Blood Pressure In Normotensive Women Research Articles

The association between salt intake and arterial stiffness is influenced by a sex-specific mediating effect through blood pressure in normotensive adults: The ELSA-Brasil study.

High salt intake is known to increase blood pressure (BP) and also to be associated with carotid-femoral pulse wave velocity (cf-PWV). However, recent data showed a sex-specific pattern in the salt-induced rise of BP. Thus, we aimed to investigate whether the association between salt intake and arterial stiffness also has a sex-specific pattern. A total of 7755 normotensive participants with a validated 12-h overnight urine collection in which daily salt intake was estimated were included. cf-PWV, as well as clinical and anthropometric parameters, was measured. Salt intake positively correlated with cf-PWV, in which the linear regression was steeper in women than in men (0.0199±0.0045 vs 0.0326±0.0052m/s per gram of salt, P<.05). cf-PWV increases over the salt quartiles in men and women. However, after adjustment for confounders, the association remained significant only for men. In the path analysis, the direct path (men: 0.048 P<.001, women: 0.029 P=.028) was higher in men while that mediated by SBP (men: 0.020 P<.001, women: 0.034 P<.001) was higher in women. We clearly demonstrated that high salt intake has a direct and independent effect increasing arterial stiffness regardless of sex. Also, the association between salt intake and arterial stiffness is more dependent on BP in normotensive women than it is in normotensive men. These results highlight the need for a sex-specific approach in the evaluation of cardiovascular risk associated with dietary habits.

73: A randomized double-blinded placebo-controlled trial of nifedipine for acute tocolysis of preterm labor

Nifedipine is frequently used for acute tocolysis of preterm labor, despite there being no reports of its effectiveness compared to placebo. We sought to compare the effectiveness of nifedipine to placebo. We conducted a randomized, double-blind, placebo-controlled trial of nifedipine. Women ages 16-44 who had documented uterine activity and who were at risk of preterm birth were included if they had a singleton pregnancy with intact membranes between 28-0/7 and 33-6/7 weeks’ gestation and cervical dilatation between 2 and 4 cm. Women who consented to participate were randomized and received nifedipine 20 mg or placebo orally, then nifedipine 20 mg or placebo orally after 90 minutes if still contracting. Nifedipine 20 mg or placebo was continued orally every 4 hours after the first dose, for 48 hours. The protocol specified that a total of 150 patients be included, but after a pre-planned interim analysis, the Data Safety Monitoring Committee recommended discontinuation of the trial due to futility. The study was terminated after randomization of a total of 88 subjects with data available for analysis: 46 for nifedipine and 42 for placebo. Nifedipine did not affect blood pressure in normotensive women, but heart rates were significantly increased after the first 4 hours and at the end of the 48-hour window. Despite this physiologic effect, there were no statistically significant differences in the primary or prespecified secondary outcomes (Table). The rate of discontinuation for side effects did not differ. There were no stillbirths and no significant differences in neonatal outcomes. Acute tocolysis of preterm labor with nifedipine did not affect preterm birth rates, with the interim analysis demonstrating futility for study continuation.

Effects of two contraceptives containing drospirenone on blood pressure in normotensive women: a randomized-controlled trial.

Drospirenone (DRSP) is a progestogen derived from spironolactone with antimineralocorticoid action that seems to exert a favorable effect on blood pressure (BP); however, when associated with ethinylestradiol (EE), this effect does not seem to occur. This study aimed to assess possible differences in BP associated with the use of combined oral contraceptives containing DRSP with different doses of EE. This open-label parallel-group randomized clinical trial involved women randomized to use either 30 mcg of EE+DRSP (n=22) or 20 mcg of EE+DRSP (n=22). Daytime, nighttime, and 24-h BP were evaluated by ambulatory blood pressure monitoring at the beginning of the trial and 6 months after drug therapy. The groups were similar in terms of demographic characteristics. The mean 24-h systolic blood pressure and diastolic blood pressure (DBP) were similar between the groups before and after treatment (P>0.05). With respect to day and nighttime systolic blood pressure and DBP, no statistically significant difference was observed in BP values between the two groups either before or after treatment, except for the daytime DBP in the 30EE+DRSP group. In this group, a decrease of 2 mmHg (3%) in daytime DBP was observed after 6 months of drug therapy (P=0.04). There was no difference in BP associated with the use of combined oral contraceptives containing DRSP irrespective of the EE dose used.

Effects of hormone therapy on blood pressure.

Although hormone therapy remains the most efficacious option for the management of vasomotor symptoms of menopause, its effects on blood pressure remain unclear. This review scrutinizes evidence of the mechanisms of action of hormone therapy on signaling pathways affecting blood pressure and evidence from clinical studies. Comprehensive Ovid MEDLINE searches were conducted for the terms "hypertension" and either of the following "hormone therapy and menopause" or "selective estrogen receptor modulator" from year 2000 to November 2013. In vitro and physiologic studies did not reveal a clear deleterious effect of hormone therapy on blood pressure. The effect of oral therapy was essentially neutral in large trials conducted in normotensive women with blood pressure as primary outcome. Results from all other trials had several limitations. Oral therapy had a neutral effect on blood pressure in hypertensive women. Transdermal estrogen and micronized progesterone had a beneficial effect on blood pressure in normotensive women and, at most, a neutral effect on hypertensive women. In general, tibolone and raloxifene had a neutral effect on blood pressure in both hypertensive and normotensive women. Large randomized trials are needed to assess the effect of oral hormone therapy on blood pressure as a primary outcome in hypertensive women and the effect of transdermal preparations on both normotensive and hypertensive women. Transdermal preparations would be the preferred mode of therapy for hypertensive women, in view of their favorable physiologic and clinical profiles. The decision regarding the use of hormone therapy should be individualized, and blood pressure should be monitored during the course of treatment.

Renin‐Angiotensin System in Trained Hypertensive Women During Climacteric Period

BackgroundEpidemiological studies have shown that the incidence of cardiovascular diseases (CVD) in women increases dramatically during climacteric phase. However, the underlying mechanisms are not fully understood.AimsTo evaluate the components of renin‐angiotensin system (RAS: ANG I, ANG II, ANG‐(1‐7) and ACE activity at baseline and after aerobic exercise training in hypertensive comparing with age‐matched normotensive women.MethodsAerobic exercise training (AET) consisted of 24 sessions in treadmill, 3 times/week, 30/40 minutes for each session, iAnthropometric, cardiovascular and biomarkers parameters were measured.ResultsHypertensive women (HT) showed higher levels of Ang I, Ang II and Ang‐(1‐7), (232, Δ=240%; 365 Δ=90% and 320 pmol/mL, Δ=140%) as compared with normotensive group (NT). No changes were found in ACE activity at baseline for both groups. In the HT group, AET was effective in lowering blood pressure, systolic (5.4%) and diastolic (5.7%), accompanied by a reduction in Ang I and Ang II levels as well as increased activity of SOD and catalase, respectively. In the NT group, we found a reduction in systolic blood pressure accompanied by an increase in SOD activity and decrease in Ang II after AET. Ambulatory blood pressure monitoring showed a reduction in systolic blood pressure in normotensive women after AET that was accompanied by reduction in ACE activity.ConclusionsOur findings show that RAS is up‐regulated in HT women. In addition, AET was efffective in lowering blood pressure with significant reduction in RAS components in both groups.Financial Support: FAPESP

High-nitrate vegetable diet increases plasma nitrate and nitrite concentrations and reduces blood pressure in healthy women.

Epidemiological studies suggest that green leafy vegetables, which are high in dietary nitrate, are protective against CVD such as stroke. High blood pressure (BP) is a major risk factor for stroke and inorganic nitrate has been shown to reduce BP. The objective of the present study was to test the hypothesis that diets containing high-nitrate (HN) vegetables would increase plasma nitrate and nitrite concentrations and reduce BP in healthy women. A randomized, crossover trial, where participants received HN vegetables (HN diet) or avoided HN vegetables (Control diet) for 1 week. Before and after each intervention, resting BP and plasma nitrate and nitrite concentrations were measured. University of Exeter, UK. Nineteen healthy women (mean age 20 (sd 2) years; mean BMI 22·5 (sd 3·8) kg/m2). The HN diet significantly increased plasma nitrate concentration (before HN diet: mean 24·4 (sd 5·6) µmol/l; after HN diet: mean 61·0 (sd 44·1) µmol/l, P<0·05) and plasma nitrite concentration (before HN diet: mean 98 (sd 91) nmol/l; after HN diet: mean 185 (sd 34) nmol/l, P<0·05). No significant change in plasma nitrate or nitrite concentration was observed after the Control diet. The HN diet significantly reduced resting systolic BP (before HN diet: mean 107 (sd 9) mmHg; after HN diet: mean 103 (sd 6) mmHg, P<0·05). No significant change in systolic BP was observed after the Control diet (before Control diet: mean 106 (sd 8) mmHg; after Control diet: mean 106 (sd 8) mmHg). Consumption of HN vegetables significantly increased plasma nitrate and nitrite concentrations and reduced BP in normotensive women.

Effects of aerobic and resistance exercise intensities on 24-hours blood pressure in normotensive women

The present study aimed to determine the effect of the intensity of aerobic and resistance exercise on the 24h BP response in normotensive women. Twenty-four women (aged 33 ± 9 years) performed five experimental sessions in randomized order: CON - no exercise; AE50 - 50% of heart rate reserve (HRR); AE70 - 70% of HRR; RE40 - 40% of 1repetition maximum (RM) and RE70 - 70% of 1RM. Systolic and diastolic BP and HR measurements were measured during 24h post-exercise at the participant's workplace. The AE50, AE70 and RE40 sessions led to the greatest and longest-lasting effects on the SBP, which persisted for up to 24h. For the DBP, the experimental sessions led to similar results; post exercise hypotension was observed until 7h post-exercise, with the exception of the AE70 session, which produced effects that persisted for 24h. Results shows that both aerobic and resistance exercise performed during the morning can decrease the mean BP above the baseline lasting 24 hours during a normal daily work. The aerobic exercise performed around 50% of HRR can better regulate both systolic and diastolic BP in this population.

Gestational weight gain as a risk factor for hypertensive disorders of pregnancy

ObjectivePregnancy interventions to limit gestational weight gain (GWG) have been proposed as a means of preventing hypertensive disorders of pregnancy (HDP); however, it is currently unclear whether GWG has a causal influence on the development of HDP. Thus, we aimed to determine whether GWG in early pregnancy is a risk factor for preeclampsia and gestational hypertension and whether GWG precedes the increases in blood pressure in normotensive women across pregnancy.Study DesignWe examined repeat antenatal clinic measurements of weight and blood pressure (median of 12 and 14 per woman, respectively) of 12,522 women in the Avon Longitudinal Study of Parents and Children.ResultsGreater prepregnancy weight was associated with an increased risk of gestational hypertension and preeclampsia per 10 kg of prepregnancy weight: odds ratio (OR), 1.80; 95% confidence interval (CI), 1.70–1.91 and OR, 1.71; 95% CI, 1.49–1.95, respectively, for women weighing 90 kg or less before pregnancy; OR, 1.24; 95% CI, 1.03–1.49 and OR, 1.61; 95% CI, 1.18–2.19 for women weighing more than 90 kg. Fully adjusted odds ratios for gestational hypertension and preeclampsia per 200 g per week GWG up to 18 weeks were OR, 1.26; 95% CI, 1.16–1.38 and OR, 1.31; 95% CI, 1.07–1.62. In normotensive women, GWG in early pregnancy was associated positively with blood pressure change in midpregnancy and negatively with blood pressure change in late pregnancy. In all gestational periods, GWG was positively associated with concurrent blood pressure change. However, there was no evidence that blood pressure changes in any period were associated with subsequent GWG.ConclusionThese findings suggest that GWG in early pregnancy may be a potential target for interventions aimed at reducing the risk of HDP.

Combined oral contraceptive containing drospirenone does not modify 24-h ambulatory blood pressure but increases heart rate in healthy young women: prospective study

BackgroundHypertension is a primary cardiovascular risk factor. Oral contraceptives (OCs) may increase blood pressure and cardiovascular events. We evaluated whether an OC containing ethynylestradiol (EE) in association with the spironolactone-derived progestin drospirenone (DRSP) influences 24-h ambulatory blood pressure of normotensive women. Study DesignTwenty-four-hour blood pressure was measured every 30 min by an ambulatory blood pressure device in 18 normotensive healthy women prior to and after 6 months of use of an OC containing 30 mcg EE and 3 mg DRSP. ResultsOC induced no modification in 24-h, nighttime and daytime blood pressure. Heart rate increased about 4 beats/min in the 24-h (p<.05) and daytime (p<.02) measurements. ConclusionsIn normotensive women, an OC containing 30 mcg EE plus 3 mg DRSP does not modify blood pressure, and significantly increases 24-h and daytime heart rate. These data suggest a neutral effect on hypertension-associated cardiovascular risk and point out an unreported effect on heart rate of which cause and effect require further evaluation.

Vasomotor hot flushes and 24-hour ambulatory blood pressure in normotensive women: A placebo-controlled trial on post-menopausal hormone therapy

Background. Blood pressure (BP) is one of the most powerful determinants of cardiovascular risk in women. This risk may differ between post-menopausal women with and without vasomotor hot flushes, possibly indicating different vascular responses to hormone therapy (HT). Thus, we compared in a clinical trial the effect of HT on ambulatory BP in normotensive, recently post-menopausal women with or without severe hot flushes.Methods. A total of 147 women recorded prospectively their hot flushes for 2 weeks; 70 women were symptomatic (≥7 moderate/severe hot flush episodes/day), whereas 77 women were defined as asymptomatic (≤3 mild hot flush episodes/day). Women were treated for 6 months with either transdermal estradiol, oral estradiol with or without medroxyprogesterone acetate, or placebo.Results. In symptomatic women decreases in BPs were seen during estradiol use. In contrast, in asymptomatic women receiving oral but not transdermal estradiol, increases in 24-h and day-time systolic and diastolic BPs were encountered.Conclusion. Hot flushes modify the HT-mediated responses in ambulatory BP. In asymptomatic women oral but not transdermal estradiol show potentially harmful cardiovascular effect by increasing BP. Our results give additional justification to prescribing HT primarily for the treatment of troublesome hot flushes and avoiding HT in women without vasomotor symptoms.

Home Blood Pressure Levels in Pregnant Women with Chronic Hypertension

Objective: To explore the difference between office and home blood pressure (BP) monitoring in normotensive and hypertensive pregnant women. Methods: We compared the mean of 1 week home BP with office BP, measured by aneroid devices, in 20 normotensive women (68 BP assessments) and 100 women with mild essential chronic hypertension without superimposed gestational hypertension (429 BP assessments). Different approaches were used including the Bland-Altman method to investigate the discrepancies between office and home BP. Results: Systolic office BP in normotensive women (p = 0.004) and diastolic office BP in hypertensive women (p = 0.001) were lower than home BP. The concordance between office and home BPs was better for diastolic BP than for systolic BP. Only a small number of hypertensive women presented home BP ≥135/85 mm Hg. Conclusions: In our study population, the concurrence between office and home BPs is good with the exception of systolic BP in normotensive women. Home blood pressure measurement criteria used in nonpregnant individuals are not adequate in pregnancy.

The Effects of Resistance Training on Resting Blood Pressure in Women

The purposes of this study were to document the effects of a 20-week resistance training (RT) program or resistance training plus walking (RT/W) program on resting blood pressure in 28 moderately obese women, and to compare resting blood pressures of 42 women of various fitness levels and states of RT. The subjects in the training study were 28 moderately obese women, and the subjects in the cross-sectional study were 42 women of various fitness levels and states of RT. For all subjects, resting blood pressure was measured on 2 consecutive days in a semirecumbent position. Results from the training study showed no significant changes in blood pressure as a result of RT or RT/W. In the cross-sectional study, no significant difference in systolic blood pressure occurred among highly (HRT), moderately (MRT) or untrained (UNT) subjects. Diastolic blood pressure (DBP) was significantly lower in the HRT group when compared with either the MRT or UNT groups, whereas DBP was not different between the MRT and UNT groups. Both the training and cross-sectional studies of this investigation demonstrate that RT is not associated with a chronic increase in resting blood pressure in normotensive women. The cross-sectional study suggests that highly RT individuals might even be at reduced risk for hypertension.

G13 Influence of oral contraceptive pill on ambulatory blood pressure in normotensive women

G13 Influence of oral contraceptive pill on ambulatory blood pressure in normotensive women

Seasonal Variation in Blood Pressure in Normotensive Women Studied by Home Measurements

1. The factors influencing the seasonal variation in blood pressure measured at home in normotensive women were examined. 2. Sixteen female subjects (56.3 +/- 7.9 years old, mean +/- SD) measured their blood pressure and pulse rate at home each morning for more than 20 times per month for at least 1.5 years. Blood pressure and body weight were also determined in the office once or twice a month in that period. Monthly means of outdoor and indoor temperatures and daytime length were obtained from the Meteorological Observatory. The single cosinor method was used to evaluate circannual rhythm. 3. We observed a biphasic seasonal variation in self-recorded blood pressure measured at home, environmental temperature and daytime length but found no apparent seasonal variation in body weight and blood pressure measured in the office. The lowest levels of systolic and diastolic blood pressure measured at home were observed in July. The longest daytime length was recorded in June, while the highest outdoor temperature and indoor temperature were recorded in August, indicating that the longest daytime length preceded and the highest environmental temperature lagged behind the lowest level of blood pressure. The shortest daytime length is in December. The lowest outdoor and indoor temperature were observed in January, while the highest levels of self-recorded systolic blood pressure and diastolic blood pressure were in January and December, respectively. Half-amplitudes of self-recorded systolic and diastolic blood pressure were 2.6 +/- 1.0 mmHg and 2.0 +/- 0.8 mmHg, respectively. 4. These findings indicate the importance of a seasonal effect, i.e. daytime length and the environmental temperature, on the blood pressure of individuals.

The effect of resistance training on blood pressure in normotensive women

The purpose of the present study was to determine whether conventional resistance training alters 24-h ambulatory and manually determined casual blood pressure of normotensive women. Seven individuals (23 +/- 2 years old) trained 2 days week-1 for 20 weeks emphasizing the hip and knee extensor muscle groups. Three sets to exhaustion of the knee extension, squat, knee flexion and leg press exercises were performed. The load for each exercise represented approximately 80-85% of the one-repetition maximum. Average values for 24-h ambulatory blood pressure were not different (P greater than 0.05) pre- and post-training (systolic, 107 +/- 4 vs. 109 +/- 1 mmHg; diastolic, 73 +/- 2 vs. 71 +/- 2 mmHg). Ambulatory values over 8-h segments of the 24 h (day, evening, night) and casual resting determinations of blood pressure were also not affected. The lack of change in blood pressure cannot be explained by an insufficient training response. Knee extensor strength during dynamic or isokinetic actions increased (approximately 43%, P less than 0.05). In addition, biopsies from the vastus lateralis muscle showed an increase (P less than 0.05) in average muscle fibre cross-sectional area of 32%. This hypertrophic response was further substantiated by an increase (P less than 0.05) in lean body mass (41.2 +/- 1.3 kg to 43.4 +/- 1.5 kg). These results indicate that resistance training, which increases muscular strength, muscle fibre area and lean body mass, does not alter ambulatory or casual blood pressure. Thus, the concern that conventional resistance training may chronically elevate blood pressure does not appear warranted, at least in normotensive women.

The Effect of Phenylpropanolamine on 24-Hour Blood Pressure in Normotensive Subjects Administered Indomethacin

We evaluated the effect of phenylpropanolamine hydrochloride (PPA) in 14 young, healthy, normotensive women who concurrently received indomethacin. Subjects received sustained-release (SR) indomethacin 75 mg bid and were randomly assigned to receive double-blind SR PPA 75 mg/d or placebo for four days. After a six-day washout period, subjects were crossed over to the opposite four-day double-blind treatment. Following an additional six-day washout period, subjects received indomethacin placebo and PPA placebo during a final, single-blind four-day period. Twenty-four-hour blood pressure (BP) monitoring every 30 minutes and a 24-hour urine collection for prostaglandin E2 (PGE2) were performed on the fourth day of each treatment period. Compliance with the medication regimen was confirmed by drug concentrations, pill counts, and urinary PGE2 concentrations. Compared with the indomethacin and placebo treatment periods, the combination of indomethacin and PPA had no significant effect on mean systolic or diastolic BP during the 24-hour study period or during any four-hour interval. We conclude that the combination of SR PPA 75 mg/d and SR indomethacin 150 mg/d for four days has no adverse effect on BP in normotensive women.

Effect of a monounsaturated diet vs. a polyunsaturated fatty acid‐enriched diet on blood pressure in normotensive women and men

The effect on blood pressure of monounsaturated and (n-6)polyunsaturated fatty acids was studied under strict dietary control in normotensive subjects. For 17 days 31 women and 27 men received a control diet providing 19.3% of energy as saturated fat. Then subjects were randomized over two test diets: one diet provided 15.1% of energy from monounsaturated and 7.9% from polyunsaturated fatty acids ('mono diet'), and the other diet provided 10.8% from monounsaturated and 12.7% from polyunsaturated fatty acids ('poly diet'). Saturated fat intake was now 12.8% on both diets. Mean blood pressure at the end of the control period was 116/69 mmHg for the mono group and 117/73 mmHg for the poly group. After 5 weeks on the test diet, blood pressure was 115/67 mmHg for the mono group and 117/72 mmHg for the poly group (difference in changes between the two diet groups was not significant). These findings suggest that at a high fat intake, linoleic acid, when providing more than 7.9% of energy intake, does not influence blood pressure relative to oleic acid in normotensive women and men.

Oral contraceptives and responsiveness of plasma renin activity and blood pressure in normotensive women.

In young normotensive women (5 without and 5 with chronic oral contraceptives (= o.c.) cardiovascular homeostasis was challenged by isoproterenol and ergometer exercise, at normal and at resitricted sodium intake. Blood pressure and plasma renin activity (= PRA) did not differ between the 2 groups. Plasma renin substrate was markedly elevated in the o.c. group. Sodium restriction induced similar changes in body weight, urinary sodium excretion, systolic blood pressure and PRA; diastolic blood pressure decreased only in the non-o.c. group (by 6 mm Hg). In both groups isoproterenol and exercise induced similar changes in heart rate and blood pressure, except that after sodium restriction both stimuli caused larger decreases in diastolic blood pressure in the o.c. group. At both levels of sodium intake, PRA increased slightly less during exercise in the o.c. group; following restriction PRA response to isoproterenol was significantly less in the o.c. group. These results indicate that following chronic use of o.c. PRA responsiveness is normal or somewhat blunted. The different responses of diastolic blood pressure to sodium restriction and subsequent isoproterenol or exercise point to subtle changes in the inter-action of aodium and pressor mechanisms during chronic o.c. use.