Tertile Of Blood Pressure Research Articles

Associations of salivary aldosterone levels during pregnancy with maternal blood pressure and birth weight-for-gestational age in a Mexico City birth cohort.

To determine associations of maternal salivary aldosterone with blood pressure (BP) in pregnancy and infant birth weight-for-gestational age (BWGA). We measured maternal salivary aldosterone, BP and BWGA z-scores in 471 Mexico City pregnancy cohort participants and performed multivariable linear regression of BP and BWGA on log-aldosterone levels. Log-aldosterone was positively associated with diastolic BP (β = 0.12 95% CI: 0.04, 0.21). There were no main effects of log-aldosterone on BWGA. However, we detected an interaction between log-aldosterone and BP in association with BWGA; higher log-aldosterone was associated with lower BWGA in the lowest (β = -0.12, 95% CI: -0.26, 0.02) and highest (β = -0.12, 95% CI: -0.29, 0.06) BP tertiles. In contrast, in the middle BP tertile the association was positive (β = 0.09, 95% CI: -0.02, 0.20), p for interaction = 0.03. Higher maternal salivary aldosterone is positively associated with diastolic BP and may affect fetal growth differently depending on concurrent maternal blood pressure.

Sympathetic transduction of blood pressure during graded lower body negative pressure

IntroductionCross‐sectional work has demonstrated that participants with high resting muscle sympathetic nerve activity (MSNA) have lower resting sympathetic transduction of blood pressure (BP), and a larger proportion of sympathetic bursts firing above the BP set‐point (or mean BP). However, to date, most of these observations have been evaluated between participants with different levels of resting MSNA. The objective of the current study is to evaluate the influence of acute elevations in MSNA on sympathetic transduction of BP in young healthy adults using graded lower body negative pressure (LBNP). We hypothesize that sympathetic transduction will decrease during acute elevations in MSNA due to an increased proportion of MSNA bursts firing above the BP set‐point.MethodsTen (1 female) young healthy participants underwent 8 minutes of quiet rest, followed by a graded LBNP protocol consisting of 8‐minute stages at ‐10, ‐20, and ‐30mmHg. Beat‐to‐beat heart rate and BP were quantified using single‐lead electrocardiography and finger photoplethysmography, respectively, while MSNA was quantified using fibular nerve microneurography. Sympathetic transduction was quantified in the time (signal‐averaging) and frequency (MSNA‐diastolic BP low frequency [LF: 0.04‐0.15 Hz] transfer function magnitude) domains. Tertiles of diastolic BP were determined for each participant, and the proportion of MSNA bursts firings within each BP tertile were quantified.ResultsMSNA burst frequency increased progressively during graded LBNP (from 15±7 to 17±7, 22±7, and 27±9 bursts/min; P<0.01), while the proportion of MSNA bursts firing in the highest BP tertile remained stable (19±7, 18±9, 19±9, 19±7 %; P=0.72). Sympathetic transduction of BP was unchanged during LBNP (from 2.1±1.1 to 2.3±1.5, 2.1±1.2, and 2.0±1.1 mmHg; P=0.51), while the BP responses to non‐burst cardiac cycles decreased progressively (from ‐0.7±0.5 to ‐0.9±0.5, ‐1.0±0.4, and ‐1.4±0.7 mmHg; P<0.01). The difference between burst and non‐burst cardiac cycles (from 2.8±1.4 to 3.2±1.9, 3.1±1.5, and 3.4±1.3 mmHg; P=0.26) and the MSNA‐diastolic BP transfer function magnitude (from 0.14±0.09 to 0.14±0.06, 0.14±0.06, and 0.13±0.07 au/mmHg; P=0.40) were also unchanged during LBNP. Lastly, the change in the proportion of MSNA bursts firing in the largest BP tertile was associated with the change in signal‐averaged sympathetic transduction across each stage of LBNP (r= ‐0.79, ‐0.78, ‐0.81; P≤0.01).ConclusionSympathetic transduction of diastolic BP is unchanged during graded LBNP due to the heterogenous inter‐individual responses in the gating of bursts to diastolic BP. The proportion of bursts firing at high BPs are associated with changes in sympathetic transduction of BP. The determinants of gating MSNA burst occurrence by the arterial baroreflex and its capacity for modulation warrant further study.

Sympathetic transduction of blood pressure during graded lower body negative pressure in young healthy adults.

Sympathetic transduction of blood pressure (BP) is correlated negatively with resting muscle sympathetic nerve activity (MSNA) in cross-sectional data, but the acute effects of increasing MSNA are unclear. Sixteen (4 female) healthy adults (26 ± 3 years) underwent continuous measurement of heart rate, BP, and MSNA at rest and during graded lower body negative pressure (LBNP) at -10, -20, and -30 mmHg. Sympathetic transduction of BP was quantified in the time (signal averaging) and frequency (MSNA-BP gain) domains. The proportions of MSNA bursts firing within each tertile of BP were calculated. As expected, LBNP increased MSNA burst frequency (P < 0.01) and burst amplitude (P < 0.02), although the proportions of MSNA bursts firing across each BP tertile remained stable (all P > 0.44). The MSNA-diastolic BP low-frequency transfer function gain (P = 0.25) was unchanged during LBNP; the spectral coherence was increased (P = 0.03). Signal-averaged sympathetic transduction of diastolic BP was unchanged (from 2.1 ± 1.0 at rest to 2.4 ± 1.5, 2.2 ± 1.3, and 2.3 ± 1.4 mmHg; P = 0.43) during LBNP, but diastolic BP responses following nonburst cardiac cycles progressively decreased (from -0.8 ± 0.4 at rest to -1.0 ± 0.6, -1.2 ± 0.6, and -1.6 ± 0.9 mmHg; P < 0.01). As a result, the difference between MSNA burst and nonburst diastolic BP responses was increased (from 2.9 ± 1.4 at rest to 3.4 ± 1.9, 3.4 ± 1.9, and 3.9 ± 2.1 mmHg; P < 0.01). In conclusion, acute increases in MSNA using LBNP did not alter traditional signal-averaged or frequency-domain measures of sympathetic transduction of BP or the proportion of MSNA bursts firing at different BP levels. The factors that determine changes in the firing of MSNA bursts relative to oscillations in BP require further investigation.

Influence of Baseline Diastolic Blood Pressure on the Effects of Intensive Systolic Blood Pressure Lowering on the Risk of Stroke.

Guidelines recommend lowering systolic blood pressure below 130 mm Hg, irrespective of previous strokes. However, there is a concern that lowering systolic blood pressure in people with low baseline diastolic blood pressure might increase the risk of stroke. We conducted a secondary analysis of the Secondary Prevention of Small Subcortical Strokes trial that randomly assigned participants with a history of subcortical strokes to an intensive (<130 mm Hg; N=1519) or standard (130-149 mm Hg; N=1501) systolic targets. We examined the effects of blood pressure intervention on stroke and cardiovascular composite across the range of baseline diastolic blood pressure in spline regression models and tested for interaction of baseline diastolic blood pressure with the intervention on outcomes. Mean baseline systolic and diastolic blood pressures were 143±19 and 78±11 mm Hg, respectively. Within each baseline diastolic blood pressure tertile, the achieved diastolic was lower in the intensive versus standard arm. There were 275 stroke events over 10 889 years of follow-up. Lower baseline diastolic blood pressure was associated with increased risk of stroke in an observational spline regression model. Hazard ratios relating blood pressure intervention with the risk of stroke in the lowest (hazard ratio, 0.78 [95% CI, 0.52-1.16]) and the highest (hazard ratio, 0.80 [95% CI, 0.53-1.21]) baseline diastolic tertiles were similar (P=0.95). Results were similar for the cardiovascular composite. Intensive systolic control does not appear to increase the risk of stroke in those with low baseline diastolic blood pressure and prior stroke. URL: https://www. gov; Unique identifier: NCT00059306.

Intensive versus standard blood pressure control and vascular procedures: insights from the Systolic Blood Pressure Intervention Trial

Abstract Background The Systolic Blood Pressure Intervention Trial (SPRINT) found that intensive versus standard blood pressure control reduced cardiovascular (CV) morbidity and mortality. Previous studies have shown that control of blood pressure reduces the risk of stroke and is one of the most modifiable risk factors for carotid artery disease. On the other hand, data on effect of blood pressure control on peripheral artery disease are more diverse. In addition, it is unknown whether intensive blood pressure control affects the risk of vascular procedures. Purpose To assess the relationship between intensive blood pressure control and incident vascular procedures. Methods SPRINT was a randomized, controlled trial comprising 9,361 individuals ≥50 years of age at high CV risk but without diabetes who had a systolic BP (SBP) 130–180 mmHg. Patients were randomized to intensive (target SBP &amp;lt;120mmHg) or standard antihypertensive treatment (target SBP &amp;lt;140mmHg). The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, heart failure, or death from CV causes. The primary safety endpoint was the composite of serious adverse events. We examined the risk of composite and individual vascular procedures with intensive versus standard blood pressure control. We further examined subgroup heterogeneity using interaction analyses. Results During a median follow-up time of 3.3 years (range 0–5.5 years), a total of 174 (1.9%) composite vascular procedures were recorded. Intensive blood pressure control did not significantly reduce the risk of composite vascular procedures (intensive blood pressure control, 76 (1.6%) versus standard blood pressure control, 98 (2.1%), hazard ratio 0.76, 95% confidence interval, 0.57 to 1.03; P=0.08) (Figure 1). Similarly, the risks of the individual endpoints of carotid angioplasty, carotid endarterectomy, peripheral angioplasty or thrombolysis, lower extremity amputation for ischemia and gangrene, surgical or vascular procedure for abdominal aortic aneurysm, surgical or vascular procedure for thoracic aortic aneurysm, and surgical or vascular procedure for other problems were not significantly affected (P≥0.05 for all). Intensive blood pressure control reduced the risk of peripheral vascular surgery (intensive blood pressure control, 7 (0.2%) versus standard blood pressure control, 21 (0.5%), hazard ratio 0.33, 95% confidence interval, 0.14 to 0.77; P=0.01), though this was based on a small number of events. The safety and efficacy of intensive BP lowering was not modified by chronic kidney disease, age, sex, race, previous cardiovascular disease, or baseline systolic blood pressure tertile (P≥0.05 for all). Conclusions In SPRINT, intensive versus standard blood pressure control did not reduce the risk of composite incident vascular procedures. Figure 1. Vascular procedures Funding Acknowledgement Type of funding source: None

Elevated exercise blood pressure in middle-aged women is associated with altered left ventricular and vascular stiffness.

Women are at higher risk for developing heart failure with preserved ejection fraction (HFpEF). We examined the utility of peak exercise blood pressure (BP) in identifying preclinical features of HFpEF, namely vascular and cardiac stiffness in middle-aged women. We studied 47 healthy, nonobese middle-aged women (53 ± 5 yr). Oxygen uptake (V̇o2) and BP were assessed at rest and maximal treadmill exercise. Resting cardiac function and stiffness were assessed by echocardiography and invasive measurement (right heart catheterization) of left ventricular (LV) filling pressure under varying preloads. LV stiffness was calculated by curve fit of the diastolic portion of the pressure-volume curve. Aortic pulse-wave velocity was measured by arterial tonometry. Body fat was measured using dual-energy X-ray absorptiometry. Subjects in the highest exercise BP tertile had peak systolic BP of 201 ± 11 compared with 142 ± 19 mmHg in the lowest tertile (P < 0.001). Higher exercise BP was associated with increased age, percentage body fat, smaller LV size, slower LV relaxation, and increased LV and vascular stiffness. After adjustment, LV and arterial stiffness remained significantly associated with peak exercise BP. There was a trend toward increased body fat and slowed LV relaxation (both P < 0.07). In otherwise healthy middle-aged women, elevated exercise BP was independently associated with increased vascular stiffness and a smaller, stiffer LV, functional and structural risk factors characteristic for stages A and B HFpEF.NEW & NOTEWORTHY Women are at increased risk for heart failure with preserved ejection fraction (HFpEF) largely due to higher prevalence of arterial and cardiac stiffening. We were able to identify several subclinical markers of early (stages A and B) HFpEF pathophysiology largely on the basis of exercise blood pressure (BP) response in otherwise healthy middle-aged women. Exercise BP response may be an inexpensive screening tool to identify women at highest risk for developing future HFpEF.

Impact of Intensive Versus Standard Blood Pressure Management by Tertiles of Blood Pressure in SPRINT (Systolic Blood Pressure Intervention Trial).

Intensive systolic blood pressure (SBP) control improved outcomes in SPRINT (Systolic Blood Pressure Intervention Trial). Our objective was to expand on reported findings by analysis of baseline characteristics, primary outcomes, adverse events, follow-up blood pressure, and medication use differences by baseline SBP (tertile 1 [T1], <132; tertile 2 [T2], 132-145; and tertile 3 [T3], >145 mm Hg). Participants with higher baseline SBP tertile were more often women and older, had higher cardiovascular risk, and lower utilization of antihypertensive medications, statins, and aspirin. Achieved SBP in both treatment arms was slightly higher in T2 and T3 compared with T1 and fewer in the T3 groups achieved SBP targets compared with T1 and T2 groups. The primary composite outcome with intensive versus standard SBP treatment was reduced by 30% in T1, 23% in T2, and 17% in T3 with no evidence of an interaction (P=0.77). Event rates were lower in the intensive arm, and there was no evidence that this benefit differed by SBP tertile. There was no difference in the hazard for serious adverse events in any of the 3 tertiles. Medication utilization differed across the SBP tertiles at baseline with a lesser percentage of diuretics and angiotensin-converting enzyme inhibitors/angiotensin receptor blocker drugs in the higher tertiles-a finding that reversed during the trial. The beneficial effects of intensive SBP lowering were not modified by the level of baseline SBP. Within the parameters of this population, these findings add support for clinicians to treat blood pressure to goal irrespective of baseline SBP.

Relation of Blood Pressure to Severity of Pericardial Effusion

Subacute tamponade is a challenging diagnosis requiring careful consideration of both clinical and imaging data. We aimed at exploring the association of initial blood pressure with markers of pericardial effusion severity in patients with moderate and large pericardial effusion. We conducted a retrospective, single-center study in 102 well-phenotyped patients with moderate and large pericardial effusion. The presenting systolic and diastolic blood pressure recordings were divided into tertiles to examine the association between the blood pressure and the different established markers of pericardial effusion severity. On presentation, 42% of patients had systolic blood pressure exceeding 130 mmHg, and only 5% of patients had systolic blood pressure <90 mmHg. Patients in the lowest blood pressure tertiles did not differ significantly from patients in the upper tertiles in terms of clinical, etiologic, or echocardiographic characteristics. Although patients who underwent pericardial drainage had higher presenting heart rates, no significant differences were seen in the blood pressure recordings, either systolic or diastolic (mean 125 mmHg vs 130 mmHg, p = 0.36 and 76 vs 75 mmHg, p = 0.82, respectively). In conclusion, systolic and diastolic blood pressure recordings upon initial presentation do not demonstrate a significant association with markers of effusion severity or the need for drainage in patients with moderate and large pericardial effusion.

Office Pulse Pressure Is a Predictor of Favorable Outcome in Young- to Middle-Aged Subjects With Stage 1 Hypertension.

The role of pulse pressure in young individuals remains controversial. The aim of the present study was to investigate the clinical significance of elevated pulse pressure in young- to middle-aged subjects screened for stage 1 hypertension. We examined 1241 subjects (mean age, 33.1±8.4 years) from the HARVEST (Hypertension Ambulatory Recording Venetia Study), during a median follow-up of 12.1 years. To evaluate the predictive value of pulse pressure and mean blood pressure for future hypertension needing treatment and for cardiovascular events, participants were grouped into pressure tertiles. Significant determinants of pulse pressure were male sex (P=0.029), younger age (P<0.001), physical activity (P=0.003), heart rate (P<0.001), systolic white coat effect (P<0.001), and stroke volume (n=829; P<0.001). During follow-up, 65.1% of participants developed hypertension requiring pharmacological treatment and 5.1% experienced a cardiovascular event. Participants in the highest pulse pressure tertile had a reduced risk of incident hypertension compared with those of the bottom tertile (hazard ratio, 0.75; 95% confidence interval, 0.62-0.91; P=0.003). In contrast, participants in the top mean blood pressure tertile had an increase in risk (1.91; 1.57-2.33; P<0.001). In addition, participants in the highest pulse pressure tertile had a reduced risk of cardiovascular events (0.35; 0.17-0.73; P=0.005) and those in the top mean blood pressure tertile had an increase in risk (3.06; 1.32-7.09; P=0.009). Our data show that in subjects <45 years, only mean blood pressure is a predictor of adverse outcome whereas high pulse pressure even carries a reduced risk.

Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries.

BackgroundThe aim of our study was to evaluate the relationship of pulse pressure (PP), a raw index of arterial stiffness, with noninvasively determined coronary flow reserve (CFR) and its components, in patients with angiographically normal epicardial coronary arteries.Methods and ResultsThe study population included 398 patients without angiographic evidence of coronary stenosis, who underwent high‐dose dipyridamole stress echocardiography with transthoracic‐derived CFR evaluation on the left anterior descending artery. CFR was calculated as the ratio between high‐dose dipyridamole and resting coronary diastolic peak velocities. Patients were divided into 2 groups: the first group included the first and second PP tertiles (n=298, PP ≤60 mm Hg) and the second group included the highest PP tertile (n=100, PP >60 mm Hg). Mean blood pressure, systolic blood pressure (both P<0.0001), age (P<0.002), and left ventricular mass index (P=0.013) were higher in the highest PP tertile, which also showed higher resting coronary flow velocity (31.6±9.6 cm/s versus 27.7±6.4 cm/s, P<0.0001) and marginally lower CFR (2.5±0.6 versus 2.6±0.6, P=0.044). Hyperemic coronary flow velocity did not differ between the 2 groups. By separate multiple linear regression analyses, after adjusting for sex, age, the highest systolic blood pressure tertile (≥140 mm Hg), left ventricular mass index, and cardiovascular risk factors, the highest PP tertile was associated with resting coronary flow velocity (P=0.003) and only marginally with hyperemic coronary flow velocity (P<0.02), whereas its association with CFR was not significant.ConclusionsIn patients without epicardial coronary artery stenosis, the highest PP tertile is associated with an increased coronary flow velocity at rest.

Abstract 605: Diastolic Blood Pressure Predicts Coronary Plaque Volume in Patients With Coronary Artery Disease

Introduction: Hypertension is a major risk factor for coronary artery disease (CAD) and is associated with increased morbidity and mortality. The effect of systolic vs. diastolic blood pressure (BP) on coronary plaque volume has not been reported. Coronary blood flow occurs during diastole; shear stress affects plaque formation. Hypothesis: Diastolic BP may be a better predictor of plaque volume than systolic BP. Methods: 285 subjects with stable CAD underwent coronary computed tomographic angiography to assess the indexed volume (plaque volume [mm3] divided by segment length [mm]) of fatty, fibrous, non-calcified, calcified and total coronary plaque. Segments with significant calcium-blooming artifact were excluded. A backward linear regression model adjusted for age, gender, BMI, estimated glomerular filtration rate, total cholesterol, LDL-C, HDL-C and triglycerides. Results: Mean (SD) age was 63.1 ± 7.7 years (18% female). A significant increase was observed in volume of all plaque components across diastolic BP tertiles except for calcified which was borderline (p= 0.069) (Table). In contrast, there was no difference in systolic tertiles. In multivariate regression, diastolic BP tertile was a significant independent predictor of volume of all plaque components - fatty (β= 0.075; p=0.038), fibrous (β= 0.178; p= 0.004), non-calcified (β= 0.256; p= 0.008), calcified (β= 0.081; p= 0.007) and total (β= 0.353; p= 0.002) whereas no association was observed between systolic BP tertile and volume of any plaque component (Table). Conclusion: In patients with CAD, diastolic BP tertile independently predicts coronary plaque volume whereas systolic BP tertile does not. Since coronary blood flow occurs during diastole, a possible mechanism for the difference between systolic and diastolic BP is increased shear stress during diastolic blood flow. Therefore, control of diastolic BP may be an important factor in determining plaque volume.

Impact of pulse pressure on left ventricular global longitudinal strain in normotensive and newly diagnosed, untreated hypertensive patients.

Little is known about the impact of pulse pressure on left ventricular systolic function. The aim of our study was to evaluate whether high pulse pressure is associated with subclinical left ventricular systolic dysfunction. The study population included 143 participants (68 newly diagnosed, never-treated hypertensive, and 75 normotensive individuals) evaluated by echo-Doppler, including determination of global longitudinal strain (GLS) by speckle tracking. According to pulse pressure tertiles, participants were divided in two groups: the first group merging the first and second pulse pressure tertiles (n = 93, pulse pressure <55 mmHg) and the second group including the highest pulse pressure tertile (HPPT; n = 50, pulse pressure ≥55 mmHg). The two groups were comparable for sex, BMI, and heart rate, whereas age was higher in individuals with the HPPT (P < 0.0001). Left ventricular mass index was significantly higher in individuals with the HPPT (P < 0.01), with no significant difference in relative wall thickness. Among several indices of left ventricular systolic function, only GLS was lower in individuals with the HPPT (P < 0.001). Transmitral E/A ratio (P = 0.006) was lower and E/e' ratio higher (P < 0.001) in the HPPT group. By a multilinear regression analysis, HPPT (P < 0.020) and overweight (P = 0.025) were independent correlates of low GLS. Replacing HPPT with the highest systolic blood pressure tertile, GLS was independently associated with BMI (P = 0.040), but not with the highest systolic blood pressure tertile (P = 0.069). Elevated pulse pressure negatively influences left ventricular longitudinal mechanics in a mixed population of normotensive and untreated hypertensive individuals.

Efficacy and Safety of Ivabradine in Patients with Chronic Systolic Heart Failure and Low Blood Pressure in the SHIFT Trial

Background and objective: Recommended pharmacological agents used in chronic heart failure (HF) usually reduce blood pressure (BP) limiting their application and/or dose in a substantial number of patients. In the SHIFT trial in 61% of participants systolic BP was lower than 130 mmHg. Ivabradine reduces heart rate without impact on BP or myocardial function and improves major HF outcomes, as shown by the SHIFT trial. We investigated 1) the clinical profile and outcomes of the SHIFT population by baseline blood pressure tertiles, and 2) the efficacy and safety of ivabradine in these different BP groups. Methods and results: 6505 patients with chronic HF and LVSD (EF ≤35%) and a HF hospitalization during the previous year, in sinus rhythm, with heart rate ≥70 bpm, randomized to placebo or ivabradine (2.5 to 7.5 mg bid), were divided into tertiles according to baseline systolic BP (SBP): low <115 mmHg (n=2010), intermediate 115-130 mmHg (n=1968), and high SBP≥130 mmHg (n=2427). Multivariate Cox model analyses were performed to assess outcomes in the placebo groups and the treatment effect of ivabradine in the SBP tertiles. Low SBP patients were younger, had CAD less often, higher heart rate, and higher cardiovascular risk profile than the other 2 tertiles. Rate of beta-blocker prescription was similar in all groups, although the doses were lower in patients with low SBP (45% of patients received ≥50% of the target dose vs 63% of patients with SBP≥130 mmHg, P<0.001). ACE inhibitors were less prescribed in low SBP patients (76% vs 81% in patients with SBP≥130 mmHg; P<0.001). In the placebo arm the primary end point and its two components, CV death and HF hospitalization, were more frequent in the low SBP subgroup than in the high SBP subgroup (hazard ratio for primary end point: 1.54, P<0.001; CV death: 1.90, P<0.001; HF hospitalization: 1.60, P<0.001) but all these endpoints were reduced similarly by ivabradine in low SBP (RRR: 16%; 11%; 22%), intermediate SBP (RRR: 14%; 4%; 26%), and high SBP (RRR: 23%; 9%; 29%) tertiles (P interaction=0.68; 0.91; 0.79). The overall occurrence of adverse events was similar in the 3 subgroups. As expected, symptomatic or asymptomatic bradycardia and phosphenes occurred more frequently with ivabradine. Conclusions: SHIFT data confirm that the clinical profile and outcomes in HF patients are influenced by baseline blood pressure. However, the benefits and tolerability of ivabradine are similar irrespective of pre-treatment blood pressure.

Effects of glucose and blood pressure control on diabetic kidney disease in old patients with type 2 diabetes.

AimsWe determined the influence of age on the effects of glucose and blood pressure control on diabetic kidney disease in patients with type 2 diabetes.MethodsA total of 721 patients with type 2 diabetes, aged 41–85 years and with an estimated glomerular filtration rate (eGFR) ≥30 mL/ [min · 1.73 m2], were enrolled in this study between August 2001 and December 2002. All participants were followed up at our clinics until December 31, 2010. Primary outcomes were the development of end-stage renal disease (ESRD) and all-cause mortality. Secondary outcomes were the development of clinical albuminuria and a severe decline in eGFR.ResultsDuring the follow-up period (median: 8.3 years), 27 (3.7%) patients developed ESRD, 130 (18.0%) patients died without developing ESRD, and 16 (2.2%) patients died after developing ESRD. Mortality rate increased with age, but the incidence rate of ESRD did not. Poor glucose and blood pressure control was associated with the development of clinical albuminuria and with a severe decline in eGFR in younger patients with diabetes, but not in older patients. The development of severe decline in eGFR and ESRD was significantly lower in the middle tertile of blood pressure (i.e., SBP of 128–141 mm Hg) in older patients.ConclusionsAdequate glucose and blood pressure control did not reduce the risk of ESRD; however, it may have delayed the onset of clinical albuminuria as well as eGFR decline in younger patients with type 2 diabetes.Electronic supplementary materialThe online version of this article (doi:10.1186/1758-5996-6-81) contains supplementary material, which is available to authorized users.

Efficacy and safety of ivabradine in patients with chronic systolic heart failure and low blood pressure in the shift trial

Background and objective: Recommended pharmacological agents used in chronic heart failure (HF) usually reduce blood pressure (BP) limiting their application and/or dose in a substantial number of patients. In the SHIFT trial in 61% of participants systolic BP was lower than 130 mmHg. Ivabradine reduces heart rate without impact on BP or myocardial function and improves major HF outcomes, as shown by the SHIFT trial. We investigated 1) the clinical profile and outcomes of the SHIFT population by baseline blood pressure tertiles, and 2) the efficacy and safety of ivabradine in these different BP groups. Methods and results: 6505 patients with chronic HF and LVSD (EF ≤35%) and a HF hospitalization during the previous year, in sinus rhythm, with heart rate ≥70 bpm, randomized to placebo or ivabradine (2.5 to 7.5 mg bid), were divided into tertiles according to baseline systolic BP (SBP): low <115 mmHg (n=2010), intermediate 115-130 mmHg (n=1968), and high SBP≥130 mmHg (n=2427). Multivariate Cox model analyses were performed to assess outcomes in the placebo groups and the treatment effect of ivabradine in the SBP tertiles. Low SBP patients were younger, had CAD less often, higher heart rate, and higher cardiovascular risk profile than the other 2 tertiles. Rate of beta-blocker prescription was similar in all groups, although the doses were lower in patients with low SBP (45% of patients received ≥50% of the target dose vs 63% of patients with SBP≥130 mmHg, P<0.001). ACE inhibitors were less prescribed in low SBP patients (76% vs 81% in patients with SBP≥130 mmHg; P<0.001). In the placebo arm the primary end point and its two components, CV death and HF hospitalization, were more frequent in the low SBP subgroup than in the high SBP subgroup (hazard ratio for primary end point: 1.54, P<0.001; CV death: 1.90, P<0.001; HF hospitalization: 1.60, P<0.001) but all these endpoints were reduced similarly by ivabradine in low SBP (RRR: 16%; 11%; 22%), intermediate SBP (RRR: 14%; 4%; 26%), and high SBP (RRR: 23%; 9%; 29%) tertiles (P interaction=0.68; 0.91; 0.79). The overall occurrence of adverse events was similar in the 3 subgroups. As expected, symptomatic or asymptomatic bradycardia and phosphenes occurred more frequently with ivabradine. Conclusions: SHIFT data confirm that the clinical profile and outcomes in HF patients are influenced by baseline blood pressure. However, the benefits and tolerability of ivabradine are similar irrespective of pre-treatment blood pressure.

Predialysis Systolic Blood Pressure Evolution in Incident Hemodialysis Patients: Effects of the Dry Weight Method and Prognostic Value

Background: The relationship between predialysis blood pressure (BP) and hemodialysis (HD) patient outcomes is controversial. We report the evolution of predialysis BP in incident patients treated with the dry weight method and its relationship with patients’ outcomes. Methods: Between January 2000 and 2009, 308 patients started HD treatment. Fluid was progressively removed. The patients were encouraged to accept long-hour dialysis session and to follow a salt-restricted diet. BP and body weight (BW) were recorded and analyzed at start (week 1, W1) and weeks 8, 12, 26 and 52. Results: The predialysis systolic BP decreased from 142.1 at W1 to 130.7 mm Hg at W52. Postdialysis BW decreased from W1 to W8 (–5.0 ± 4.5%). It was correlated with the decrease of the predialysis systolic BP at W26 and W52. Whereas the patient survival was significantly lower in the lower predialysis systolic BP tertile at W1 like in previous reports calling this phenomenon ‘reverse epidemiology’, no relationship between predialysis BP levels and outcomes was found at W12, W26 and W52. The patients in the tertile of the greater predialysis systolic BP decrease at W12 had significantly better survival in the whole group and in hypertensive patients. This relationship remained significant in the Cox proportional-hazards analysis. Conclusions: Hence the dry weight method is efficient in decreasing the predialysis BP in incident HD patients. The initial BW decrease was correlated with BP decrease at W26 and W52. Early correction of BP by fluid removal erases the reverse epidemiology for BP and influences positively the patient survival.

The role of Dietary Approaches to Stop Hypertension (DASH) diet food groups in blood pressure in type 2 diabetes

The role of each Dietary Approaches to Stop Hypertension (DASH) diet component in blood pressure (BP) of patients with diabetes is still uncertain. The aim of the present study was to evaluate possible associations of the recommended food groups of the DASH diet eating plan with BP values in patients with type 2 diabetes. In the present cross-sectional study, 225 patients with type 2 diabetes (age 61·1 (SD 10·4) years; diabetes duration 13·1 (SD 9·1) years; males 48·4 %; BMI 28·5 (SD 4·3) kg/m(2); HbA1c 7·1 (SD 1·3) %; systolic BP 136·7 (SD 20·0) mmHg; diastolic BP 78·4 (SD 11·8) mmHg) without dietary counselling during the previous 6 months had their dietary intake assessed by 3 d weighed-diet records. Patients were divided into two groups according to BP tertiles: LOW BP (first tertile) and HIGH BP (second plus third tertiles). Multivariate logistic regression models demonstrated that the daily intake of 80 g of fruits per 4184 kJ (1000 kcal) (OR 0·781; 95 % CI 0·617, 0·987; P = 0·039) or 50 g of vegetables per 4184 kJ (1000 kcal) (OR 0·781; 95 % CI 0·618, 0·988; P = 0·040) reduced the chance of the presence of HIGH mean BP (MBP ≥ 92 mmHg) by 22 % each, adjusted for possible confounders. In conclusion, fruit and vegetables were the food groups of the DASH diet associated with reduced BP values in patients with type 2 diabetes, and their consumption might play a protective role against increased BP values.

Right ventricular dysfunction in early systemic hypertension: a tissue Doppler imaging study in patients with high-normal and mildly increased arterial blood pressure

To analyze the relationship between increasing systemic blood pressure (BP) and right ventricular (RV) function. Ninety-eight never-treated, nonobese patients with BP values varying from the optimal to the mild hypertensive range. Peak early diastolic (Em) and systolic (Sm) velocities were recorded at the tricuspid and mitral annuli by tissue Doppler imaging (TDI); global RV and left ventricular (LV) structure and function by conventional echo-Doppler sonography; insulin sensitivity by homeostasis model assessment (HOMA) index. Data were analyzed by 24-h systolic BP (cut-offs 117 and 130 mmHg), thus partitioning an optimal BP from an intermediate high-normal and an upper mildly increased BP stratum. Em decreased in the mid-third and decelerated further in association with reduced Sm in the upper BP tertile; both correlated negatively to septal thickness and positively to homologous TDI-derived LV indices. RV and LV indices of global ventricular function, estimated pulmonary pressure, HOMA did not differ by systemic BP. RV diastolic and systolic function deteriorates in response to slightly increased systemic BP. The process paralleled homologous changes at the LV side and was driven by interventricular septum remodeling, perhaps as a reflection of its role in RV function and biventricular interdependence. Insulin sensitivity seemed to play no relevant role.

Metabolic Profile (Blood Pressure, Lipids and Body Mass Index) in Relation to Breast Cancer Mortality.

Abstract Background: Metabolic profile (body mass, blood pressure, lipids) may affect biological mechanisms of importance for breast cancer. In the present study we have studied whether these factors are related to breast cancer mortality.Material and Methods: Within the Norwegian Counties Study, a population-based study (1974-2005), we identified 1364 female invasive breast cancer cases.Results: The 1364 cases had a mean age at diagnosis 57.5 years (range 27.1-79.4 years), mean body mass index (BMI) was 24.0 kg/m2, mean systolic blood pressure was 128.1 mmHg, mean diastolic blood pressure 78.6 mmHg, mean serum cholesterol was 6.17 mmol/L and mean HDL-cholesterol was 1.45 mmol/L. A total of 429 cases died during a mean follow-up of 8.2 years. Those with a BMI ≥30 kg/m2 had a 1.45 (CI, 1.07 to 1.95) higher risk of dying during the follow-up than women with a BMI of 18.5–25 kg/m2. Women in the highest tertile of blood pressure had a 43% increase in mortality compared to women in the lowest tertile of blood pressure (HR=1.43, 95% CI, 1.10 to 1.85). Additionally, women in the highest tertile of total cholesterol had a 29% increase in mortality compared to women in the lowest tertile (HR=1.29, 95% CI, 1.01 to 1.65).Conclusion: Our study supports a relationship between total mortality among breast cancer patients and metabolic profile. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3047.

Abstract 4897: Right Ventricular Diastolic Dysfunction in Upper-normal and Mildly Hypertensives: A Tissue Doppler Imaging Study

Background: Systemic hypertension is known to affect the right ventricle in addition to its wide-ranging effects on left ventricular structure and function. Whether upper-normal increments in systemic blood pressure (BP), sampled by ABPM, exert any effect on right ventricular function is, however, unknown at this point. Methods: Left (LV) and right ventricular (RV) diastolic longitudinal function were assessed by pulsed-wave TDI sampled at mitral (early:Em MIT and late:Am MIT ) and tricuspid (Em TRIC and Am TRIC ) annular level in a group of 98 (37F/61M, age: 46 ± 14yrs) otherwise normal subjects with office BP values ranging from the optimal (&lt; 120/80 mmHg) to the mild hypertensive (140–160/90–100 mmHg) range. RV free wall (FWT) and interventricular septum thickness (IVST), LV ejection fraction (EF), TRIC annulus plane systolic excursion (TAPSE, an index of RV systolic function), LV mass index (MI, g/m 2.7 ) were evaluated by standard methods. The sample was stratified by ascending 24-hr systolic(S) BP tertiles (cutoffs:117 and 130 mmHg, I:110 ± 7/68 ± 7, II:125 ± 4/77 ± 7, III:139 ± 7/87 ± 8 mmHg) and analyzed accordingly. Results : Em TRIC decreased significantly at each increasing 24-hr SBP stratum (I:15.9 ± 2.8, II:12. ± 3.1, III:10.9 ± 3.6 cm/sec, I vs II p &lt; 0.01, II vs III p &lt; 0.01) in parallel with consensual reductions in Em MIT (I:11.1 ± 2.8, II:8.7 ± 2.9, III:8.3 ± 2.6 cm/sec, I vs II &amp; III p &lt; 0.001). RVFWT (I:3.5 ± 0.6, II:4.0 ± 1.1, III:3.6 ± 0.9 mm, NS) and LVMI (I:38.6 ± 8.3, II: 41.3 ± 6.6, III: 43.0 ± 9.1 g/m 2.7 , NS) did not change in contrast to the graded, BP-related thickeness of IVS (I: 7.9 ± 1.1, II: 9.3 ± 1.25, III: 10.3 ± 1.34 mm, I vs II: p = 0.001, II vs III: p = 0.001). Intra-individually (n = 98), Em TRIC associated with 24-hr SBP (r =−0.52, p &lt; 0.001), IVST (r = −0.63, p &lt; 0.001) and Em MIT (r = 0.41, p &lt; 0.001) but only the two latter (IVST: t = 5.5, p &lt; 0.0001; Em MIT : t = 2.8, p = 0.006) were independent predictors of Em TRIC when entered in a multiple regression model. Conclusions : Systemic BP increments still within the normal range associate with echocardiographic evidence of RV diastolic longitudinal dysfunction. Interventricular septum thickening appears to be the main determinant of that behavior, possibly as an expression on interventricular dependence.