressure (BP) are at great risk for developing clinical hypertension and future cardiovascular disease (CVD). There remains a lack of consensus regarding treatment strategies for mildly elevated BP, termed prehypertension, and the knowledge of pathophysiology and mechanisms of its clinical outcomes remains limited. Our primary aim was to investigate βAR-mediated inflammation control (BARIC) responses of blood monocytes to isoproterenol (Iso) in relation to BP and CVD risk factors, including obesity, depressive mood, fasting glucose, triglycerides, and cholesterol levels in the 64 prehypertensive compared to 84 individuals with normal BP. BARIC was determined by measuring the degree of inhibition in lipopolysaccharides-stimulated monocytic intracellular TNF production by ex vivo Iso treatment (10−8M). Depressive mood was assessed by Beck Depression Inventory (BDI). Fasting metabolic and lipid panels were assessed, and plasma levels of inflammatory cytokines TNF, IL-1β, IL-6 were measured in a subset to confirm proinflammatory state of prehypertensive participants. Prehypertensive participants were older, heavier, included more men, and presented higher levels of fasting glucose, triglycerides, cholesterol, and plasma TNF compared to normotensive participants (p’s<.05). BARIC was significantly attenuated in the prehypertensive compared to normotensive group (p<.05). BARIC was negatively associated with systolic BP, diastolic BP, age, BMI, fasting glucose, triglycerides, total and low density cholesterol levels, and somatic depressive symptoms in all participants (p’s<.0001 to .05). However, among the prehypertensive individuals BARIC was positively associated with SBP even after controlling for the covariates (age, gender, race, BMI, glucose and lipid panel, somatic BDI scores) (p<.05). This differing nature of the BARIC–SBP relationship between the two BP groups may be attributed to moderating factors such as cardiorespiratory fitness or depressive symptoms that could not be clearly deciphered in this current study. Nonetheless, our findings indicate the associations between inflammation dysregulation mediated by sympathoadrenal activation and BP that is observable even among individuals with normal to mildly elevated BP. BARIC may be a useful and sensitive indicator of elevated risk for vascular inflammatory disease that can be detected even at lower BP levels, especially given its associations with traditional CVD risk factors and the critical role of monocytes in atherogenic processes.

Effect of birth weight on life-course blood pressure levels among children born premature: the Cardiovascular Risk in Young Finns Study.

Both fetal growth restriction and prematurity have been associated with elevated blood pressure (BP). However, their combined effects on adult BP are unclear. Our analyses were based on 1756 participants in the population-based Cardiovascular Risk in Young Finns Study who had information on birth weight and gestational age, together with longitudinal data on cardiovascular risk markers from age 3-18 years in 1980 to age 34-49 years in 2011. Three groups were defined by birth data: those born at term (term); those born preterm (<37 weeks) with an appropriate birth weight (>-1 SD z score according to national sex and gestational week-stratified data) for gestational age (preterm appropriate birth weight for gestational age); and those born preterm with low birth weight (≤-1 SD z score) for gestational age [preterm small birth weight for gestational age (SGA)]. There were no differences between the three groups in BP at baseline, but at the 31-year follow-up (mean age 41 years), mean SBP in the preterm SGA group was 7.2 mmHg (95% confidence interval = 2.3-12.1 mmHg, P = 0.004) higher than the preterm appropriate birth weight for gestational age group and 7.3 mmHg (95% confidence interval = 5.2-9.4 mmHg, P < 0.0001) higher than the term group, adjusted for age and sex. In addition, preterm SGA individuals had a higher prevalence of adult hypertension compared with those born at term (36.9 vs. 25.4%; age, sex, and risk factors adjusted P = 0.006). These longitudinal data suggest that elevated BP levels associated with prematurity are more likely to be present in those with fetal growth restriction.

Sympathetic nerve traffic and baroreflex function in optimal, normal, and high-normal blood pressure states.

Adrenergic activation and baroreflex dysfunction are common in established essential hypertension, elderly hypertension, masked and white-coat hypertension, resistant hypertension, and obesity-related hypertension. Whether this autonomic behavior is peculiar to established hypertension or is also detectable in the earlier clinical phases of the disease, that is, the high-normal blood pressure (BP) state, is still largely undefined, however. In 24 individuals with optimal BP (age: 37.1 ± 2.1 years, mean ± SEM) and in 27 with normal BP and 38 with high-normal BP, age matched with optimal BP, we measured clinic, 24-h and beat-to-beat BP, heart rate (HR), and muscle sympathetic nerve activity (MSNA) at rest and during baroreceptor stimulation and deactivation. Measurements also included anthropometric as well as echocardiographic and homeostasis model assessment (HOMA) index. For similar anthropometric values, clinic, 24-h ambulatory, and beat-to-beat BPs were significantly greater in normal BP than in optimal BP. This was the case when the high-normal BP group was compared to the normal and optimal BP groups. MSNA (but not HR) was also significantly greater in high-normal BP than in normal BP and optimal BP (51.3 ± 2.0 vs. 40.3 ± 2.3 and 41.1 ± 2.6 bursts per 100 heartbeats, respectively, P < 0.01). The sympathetic activation seen in high-normal BP was coupled with an impairment of baroreflex HR control (but not MSNA) and with a significant increase in HOMA Index, which showed a significant direct relationship with MSNA. Thus, independently of which BP the diagnosis is based, high-normal BP is a condition characterized by a sympathetic activation. This neurogenic alteration, which is likely to be triggered by metabolic rather than reflex alterations, might be involved, together with other factors, in the progression of the condition to established hypertension.

Higher blood pressure as a risk factor for diseases other than stroke and ischemic heart disease.

Hypertension is an established risk factor for stroke, ischemic heart disease,1,2 and renal dysfunction.3 The management and prevention of hypertension are important to the prevention of these diseases. Recent evidence has suggested that hypertension also plays a central role in the underlying pathophysiological condition or at prodromal stages before the development of these diseases. Accumulating evidence also indicates that hypertension seems to be linked with common noncardiovascular diseases including dementia, cancer, oral health diseases (OHDs), and osteoporosis. In this brief review, we organize the reported results about the associations between hypertension and these diseases, discussing mainly epidemiological surveys, with the goal of clarifying the relationships between these diseases and hypertension. ### Atrial Fibrillation Atrial fibrillation (AF) is one of the most common types of chronic arrhythmia and is a risk factor for ischemic stroke.4 The Framingham Heart Study revealed that hypertension increases the risk of AF by factors of 1.5 for men and 1.4 for women.5 The Women’s Health Study and a cohort study of Norwegian men showed that high-normal blood pressure (BP) was associated with incident AF.6,7 All of these cohort studies were conducted in Westerners, and these associations were also confirmed in a recent Japanese cohort study.8 In that investigation, compared with normal BP and normal weight, systolic prehypertension with overweight was shown to be associated with an increased risk of incident AF ( P for interaction=0.04). Arterial stiffness, left ventricular hypertrophy, and increased left atrial size are important mediators of the relationship between BP and incident AF.9 Higher systolic BP (SBP) and overweight may mutually exacerbate left ventricular hypertrophy and hypertension, and consequently, they may synergistically increase the risk of AF. ### Chronic Kidney Disease and High BP Chronic kidney disease (CKD) is characterized by a progressive decline in an individual’s glomerular filtration rate over several decades, …

Effect of Education On Blood Pressure Monitoring

Background: Hypertension is a chronic disease that requires lifelong medical treatment. Guidelines offer blood pressure monitoring office or house follow up. We hypothesized in this study education level of the patient may effect diagnostic approach. Objective: Objective of this study was the reliability of home blood pressure measurement and relation between the education period and patient characteristics. Methods: This study includes 120 patients who were followed by our outpatient clinic. Consecutive 120 patients enrolled to the study. Patient's blood pressure measured at least 10 days and ambulatory blood pressure monitors. Education groups were divided according to country education system. Group 1: primary education (at least 5 years), group 2: secondary (6–11 years), group 3: higher education (> 11 years). Both of the blood pressure mean values and the group's characteristics were compared. Each groups consist of consecutive 40 patients. Results: 42 of the patients (35%) were female, mean age was 57+- 11(20- 77). Group 3 office and ambulatory mean systolic (MS) and diastolic (MD) values are almost similar (p > 0, 05). On the other hand group 2 values statistically insignificant (p > 0, 05). Group 1 values were statistically different (p < 0, 05). Other findings of our study were values were statistically differentiated with increased in BMI and usage of more than two antihypertensive drugs in all groups (p < 0,05). 26 patients of (74%) Group 1 BP measurement lower than ambulatory BP values, 10 patients BP is higher than ABPM values. Comparison according to the values; 39.6% were lower and 9,6% were higher than AMBP. 49 of the patient were (40.8%) overweight, 22 were obese (18,3%). Discussion and conclusion: Higher education group's blood pressure values are more similar than other two groups as literature (1). Not only the education level but also BMI and increased number of antihypertensive drugs were also affecting the blood pressure monitoring differences. According to our study increase in BMI and usage of more than 2 antihypertensive drugs also decrease the reliability of house measuring BP (2). Increase in BMI and usage of 2 or more antihypertensive drug are derivative of cognitive function (3).

Blood pressure is associated with the presence and severity of nonalcoholic fatty liver disease across the spectrum of cardiometabolic risk.

To determine the relationship between clinically relevant blood pressure (BP) groups and nonalcoholic fatty liver disease (NAFLD) presence and severity especially in the milieu of other metabolic risk factors. From a Brazilian cohort of 5362 healthy middle-aged men and women who presented for yearly physical examination and testing, the cross-sectional relationship between BP categories and NAFLD was assessed. BP groups were categorized as normal, prehypertension (PHT), and hypertension (HTN) according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure classification. NAFLD was ultrasound diagnosed, excluding persons with alcohol consumption more than 20 g/day. NAFLD severity was estimated using the Fibrosis-4 (FIB-4) risk score. The prevalence of NAFLD was 36.2%. Participants with NAFLD were older (mean 46 vs. 42 years, P < 0.001) and had elevated BMI (mean 29.0 vs. 24.7 kg/m, P < 0.001). The prevalence of NAFLD among persons with normal BP, PHT, and HTN was 16.5, 37.5, and 59.3%, respectively. In multivariate analyses, PHT and HTN were associated with elevated odds of NAFLD (PHT-adjusted odds ratio 1.3, 95% confidence interval 1.1, 1.6; HTN-adjusted odds ratio 1.8, 95% confidence interval 1.4-2.3) compared with normal BP. Among nonobese hypertensive patients, BP control (BP < 140/90 mmHg) was independently associated with 40% lower odds of prevalent NAFLD. Compared with hypertensive patients, both normotensive individuals and prehypertensive patients were more likely to have a low fibrosis risk (FIB-4 ≥ 1.3). Prevalent NAFLD may be seen early in the development of hypertension, even in the absence of other metabolic risk factors. Controlling BP among nonobese hypertensive patients may be beneficial in preventing or limiting NAFLD.

Prognostic impact of sleep-time relative blood pressure decline for predicting the risk of developing chronic kidney disease

Some patients with hypertension exhibit disturbed circadian organization in the cardiovascular system. Hormone melatonin can synchronize circadian rhythms and its repeated administration can improve synchronization of rhythmicity in blood pressure (BP). In our study we measured endogenous melatonin production in patients with essential hypertension exhibiting a dipping and non-dipping BP profile. Blood pressure was monitored for at least 24-hr with an automatic ambulatory BP monitor and patients with no decline in BP were classified as non-dippers. Plasma melatonin was measured in the middle of the daytime and night-time by radioimmunoassay. As expected night-time systolic (P < 0.05), diastolic (P < 0.001) and mean arterial (P < 0.001) BP was higher in non-dippers than in dippers. No significant difference was found between both groups in BP during the day. Mean melatonin concentrations were higher during the night than during the day in both dippers and non-dippers. When patients were divided into dippers and non-dippers on the basis of mean arterial or diastolic BP a lower ratio of night/day concentration was determined in non-dippers than in dippers. Our study showed a blunted night/day difference in plasma melatonin concentrations in hypertensive patients with the non-dipping profile in diastolic BP indicating disturbances in the circadian system of these patients.

Increased Protein Intake Is Associated With Uncontrolled Blood Pressure by 24-Hour Ambulatory Blood Pressure Monitoring in Patients With Type 2 Diabetes

Objective: To analyze possible associations of dietary components, especially protein intake, with blood pressure (BP) during ambulatory BP monitoring (ABPM) in patients with type 2 diabetes.Methods: In this cross-sectional study, BP of outpatients with type 2 diabetes was evaluated by 24-hour ABPM (Spacelabs 90207) and usual diet by 3-day weighed diet records. Patients were divided into 2 groups according to their daytime ABPM: uncontrolled BP (systolic BP ≥ 135 mmHg or diastolic BP ≥ 85 mmHg) and controlled BP (systolic BP < 135 mmHg and diastolic BP < 85 mmHg). Logistic regression models unadjusted and adjusted for possible confounders (covariates) were used to analyze the association of protein and uncontrolled BP.Results: A total of 121 patients with type 2 diabetes aged 62.3 years, 54.5% of whom were women, were studied. The uncontrolled BP group had higher glycated hemoglobin (HbA1C) values (8.4 ± 2.0 vs 7.6 ± 1.3%; p = 0.04) and consumed more protein (20.0 ± 3.8 vs 18.2 ± 3.6% of energy; p = 0.01) and meat, (2.6 [1.45, 2.95] vs 2.0 [1.49, 2.90] g/kg weight; p = 0.04) than the controlled BP group. In a multivariate analysis, protein intake (% of energy) increased the chance for uncontrolled BP (odds ratio [OR] = 1.16; 95% confidence interval [CI], 1.02, 1.30; p = 0.02), adjusted for body mass index (BMI), HbA1C, low-density lipoprotein (LDL) cholesterol, number of antihypertensive medications, and ethnicity. Meat consumption higher than 3.08 g/kg weight/day more than doubled the chance for uncontrolled BP (OR = 2.53; 95% CI, 1.01, 7.60; p = 0.03).Conclusion: High protein intake and meat consumption were associated with high daytime ABPM values in patients with type 2 diabetes. Reducing meat intake might represent an additional dietary intervention in hypertensive patients with type 2 diabetes.

Evaluación de un programa de ejercicio físico supervisado en pacientes sedentarios mayores de 65 años con diabetes mellitus tipo 2

ObjectiveTo analyze whether an exercise program can modify glycated hemoglobin (HbA1c), blood pressure (BP), body mass index (BMI), lipids, cardiovascular risk profile (CVR), self-perceived health status (SHS), and pharmaceutical expenditure (PE). DesignA randomized, single blind, controlled trial. Intervention: program of supervised aerobic physical exercise. Analysis by intention to treat. LocationPrimary Care: 2 rural health areas. Health Area of Navalmoral. Cáceres. Extremadura. Spain. Participants100 type 2 diabetic patients, aged 65 to 80 years, sedentary. Distribution: 50% control group (CG) and 50% intervention group (IG). Abandoned 12%. Interventionmonitored aerobic exercise: 40minutes, 2 days/week, 3 months. Key measuresHbA1c, BP, BMI, lipid, CVR, SHS, PE. Complications during exercise. ResultsThere were post-intervention differences between groups in HbA1c, BP, BMI, cholesterol and SHS. In the IG, there was a significant decrease in; HbA1c: 0.2±0.4% (95% CI: 0.1 to 0.3), systolic BP: 11.8±8.5mmHg (95% CI: 5.1 to 11.9), BMI: 0.5±1 (95% CI: 0.2 to 0.8), total cholesterol: 14±28.2mg/dl (95% CI: 5.9 to 22.2), LDL: 18.3±28.2mg/dl 95% CI: 10.2 to 26.3), CVR: 6.7±7.7% (95% CI: 4.5 to 8.9), PE: 3.9±10.2 € (95% CI: 0.9 to 6.8), and an increase in SHS; 4.7±5.7 (95% CI: 3 to 6.3). ConclusionsIn diabetics over 65 years, a program of monitored aerobic exercise, of easy implementation, improves HbA1c, BP, cholesterol, CVR, PE, and SHS.

Abstract W P224: Higher Pre-Hospital Blood Pressure Prolongs Door to Needle Thrombolysis Times

Background: Per American Heart Association guidelines, blood pressure (BP) should be &lt; 185/110 to be eligible for intravenous tissue plasminogen activator (tPA). It is shown that door to needle (DTN) time is prolonged in patients who require anti-hypertensive medications prior to thrombolysis in the emergency department (ED). To our knowledge, no studies have focused on pre-hospital BP and its impact on DTN times. We hypothesize that DTN times are longer for patients with higher pre-hospital BP. Methods: We conducted a retrospective review of acute ischemic stroke patients who presented between 1/2010 and 12/2010 to our ED through Emergency Medical Services (EMS) within 3-hrs of symptom onset. Patients were identified from our registry and categorized into two groups: Pre-hospital BP ≥ 185/110 (Pre-hsp HBP) and &lt; 185/110 (Pre-hsp LBP). BP records were abstracted from EMS sheets. Two groups were compared using two-sample t-test or Wilcoxon rank sum test for continuous variables and Chi-square test or Fisher’s exact test for categorical variables. Results: A total of 107 consecutive patients were identified. Out of these, 75 patients (70%) were treated with tPA. Among the patients who received thrombolysis, 35% had pre-hospital BP ≥ 185/110 (n= 26/75). Greater number of patients required anti-hypertensive medications in ED in high BP group compared to low BP group (Pre-hsp HBP n= 14/26, 54%; Pre-hsp LBP n= 13/49, 27%, p &lt; 0.02). Mean door to needle times were significantly higher in Pre-hsp HBP group. (mean ± SD 87.5± 34.2 Vs. 59.7±18.3, p&lt;0.0001). Analysis of patients only within the Pre-hsp HBP group (n= 26) revealed that DTN times were shorter if patients received pre-hsp BP medications compared to patients in the same group who did not receive pre-hsp BP medication (n= 10 vs 16; mean ± SD 76.5 ± 25.7 Vs. 94.3 ± 37.7, p = 0.20) Conclusion: Higher pre-hospital BP is associated with prolonged DTN times and it stays prolonged if pre-hospital high BP remains untreated. Although the later finding was not statistical significant due to small sample size, pre-hospital blood pressure control could be a potential area for improvement to reduce door to needle times in acute ischemic stroke.

The association between arterial properties and blood pressure in children.

Elevated blood pressure (BP) in adults is associated with increased arterial stiffness and thickness; however, its effect on arterial health in a pediatric population is less understood. The purpose of this study was to identify the relationship between childhood BP and arterial markers of arteriosclerotic progression. The study consisted of 106 children across a wide range of BP values divided into 2 BP groups: high BP (HBP; ≥ 95th percentile; n = 21) and normal BP (NBP; < 90th percentile; n = 85) based on consistent automated BP measures taken at 2 time points. The laboratory examination involved systemic pulse wave velocity (PWV), common carotid artery (CCA) intima media thickness (IMT) and distensibility, as well as body mass index (BMI) and pubertal maturation. BMI and heart rate, as well as PWV (HBP: n = 15 and NBP: n = 56), were higher in the HBP group (p < 0.001) with no difference between groups for both CCA distensibility and IMT (HBP: n = 21 and NBP: n = 83). Multivariate linear regression revealed that BP group (p = 0.003) was an independent predictor of PWV after controlling for age, sex, BMI, heart rate, and maturation. Our findings demonstrate a higher systemic PWV with no difference in CCA IMT or distensibility in children with elevated BP. Hence, markers of cardiovascular disease risk are augmented in healthy children with elevated BP.

A prospective study on the relationship between blood pressure and blood group among adult male blood donors in a Tertiary care center

Background and Aim: The ABO blood type, an easily accessible factor in patient's genetic make-up has been associated with many diseases; perhaps the ABO antigens play a role by influencing renin levels. It may be speculated that since blood pressure (BP) is multifactorial, the ABO antigens may indirectly influence arterial pressure. Therefore, in the present study, we intend to assess the relationship between BP and blood group among the male blood donors (20-60 years) attending the blood bank in a tertiary care center. Methods: Basal cardiovascular parameters such as basal heart rate, systolic BP, diastolic BP (DBP) and rate pressure product (RPP) were recorded. ABO and Rh (D) blood groups were also determined for each subject. Tube test for ABO and Rh typing of red cells and serum typing was done on the donor blood samples. Results: The test group comprised of 767 subjects within the age-group of 20-60 years. All the values were expressed as mean ± standard deviation with the P Conclusion: There was a positive correlation between DBP and blood groups, but RPP was not found to be significant between the groups. Hence, we presume that further studies with a population-based screening of various blood groups might help in identifying and modifying the risk factors for hypertension.

Blood pressure control predicts plasma matrix metalloproteinase-9 in diabetes mellitus type II.

IntroductionMatrix metalloproteinase-9 (MMP-9) plays an important role in extracellular and vascular remodelling. We aimed therefore to assess the role of blood pressure (BP) control on plasma MMP-9 in relation to the presence of diabetes mellitus (DM) type II.Material and methodsPlasma MMP-9 was measured in 61 patients who were divided into two groups depending on their BP control as follows: 49 patients with uncontrolled arterial hypertension (AH) defined as BP values > 130/80 mm Hg and 12 patients with optimal blood pressure values. Plasma MMP-9 levels were measured with immunoassay at discharge. Group comparisons were made with the independent t-test, Mann-Whitney U-test and χ2 test where appropriate. The associations of the variables with MMP-9 were investigated with linear regression analyses.ResultsThe diabetics made up 34.4% of the investigated patients. Frequency of DM did not differ between the two BP groups (30.0% vs. 36.6%, p > 0.05). Plasma MMP-9 concentrations differed significantly between the diabetics vs. non-diabetics (median: 1.9 ng/ml, range: 1.0–7.3 vs. 1.4 ng/ml, range: 0.5–4.7, p < 0.05). Stratification across the categories of BP control showed a significant correlation between plasma MMP-9 and DM type II only in the uncontrolled BP group. The significance of that relationship disappeared in the group of patients with optimal BP control.ConclusionsPlasma values of MMP-9 are raised in patients with DM type II. The results revealed the impact of the combination of uncontrolled AH and DM type II on vascular remodelling processes.

High prevalence of metabolic syndrome in a middle-aged and elderly population with prehypertension in Tianjin

Background: Prehypertension has been reported as being correlated with future cardiovascular risk and end-organ damage in middle-aged and elderly persons, and also playing an important role in metabolic syndrome (MetS). The association between prehypertension and MetS has rarely been reported among urban adults in Tianjin, China. Methods: In this cross-sectional study, a total of 1176 participants aged 40–70 years (524 males and 652 females) were enrolled after excluding participants with hypertension or treated hypertension. Participants were divided into two groups [optimal blood pressure (BP) and prehypertension] based on the classification of BP from the JNC-7. The definition of MetS was as per the International Diabetes Federation standard. An adjusted logistic regression model was used to assess relationships between prehypertension and MetS. Results: The prehypertension group had a significantly higher odds ratio (OR) than the optimal BP group for abnormal waist circumference (WC), fasting plasma glucose (FPG) and triglycerides (TG). In addition, the prehypertension group had a higher OR (3.12; 95% confidence interval 2.34–4.18) for having MetS after adjusting for potential confounders. Conclusions: The risk of having MetS was significantly associated with prehypertension in middle-aged and elderly persons in Tianjin. Stricter control of BP in this age group is warranted.

Should Blood Pressure Targets After Lacunar Stroke Vary by Body Size? The SPS3 Trial.

It is unknown whether the physiological impact of a given blood pressure (BP) varies by body size. We explored interactions between higher vs. lower systolic BP (SBP) targets and anthropometric measures (body mass index (BMI), body surface area (BSA), height, weight) and recurrent stroke and death in the Secondary Prevention of Small Subcortical Strokes (SPS3) Trial. Patients with recent magnetic resonance imaging-proven lacunar infarcts were randomized to 2 BP targets (130-149 mm Hg vs. <130) in a prospective, open-label, blinded end-point design. Time to outcome was evaluated with Cox proportional hazard models and compared between targets. We examined multiplicative interactions between each anthropometric measure and target and mean difference in achieved BP 1 year after randomization between BP groups by quartile. We also computed rates of recurrent stroke and death by quartiles of anthropometrics. Three thousand and twenty patients were followed over a mean of 3.7 (SD 2.0) years. Mean age was 63; 63% were male. Mean height was 167 (SD 11) cm, weight 81 (18) kg, BMI 29 (5.9) kg/m(2), and BSA 1.9 (0.25) m(2). Achieved BP at 1 year was comparable between quartiles for each anthropometric measurement. We found no consistent interactions between BP target and anthropometrics for either outcome, nor were there any significant associations between hazard of stroke or death when assessed by BMI, BSA, height, or weight. We found no interactions between BP target groups and quartiles of anthropometrics for rates of stroke and death in SPS3. There is no evidence at this time supporting body size-based modifications to current BP targets for secondary prevention after lacunar stroke. Trial Number NCT00059306.

Abstract 12161: Dipeptidyl Peptidase IV Inhibitor Therapy Modifies Systolic Blood Pressure in High Blood Pressure Diabetic Patients: Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) 2 Trial

Introduction: It has been reported that dipeptidyl peptidase (DPP) IV inhibitor treatment increased glucagon like peptide (GLP)-1 and GLP-1 receptor expression levels, and subsequently endothelial nitric oxide synthase levels in experimental studies. It is possible that DPP IV inhibitors modify blood pressure (BP) through the improvement of endothelial function. Hypothesis: The aim of this study was to investigate whether DPP IV inhibitors ameliorated BP in diabetic patients. Methods: The JPAD trial, 2002 to 2008, a multicenter, prospective, randomized, open label, blinded, end-point study, was undertaken to examine the efficacy of aspirin therapy. After completion of the trial in 2008, we followed the same subjects until 2013 as JPAD2 trial cohort. BP was measured in 1244 patients in both 2009 and 2013. Among the 1244 patients, 4 patients received DPPIV inhibitors in 2009, 280 patients in 2011, 573 patients in 2013. We examined the change of BP in the 573 patients. Among them, 344 patients had systolic BP≥140 mmHg or diastolic BP≥90 mmHg or both (high BP group). Results: The systolic BP from 2009 to 2013 did not significantly change in the 1244 patients (Figure). The diastolic BP significantly decreased in the 1244 patients (Figure). The systolic BP from 2009 to 2013 did not significantly change in the 573 patients receiving DPPIV inhibitors (Figure). The diastolic BP significantly decreased in the 573 patients receiving DPPIV inhibitors (Figure). In the high BP group, the systolic BP from 2009 to 2013 significantly decreased in the 148 patients receiving DPPIV inhibitors (Figure). In the high BP group, the diastolic BP significantly decreased in the 148 patients receiving DPPIV inhibitors (Figure). Conclusions: In 4 year-observation of the JPAD2 trial cohort, diastolic BP decreased and systolic BP did not change in diabetic patients. User of DPPIV inhibitors has been dramatically increased, and it significantly modifies systolic BP in high BP diabetic patients.

Chronic hypertension increases susceptibility to acute IOP challenge in rats.

To consider the effect of chronic arterial hypertension on the susceptibility of the retina to acute IOP challenge. Anesthetized adult Long-Evans rats with normal (n = 5, receiving saline subcutaneously), chronic high blood pressure (BP) for 4 weeks (n = 15, Angiotensin II subcutaneously), and acute high BP for 1 hour (n = 10, Angiotensin II intravenously) underwent IOP elevation (10-120 mm Hg, 5 mm Hg steps each 3 minutes). During IOP elevation, retinal function and ocular blood flow were monitored with electroretinogram (ERG) and laser-Doppler flowmetry (LDF), respectively. Blood pressure was monitored via a femoral artery cannula. Electroretinogram and LDF responses are expressed as a percentage of baseline and compared between groups. The left ventricle and the aorta were dissected to assess the morphologic changes associated with chronic hypertension. Four weeks of hypertension (systolic BP 192 ± 4 mm Hg) produced cardiac hypertrophy and thickened aortic arterial walls compared with controls (systolic BP 112 ± 3 mm Hg). Retinal function was unaltered with chronic hypertension compared with normotensive animals. During acute IOP elevation, ERG and LDF were reduced in a dose-dependent manner in all BP groups. Both chronic and acute hypertension made the ERG and LDF less susceptible to IOP elevation. However, the degree of resistance to IOP elevation was greater in acute hypertension compared with chronic hypertension (P < 0.05). Acute BP elevation makes retinal function and blood flow less susceptible to IOP elevation. The reduced susceptibility afforded by improved ocular perfusion pressure is compromised after 4 weeks of chronic hypertension.

Prevalence and risk factors associated with prehypertension in Shunde District, southern China

ObjectiveTo explore the prevalence and combined cardiovascular risk factors of prehypertension in southern China.DesignA retrospective study; the logistic regression model was used to find the risk factors of prehypertension.SettingThe study...