Decline In Diastolic Blood Pressure Research Articles

The undoing-hypothesis in athletes - three pilot studies testing the effect of positive emotions on athletes’ psychophysiological recovery

Three pilot studies were performed to investigate the undoing-hypothesis (i.e., fast psychophysiological recovery due to positive emotions after stressor) in an athletic sample – after 1) a psychosocial stressor (study 1, N = 19), 2) a physiological stressor (study 2, N = 14), and 3) a simulated competition (study 3, N = 13). Therefore, the effect of positive emotion interventions on cardiovascular (heart rate, blood pressure, heart rate variability) and psychological (perceived positive and negative emotions, arousal, valence) recovery was tested in comparison to neutral interventions. Additionally, study 3 examined the impact on performance after the intervention. Results only confirmed the undoing-hypothesis after a psychosocial stressor (study 1), showing greater increases in perceived positive emotions and a long-lasting decline in diastolic blood pressure after the positive emotion induction compared to the neutral condition. No effects on performance were found. Despite missing significance, descriptive analyzes indicated that our results are in line with the undoing-hypothesis, calling for further research in a greater sample to explore its full potential for athletes. Especially its impact on performance should be examined in future studies.

BLOOD PRESSURE VARIATIONS ASSOCIATED WITH AGEING IN SUB-SAHARAN AFRICA

Elderly persons who live in communities and appear to be in good health frequently experience postural hypotension, which is frequently asymptomatic. Uncertainty exists regarding the relationship between postural changes in blood pressure and numerical factors including age, gender, and body mass index. The goal of the current study is to identify the orthostatic blood pressure (OBP) changing patterns, symptoms, and related factors in various age groups. In this study, sixty participants ranging in age from 20 to 75 years old were used. To check for orthostatic hypotension in these groups, various blood pressure readings are taken in the lying and standing positions at intervals of one minute and three minutes. The findings demonstrated that in the elderly groups, symptoms of headache, blurred vision, dizziness, and lightheadedness were unrelated to orthostatic hypotension. These subjects' Body Mass Indexes were calculated based on their nutritional condition, and they were found to be 60% well-nourished, 6% under-nourished, and 34% overweight. The elderly person had systolic hypotension (P<0.01) more frequently than diastolic hypotension (P>0.05). In the senior group, standing hypotension was equally common in both sexes. BMI declines with aging in males as well, n=60. In all four groups, heart rate readings in the standing position were greater than the supine measurement. In the older population of Ndola which was the subject group of the study, 16.7% had OH. Age and the decline in diastolic blood pressure after three minutes of standing were positively correlated in all males. In all females, a positive link was seen between body mass index and a reduction in diastolic blood pressure after three minutes of standing. After 3 minutes of standing, all males showed a positive link between body mass index and a decrease in systolic blood pressure. Therefore, there is a link between body mass index and a drop in blood pressure readings when standing. On the basis of the current study, we draw the conclusion that orthostatic hypotension rises with age and that symptoms are unrelated to physical measurements.<p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0202/a.php" alt="Hit counter" /></p>

Effects of Diastolic Blood Pressure on Brain Structures and Cognitive Functions in Middle and Old Ages: Longitudinal Analyses.

Hypertension is a pervasive public health concern due to strong associations with cardiovascular diseases and stroke. Alternatively, the associations between hypertension and the risk of Alzheimer’s disease are complex and recent large sample studies reported positive associations. In this paper, we examine the associations between diastolic blood pressure (BP) and subsequent changes in brain structure and cognitive function over several years by multiple regression analyses (with adjustment for a wide range of potential confounding variables) among a large cohort from the UK Biobank. Higher baseline diastolic BP was associated with a slightly smaller relative increase (relative improvements) in reaction time and a slightly greater reduction in depression scores. Higher baseline diastolic BP was also associated with a greater total gray matter volume (GMV) retention, while aging alone was associated with GMV reduction. White matter microstructural analyses revealed that a greater diastolic BP was associated with reduced longitudinal mean and regional fractional anisotropy, greater increases in mean and regional mean diffusivity, radial diffusivity, and axial diffusivity, a greater decline in mean intracellular volume fraction, and greater increases in mean and regional isotropic volume fraction. These white matter microstructural changes were consistent with those seen in the aging process. Additional analyses revealed a greater cheese intake level at baseline, which is associated with a subsequent decline in diastolic BP and a relative subsequent increase in depressive tendency together with a relative increase in fluid intelligence and visuospatial memory performance. These results are congruent with the view that a higher BP in the aging brain has a complex role.

PREVALENCE AND CONTROL OF HYPERTENSION IN DIABETIC PATIENTS WITH VERSUS WITHOUT CHRONIC KIDNEY DISEASE

Objective: Adequate control of hypertension is a guideline based strategy to retard the progression of kidney injury in patients with diabetes. The aim of this cross-sectional study was to compare the prevalence and control rates of hypertension in diabetic patients with versus without chronic kidney disease (CKD). Design and method: In 483 outpatients with type 1 or type 2 diabetes from a tertiary university hospital of the region of Thessaloniki, office blood pressure (BP) was recorded under standardized conditions (triplicate recordings after a 5-minute seated rest period) using the validated automated device HEM-705 (Omron, HealthCare). Hypertension was defined as office BP equal as or higher than 140/90 mmHg or current use of at least 1 antihypertensive drug. Results: The prevalence of hypertension was 69.8% in diabetic patients with estimated-glomerular-filtration-rate (eGFR) > 90 ml/min/1.73m2, 79.6% in patients with eGFR 60–90 ml/min/1.73m2 and 91.4% in those with eGFR < 60 ml/min/1.73m2 (P< 0.001 for the trend across eGFR strata). Despite the fact that 69.6% of the overall population was being treated with an average of 2.2 antihypertensive drugs daily, the control rates of hypertension were 41.8%, 40.0% and 34.5% in patients with eGFR > 90, 60–90 and < 60 ml/min/1.73m2, respectively (P = 0.245). The decline in eGFR was accompanied by a parallel rise in systolic BP, decline in diastolic BP, and widening of pulse pressure (51.5 ± 14.8 vs. 55.5 ± 16.5 vs. 65.9 ± 17.3 mmHg in the eGFR strata of > 90, 60–90 and < 60 ml/min/1.73m2, respectively, P < 0.001). A similar distribution of the severity of hypertension was observed when the patients were stratified by level of albuminuria. Conclusions: The present study shows that among patients with diabetes, the severity of hypertension increases in parallel with the decline in eGFR and rise in albuminuria. The widening of pulse pressure is possibly reflecting the more severe arteriosclerosis in patients with diabetes and established CKD.

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

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

Impact of astaxanthin supplementation on blood pressure: A systematic review and meta-analysis of randomized controlled trials

• Astaxanthin supplementation had beneficial effects on diastolic blood pressure (DBP). • Reduction in DBP was stronger in non-healthy participants compared to healthy ones. • Astaxanthin supplementation reduced DBP in Asian populations more than non-Asians. • Astaxanthin supplementation did not considerably affect systolic blood pressure. This systematic review and meta-analysis on randomized controlled trials (RCTs) evaluated the impact of astaxanthin (AST) supplementation on blood pressure in adults. We conducted a comprehensive search using different electronic databases. Ten RCTs with 493 participants that reported the effect of AST supplementation on blood pressure in adults were included. AST supplementation led to a marginally decline in diastolic blood pressure (DBP) (mean difference (MD) = −1.21; 95 %CI: −2.51, 0.09), but not systolic blood pressure. In patients, AST supplementation reduced DBP by 2.77 mmHg (95 %CI: −4.34, −1.19). Also, assigning ≥ 12 mg of AST to adults resulted in a slight decrease in DBP (MD = −0.89; 95 %CI: −1.82, 0.04). AST supplementation significantly reduced DBP by 2.27 mmHg in participants from Asian countries (95 %CI: −3.71, −0.83). This meta -analysis of RCTs disclosed that AST supplementation could reduce DBP, especially with a dose of ≥ 12 mg/d supplementation, in patient individuals and in participants from Asian countries.

Effect of diltiazem on exercise tolerance in patients with stable coronary artery disease and hypertension.

The present study aimed to investigate the effect of diltiazem on cardiovascular risk and exercise tolerance in patients with stable coronary artery disease and hypertension. From 2016 to 2018, 80 patients with stable coronary artery disease (5 < Gensini score < 20) and hypertension were enrolled into the present study. These patients were randomly divided into two groups: diltiazem group (Dil, 90 mg, bid), and control group (angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB) for reducing blood pressure and β-receptor blockers for controlling heart rate). Liver and kidney function, heart rate variability (HRV), blood pressure variability (BPV) and bicycle exercise were measured at baseline and after six months. The incidence of cardiovascular events (re-hospitalization due to angina pectoris, acute myocardial infarction, and cardiogenic death) was also assessed. The differences in all indexes at baseline between these two groups were not statistically significant (P > 0.05, respectively). After six months of treatment, both groups of patients had significant improvements in HRV, BPV and exercise tolerance compared that before treatment (p < 0.05). The difference in the decrease in systolic blood pressure, improvement of HRV and BPV, and cardiovascular events between these two groups was not statistically significant (P = 0.588, 0.431, 0.152, 1.000, respectively). But the Dil group was significantly better than the control group in degree of heart rate decline, diastolic blood pressure decline, and improvement of ST segment depression (P < 0.001), and the improvement in exercise tolerance was also better than that of the control group. We found that diltiazem compared with ACEI/ARB and β-receptor blockers can further improve the exercise tolerance of patients with stable coronary artery disease and hypertension.

THE EFFECT OF ADD-ON THERAPY OF LIRAGLUTIDE AND EMPAGLIFLOZIN ON AMBULATORY BLOOD PRESSURE IN PATIENTS WITH POORLY CONTROLLED TYPE 2 DIABETES MELLITUS

Objective: It is known that both liraglutide and empagliflozin, except for their anti-hyperglycaemic effect, have a favorable effect on major cardiovascular outcomes. Furthermore, it has been shown that they reduce systolic (SBP) and to a lesser extent diastolic blood pressure (DBP). Therefore, the purpose of this study is to evaluate the effect of liraglutide and empagliflozin on ambulatory BP in patients with poorly controlled type 2 diabetes (T2D). Design and method: 42 patients [20 men, mean age (± SD): 60.6 ± 9.4 years, were randomized to liraglutide therapy. 32 patients (16 men, mean age: 64.8 ± 7.1 years), were randomized to empagliflozin therapy. All patients underwent a complete clinical examination, laboratory testing, and ambulatory BP recording on baseline and three months after initiation of treatment with liraglutide and empagliflozin. Ambulatory BP was measured with the oscillometric Mobil-O-Graph NGW 24-hour ambulatory BP and PWA monitor (IEM; Stolberg, Germany). Results: In the liraglutide group, daytime SBP and DBP, mean change from baseline was –4.0 mmHg (P = 0.26) and –3.6 mmHg (P = 0.05). Nighttime SBP and DBP, mean change from baseline was –8.9 mmHg (P = 0.009) and –5.6 mmHg (P = 0.009). In the empagliflozin group, for daytime SBP and DBP, mean change from baseline was –1.4 mmHg (P = 0.61) and 0.2 mmHg (P = 0.91), respectively. For nighttime SBP and DBP, mean change from baseline were –8.9 mmHg (P = 0.03) and –4.5 mmHg (P = 0.02), respectively. Liraglutide caused higher daytime SBP and DBP decline from baseline than empagliflozin (P = 0.005). No statistically significant differences were observed for nighttime SBP and DBP between the two study groups. Conclusions: The results of the present study showed a favorable effect of 3-month therapy with liraglutide had a favorable effect on daily DBP and SBP and DBP during the night. A favorable effect of 3-month therapy with empagliflozin on nighttime SBP and DBP was also observed. Liraglutide caused higher daytime SBP and DBP decline from baseline than empagliflozin.

Frailty and Trajectories of Blood Pressure Among Older Mexican Americans Over Time

The objective of this study was to examine whether blood pressure (BP) trajectories differ by frailty status among older Mexican Americans. Data are from an 18-year prospective cohort study of 1,781 non-institutionalized Mexican American aged ≥ 67 years from the Hispanic Established Population for the Epidemiological Study of the Elderly (1995/96-2012/13). Frailty was defined as meeting three or more of the following: unintentional weight loss of >10 pounds, weakness, self-reported exhaustion, low physical activity, and slow walking speed. General linear mixed models were used to estimate trajectories of systolic and diastolic BP over an 18-year period as a function of frailty status. All variables were analyzed as time-dependent covariates except for gender and education. At baseline, 46.3% participants were non-frail, 44.8% were pre-frail, and 9.0% were frail; and the mean of systolic and diastolic BP was 136.9 mmHg (SD=18.6) and 77.3 mmHg (SD=12.2), respectively. Frail participants had greater systolic and diastolic BP decline over time than non-frail (estimate=-3.94, SE=0.88, p-value=<0.0001 and estimate=-1.32, SE=0.54, p-value=0.0138, respectively); and pre-frail participants had greater systolic BP decline than non-frail (estimate=-1.51, SE=0.54, p-value=0.0049), after controlling for all covariates. Those with high body mass index and hypertension with and without treatment had increased levels of systolic and diastolic BP over time. Older age, female gender, arthritis, diabetes, and stroke had decreased levels of diastolic BP over time. This study showed progressive decline in systolic and diastolic BP in frail compared to non-frail older Mexican Americans, which might have implications when treating frail older adults with hypertension.

Blood pressure measurement protocol determines hypertension phenotypes in a Middle Eastern population.

Clinic blood pressure (BP) measurement remains a crucial step in managing hypertension. While the number of measures recorded in different settings varies, with typically 1-3 measures, there has been no prior justification for the actual number of measures required. We investigated the pattern of BP variability over 5 consecutive automated readings (R1-R5) and the influence of patient characteristics on this pattern to identify the phenotype of hypertension in a Middle Eastern population. There were 1389 outpatients (51% men, 49% women), age range (18-87 y) who had 5 unattended automated consecutive BP measurements with one-minute intervals using the validated Datascope Mindray Passport V Monitor with the patient blinded from the results. Mean (±SEM) SBP for R1 (136.0±2mm Hg) was similar to R2 (136.2±2mm Hg). Thereafter SBP progressively declined till R5 by total of 5.5mm Hg. The SBP decline was less (4.2mm Hg) in older (>50years) vs younger participants (8.1mm Hg; P<.001) and was blunted in diabetic and hypertensive participants. Overall, 43% of participants had R2>R1, and 24% additionally had R5>R1. Age was a strong independent predictor of having both R2>R1 and R5>R1, as well as diabetes. Diastolic blood pressure (DBP) decreased by average 2.8mm Hg from R1 to R5. Females had a 5-fold greater total decline in DBP vs males (P<.001). Using the mean of 5 BP measures resulted in fewer participants being classified as hypertensive (36% of the population) compared to using one measurement (46%), or established BP guidelines which use different combinations of R1-R3 (37%-42%). Our findings in a Middle Eastern population highlight the importance of the BP measurement protocol in combination with patient characteristics in determining whether a patient is diagnosed with hypertension. Protocols that rely on different combinations of only 3 measures (R1-3) will classify more participants as hypertensive, compared to using 5 measures or disregarding a high R2.

Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India: A cluster randomised controlled trial.

BackgroundNew methods are required to manage hypertension in resource-poor settings. We hypothesised that a community health worker (CHW)–led group-based education and monitoring intervention would improve control of blood pressure (BP).Methods and findingsWe conducted a baseline community-based survey followed by a cluster randomised controlled trial of people with hypertension in 3 rural regions of South India, each at differing stages of epidemiological transition. Participants with hypertension, defined as BP ≥ 140/90 mm Hg or taking antihypertensive medication, were advised to visit a doctor. In each region, villages were randomly assigned to intervention or usual care (UC) in a 1:2 ratio. In intervention clusters, trained CHWs delivered a group-based intervention to people with hypertension. The program, conducted fortnightly for 3 months, included monitoring of BP, education about hypertension, and support for healthy lifestyle change. Outcomes were assessed approximately 2 months after completion of the intervention. The primary outcome was control of BP (BP < 140/90 mm Hg), analysed using mixed effects regression, clustered by village within region and adjusted for baseline control of hypertension (using intention-to-treat principles). Of 2,382 potentially eligible people, 637 from 5 intervention clusters and 1,097 from 10 UC clusters were recruited between November 2015 and April 2016, with follow-up occurring in 459 in the intervention group and 1,012 in UC. Mean age was 56.9 years (SD 13.7). Baseline BP was similar between groups. Control of BP improved from baseline to follow-up more in the intervention group (from 227 [49.5%] to 320 [69.7%] individuals) than in the UC group (from 528 [52.2%] to 624 [61.7%] individuals) (odds ratio [OR] 1.6, 95% CI 1.2–2.1; P = 0.001). In secondary outcome analyses, there was a greater decline in systolic BP in the intervention than UC group (−5.0 mm Hg, 95% CI −7.1 to −3.0; P < 0.001) and a greater decline in diastolic BP (−2.1 mm Hg, 95% CI −3.6 to −0.6; P < 0.006), but no detectable difference in the use of BP-lowering medications between groups (OR 1.2, 95% CI 0.8–1.9; P = 0.34). Similar results were found when using imputation analyses that included those lost to follow-up. Limitations include a relatively short follow-up period and use of outcome assessors who were not blinded to the group allocation.ConclusionsWhile the durability of the effect is uncertain, this trial provides evidence that a low-cost program using CHWs to deliver an education and monitoring intervention is effective in controlling BP and is potentially scalable in resource-poor settings globally.Trial registrationThe trial was registered with the Clinical Trials Registry-India (CTRI/2016/02/006678).

Effectiveness of mindfulness based cognitive therapy on weight loss, improvement of hypertension and attentional bias to eating cues in overweight people

ObjectivesPrevalence rates of overweight and obesity are dramatically ever-increasing across the world. Therefore, this study was to evaluate the effect of mindfulness-based cognitive therapy (MBCT) on weight loss, hypertension, and attentional bias towards food cues in a group of women affected with this condition. MethodsA total of 45 participants were selected out of women referring to the Nutrition and Diet Therapy Clinic affiliated to Shahid Beheshti University of Medical Sciences, Iran, and then randomized into three groups of 15. The first experimental group was subjected to an energy-restricted diet therapy together with MBCT during 8 sessions, the second group took the diet therapy alone, and the third group received no intervention. Body mass index (BMI), hypertension, and attentional bias towards food cues were correspondingly evaluated before, at the end, and four weeks after the completion of the interventions. ResultsThe results of this study revealed that MBCT, along with diet therapy, had been significantly more effective in weight loss, decrease in BMI, lower systolic blood pressure (SBP), and attentional bias towards food cues compared with the diet therapy alone (P ≤ 0.01). MBCT had no significant impact on the decline in diastolic blood pressure (DBP) in participants in the follow-up phase. ConclusionThis study demonstrated that MBCT along with the conventional diet therapy was more effective in weight loss, decrease in BMI, hypertension control, as well as attentional bias towards food cues than the diet therapy alone.

THE EFFECT OF STATIN ADDED TO ANTIHYPERTENSIVE THERAPY ON ARTERIAL STIFFNESS IN HYPERTENSIVE PATIENTS AT HIGH CARDIOVASCULAR RISK

Background. Little is known about the effect of statins addition to standard antihypertensive therapy on blood pressure level and vascular stiffness in high-risk hypertensive patients.The aim of the study was to assess the dynamics of vascular stiffness in hypertensive patients of high or very high cardiovascular risk under the influence of rosuvastatin addition to combined two-component amlodipine and lisinopril antihypertensive therapy.Materials and methods. We investigated 60 hypertensive patients who were randomized into two groups: the 1st group received a fixed amlodipine/lisinopril combination, the 2nd one followed the same regimen of therapy with addition of 20 mg rosuvastatin. Mean office and ambulatory blood pressure as well as central aortic blood pressure and pulse wave velocity were evaluated in both groups before and after 24-week follow-up period.Results. At end of follow-up period the office and average daily blood pressure significantly decreased in both groups, with more prominent office diastolic blood pressure decline in the 2nd one. The central aortic blood pressure equally decreased in both groups. The augmentation index significantly reduced in both groups, mostly in the 2nd one. The carotid-femoral pulse wave velocity declined in both groups to the same extent. The carotid-radial pulse wave velocity decreased statistically only in the second group.Conclusions. Addition of rosuvastatin to a fixed amlodipine/lisinopril combination in high/very high cardiovascular risk hypertensive patients was accompanied by more pronounced decline of diastolic blood pressure and augmentation index, as well as significantly reduction of pulse wave velocity.

Resistance Exercise Training Is More Effective than Interval Aerobic Training in Reducing Blood Pressure During Sleep in Hypertensive Elderly Patients.

Bertani, RF, Campos, GO, Perseguin, DM, Bonardi, JMT, Ferriolli, E, Moriguti, JC, and Lima, NKC. Resistance exercise training is more effective than interval aerobic training in reducing blood pressure during sleep in hypertensive elderly patients. J Strength Cond Res 32(7): 2085-2090, 2018-An appropriate fall in blood pressure (BP) during sleep is known to be related to a lower cardiovascular risk. The objective of this study was to compare the effect of different types of training on hypertensive elderly patients under treatment in terms of pressure variability assessed by the nocturnal decline in BP. Hypertensive elderly subjects under pharmacological treatment were randomly assigned to the following groups: 12 weeks of continuous aerobic training, interval aerobic training (IA), resistance training (R), or control (C). All subjects underwent ambulatory BP monitoring before and 24 hours after the last exercise session. The results were assessed using the mixed effects model. A greater nocturnal decline in diastolic BP compared with the wakefulness period was observed in R in comparison with C (11.0 ± 4.1 vs. 6.0 ± 5.7 mm Hg and p = 0.01) and with IA (11.0 ± 4. vs. 6.5 ± 5.1 mm Hg and p = 0.02). No fall in BP during a 24-hour period was observed in training groups compared with C, perhaps because the subjects were mostly nondippers, for whom the effect of training on BP is found to be lower. In conclusion, resistance training promoted a greater nocturnal fall in BP among hypertensive elderly subjects under treatment compared with IA subjects.

Abstract WP142: Baseline and Demographic Factors Associated With Improvements in Physical Activity, Cognition and Mood: Preliminary Data from the Bugher Foundation’s Stroke and Exercise Study

Background: The Bugher Stroke and Exercise Study examines the impact of a structured exercise and cognitive training program after stroke. In this preliminary analysis we investigated baseline predictors and demographics related to physical, cognitive and affective improvements. Methods: Participants with recent stroke and limited physical activity ≥ 3 months prior to enrollment were randomized to one of two arms of a 3-month intervention. Arm 1 (N=62) received exercise (strength &amp; cardiovascular) and cognitive training. Arm 2 (N=35) received light stretching and sham cognitive training. Outcome measures included depression (CES-D), cognition (MoCA), stroke impact scale (SIS), impairment (NIHSS), degree of disability (mRS), and physical measures of hand grip (HG), time up and go (TUG), 30-second chair stand test, 6-minute walk, waist circumference, BMI and blood pressure (BP). The trial is ongoing, therefore treatment group comparisons were not available. T-tests evaluated change in outcome measures among all participants. Regression analyses evaluated demographic variables and baseline factors (i.e., time-since-stroke, ischemic vs. hemorrhagic, &amp; pre-stroke physical activity) associated with change in outcome measures. Results: To date, 97 participants were enrolled ( M age 59±11 years; 34% women; 53% white, 49% Hispanic, 39% black &amp; 7% other). Participants demonstrated significant improvement on the CES-D (p=.005), MoCA (p=.005), NIHSS (p&lt;.001), SIS (p=.015), mRS (p&lt;.001), HG (p=.002), TUG (p=.004), 30-second chair (p&lt;.001), 6-minute walk (p=.001), waist circumference (p=.010), and both systolic (p=.009) and diastolic (p&lt;.001) BP. Regression analyses revealed that older adults were less likely to improve in MoCA scores (p=.010), 6-minute walk (p=.041), and systolic BP (p=.032). Participants with more pre-stroke physical activity demonstrated greater improvement in 6-minute walk (p=.024). Black participants saw less decline in systolic BP (p=.033) while participants with hemorrhagic (vs. ischemic) stroke saw less decline in diastolic BP (p=.039). Conclusions: Participation in an exercise and cognitive training intervention benefit stroke survivors; however, improvement may depend on baseline and demographic factors.

Nocturnal diastolic blood pressure decline is associated with higher 25-hydroxyvitamin D level and standing plasma renin activity in a hypertensive population

ABSTRACTPatients with nondipper hypertension are known to carry a high risk of cardiovascular complications. Vitamin D deficiency is associated with hypertension. Because vitamin D deficiency activates the renin–angiotensin–aldosterone system (RAAS), we hypothesized that this vitamin would interact with the RAAS to influence blood pressure (BP) in nondipper hypertensive patients. We performed a cross-sectional analysis of 1,007 outpatients with hypertension (HTN). Dipper and nondipper patterns were detected, and the two groups were matched for clinical, laboratory, 25-hydroxyvitamin D (25OHD) levels, and ambulatory blood pressure recording. Plasma renin activity (PRA), angiotensin II, and plasma aldosterone concentration (PAC) were assessed in 174 patients treated with calcium channel blockers or no medication. The mean 25OHD concentration in the entire study population was 12.3ng/dL, and the prevalence of vitamin D deficiency was 87.0%. Dipper and nondipper HTN were noted in 187 patients (24.6%) and 573 patients (75.4%). 25OHD levels were similar between nondipper and dipper HTN groups. Forward stepwise logistic regression analysis showed that BMI and age were independent predictors of nondipper HTN. Neither 25OHD levels nor RAAS components were included in the model. In correlation analyses, nocturnal decline of diastolic BP was positively associated with 25OHD levels and standing PRA (r = 0.152 p = 0.045, r = 0.165 p = 0.038, respectively). The present study showed that vitamin D deficiency was astonishingly prevalent in hypertensive subjects residing in Xinjiang, China. There may be a weakly association of nocturnal DBP decline with 25OHD levels and standing PRA levels. We found no association between vitamin D deficiency and nondipper HTN.

Effects of mindfulness training on emotional and physiologic recovery from induced negative affect

ObjectiveMindfulness training has been shown to improve psychological well-being and physical health. One proposed pathway for the positive effects of mindfulness training is through the development of new emotion regulation strategies, such as the ability to experience emotions by observing and accepting them without judgment. Theoretically, this should facilitate recovery from negative emotional states; however, this has rarely been examined empirically. The goal of the current study was to determine whether mindfulness training is associated with more efficient emotional and cardiovascular recovery from induced negative affect. MethodsThe current study tested emotional and cardiovascular recovery from induced negative affect during a personal recall task in women randomly assigned to 6-weeks of mindfulness training (n=39) compared to women assigned to a wait-list control condition (n=32). During baseline, task, and post-task rest, blood pressure and heart rate were monitored at fixed intervals and heart rate variability (HRV) and pre-ejection period (PEP) were monitored continuously. This study was embedded within a randomized trial that evaluated the effects of mindfulness training in a sample of younger breast cancer survivors, a group in need of access to effective psychosocial intervention as they can experience high stress, anxiety, and physical symptoms for many years in to survivorship. ResultsIn response to the personal recall task, women in both the intervention and control groups showed significant increases in sadness, anxiety, and anger, with the intervention group reaching higher levels of sadness and anger than controls. Further, the intervention group showed a significantly steeper decline in sadness and anger, as well as steeper initial decline in diastolic blood pressure compared to women in the wait list control condition. Groups did not differ in their self-reported feelings of anxiety, or in blood pressure, heart rate, or pre-ejection period (PEP) responses to the task. The control group demonstrated an increase in heart rate variability (HRV) during the task (indexed by the root mean square of successive differences in heart rate; RMSSD) while the intervention group remained flat throughout the task. ConclusionCompared to the control group, women in the intervention group experienced greater negative emotions when recalling a difficult experience related to their breast cancer, and demonstrated an efficient emotional and blood pressure recovery from the experience. This suggests that mindfulness training may lead to an enhanced emotional experience coupled with the ability to recovery quickly from negative emotional states.

Impact of Yoga on Blood Pressure and Quality of Life in Patients with Hypertension

Background: Medical treatment of hypertension is not always sufficient to achieve blood pressure control. Despite this, previous studies on supplementary therapies, such as yoga, are relatively few. The investigator evaluated the effects of yoga intervention on blood pressure and quality of life in patients in selected hospital diagnosed with hypertension. Methods: Adult patients (age 20–80 years) with diagnosed hypertension were identified at OPD of Meenakshi Medical College and Hospital. In total, 83 subjects with blood pressure values of 120–179/≤109 mmHg at baseline were enrolled. At baseline, the patients underwent standardized blood pressure measurement at the health care center and they completed a questionnaire on self-rated quality of life (WHOQOL). There were three groups: 1) Yoga class with investigator (n = 28); 2) Yoga at home (n = 28); and 3) a control group (n = 27). The participants were matched at the group level for systolic blood pressure. After 12 weeks of intervention, the assessments were performed again. At baseline a majority of the patients (92%) were on antihypertensive medication, and the patients were requested not to change their medication during the study. Results: The yoga class group showed improvement in blood pressure or self-rated quality of life, while in the yoga at home group there was a decline in diastolic blood pressure of 4.4 mmHg (p less tha 0.05) compared to the control group. Moreover, the yoga at home group showed significant improvement in self-rated quality of life compared to the control group (p less than 0.05). Conclusions: A short yoga program for the patient to practice at hospital seems to have an antihypertensive effect, as well as a positive effect on self-rated quality of life compared to controls. This implies that simple yoga exercises may be useful as a supplementary blood pressure therapy in addition to medical treatment.

Workflow standardization of a novel team care model to improve chronic care: a quasi-experimental study

BackgroundTeam-based chronic care models have not been widely adopted in community settings, partly due to their varying effectiveness in randomized control trials, implementation challenges, and concerns about physician acceptance. The Palo Alto Medical Foundation designed and implemented “Champion,” a novel team-based model that includes new standard work (e.g. proactive patient outreach, pre-visit schedule grooming, depression screening, care planning, health coaching) to support patients’ self-management of hypertension and diabetes. We investigated whether Champion improved clinical outcomes.MethodsWe conducted a quasi-experimental study comparing the Champion clinic-level intervention (n = 38 physicians) with a usual care clinic (n = 37 physicians) in Northern California. The primary outcomes, blood pressure and glycohemoglobin (A1c), were analyzed using a piecewise linear growth curve model for patients exposed to a Champion physician visit (n = 3156) or usual care visit (n = 8034) in the two years prior and one year post implementation. Secondary outcomes were provider experience, compared at baseline and 12 months in both the intervention and usual care clinics using multi-level ordered logistic modeling, and electronic health record based fidelity measures.ResultsCompared to usual care, in the first 6 months after a Champion physician visit, diabetes patients aged 18-75 experienced an additional -1.13 mm Hg (95% CI: -2.23 to -0.04) decline in diastolic blood pressure and -0.47 (95% CI: -0.61 to -0.33) decline in A1c. There were no additional improvements in blood pressure or A1c 6 to 12 months post physician visit. At 12 months, Champion physicians reported improved experience with managing chronic care patients in 6 of 7 survey items (p < 0.05), but compared to usual, this difference was only statistically significant for one item (p < 0.05). Fidelity to standard work was uneven; depression screening was the most commonly documented element (85% of patients), while care plans were the least (30.8% of patients).ConclusionsChampion standard work improved glycemic control over the first 6 months and physicians’ experience with managing chronic care; changes in blood pressure were not clinically meaningful. Our results suggest the need to understand the relationship between the intervention, the contextual features of implementation, and fidelity to further improve chronic disease outcomes. This study was retrospectively registered with the ISRCTN Registry on March 15, 2017 (ISRCTN11341906).

The effects of GLP-1 based therapies on postprandial haemodynamics: Two randomised, placebo-controlled trials in overweight type 2 diabetes patients.

To assess the effects of glucagon-like peptide (GLP)-1 receptor agonists and dipeptidyl peptidase (DPP)-4 inhibitors on postprandial haemodynamics. 57 patients with type 2 diabetes (mean±SD age 62.8±6.9years; BMI 31.8±4.1kg/m2; HbA1c 7.3±0.6%) were included in an acute (exenatide- or placebo-infusion) and 12-week (liraglutide, sitagliptin or placebo) randomised, placebo-controlled, double-blind trial. Systemic haemodynamics (oscillometric technique and finger photoplethysmography), vascular stiffness (tonometry), and sympathetic nervous system (SNS)-activity (heart rate variability) were determined in the fasting state and following a standardised mixed meal. In both studies, postprandial blood pressure (BP) decreased during placebo-intervention. Compared with placebo, acute exenatide-infusion increased postprandial diastolic BP (6.7 [95%-confidence interval 3.6-9.9]mmHg, p<0.001) and vascular resistance (683.6 [438.5-928.8]dyn*s/cm5/1.73m2, p<0.001), while cardiac index decreased (0.6 [0.40.8]L/min/1.73m2; p<0.001). Systolic BP, augmentation index and SNS-activity were unaffected. Twelve-week liraglutide-treatment did not affect postprandial haemodynamics, while sitagliptin decreased diastolic BP (3.5 [0.0-6.9] mmHg; p=0.050), vascular resistance (309.9 [66.6-553.1]dyn*s/cm5/1.73m2; p=0.013) and cardiac index (0.3 [0.0-0.6]L/min/1.73m2; p=0.040), compared with placebo. Neither liraglutide nor sitagliptin affected SNS-activity or augmentation index. All treatments significantly lowered postprandial glucose levels. Acute exenatide-infusion prevented the meal-induced decline in diastolic BP, although prolonged liraglutide intervention did not affect postprandial haemodynamics. The meal-induced drop in BP was augmented during sitagliptin-treatment.