Clinic Systolic Blood Pressure Research Articles

#654 Double-blind randomised controlled trial of nitrate-replete beetroot juice on blood pressure in autosomal dominant polycystic kidney disease

Abstract Background and Aims Hypertension in autosomal dominant polycystic kidney disease is in part mediated by reduced polycystin-regulated nitric oxide synthase activity. In this study, the hypothesis that beetroot juice (BRJ, a rich natural dietary source of nitrate) reduces blood pressure in hypertensive autosomal dominant polycystic kidney disease (ADPKD) patients was evaluated. Method Stable hypertensive patients (n = 60) with ADPKD (eGFR > 30 mL/min/1.73 m2) were randomised (1:1) to either nitrate-replete BRJ (400 mg nitrate/day) or nitrate-deplete BRJ for 4 weeks. Patients and investigators were blinded to the allocation. The primary endpoints were changes in systolic and diastolic clinic blood pressure between baseline and at 4 weeks. The secondary endpoints were serum nitrate/nitrite levels, daily home blood pressure and albuminuria. Results Serum nitrate/nitrite increased 3.6-fold in the nitrate-replete compared to the nitrate-deplete group (p < 0.01). Both groups had similar baseline characteristics. After 4 weeks, clinic systolic and diastolic blood pressure significantly declined in both nitrate-replete and nitrate-deplete BRJ groups compared to baseline (systolic blood pressure: −5.36 vs. −7.65 mmHg; diastolic blood pressure: −3.55 vs. −2.73 mmHg; P < 0.05). Other secondary endpoints, treatment adherence, discontinuations and adverse effects were similar in both groups. Conclusion Increasing serum nitrate with BRJ did not lower blood pressure in hypertensive patients with ADPKD. The blood pressure reduction in both groups could be due to non-nitrate phytonutrients in BRJ and/or placebo-associated effects. These data further emphasise the importance of healthy eating and regular monitoring of blood pressure in patients with ADPKD.

Effects of acute carotid baroreceptor stimulation on sympathetic nerve traffic in resistant and uncontrolled hypertension: a systematic review and meta-analysis.

In resistant hypertensive patients acute carotid baroreflex stimulation is associated with a blood pressure (BP) reduction, believed to be mediated by a central sympathoinhbition.The evidence for this sympathomodulatory effect is limited, however. This meta-analysis is the first to examine the sympathomodulatory effects of acute carotid baroreflex stimulation in drug-resistant and uncontrolled hypertension, based on the results of microneurographic studies. The analysis included 3 studies assessing muscle sympathetic nerve activity (MSNA) and examining 41 resistant uncontrolled hypertensives. The evaluation included assessment of the relationships between MSNA and clinic heart rate and BP changes associated with the procedure. Carotid baroreflex stimulation induced an acute reduction in clinic systolic and diastolic BP which achieved statistical significance for the former variable only [systolic BP: -19.98 mmHg (90% CI, -30.52, -9.43), P < 0.002], [diastolic BP: -5.49 mmHg (90% CI, -11.38, 0.39), P = NS]. These BP changes were accompanied by a significant MSNA reduction [-4.28 bursts/min (90% CI, -8.62, 0.06), P < 0.07], and by a significant heart rate decrease [-3.65 beats/min (90% CI, -5.49, -1.81), P < 0.001]. No significant relationship was detected beween the MSNA, systolic and diastolic BP changes induced by the procedure, this being the case also for heart rate. Our data show that the acute BP lowering responses to carotid baroreflex stimulation, although associated with a significant MSNA reduction, are not quantitatively related to the sympathomoderating effects of the procedure. This may suggest that these BP effects depend only in part on central sympathoinhibition, at least in the acute phase following the intervention.

The Risk of Atrial Fibrillation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Objective: To evaluate the role of acute exacerbation of COPD in the risk of atrial fibrillation. Study Design: Cross sectional study design.Place and Duration of Study: The study was conducted at Bakhtawar Amin Hospital Multan and Recep Tayyip Erdogan Hospital Muzaffargarh, Pakistan from March 2022 to March 2023.Methods: The patients with acute, hypercapnic chronic obstructive pulmonary disease(COPD) exacerbation were included in the study. A total of 200 patients were analyzed. Baseline data including demographic and clinical details, blood tests, ABG, systolic and diastolic blood pressure, ECG, pulmonary function test, and transthoracic echocardiography were recorded.Results: Of 200 patients, 40(20%) had an episode of paroxysmal atrial fibrillation (AF). Atrial fibrillation was more prevalent in cases with lower FEV1 (P&lt;.05). In addition, it was also more common in cases with higher PaCO2 (P&lt;.05). Atrial Fibrillation was significantly higher in cases with larger LA diameters (34.1 ± 2.3 mm vs 46.1 ± 2.3 mm, P&lt;.05), area (22.8 ± 4.1 cm2 vs 34.1 ± 5.1 cm2, P&lt;.05) and higher PASP (36.1 mmHg ± 2.2 vs 46.4 mmHg ± 3.7, P&lt;.05). RA area was larger in patients with AF and COPD compared to those without AF (25.6 ± 5.1cm2 vs 30.2 ± 6.4 cm2, P&lt;0.05). These findings suggest COPD patients are at increased risk of AF and require measures to reduce the risk. These data will be helpful for further investigation and development of strategies to prevent AF morbidities in COPD patients.Conclusion: In patients with acute exacerbations of chronic obstructive pulmonary disease, blood gas fluctuations, hemodynamic alterations, and abnormal pulmonary functions can lead to an increased risk of atrial fibrillation. How to cite this: Razzaq MA, Atif M, Ullah U, Mehmood M, Irfan M, Sardar K. The Risk of Atrial Fibrillation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Life and Science. 2024; 5(2): 132-137. doi: http://doi.org/10.37185/LnS.1.1.487

ENDOVASCULAR RADIOFREQUENCY RENAL DENERVATION IN DIFFICULT TO TREAT ARTERIAL HYPERTENSION: A SINGLE CENTER EXPERIENCE

Objective: To assess safety and effectiveness of catheter-based renal denervation (RDN) for reduction of blood pressure (BP) in patients with difficult to treat arterial hypertension. Design and method: Thirtyfive patients selected with difficult to treat arterial hypertension, underwent RDN. Secondary forms of hypertension were excluded, and an appropriate renal artery anatomy was confirmed in all patients. Every patient underwent follow-up at 30 days, and then every 12 months, consisting in clinical examination, office BP measurements, ambulatory blood pressure monitoring, and biochemical analysis. At 12 months tansthoracic echocardiography and renal duplex sonography were performed. Results: The median value of systolic clinic BP decreased from 161 mmHg (25th-75th percentiles 158 - 191) at baseline to 144 mmHg (25th-75th percentiles 136 - 153) at follow up (p= 0.012), and the median value of diastolic clinic BP decreased from 102 mmHg (25th-75th percentiles 94 - 122) at baseline to 90 mmHg (25th-75th percentiles 78 - 99) at follow-up (p= 0.012). The number of medications changed from 5 (range 2-8) at baseline to 3.3 (range 0-6) at follow up. A significant decrease of left ventricular mass index from a median of 160 g/m2 (25th-75th percentiles 147 - 151) at baseline to 126 g/m2 (25th-75th percentiles 107 - 151) at follow-up (p= 0.043) was detected. The renal function did not demonstrate significant changes, however plasma renin activity and HOMA index were significantly reduced. No periprocedural or long term complications were observed. Conclusions: Our data confirm that RDN may constitute an effective and safe therapeutic choice for the treatment of difficult to treat hypertension.

Abstract P422: Lifestyle Intervention Improved Blood Pressure and Cardiovascular Disease Biomarkers in Patients With Chronic Kidney Disease and Resistant Hypertension: Insights From the TRIUMPH Randomized Clinical Trial

Introduction: Evidence is limited regarding the effect of lifestyle modification on health outcomes in patients with chronic kidney disease (CKD). Hypothesis: We hypothesized that lifestyle modification involving the DASH diet, exercise and weight loss would improve blood pressure (BP) and cardiovascular disease (CVD) biomarkers in CKD patients with resistant hypertension. Methods: The Treating Resistant Hypertension Using Lifestyle Modification to Promote Health (TRIUMPH) trial randomized patients with resistant hypertension to either a 16-week cardiac rehabilitation (CR) facility-based lifestyle modification program involving thrice weekly aerobic exercise and weekly classes on DASH diet and behavioral weight loss (C-LIFE) or to a standard education and physician advice (SEPA) control condition. We conducted a secondary analysis involving participants with CKD. CKD was defined as having eGFR &lt;60 mL/min/1.73 m 2 or albuminuria at baseline. Primary outcome was mean change in clinic systolic BP. Secondary outcomes were mean changes in clinic diastolic BP, 24-hour ambulatory BP, and CVD biomarkers including baroreflex sensitivity (BRS), high-frequency heart rate variability, flow-mediated dilation, pulse wave velocity, and left ventricular mass index. Results: Ninety-seven (69%) of 140 TRIUMPH participants were considered to have CKD. Mean age was 62 years, 57% self-identified as Black race, 67% were male, and the majority (82%) had CKD stage 3. Participants with CKD randomized to C-LIFE achieved greater reduction in clinic SBP and greater improvement in BRS compared to SEPA. There were no differences between groups in ambulatory BP or other CVD biomarkers. Conclusions: A structured 16-week diet, exercise and weight management program conducted in a CR setting improved BP and resting BRS in resistant hypertension patients with CKD. Future studies are needed to confirm the beneficial effect of multi-component lifestyle modification on CVD biomarkers in CKD and to determine the persistence of benefit over time.

Effect of Azilsartan on clinical blood pressure reduction compared to other angiotensin receptor blockers: a systematic review and meta-analysis

Background: Hypertension has significantly contributed to morbidity and mortality, necessitating effective management. Angiotensin receptor blockers (ARBs) have emerged as a cornerstone in hypertension treatment. Azilsartan, a relatively recent addition to the ARB family, offers unique characteristics, including prodrug activation. This systematic review and meta-analysis aimed to evaluate Azilsartan’s role in reducing clinical blood pressure compared to other ARBs and determine the most effective dosage. Methods: Following PRISMA guidelines, a comprehensive literature search was conducted in Medline, Web of Science, Cochrane Library, and clinicaltrials.gov. Eligible studies included adult hypertensive patients receiving Azilsartan compared to other ARBs, with clinical systolic blood pressure (SBP) and diastolic blood pressure (DBP) outcomes. Data extraction and quality assessment were performed, and statistical analysis employed comprehensive meta-analysis (CMA) software. Results: Eleven randomized controlled trials encompassing 18 studies involving 6024 patients were included. Azilsartan demonstrated significant reductions in clinical SBP (mean difference=−2.85 mmHg) and DBP (mean difference=−2.095 mmHg) compared to other ARBs. Higher doses of Azilsartan showed greater efficacy, with 80 mg exhibiting the most substantial reduction in SBP. The analysis emphasized the need for more studies investigating lower Azilsartan doses (10 and 20 mg). Conclusion: This systematic review and meta-analysis underscore Azilsartan’s effectiveness in reducing SBP and DBP. Dose-dependent effects emphasize the importance of optimal dosing when prescribing Azilsartan. These findings provide valuable insights for clinicians in managing hypertension effectively and call for further research, primarily focusing on lower Azilsartan doses and a more diverse patient population.

Biological response of nonhuman primates to controlled levels of acute blood loss.

The global shortage of human blood for medical use has prompted the development of alternative blood sources. Nonhuman primates (NHPs) are commonly used owing to their physiological similarities to humans. The objective of the current study was to establish a controlled-blood-loss model in NHPs to explore their clinical and biological responses. Blood was sequentially withdrawn from 10 cynomolgus monkeys (10, 14, 18, 22, and 25% of the total blood volume); their vital signs were monitored, and blood parameters were serially analyzed. Humoral mediators in the blood were measured using flow cytometry and enzyme-linked immunosorbent assays. In NHPs subjects to 25% blood loss and presenting with related clinical symptoms, the systolic blood pressure ratio on day 0 after bleeding was significantly lower than that of the animals from the other groups (median: 0.65 vs. 0.88, P = 0.0444). Red blood cell counts from day 0-14 and hematocrit levels from day 0-7 were markedly decreased relative to the baseline (P < 0.01). These parameters showed a direct correlation with the extent of blood loss. The levels of creatine phosphokinase, aspartate aminotransferase, and alanine aminotransferase exhibited increases in response to blood loss and had a stronger correlation with the hemoglobin ratio than the volume of blood loss. The levels of C3a and C4a, as well as interleukin (IL)-1α and IL-15, displayed a strong correlation, with no apparent association with blood loss. The findings of the present study showed that only NHPs with 25% blood loss exhibited clinical decompensation and significant systolic blood pressure reduction without fatalities, suggesting that this level of blood loss is suitable for evaluating blood transfusion efficacy or other treatments in NHP models. In addition, the ratio of hemoglobin may serve as a more dependable marker for predicting clinical status than the actual volume of blood loss. Thus, our study could serve as a basis for future xenotransfusion research and to predict biological responses to massive blood loss in humans where controlled experiments cannot be ethically performed.

The effects of opium consumption on severity of disease on hospitalized COVID-19 patients in East of Iran, a prospective cohort study.

There are few theories and little empirical evidence about the bilateral impact of substance use and coronavirus disease 2019 (COVID-19), so a logical and accurate picture of this area is required. We investigated the effects of opium use on severity of disease on hospitalized COVID-19 patients in east of Iran. Demographic and clinical characteristics, vital signs, laboratory tests, mortality rate, type and duration of opium consumption in hospitalized patients who recovered from COVID-19 in the follow-up after 3 months were evaluated. In this study, 60 (20%) participants were the opium user and 251 (80%) were the non-user patients. Based on clinical symptoms, hypertension and systolic blood pressure in opium user were significantly higher than non-user patients (p < 0.05). In the laboratory tests, only the level of urea was higher in the opium positive group (37 [26.5-48.5] vs. 32 [23-43], respectively) and the percent of lymphocytes were lower in the opium positive (17 [8.2-25.8] vs. 18.7 [13.85-26.35], respectively). The initial therapies of both opium positive and negative infected patients showed not any significant changes (p > 0.05). Among the studied groups, one deceased case with COVID-19 was related to a drug user patient. Although, uses of opium reduced the levels of some risk factors, vital signs at admission and initial therapies during hospitalization in COVID-19 patients but it increased lung and heart diseases. Also, the severity of COVID-19 including hospitalization and mortality were associated with opium consumption.

Homoeopathic management of essential hypertension: A narrative review

Objectives: Hypertension (HTN) or elevated blood pressure is a serious medical condition that significantly increases the risk of heart, brain, kidney, and other diseases. HTN in an adult is said to be present when clinical systolic and diastolic blood pressure exceed 140 mm and 90 mm of hg, respectively. An estimated 1.28 billion people aged 30–79 years have HTN worldwide, most (two-thirds) living in low- and middle-income countries (World Health Organization). Homoeopathy can be useful in managing HTN and its complications, for which a proper knowledge of treatment modalities available in homoeopathy is essential. Materials and Methods: An intensive search of articles, publications, and writings, both online and offline, dealing with the management of essential HTN through homoeopathy was conducted between November 2021 to January 2022. Databases such as Google Scholar, PubMed, ScienceDirect, and various other published books, literature, and anecdotes in homoeopathy were explored, collecting data on the role of homoeopathy in essential HTN. Emphasis was on words such as homoeopathy, HTN, and blood pressure. Results: Management of essential HTN through homoeopathy can be broadly divided into two categories. First, drugs or medicines given in homoeopathic literature, such as Materia Medicas and Repertories, whose choice of administration in HTN depends on the classical methods of prescription, and secondly, drugs or medicines obtained from research outcomes on HTN. Conclusion: In homoeopathic therapeutics, many medicines are available and used in cases of essential HTN. Recently, research activities targeted toward managing HTN through homoeopathy have increased, and data have been generated. Even then, the available data till now are not sufficient in bringing homoeopathy equivalent or near to the conventional system of medicine in managing HTN demands; in turn, more research works in homoeopathy with statistical rigour.

Preeclampsia Prediction Using Machine Learning and Polygenic Risk Scores From Clinical and Genetic Risk Factors in Early and Late Pregnancies.

Preeclampsia, a pregnancy-specific condition associated with new-onset hypertension after 20-weeks gestation, is a leading cause of maternal and neonatal morbidity and mortality. Predictive tools to understand which individuals are most at risk are needed. We identified a cohort of N=1125 pregnant individuals who delivered between May 2015 and May 2022 at Mass General Brigham Hospitals with available electronic health record data and linked genetic data. Using clinical electronic health record data and systolic blood pressure polygenic risk scores derived from a large genome-wide association study, we developed machine learning (XGBoost) and logistic regression models to predict preeclampsia risk. Pregnant individuals with a systolic blood pressure polygenic risk score in the top quartile had higher blood pressures throughout pregnancy compared with patients within the lowest quartile systolic blood pressure polygenic risk score. In the first trimester, the most predictive model was XGBoost, with an area under the curve of 0.74. In late pregnancy, with data obtained up to the delivery admission, the best-performing model was XGBoost using clinical variables, which achieved an area under the curve of 0.91. Adding the systolic blood pressure polygenic risk score to the models did not improve the performance significantly based on De Long test comparing the area under the curve of models with and without the polygenic score. Integrating clinical factors into predictive models can inform personalized preeclampsia risk and achieve higher predictive power than the current practice. In the future, personalized tools can be implemented to identify high-risk patients for preventative therapies and timely intervention to improve adverse maternal and neonatal outcomes.

Home versus Clinic Blood Pressure Monitoring: Evaluating Applicability in Hypertension Management via Telemedicine.

Hypertension is a significant public health concern in Saudi Arabia, affecting 28.6% of the population. Despite the availability of effective treatments, optimal blood pressure control is not always achieved, highlighting the need for effective management strategies. This study aimed to evaluate the applicability of home, compared to clinic, blood pressure measurements for managing hypertension in the Qassim region of Saudi Arabia. The study included 85 adults undergoing antihypertensive treatment. Home blood pressure measurements were obtained during the day and the evening using automated oscillometric sphygmomanometers, whereas clinic measurements were taken during clinic hours. Home blood pressure readings were significantly lower than clinic blood pressure readings, with mean differences of 20.4 mmHg and 4.1 mmHg for systolic and diastolic blood pressures, respectively. There was a positive correlation between the clinic systolic and diastolic blood pressures (r = 0.549, p < 0.001) and a weak correlation between the daytime home and clinic systolic blood pressures (r = 0.218, p < 0.05). This study provides insight into the applicability of home blood pressure monitoring, which may aid in the development of more effective hypertension management strategies, particularly the use of morning home blood pressure monitoring to aid treatment decisions through telehealth medicine.

Transforming blood pressure control in primary care through a novel remote decision support strategy based on wearable blood pressure monitoring: The NEXTGEN-BP randomized trial protocol

Despite high blood pressure being the leading preventable risk factor for death, only 1 in 3 patients achieve target blood pressure control. Key contributors to this problem are clinical inertia and uncertainties in relying on clinic blood pressure measurements to make treatment decisions. The NEXTGEN-BP open-label, multicenter, randomized controlled trial will investigate the efficacy, safety, acceptability and cost-effectiveness of a wearable blood pressure monitor-based care strategy for the treatment of hypertension, compared to usual care, in lowering clinic blood pressure over 12 months. NEXTGEN-BP will enroll 600 adults with high blood pressure, treated with 0 to 2 antihypertensive medications. Participants attending primary care practices in Australia will be randomized 1:1 to the intervention of a wearable-based remote care strategy or to usual care. Participants in the intervention arm will undergo continuous blood pressure monitoring using a wrist-wearable cuffless device (Aktiia, Switzerland) and participate in 2 telehealth consultations with their primary care practitioner (general practitioner [GP]) at months 1 and 2. Antihypertensive medication will be up-titrated by the primary care practitioner at the time of telehealth consults should the percentage of daytime blood pressure at target over the past week be <90%, if clinically tolerated. Participants in the usual care arm will have primary care consultations according to usual practice. The primary outcome is the difference between intervention and control in change in clinic systolic blood pressure from baseline to 12 months. Secondary outcomes will be assessed at month 3 and month 12, and include acceptability to patients and practitioners, cost-effectiveness, safety, medication adherence and patient engagement. NEXTGEN-BP will provide evidence for the effectiveness and safety of a new paradigm of wearable cuffless monitoring in the management of high blood pressure in primary care. ACTRN12622001583730.

Leveraging Electronic Health Record Technology and Team Care to Address Medication Adherence: Protocol for a Cluster Randomized Controlled Trial.

Low medication adherence is a common cause of high blood pressure but is often unrecognized in clinical practice. Electronic data linkages between electronic health records (EHRs) and pharmacies offer the opportunity to identify low medication adherence, which can be used for interventions at the point of care. We developed a multicomponent intervention that uses linked EHR and pharmacy data to automatically identify patients with elevated blood pressure and low medication adherence. The intervention then combines team-based care with EHR-based workflows to address medication nonadherence. This study aims to describe the design of the Leveraging EHR Technology and Team Care to Address Medication Adherence (TEAMLET) trial, which tests the effectiveness of a multicomponent intervention that leverages EHR-based data and team-based care on medication adherence among patients with hypertension. TEAMLET is a pragmatic, cluster randomized controlled trial in which 10 primary care practices will be randomized 1:1 to the multicomponent intervention or usual care. We will include all patients with hypertension and low medication adherence who are seen at enrolled practices. The primary outcome is medication adherence, as measured by the proportion of days covered, and the secondary outcome is clinic systolic blood pressure. We will also assess intervention implementation, including adoption, acceptability, fidelity, cost, and sustainability. As of May 2023, we have randomized 10 primary care practices into the study, with 5 practices assigned to each arm of the trial. The enrollment for the study commenced on October 5, 2022, and the trial is currently ongoing. We anticipate patient recruitment to go through the fall of 2023 and the primary outcomes to be assessed in the fall of 2024. The TEAMLET trial will evaluate the effectiveness of a multicomponent intervention that leverages EHR-based data and team-based care on medication adherence. If successful, the intervention could offer a scalable approach to address inadequate blood pressure control among millions of patients with hypertension. ClinicalTrials.gov NCT05349422; https://clinicaltrials.gov/ct2/show/NCT05349422. DERR1-10.2196/47930.

CORRELATION BETWEEN CLINIC AND AMBULATORY BLOOD PRESSURE MEASUREMENT

Objective: Blood pressure (BP) measurements taken in the clinic provide limited information about the BP load. Ambulatory blood pressure monitoring (ABPM) provide a more comprehensive assessment of blood pressure over the course of a day. This study examined the correlation between clinic and ambulatory BP measurements. Design and method: We collated clinic and 24 hour ambulatory BP data of 100 patients aged &gt; 18 years from the outpatient cardiology clinic of Mohamed Taher Maamouri University hospital in Nabeul (n = 100) over a six months period (July-December 2021). Laying of ABPM was performed using a Bravo Mini validated device from Sun Tech Medical. We used the Pearson correlation coefficient (r) to measure the strength of the relationship between these two measurements methods. Results: The mean age of our population was 59.14±13.12 years (range 21-92 years), composed of 47 women and 53 men. The most frequent reason for carrying out ABPM was the monitoring of hypertensive patients in 84% of cases, 16% were done to confirm the diagnosis of hypertension. ABPM confirmed the diagnosis of hypertension in 62.5% and detected 18.75% isolated nocturnal hypertension in patients with suspected hypertension and 14.3% masked uncontrolled nocturnal hypertension in hypertensive patients. Concordance was found in 66% of cases between clinic measurement and the 24-hour ABPM data. There was a weak correlation between clinic systolic BP and 24-hour ambulatory systolic BP (P &lt;0.001; r = 0.349; Curve A) and moderate correlation between clinic diastolic BP and 24-hour ambulatory diastolic BP (P &lt;0.001; r = 0.566; Curve B). Conclusions: The correlation between these two methods isn’t important mainly explained by variation of BP especially at night detected by ABPM which remains the reference method for diagnosing and monitoring hypertension

24HOUR, HOME AND CLINIC BLOOD PRESSURE FOR THE PREDICTION OF LEFT VENTRICULAR HYPERTROPHY IN UNTREATED HYPERTENSIVE POPULATION

Objective: The aim of this study was to investigate which way of measuring blood pressure (BP), clinic, home or 24h-ABPM, can predict better left ventricular hypertrophy in the untreated hypertensive population. Design and method: 175 consecutive subjects (42% male) aged 57.9±14.9 years were included in the study. Subjects were never treated before for hypertension. All subjects underwent 24h-ABPM on a usual working day. Home BP monitor was provided to all patients for 7 days, while office BP was measured in the clinic using a mercury sphygmomanometer. Left ventricular hypertrophy was evaluated by a cardiologist with the use of a 3D echocardiography. Results: In the univariate analysis, only home systolic and diastolic BP were independently associated with left ventricular hypertrophy, while both clinic and 24hour systolic and diastolic BP found not to be. From ROC curves for left ventricular hypertrophy, AUC of home systolic BP monitor (0.758, p&lt;0.05) was larger than that of 24h (0.538, p&gt;0.05) and clinic BP (0.497, p&lt;0.05). As regards DBP, the ROC curves suggest no discrimination for the different ways of BP measurement. Conclusions: Home systolic BP can be a better predictor of left ventricular hypertrophy in untreated population, when compared to 24h and office systolic BP. This result shows the importance of home monitoring for the prediction of left ventricular hypertrophy, even in the untreated population.

Monitoring of the regulatory ability and regulatory state of the autonomic nervous system and its application to the management of hypertensive patients: a study protocol for randomised controlled trials

IntroductionMany causes lead to sympathetic-vagus imbalance, which promotes the development of hypertension and accelerates the process of target organ damage. Many studies have shown that exercise training and heart rate...

THE DIFFERENCE IN BLOOD PRESSURE BETWEEN THE TUNNEL BLOOD PRESSURE MONITORS IN THE WAITING AREA AND UPPER ARM BLOOD PRESSURE MONITORS IN THE CLINIC

Objective: Tunnel blood pressure as an out-of-clinic screening program is often more casual, and its consistency with office blood pressure dominated by upper arm blood pressure and whether it can replace office blood pressure remains unclear. The aim of this study was to analyze the differences between the two blood pressure measurements. Design and method: The study dates from the Majiapu community, which is a big community in Beijing. We analyzed blood pressure with different measurements containing tunnel (waiting area,9002P) and upper arm (clinic, OMRON 1120U) blood pressure measurements. We compare the two measurements by the mean average value and standard deviation (SD) of the two measurements. Besides, we compare the mean blood pressure in the subgroups which contain the age, sex, blood lipids, blood glucose, and different blood pressure levels. Results: In this study, a cohort of 35069 individuals aged 0 to 105 years, 19443 were randomly assigned to the tunnel blood pressure measurement group (TBPG) and 15626 to the upper arm blood pressure measurement group (UBPG). The qualified rate of the UBPG was 64.76% in 140/90 mm Hg and 54.66% in 130/80 mm Hg. In baseline, the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 134.0±21.3 mm Hg and 76.3±12.0 in the TBPG, 134.9±22.3 mm Hg and 80.3±12.5 in the UBPG. In the age more than 60 years subgroup, the mean SBP in the TBPG with 139.0±21.1 mm Hg was similar to the other group, which was 138.5±22.4 mm Hg, the mean DBP was on the contrary, which was 74.8±11.4 and 79.6±11.9 mm Hg respectively. Similar results can be found in the age&lt; 60 years, sex, blood lipids, and blood glucose subgroups. In the BP more than 140/90 mmHg subgroup, the SBP difference was only 0.1 mmHg, but the DBP was 5 mmHg, as same as the BP more than 130/80 mmHg subgroup. The DBP difference was much smaller in the low BP level. Conclusions: The clinic SBP for the tunnel (waiting area) and upper arm (clinic) blood pressure monitors were similar, but the DBP differ significantly between the two groups.

Using urinary metabolomics to identify metabolic pathways linked to cardiac structural alterations in young adults: The African-PREDICT study

Background and aimsRisk factor exposure from young ages was shown to contribute to cardiovascular events - cardiac hypertrophy, which may be accompanied by an altered metabolism. To determine how early metabolic alterations associate with myocardial structural changes, we profiled urinary metabolites in young adults with cardiovascular disease (CVD) risk factor(s) and a control group without CVD risk factors. Methods and resultsWe included healthy adults (N = 1202), aged 20–30 years, stratified based on risk factors, i.e., obesity, physical inactivity, elevated blood pressure (BP), hyperglycemia, dyslipidemia, low socio-economic status, smoking and excessive alcohol use - forming the CVD risk group (N = 1036) and the control group (N = 166). Relative wall thickness (RWT) and left ventricular mass index (LVMi) were measured using echocardiography. Targeted metabolomics data were obtained using a liquid chromatography-tandem mass spectrometry method. Clinic systolic BP, 24 h BP and RWT were higher in the CVD risk group compared to the control group (all P ≤ 0.031). Exclusively in the CVD risk group, RWT associated with creatine and dodecanoylcarnitine; while LVMi associated with glycine, serine, glutamine, threonine, alanine, citrulline, creatine, proline, pyroglutamic acid and glutamic acid (all P ≤ 0.040). Exclusively in the control group, LVMi associated with propionylcarnitine and butyrylcarnitine (all P ≤ 0.009). ConclusionIn young adults without CVD, but with CVD risk factors, LVMi and RWT associated with metabolites linked energy metabolism (shifting from solely fatty acid oxidation to glycolysis, with impaired creatine kinase activity) and oxidative stress. Our findings support early onset metabolic changes accompanying cardiac structural alterations due to lifestyle and behavioural risk factors.

Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients

Ambulatory blood pressure provides a more comprehensive assessment than clinic blood pressure, and has been reported to better predict health outcomes than clinic or home pressure. We aimed to examine associations of clinic and 24-h ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of primary care patients referred for assessment of hypertension. We did an observational cohort study using clinic and ambulatory blood pressure data obtained from March 1, 2004, to Dec 31, 2014, from the Spanish Ambulatory Blood Pressure Registry. This registry included patients from 223 primary care centres from the Spanish National Health System in all 17 regions of Spain. Mortality data (date and cause) were ascertained by a computerised search of the vital registry of the Spanish National Institute of Statistics. Complete data were available for age, sex, all blood pressure measures, and BMI. For each study participant, follow-up was from the date of their recruitment to the date of death or Dec 31, 2019, whichever occurred first. Cox models were used to estimate associations between usual clinic or ambulatory blood pressure and mortality, adjusted for confounders and additionally for alternative measures of blood pressure. For each measure of blood pressure, we created five groups (ie, fifths) defined by quintiles of that measure among those who subsequently died. During a median follow-up of 9·7 years, 7174 (12·1%) of 59 124 patients died, including 2361 (4·0%) from cardiovascular causes. J-shaped associations were observed for several blood pressure measures. Among the top four baseline-defined fifths, 24-h systolic blood pressure was more strongly associated with all-cause death (hazard ratio [HR] 1·41 per 1 - SD increment [95% CI 1·36-1·47]) than clinic systolic blood pressure (1·18 [1·13-1·23]). After adjustment for clinic blood pressure, 24-h blood pressure remained strongly associated with all-cause deaths (HR 1·43 [95% CI 1·37-1·49]), but the association between clinic blood pressure and all-cause death was attenuated when adjusted for 24-h blood pressure (1·04 [1·00-1·09]). Compared with the informativeness of clinic systolic blood pressure (100%), night-time systolic blood pressure was most informative about risk of all-cause death (591%) and cardiovascular death (604%). Relative to blood pressure within the normal range, elevated all-cause mortality risks were observed for masked hypertension (HR 1·24 [95% CI 1·12-1·37]) and sustained hypertension (1·24 [1·15-1·32]), but not white-coat hypertension, and elevated cardiovascular mortality risks were observed for masked hypertension (1·37 [1·15-1·63]) and sustained hypertension (1·38 [1·22-1·55]), but not white-coat hypertension. Ambulatory blood pressure, particularly night-time blood pressure, was more informative about the risk of all-cause death and cardiovascular death than clinic blood pressure. Spanish Society of Hypertension, Lacer Laboratories, UK Medical Research Council, Health Data Research UK, National Institute for Health and Care Research Biomedical Research Centres (Oxford and University College London Hospitals), and British Heart Foundation Centre for Research Excellence.

Effect of weight loss on blood pressure changes in overweight patients: A systematic review and meta-analysis.

To determine quantitative differences between weight loss and changes in clinic blood pressure (BP) and ambulatory BP in patients with obesity or overweight, the authors performed a meta-analysis. PubMed, Embase, and Scopus databases were searched up to June 2022. Studies that compared clinic or ambulatory BP with weight loss were included. A random effect model was applied to pool the differences between clinic BP and ambulatory BP. Thirty-five studies, for a total of 3219 patients were included in this meta-analysis. The clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly reduced by 5.79mmHg (95% CI, 3.54-8.05) and 3.36mmHg (95% CI, 1.93-4.75) after a mean body mass index (BMI) reduction of 2.27 kg/m2 , and the SBP and DBP were significantly reduced by 6.65mmHg (95% CI, 5.16-8.14) and 3.63mmHg (95% CI, 2.03-5.24) after a mean BMI reduction of 4.12 kg/m2 . The BP reductions were much larger in patients with a BMI decrease ≥3kg/m2 than in patients with less BMI decrease, both for clinic SBP [8.54mmHg (95% CI, 4.62-12.47)] versus [3.83mmHg (95% CI, 1.22-6.45)] and clinic DBP [3.45mmHg (95% CI, 1.59-5.30)] versus [3.15mmHg (95% CI, 1.21-5.10)]. The significant reduction of the clinic and ambulatory BP followed the weight loss, and this phenomenon could be more notable after medical intervention and a larger weight loss.