Blood Pressure In Adults Research Articles

SYSTOLIC BLOOD PRESSURE, FRAILTY, AND ALL-CAUSE MORTALITY IN COMMUNITY-DWELLING OLDER ADULTS: FINDINGS FROM THE CHINESE LONGITUDINAL HEALTHY LONGEVITY SURVEY 2002-2014

Objective: Although convincing evidence on blood pressure (BP) targets in older adults is increasing, data of individual BP management in this group is lacking, especially in frail subjects. We aimed to investigate whether frailty modifies the association between systolic blood pressure (SBP) and all-cause mortality in community-dwelling older adults. Design and method: This study included participants aged 65 years or older from the Chinese Longitudinal Healthy Longevity Survey 2002–2014 and followed up to 2018. They were divided into two groups according to a frailty index based on the accumulation of 44-items deficits. The association between SBP and mortality was analyzed using Cox proportional hazards models adjusted for age, sex, marital status, education, residence, economic income, current smoking, current alcohol consumption, BMI, DBP, cognitive impairment, hypertension, diabetes, cardiovascular disease, stroke and other cerebrovascular diseases, respiratory disease, and cancer. Results: Among 18,503 participants included, 75.2% of them were 80y or older, and 42.2% were frail. The median follow-up time was 42.7 months, detecting 15,901 (85.9%) deaths. We identified 7808 (42.2%, 7533 deaths) frail participants (mean frailty index = 0.33). Effect modification by frailty was detected. Among frail participants, a U-shaped association was found with hazard ratios of 1.16 (95% CI, 1.02–1.32) for SBP < 100 mmHg, and 1.11 (95% CI, 1.00–1.24) for SBP 150 mmHg or higher compared with SBP 120–130 mmHg. For non-frail older adults, a tendency toward higher risk among those with SBP 130 mmHg or higher was observed. Conclusions: Our results suggest the presence of effect modification by frailty indicating a possible negative effect for elevated SBP in non-frail older adults and a U-shaped relationship of SBP in frail older adults with respect to all-cause mortality even after adjusting for diastolic blood pressure.

A Modified Recommended Food Score Is Associated with a Lower Incidence of High Blood Pressure in Middle-Aged and Older Korean Men: The Korean Genome and Epidemiology Study

ObjectivesThis cohort study investigated the association between the modified RFS (Recommended Food Score) and incident high blood pressure in Korean adults from the Korean Genome and Epidemiology Study (KoGES).MethodsWe prospectively analysed 2,854 (1,028 men and 1,556 women) participants aged 40–69 years without high blood pressure at baseline during a 16-year follow-up period. A dish-based, semi-quantitative, 103-item food frequency questionnaire was used to assess dietary intakes at baseline. The modified RFS (a total of 65 points) is based on the reported consumption of foods recommended in the Dietary Approaches to Stop Hypertension (DASH) diet modified for Korean foods. High blood pressure included hypertension and prehypertension, also known as stage 1 hypertension (a systolic blood pressure ≥120 mmHg, diastolic blood pressure ≥80 mmHg). Cox proportional hazards model was used to examine the association between modified RFS scores and the risk of incident high blood pressure.ResultsA total of 1,663 participants (761 men and 902 women) developed high blood pressure during an average follow-up of 87 months (range 17‒183 months). The modified RFS was positively correlated with the DASH diet score in men (r = 0.6492; p < 0.0001) and women (r = 0.7291; p < 0.0001), respectively. Men with the highest quintile of the modified RFS had a 24% lower incidence of high blood pressure than those with the lowest quintile (adjusted hazard ratio = 0.76, 95% confidence interval = 0.60–0.96, p-trend = 0.0218). However, there was no association between modified RFS and incident high blood pressure in women.ConclusionsA higher modified RFS was associated with a reduced risk of incident high blood pressure in middle-aged and older Korean men. Further prospective studies of larger scale or intervention studies are needed to confirm these findings.Funding SourcesThis work was supported by the Bio & Medical Technology Development Program of the National Research Foundation funded by the Ministry of Science & ICT (2012M3A9C4048761) and the BK21 FOUR (Fostering Outstanding Universities for Research) funded by the Ministry of Education (MOE, Korea) and National Research Foundation of Korea.

WORK-BASED ISOMETRIC EXERCISES EFFECT ON BLOOD PRESSURE: THE EEFIT STUDY

Objective: To evaluate the effect of two workplace isometric exercise interventions on blood pressure in hypertensive adults. Design and method: A randomized controlled multicenter clinical trial conducted in hypertensive (&gt;130 mmHg systolic blood pressure (SBP)) 35 to 65 years old in work places in Colombia. Participants were assigned to either of two interventions: isometric handgrip dynamometer training at 30% of maximum strength (HGD) or wall squat (WS), or to a control group following standard recommendations. The interventions were performed at the participant’s workplace and consisted of 4 sets of 2 minutes of sustained isometric contraction with 2 minutes’ rest between sets, 3 times per week for 12 weeks. SBP and diastolic blood pressure (DBP) were measured using an automatic device (Omron) with a standardized protocol before and after the 12-week intervention. Results: Pre and post measurements were completed by 105 hypertensive participants: mean age of 45 years (SD 9.5), 63.8% of which were men. In the HGD group (n = 38) there were significant decreases in SBP [Pre: 141 mmHg (SD 7.8), Post: 127 mmHg (SD 9.1) (p &lt; 0.001)], and in DBP [Pre: 87 mmHg (SD 5.8), Post: 82 mmHg (SD 9.5) (p &lt; 0.001)]. There were also significant decreases in the WS-group (n = 35) in SBP [Pre: 139 mmHg (SD 7.5), Post: 126 mmHg (SD 12.4) (p &lt; 0.001)], and in DBP [Pre: 86 mmHg (SD 5.2), Post 82 mmHg (SD 8.1) (p &lt; 0.001)]. In the control group (n = 32), there were no significant changes in either in SBP [Pre: 140 mmHg (SD 8.4), Post: 137 mmHg (SD 12.9)], or DBP [Pre: 86 mmHg (SD 5.0), Post: 85 mmHg (SD 8.0) (p = 0.71)]. Conclusions: Both workplace isometric training interventions resulted in significant and clinically relevant reductions in blood pressure in subjects with high blood pressure. The combination of effectiveness, modest time commitment (42 minutes per week) and ease with which the interventions can be implemented in the workplace setting makes them both attractive and practical options with minimal barriers for participation. Furthermore, WS can be performed without any equipment.

Decreased Diastolic Blood Pressure and Average Grip Strength in Adults With Type 1 Diabetes Compared With Controls: An Analysis of Data From the Canadian Longitudinal Study on Aging

ObjectivesOur aim in this study was to determine whether aging individuals with type 1 diabetes (T1D) have differences in cardiovascular health, assessed by blood pressure, and skeletal muscle function, assessed by grip strength, compared with matched nondiabetic controls (CON). MethodsThis investigation was a retrospective cohort analysis using baseline and 3-year follow-up data from the Canadian Longitudinal Study on Aging. Bivariate and multivariate regression analyses were used to examine the association between sociodemographic, health, behavioural and T1D-specific variables on blood pressure and grip strength in T1D and CON groups. Generalized estimating equations were used to model the average population changes in blood pressure and grip strength from baseline to follow up. ResultsThe sample included 126 individuals (63 T1D and 63 CON). Systolic blood pressure was not significantly different between groups at baseline or follow up (p>0.05). However, compared with CON, diastolic blood pressure was significantly lower at both time-points in the T1D group (p<0.001). Grip strength was consistently lower among persons with T1D (p=0.03). In the multivariate regression model, body mass index, age and sex were significantly associated with diastolic blood pressure and grip strength in both groups. In the T1D group, disease duration accounted for a large proportion of the variance in diastolic blood pressure and grip strength (17% and 9%, respectively). The rate of decline in diastolic blood pressure and grip strength did not differ between groups (p>0.05). ConclusionsDiastolic blood pressure and grip strength appear to be consistently lower and differentially regulated in individuals with T1D vs CON. Aging individuals with T1D may be at risk of premature morbidity and mortality.

0586 Extending Sleep in Short Sleeping Middle-aged Adults at Risk for the Metabolic Syndrome

Abstract Introduction Short sleep predicts the metabolic syndrome (MetS). Extending sleep improves certain MetS factors, specifically insulin sensitivity and blood pressure in adults without MetS. The absence of sleep intervention studies in community-dwelling adults with MetS limits progress in advancing sleep extension interventions to this subgroup. This study evaluated the feasibility, acceptability, and impact on End-of-Treatment (EOT) sleep outcomes of a 12-week sleep intervention. Methods Middle aged adults who were short sleepers and at risk for METs participated in a single-arm 12-week, 12-session sleep intervention based on cognitive behavioral therapy for insomnia delivered via videoconferencing platform. Feasibility and acceptability were assessed using retention and attendance rates as well as mean sleep diary completions (≥4 diaries/week). Anticipated (baseline) and experienced (EOT) acceptability were assessed using a 16-item survey that estimated self-reported acceptability, feasibility, perceived benefit, satisfaction, and overall satisfaction. Sleep was estimated from baseline and EOT 2-week wrist actigraphy data. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Paired sample t-tests modeled changes in acceptability, feasibility, perceived benefit, satisfaction, overall satisfaction, sleep and daytime sleepiness from baseline to EOT. Results The intent-to-treat sample included 44 adults (mean age 52y, 59% female, 41% Black, 48% White, 11% Other, 82% non-Hispanic). Three participants withdrew leaving N=41 (retention rate=93%). Eighty-six percent attended &amp;gt;80% of sessions and mean sleep diary completion was 6.7 diaries/week. There were statistically significant changes in self-reported anticipated (baseline) and experienced (EOT) acceptability surveys indicating greater EOT acceptability (p&amp;lt;0.001), perceived benefit (p&amp;lt;0.001), satisfaction (p&amp;lt;0.001), and overall evaluation (p&amp;lt;0.001). Statistically significant improvements in sleep from baseline to EOT included increased time-in-bed (Mbaseline=6.00h SD= 0.68h – MEOT=7.48, SD= 1.21; p&amp;lt;0.001), increased total sleep times (Mbaseline=5.16, SD= 0.63 – MEOT=6.26, SD= 1.23 p&amp;lt;0.001), earlier sleep onsets (Mbaseline=12.26am, SD= 0.05 – MEOT=11.53pm, SD= 0.06 p&amp;lt;0.05), more regular sleep onsets (Mbaseline=0.06, SD= 0.04 – MEOT=0.04, SD= 0.02 p&amp;lt;0.01), a higher sleep regularity index (Mbaseline=44.02, SD= 17.25 – MEOT=55.88, SD= 12.82 p&amp;lt;0.01), and reduced daytime sleepiness (Mbaseline=7.26, SD= 4.30 – MEOT=3.15, SD= 2.46, p&amp;lt;0.001). Conclusion Extending sleep, as well as improving sleep timing and regularity in racially/ethnically diverse middle-aged short sleepers using a videoconferencing platform is acceptable and feasible. Support (If Any)

Dropout rates in controlled trials with exergames for blood pressure management: a systematic review and meta-analysis protocol

Exergame, a type of enjoyable active video game that combines physical exertion and game is a technological innovation that has generated important information for the health field. In the cardiovascular area, exergames have been used to manage blood pressure in adults with some positive results. Despite this, in primary studies, it is possible to identify that participants dropout of the exergames interventions, but no synthesis of evidence has been produced so far to explore that. The aims of this review are i) to estimate the pooled rate of dropouts in controlled trials assessing the effects of exergame-based interventions on resting blood pressure in adults and older people; ii) to compare dropout rates between exergame and controls groups, and iii) to investigate the intervention characteristics associate with dropout rates. Inclusion criteria: Randomized controlled trials (RCTs) or quasi-RCTs (≥ 4 weeks) assessing the effects of exergame-based interventions on resting blood pressure in adults aged ≥ 18 years old. Without restriction to language, date of the publication, and intervention setting. Literature searches will be conducted using PubMed, Scopus, SPORTDiscus, Cumulative Index of Nursing and Allied Health Literature, Web of Science, Cochrane Central Register of Controlled Trials, and Scientific Electronic Library Online. The quality of the RCTs will be assessed using Cochrane’s risk of bias tool. A descriptive narrative synthesis and a random-effects model meta-analysis of the pooled event rate (prevalence) will be provided (p &lt; 0.05). This protocol is registered with PROSPERO: CRD42020199547.

Effect of moderate to high intensity aerobic exercise on blood pressure in young adults: The TEPHRA open, two-arm, parallel superiority randomized clinical trial

SummaryBackgroundExercise is advised for young adults with elevated blood pressure, but no trials have investigated efficacy at this age. We aimed to determine whether aerobic exercise, self-monitoring and motivational coaching lowers blood pressure in this group.MethodsThe study was a single-centre, open, two-arm, parallel superiority randomized clinical trial with open community-based recruitment of physically-inactive 18–35 year old adults with awake 24 h blood pressure 115/75mmHg-159/99 mmHg and BMI<35 kg/m2. The study took place in the Cardiovascular Clinical Research Facility, John Radcliffe Hospital, Oxford, UK. Participants were randomized (1:1) with minimisation factors sex, age (<24, 24–29, 30–35 years) and gestational age at birth (<32, 32–37, >37 weeks) to the intervention group, who received 16-weeks aerobic exercise training (three aerobic training sessions per week of 60 min per session at 60–80% peak heart rate, physical activity self-monitoring with encouragement to do 10,000 steps per day and motivational coaching to maintain physical activity upon completion of the intervention. The control group were sign-posted to educational materials on hypertension and recommended lifestyle behaviours. Investigators performing statistical analyses were blinded to group allocation. The primary outcome was 24 h awake ambulatory blood pressure (systolic and diastolic) change from baseline to 16-weeks on an intention-to-treat basis. Clinicaltrials.gov registered on March 30, 2016 (NCT02723552).FindingsEnrolment occurred between 30/06/2016-26/10/2018. Amongst the 203 randomized young adults (n = 102 in the intervention group; n = 101 in the control group), 178 (88%; n = 76 intervention group, n = 84 control group) completed 16-week follow-up and 160 (79%; n = 68 intervention group, n = 69 control group) completed 52-weeks follow-up. There were no group differences in awake systolic (0·0 mmHg [95%CI, -2·9 to 2·8]; P = 0·98) or awake diastolic ambulatory blood pressure (0·6 mmHg [95%CI, -1·4. to 2·6]; P = 0·58). Aerobic training increased peak oxygen uptake (2·8 ml/kg/min [95%CI, 1·6 to 4·0]) and peak wattage (14·2watts [95%CI, 7·6 to 20·9]) at 16-weeks. There were no intervention effects at 52-weeks follow-up.IntepretationThese results do not support the exclusive use of moderate to high intensity aerobic exercise training for blood pressure control in young adults.FundingWellcome Trust, British Heart Foundation, National Institute for Health Research, Oxford Biomedical Research Centre.

Can Walking Lower Blood Pressure in Adults?: A Cochrane Review Summary With Commentary.

Can Walking Lower Blood Pressure in Adults?: A Cochrane Review Summary With Commentary.

Exposure to barium and blood pressure in children and adolescents: results from the 2003-2018 National Health and Nutrition Examination Survey.

Barium (Ba) is ubiquitous in the environment, and humans are primarily exposed to it through ingestion of drinking water. Previous studies focused on the exposure to lead, cadmium, and arsenic, but have not focused on exposure to Ba. Recent studies found a significant association between Ba exposure and elevated blood pressure in pregnant women and adults. However, there are no studies regarding the effect of Ba exposure on blood pressure in children and adolescents, and the potential biological mechanisms remain unclear. We evaluated the associations between urinary Ba and systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) among 8- to 17-year-old participants (n = 3707) of the 2003-2018 National Health and Nutrition Examination Survey. Furthermore, the potential roles of inflammation in these associations were explored. Weighted linear regression was used to analyze the association between urinary Ba and blood pressure, and mediation analyses were used to estimate the potential role of white blood cell count (WBC) in these associations. Quantile g-computation models were used to explore the effect of co-exposure to Ba and other metals on blood pressure. After adjusting for covariates, a two-fold increase in urinary Ba concentration was associated with a 0.41 (95% CI 0.12, 0.70) mmHg increase in SBP, a 1.04 (95% CI 0.55, 1.53) mmHg increase in PP, but a -0.63 (95% CI -1.04, -0.22) mmHg decrease in DBP. WBC significantly mediated 6% of the association between urinary Ba and SBP. Quantile g-computation models suggested that urinary Ba was the main contributor to the elevation of SBP and PP in the urinary metal mixture. Our findings revealed that exposure to Ba was associated with elevated SBP and PP among children and adolescents. Inflammation may play an important role in the associations of Ba exposure with SBP.

Nicotinamide Riboside Supplementation for Treating Elevated Systolic Blood Pressure and Arterial Stiffness in Midlife and Older Adults.

BackgroundAging is the primary risk factor for cardiovascular diseases, the leading cause of death worldwide. Age-related increases in systolic blood pressure (SBP) link advancing age to cardiovascular disease risk. A key mechanism mediating the increase in SBP with aging is stiffening of the large elastic arteries, which occurs due to increases in oxidative stress, inflammation, and vascular smooth muscle tone. Nicotinamide adenine dinucleotide (NAD+) is a key molecule in energy metabolism and cellular functioning which declines with advancing age and chronic disease. Dietary supplementation with NAD+ precursors, such as nicotinamide riboside, boosts NAD+ bioavailability and may improve cardiovascular health. Here, we present the protocol for a randomized, controlled trial investigating the efficacy of 3 months of oral supplementation with nicotinamide riboside for decreasing SBP and arterial stiffness in midlife and older adults with initial above-normal (120–159 mmHg) SBP (ClinicalTrials.gov Identifier: NCT03821623). The primary outcome is casual (resting) SBP and secondary outcomes include 24-h SBP and aortic stiffness. Other outcomes include assessment of safety; tolerability; adherence; diastolic BP; systemic NAD+ bioavailability; and circulating biomarkers of oxidative stress, inflammation, and sympathoadrenal activity.MethodsA randomized, double-blind, placebo-controlled, single-site parallel-group design clinical trial will be conducted in 94 (47/group) midlife and older (age ≥ 50 years) adults with initial above-normal SBP. Participants will complete baseline testing and then will be randomized to either nicotinamide riboside (500 mg, 2×/day, NIAGEN®; ChromaDex Inc.) or placebo supplementation. Outcome measures will be assessed again after 3 months of treatment.DiscussionThis study is designed to establish the safety and efficacy of the NAD+ boosting compound, nicotinamide riboside, for reducing casual and 24-h SBP and aortic stiffness in midlife and older adults with above-normal SBP at baseline, a population at increased risk of cardiovascular diseases.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT03821623].

Utilizing stratified generalized propensity score matching to approximate blocked randomized designs with multiple treatment levels

ABSTRACT Conducting causal inference in settings with more than one treatment level can be challenging. Classical methods, such as propensity score matching (PSM), are restricted to only a binary treatment. To extend propensity score methods beyond a binary treatment, generalized propensity score methods have been proposed, with generalized propensity score matching (GPSM) standing as the multi-level treatment analog to PSM. One drawback of GPSM is it is only capable of emulating a completely randomized trial (CRT) design and not the more efficient blocked randomized trial design. Motivated by the desire to emulate the more efficient design, we expand on GPSM estimating literature and develop a new estimator incorporating relevant stratifying variables into the GPSM framework. We examine the variance estimation methods available for GPSM and demonstrate how to extend the estimator to one where stratifying variables are included. While it would be straightforward to include relevant stratifying variables as covariates in the propensity score estimation, our method provides for researchers to conduct retrospective analyses more consistently with the prospective experiment they would have designed if permitted. Namely, our method permits researchers to approximate a stratified randomized trial as opposed to the CRT otherwise obtainable by GPSM. We apply our proposed method to an analysis of how the number of children in a household affects systolic blood pressure in adults. We conduct a simulation study assessing how the relationship between response, treatment, and strata affect the performance of our method and compare the results to non-stratified GPSM.

MO1029: Is there a Relationship Between Fibroblast Growth Factor 23 and Blood Pressure in Children with Chronic Kidney Disease?

Abstract BACKGROUND AND AIMS Chronic kidney disease (CKD) is a complex medical and social problem worldwide due to high prevalence and mortality rates. According to the ESPN/ERA-EDTA, the prevalence of CKD stages 3–5 in children is about 55–60 pmarp [1]. Moreover, CKD usually causes different severe complications, including pathologic changes in the cardiovascular system, which significantly affect long-term survival. Unlike many complications of CKD, hypertension can be present in the earliest stages of the disease [2]. Nowadays, there has been a scientific and practical interest in Fibroblast growth factor 23 (FGF-23) which is mostly considered as a phosphate-regulating biomarker [3]. There are some speculations that FGF-23 affects blood pressure (BP) in adults due to the impact on the renin-angiotensin-aldosterone system (RAAS) by decreasing calcitriol [4] and the direct effect of FGF-23 on sodium reabsorption, which has been demonstrated in experimental models [5]. Therefore, the aim of our study was to investigate the link between FGF-23 and BP in children with CKD. METHOD There were 73 children with CKD stages 1–5, mean age was 9.79 ± 0.58 years. BP was determined by 3 times measurement and calculating the mean value. Received results were compared with percentile norms according to age and gender in order to divide patients into two groups: normotensive and hypertensive. FGF-23 was determined in serum by multimatrix ELISA kit (Biomedica Medizinprodukte GmbH, Austria). Statistical analysis was performed using SPSS version 26 (IBM, USA). RESULTS In the group with normal BP the median of FGF-23 in serum was 1.8 [0.7–3.4] pmol/L. In comparison, in the group with a hypertensive level of BP median indicator of FGF-23 was 7.6 (1.98–18.5) pmol/L (P &amp;lt; .001). The prevalence of elevated FGF-23 in children with high BP predominates 1.6 times [95% confidence interval (95% CI): 1.2–2.1]. It is also noticed that pulse BP positively correlated with FGF-23 level in serum (r = 0.402, P &amp;lt; .001). CONCLUSION Our findings confirm that FGF-23 is linked to BP in children with CKD what makes us conclude that more careful attention to children with a high level of FGF-23 is needed in relation to hypertension and as a consequence cardiovascular complications. However, more investigations should be done in order to establish a causal relationship.

Mediating effect of adulthood BMI/waist circumference on correlation between juvenile BMI/waist circumference and adulthood blood pressure

To analyze the relationship between juvenile body mass index(BMI)/waist circumference(WC) and adult blood pressure(BP), and to further explore the mediating role of adult BMI/WC in this association. Based on the data of China Health and Nutrition Survey(CHNS) from 1993 to 2015, 1313 subjects were selected, who participated in the survey both in juvenile(6-17 years old) and adult(18-35 years old). The mediating effect model was used to analyze the effect of adult BMI/WC in the association between juvenile BMI/WC and adult BP. There was a positive correlation between juvenile BMI/WC and adult systolic blood pressure [β(SE)_(adjusted)=0.10(0.03)/0.08(0.03)] and diastolic blood pressure [β(SE)_(adjusted)=0.13(0.03)/0.08(0.03)] with P &lt;0.01. Adult BMI/WC played partial mediating effect in the association between juvenile BMI/WC and adult systolic blood pressure and diastolic blood pressure: the percentage of mediating effect of BMI were 70.00%(95%CI 42.68%-73.33%)for SBP and 23.08%(95%CI 14.29%-26.32%) for DBP, the percentage of mediating effect of WC were 37.50%(95%CI 20.00%-41.67%)for SBP and 25.00%(95%CI 20.00%-35.71%) for DBP, respectively. There is a positive correlation between juvenile BMI/WC and adult BP, and adult BMI/WC might mediate the effect of juvenile BMI and WC on adult BP.

Repeated Exposure to Mild Intermittent Hypoxia Mitigates the Severity of OSA, Reduces Blood Pressure and Improves Microvascular Function and Walking Endurance in Adults with OSA for 4 ‐ 8 Weeks Post Therapy

ObjectiveWe previously reported that repeated exposure to mild intermittent hypoxia (MIH) improves autonomic function and lowers blood pressure (BP) in adults with hypertension and obstructive sleep apnea (OSA). We also showed that the reduction in BP was concurrent with an improvement in upper airway (UA) collapsibility that might lead to a reduction in the severity of OSA. However, whether mitigation of OSA severity occurs and whether decreases in BP and UA collapsibility are sustained for long periods of time is unknown. Moreover, whether improved microvascular (MV) function is coupled to reductions in BP following MIH is unknown in OSA. Improved MV function could lead to increased oxygen availability to skeletal muscles and improved exercise endurance. Thus, we investigated if MIH promotes long‐term positive effects on UA collapsibility, BP, MV function and walking endurance in adults with hypertension and OSA.MethodsTwo males (age: 46 ± 7 yrs; BMI: 32.5 ± 2.3 kg/m2; systolic BP: 158 ± 6 mmHg) with OSA [apnea hypopnea index (AHI): 55.7 ± 2.8 events/hr] were exposed to twelve 2‐min hypoxic episodes (PETO2 ≍ 50 mmHg) separated by 2‐min normoxic intervals with sustained PETCO2 maintained 2 mmHg above baseline for 15 days and were treated with in‐home continuous positive airway pressure on nightly basis throughout the study. The active critical closing pressure (Acrit), AHI, 24‐hr BP, BP variability, post‐occlusion reactive hyperemia (PORH), and fatigability (i.e. 10‐min walk test) were measured before and 1 day, 4 weeks and 8 weeks after exposure to MIH. Based on the small sample size, Cohen’s D effect sizes are reported. Data are expressed as Δ from baseline ± SE.ResultsSystolic BP was reduced 1 day after (17.2 ± 2.1 mmHg, d = 2.4), and 4 (12.8 ± 1.2 mmHg, d = 1.7) and 8 wks. (4.1 ± 0.7 mmHg, d = 0.5) after MIH. Likewise, improvements in autonomic function were evident at the three time points after MIH (HF norm: 23 ± 19, 8 ± 7 and 11 ± 5 n.u. LF norm: ‐26 ± 14, ‐10 ± 3 and ‐13 ± 3 n.u., d &gt; 0.8 for all measures). Acrit decreased (‐2 ± 0 cmH2O) following MIH and the magnitude of this response was sustained for 4 and 8 wks. after MIH (d = 0.7 for all measures). Similarly, the AHI decreased at the three time points (‐10 ± 1.5 events/hr, d = 3.1, ‐20 ± 3 events/hr, d = 7.2, ‐24 ± 0.9 events/hr, d = 5.2) after MIH. In addition, the PORH response increased immediately after the MIH protocol (12.6 ± 2.2%, d = 5.9) and remained elevated at 4 wks. post MIH (3 ± 0.7%, d = 3.6) before returning to baseline values 8 wks. after MIH. The 10‐min walking distance increased (217 ± 48 m, d = 3.9) and fatigability reduced (‐17 ± 3.4% reduction in d = 4.9) 1 day following the MIH protocol. These modifications were sustained for 4 wks. (+151 ± 9 m, ‐11 ± 0.3% respectively, both d &gt; 0.8) and 8 wks. (+86 ± 38 m, ‐6 ± 2% respectively, both d &gt; 0.8) after MIH.ConclusionOur preliminary results suggest that exposure to MIH improves UA collapsibility and reduces the severity of OSA. Likewise, BP is reduced, and MV function is improved leading to increased walking endurance in adults with OSA. These modifications may be sustained for up to 8 weeks.

Impact of COVID‐19 on Ambulatory Daytime and Nighttime Blood Pressure in Young Otherwise Healthy Adults

BackgroundCOVID‐19 has been shown to cause impairments in vascular function and elevations in resting sympathetic nerve activity in young otherwise healthy adults. Notably, our laboratory recently reported that persistence of COVID‐19 symptoms beyond the acute phase of the illness (i.e., beyond 4 weeks) was accompanied by macro‐ and micro‐ vascular dysfunction as measured by flow mediated dilation and reactive hyperemia, respectively. Interestingly, despite consistent reports of vascular alterations, no studies have reported changes in resting blood pressure (BP) following COVID‐19. One caveat is that BP has only been measured in the laboratory setting. Indeed, to date, no studies have assessed the effect of COVID‐19 on ambulatory BP, which allows for a complete assessment of daytime and nighttime BP without the potential for well known “white coat” effects on BP. Thus, we aimed to investigate the effect of COVID‐19 on 24‐hr ambulatory BP in young adults diagnosed with COVID‐19 within the preceding 6 months. We hypothesized that ambulatory BP would be greater in individuals who had COVID‐19 compared to controls who never had COVID‐19, and that those with symptoms would have higher BP compared to those who were asymptomatic at the time of testing.MethodsWe studied 21 young healthy adults who had a positive laboratory diagnosis of COVID‐19 (COVID: 23 ± 1 years [Mean ± SE]; 12 ± 1 [range: 4 to 22] weeks since diagnosis; 13 females) and 10 controls (23 ± 1 years, 6 females) who never had COVID‐19. Eleven individuals who had COVID‐19 were asymptomatic at the time of testing while 10 were symptomatic. Ambulatory BP was measured using the Oscar 2 oscillometric monitor (Sun Tech Medical). Participants were instructed to perform normal daily activities but not to perform any exercise during the 24‐hr period. Measurements were obtained every 20 min during daytime and every 30 min during nighttime. Average daytime, nighttime and 24‐hr systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were calculated.ResultsDaytime, nighttime, and 24‐hr BPs were not different between control and COVID subjects (P > 0.05 for all comparisons). Similarly, there were no differences in any of the BP assessments between control, asymptomatic or symptomatic COVID subjects (e.g., daytime SBP: control 122 ± 4; asymptomatic 119 ± 4; symptomatic 125 ± 2 mmHg, P = 0.451). Interestingly, in the COVID group, daytime, nighttime, and 24‐hr SBP, DBP, and MAP were inversely correlated with time since diagnosis (P < 0.05 for all with medium to large effect size). Multiple linear regression showed that after accounting for age, BMI, and physical activity (reported average exercise minutes/week), time since diagnosis was a significant predictor of daytime and 24‐hr SBP, DBP, and MAP (e.g., daytime SBP: P = 0.028, β coefficient = ‐0.697). For nighttime BP, time since diagnosis was a significant predictor only for SBP.ConclusionThese preliminary data suggest that the effect of COVID‐19 on ambulatory BP in young adults may be dependent on the time since diagnosis with higher daytime and nighttime BP present closer to the onset of the infection, which appeared to be independent of symptomology. Longitudinal follow up studies are warranted.

Effects of Transcendental Meditation on Blood Pressure: A Meta-analysis.

The World Health Organization estimates that 1.13 billion people worldwide have hypertension. Although pharmaceutical management of blood pressure is available, there are reasons why people prefer not to take medications including costs, adverse effects, and lack of access. Nonpharmacological healthy lifestyle methods are needed. One alternative method is transcendental meditation (TM). The purpose of this study was to quantitatively synthesize the effects of TM on blood pressure. In addition, we examined the moderator effects of participant, methods, and intervention characteristics. We searched 19 electronic databases without date restrictions to March 2021 including the gray literature and specific journals for primary studies evaluating TM to reduce blood pressure in adults and written in English. We coded primary studies for 5 categories (source, method, intervention, participant characteristics, and outcomes). Across 18 primary studies (N = 1207), TM mildly improved systolic blood pressure by -3.3 mm Hg (P = .025) and diastolic blood pressure by -1.8 mm Hg (P = .008) compared with comparison groups, but the effects waned after 3 months. Transcendental meditation reduced systolic blood pressure in samples that were 65 years and older significantly more than in samples that were younger than 65 years (-1.44 vs -9.87, P = .021) but showed no differential effect on diastolic blood pressure. Transcendental meditation mildly reduced blood pressure, but the effect waned after 3 months. Adults older than 65 years benefited more than younger adults. Transcendental meditation might be recommended as one aspect of a healthy lifestyle.

Effects of Prematurity and Growth Restriction on Adult Blood Pressure and Kidney Volume.

Gaining insight into the complex cycle of renal programming and its early-life clinical associations is essential to understand the origins of kidney disease. Prematurity and intrauterine growth restriction are associated with low nephron endowment. This increases the risk of developing hypertension and chronic kidney disease later in life. There is appreciable evidence to support mechanistic links between low nephron endowment secondary to intrauterine events and kidney size, kidney function, and blood pressure in postnatal life. A clear understanding of the cycle of developmental programming and consequences of fetal insults on the kidney is critical. In addition, the impact of events in the early postnatal period (accelerated postnatal growth, development of obesity, exposure to nephrotoxins) on the cardiovascular system and blood pressure of individuals born prematurely or with low birth weight is discussed. In summary, this review draws attention to the concepts of renal programming and nephron endowment and underscores the associations between intrauterine growth restriction, prematurity, and its clinical consequences in adult life.

Nighttime Blood Pressure Dipping is Attenuated in Young and Apparently Healthy Black Adults Compared to White Adults

In America, Black adults are 30% more likely to die from cardiovascular disease (CVD) compared to White adults, and more than half of this racial disparity in CVD‐related mortality may be attributed to the substantially greater prevalence of high blood pressure (BP) in Black adults. Furthermore, compared to White adults with hypertension, Black adults with hypertension are less likely to exhibit a nocturnal reduction in BP (i.e., “dipping”). Importantly, non‐dipping BP is associated with target organ damage and increased CVD risk. However, it is unclear whether young and apparently healthy Black adults exhibit reduced BP dipping compared to their White peers.PURPOSETherefore, the purpose of this preliminary investigation was to determine whether there are racial differences in BP dipping using ambulatory BP monitoring (ABPM), including 24‐hour‐, daytime‐, and nighttime‐BP, in young and apparently healthy Black and White adults.METHODSWe obtained clinical BP and 24‐hour ABPM readings in 10 self‐identified White adults (5M/5F; age: 21.6±4.4 yrs; BMI: 23.8±2.9 kg/m2; Mean±SD) and 7 self‐identified Black adults (3M/4F; age: 21.7±3.5 yrs; BMI: 25.1±2.8 kg/m2). The ABPM monitors were programmed to record BP every 20 and 30 minutes during each participants daytime‐ and nighttime‐period, respectively. True daytime‐ and nighttime‐BP periods were adjusted during analysis based upon participant activity logs. We defined “non‐dipping” as a failure to achieve a dipping ratio of &lt;0.90 (night‐to‐day BP ratio). BP data were compared using independent t‐tests and the Fisher’s exact test was used to compare dipping frequency between races (α=0.05).RESULTSClinically measured BP (systolic/diastolic) was not different (P&gt;0.05) between White (117±9/67±6 mmHg) and Black (124±12/70±9 mmHg) adults. There was also no difference (P&gt;0.05) in 24‐hour‐BP between White (117±11/66±7 mmHg) and Black (114±14/63±7 mmHg) adults. Likewise, daytime‐BP was not different (P&gt;0.05) between White (122±12/71±8 mmHg) and Black (116±14/66±8 mmHg) participants, nor was there a difference in nighttime‐BP (P&gt;0.05) between White (102±9/51±4 mmHg) and Black (105±13/54±7 mmHg) adults. However, systolic BP dipping was attenuated (P=0.04) in Black (0.90±0.05) compared to White (0.84±0.07) adults. Non‐dipping of systolic BP was observed in 5 of 7 Black participants and 2 of 10 White participants (P=0.06). Diastolic BP dipping in Black adults was 0.79±0.06 and White adults was 0.73±0.09 (P=0.05). Non‐dipping of diastolic BP was observed in 1 of 7 Black participants and 1 of 10 White participants (P=1.00).CONCLUSIONSThese preliminary data suggest that despite similar clinical and 24‐hour ambulatory BP compared to White adults, young and apparently healthy Black adults exhibit impaired BP dipping, which may contribute to increased likelihood of CVD.

Objectively Assessed Habitual Sleep Duration Is Associated with Peripheral and Central Blood Pressure in Non‐Hypertensive Young Adults

Habitual short sleep duration (&lt;6 hrs/night) has been reliably shown to predict higher blood pressure (BP) and hypertension in adults. However, most studies evaluating this association in free‐living adults (i.e., non‐experimental settings) have: 1. relied on subjective sleep duration estimates or actigraphy‐derived estimates spanning ≤7 days; 2. failed to consider central BP, which has been reported to provide greater insight into future cardiovascular risk as compared to peripheral BP; and 3. neglected to consider the influence of sleep duration the night prior to BP evaluation despite evidence that episodes of acute sleep loss (e.g., experimentally shortened sleep duration) increases peripheral BP values in young adults. Therefore, the purpose of the present study was to investigate the association between objectively measured habitual sleep duration (HSD) with peripheral and central BP in non‐hypertensive, non‐shift working, apparently healthy, young adults free of sleep disorders. This study also examined whether changes in sleep duration the night before BP measurement (ΔSD) influenced these relationships. We hypothesized that shorter HSD would significantly predict higher peripheral and central BP values, but that the association would be weakened after adjusting for ΔSD the night before assessment. Sleep duration (the total time scored as sleep between sleep onset and offset) was measured via wrist‐worn actigraphy for 14 consecutive nights (days 1‐14) and mean HSD was generated. Additionally, ΔSD was calculated as the difference between sleep duration the night before testing (day 14) and mean sleep duration across days 1‐13. On the morning following the final night of sleep monitoring (day 15), resting supine peripheral BP was measured, and central BP was estimated using pulse wave analysis. BP measures included systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP). The associations between HSD and peripheral and central BP values were evaluated using linear regression models of BP values. Regression models were further adjusted for ΔSD to determine whether this influenced these associations. The analytic sample consisted of 28 participants (11M/17F; 27±7 yrs). Mean HSD for the sample was 6.91±0.74 hours per night. ΔSD sleep was ‐25±53 minutes, indicating that on average, sleep duration was shorter the night before testing. Shorter mean HSD significantly predicted both higher peripheral BP (SPB: β= ‐6.44, SE= 2.11, p&lt; 0.01; DBP: β= ‐5.03, SE= 1.63, p&lt; 0.01; MAP: β= ‐5.42, SE= 1.63, p&lt; 0.01) and higher central BP (cSBP: β= ‐5.79, SE= 2.00, p&lt; 0.01; cDBP: β= ‐5.06, SE= 1.59, p&lt; 0.01; cMAP: β= ‐5.45, SE= 1.74, p&lt; 0.01) values. When models were adjusted for ΔSD, HSD remained a significant predictor of peripheral BP (SPB: β= ‐5.45, SE= 2.06, p= 0.01; DBP: β= ‐4.50, SE= 1.66, p= 0.01; MAP: β= ‐4.71, SE= 1.60, p= 0.01) and central BP (cSBP: β= ‐4.91, SE= 2.00, p= 0.02; cDBP: β= ‐4.57, SE= 1.62, p= 0.01; cMAP: β= ‐4.81, SE= 1.75, p= 0.01). Our findings support prior evidence that HSD plays a key role in peripheral BP regulation and newly demonstrate that HSD is also significantly inversely associated with central BP values. Acute alterations in sleep duration the night prior to BP evaluation has a minimal influence on the association between HSD and BP in young, otherwise healthy free‐living adults.

Lower blood pressure, but not muscle sympathetic nerve activity, in female compared to male adults during progressive central hypovolemia

INTRODUCTIONRapid adjustments in cardiac output and sympathetically‐mediated vasoconstriction are critical to prevent blood pressure (BP) from falling during central hypovolemia. Female adults have a reduced ability to tolerate central hypovolemia (i.e., orthostatic hypotension), potentially due to reduced sympathetically‐mediated vasoconstriction. However, there are minimal data evaluating sex differences in muscle sympathetic nerve activity (MSNA) during pre‐syncopal limited central hypovolemia. Therefore, the purpose of this study was to compare autonomic cardiovascular responses during central hypovolemia between sexes. We tested the hypothesis that young healthy female, compared to male, adults would have a lower tolerance to progressive hypovolemia, accompanied by attenuated MSNA responses.METHODSTwenty‐eight female (28±8 years old, 170±7 cm, 75±8 kg, BMI: 26±3 kg/m2) and 31 male (age: 30±5 years old, height: 176±6 cm, mass: 82±9 kg, BMI: 26±3 kg/m2) adults completed a staged lower‐body negative pressure (LBNP) protocol. The LBNP protocol started at minus 40 mmHg (LBNP40) and was further reduced by 10 mmHg every 3 minutes until the participant reached pre‐syncope. MSNA (radial nerve), heart rate, and BP were collected continuously throughout the protocol. LBNP tolerance was quantified as a cumulative stress index (mmHg*min) and was compared between sexes using a two‐tailed Mann‐Whitney test. MSNA, heart rate, and BP responses during LBNP were compared between sexes (LBNP stage [repeated measure] x sex) using mixed‐model analysis of variance tests.RESULTSConsistent with prior findings, female adults had a lower tolerance to progressive LBNP (female: 513±283 vs. male: 929±357 mmHg*min, p&lt;0.0001). Due to more females reaching pre‐syncope sooner in the protocol, we compared responses during the early stages of LBNP. At these early LBNP stages (LBNP40 &amp; LBNP50), significant interactions for heart rate and BP were observed (heart rate: p&lt;0.0001, BP: p=0.0464). Post‐hoc analyses revealed a significantly higher heart rate (98±20 vs. 82±15 bpm, p&lt;0.0001) and lower mean BP (80±11 vs. 87±7 mmHg, p = 0.0343) in females at LBNP50. However, MSNA burst frequency responses were not different between sexes at the assessed time points (female vs. male; Baseline: 14±9 vs. 17±10, LBNP40: 29±14 vs. 34±12, LBNP50: 34±16 vs. 35±16 bursts/min; sex: p=0.2685, interaction: p=0.2334, stage: p&lt;0.0001).DISCUSSIONConsistent with previous reports, this study demonstrated a lower tolerance to progressive central hypovolemia in female compared to male adults. However, contrary to our hypothesis, there was no difference in MSNA burst frequency between sexes, despite lower BP in female adults during the early stages of LBNP. These findings support the need for future studies to explore other mechanisms contributing to sex differences in tolerance to central hypovolemia.