Greater Decrease In Systolic Blood Pressure Research Articles

The impact of age on the vascular response to acute sauna exposure

Passive heat exposure has been shown to be a promising method to improve endothelial health. Sauna usage specifically, has been linked to reduced risk of cardiovascular disease in young and middle-aged populations. Increases in blood flow and shear rates associated with heat exposure are often considered to have a major influence on the observed improved endothelial function following repeated heat exposure; however, the magnitude of these shear and flow responses may potentially vary with age or starting endothelial function. Purpose: The purpose of this study was to determine if the vascular response to acute sauna heating is similar between healthy young and middle-aged adults and if the response is related to baseline endothelial function. Methods: 10 young (24.9 ± 4.2 years, 6 male and 4 female) and 8 middle aged adults (55.6 ± 3.9 years 4 males and 4 females) underwent 40 min of sauna exposure at 80ºC. Esophageal temperature was recorded throughout the duration of the experiment. Brachial artery flow-mediated dilation (FMD) blood flow, artery diameter, shear rates and blood pressure were recorded at baseline and following heat exposure. Results: The increase in core temperature (Tc) followed similar trends in both the young and middle-aged adults (young ΔTc = 1.386 ± 0.52 ºC vs middle-Age Δ Tc = 1.637 ± 0.56 ºC). Heat-induced brachial artery dilation and brachial artery shear rate also increased similarly in both age groups (young Δ diameter = 0.048 ± 0.022 cm vs middle-age Δ diameter = 0.074 ± 0.036 cm, young Δ shear = 164.5± 106.8 sec- 1 vs middle-age Δ shear = 150.3 ± 56.29 sec -1 ). Heat induced dilation was strongly correlated to baseline endothelial function in the young (r = 0.86, P=0.006). This relationship was not observed in the brachial artery of middle-aged adults (r = 0.257, P=0.539). Systolic blood pressure (SBP) was significantly reduced following sauna in the middle-aged participants from 135.25 ± 17.50 mmHg to 122.38 ± 19.7 mmHg (P=0.017). There was a slight elevation in SBP following sauna in the young participants from 119.4 ± 6.38 mmHg to 123.1 ± 7.65 mmHg (P=0.017). Diastolic blood pressure (DBP) was significantly reduced in both age groups (P<0.001) with middle age seeing greater reductions (P=0.05) from 80.63 ± 10.97 mmHg to 69.75 ± 8.41 mmHg vs the young 71.2 ± 8.24 mmHg to 66.9 ± 4.56 mmHg. Conclusion: Young and middle-aged adults have similar changes in shear rate and brachial artery dilation in response to acute sauna heating, but the middle-aged adults exhibit significantly greater decreases in SBP and DBP than young adults. In young adults, endothelial function is strongly correlated to heat induced dilation in the brachial artery. This relationship is not present in the middle age population suggesting that heat-induced dilation may rely on mechanisms other than endothelial function in middle-aged adults. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The efficacy and safety of SGLT2 inhibitors in patients with non-diabetic chronic kidney disease: a systematic review and meta-analysis.

In recent years, increasing evidence has shown that sodium-glucose cotransporter 2 inhibitors (SGLT2i) drugs have potential renoprotective effects in patients with diabetes mellitus (DM). However, the renal protective effect of SGLT2i in non-diabetic nephropathy patients has not been extensively demonstrated. In this systematic review and meta-analysis, we aimed to evaluate the renal protective effect and safety of SGLT2i in non-diabetic nephropathy patients. we searched for relevant clinically randomised controlled trials and analyzed the effects of SGLT2i on estimated glomerular filtration rate (eGFR), urinary albumin/creatinine ratio (UACR), and systolic blood pressure (SBP) and the incidence of adverse events in patients with non-diabetic nephropathy. We collated and analysed clinical data from six groups of patients with nondiabetic nephropathy. It was found that the SGLT2i significantly delayed the decline in eGFR [MD = 1.35ml/min/1.73 m2, 95% CI 0.84, 1.86), P < 0.0001]. Furthermore, the SGLT2i significantly reduced UACR [MD = - 24.47% l, 95% CI (- 38.9, -10.04), P = 0.0009], and showed a greater decrease in SBP [MD = - 4.13mmHg, 95% CI (-7.49, - 0.77), P = 0.02]. There was no significant difference in the incidence of adverse reactions between dapagliflozin/empagliflozin and the control group [OR = 1.14, 95% CI (0.88, 1.47), P = 0.33]. This study shows that SGLT2i help to delay the progression of non-diabetic kidney disease. Therefore, SGLT2i may contribute to the general treatment of nondiabetic nephropathy.

Changes in Pharmacokinetics and Pharmacodynamics of Losartan in Experimental Diseased Rats Treated with Curcuma longa and Lepidium sativum.

The current study investigated "pharmacodynamics and pharmacokinetics interactions" of losartan with Curcuma longa (CUR) and Lepidium sativum (LS) in hypertensive rats. Hypertension was induced by oral administration of L-NAME (40 mg/kg) for two weeks. Oral administration of CUR or LS shows some substantial antihypertensive activity. The systolic blood pressure (SBP) of hypertensive rats was decreased by 7.04% and 8.78% 12 h after treatment with CUR and LS, respectively, as compared to rats treated with L-NAME alone. LS and CUR display the ability to potentiate the blood pressure-lowering effects of losartan in hypertensive rats. A greater decrease in SBP, by 11.66% and 13.74%, was observed in hypertensive rats treated with CUR + losartan and LS + losartan, respectively. Further, both the investigated herbs, CUR and LS, caused an increase in plasma concentrations of losartan in hypertensive rats. The AUC0-t, AUC0-inf and AUMC0-inf of losartan were increased by 1.25-fold, 1.28-fold and 1.09-fold in hypertensive rats treated with CUR + losartan. A significant (p &lt; 0.05) increase in AUC0-t (2.41-fold), AUC0-inf (3.86-fold) and AUMC0-inf (8.35-fold) of losartan was observed in hypertensive rats treated with LS + losartan. The present study affirms that interactions between CUR or LS with losartan alter both "pharmacokinetics and pharmacodynamics" of the drug. Concurrent administration of losartan with either CUR or LS would require dose adjustment and intermittent blood pressure monitoring for clinical use in hypertensive patients. Additional investigation is necessary to determine the importance of these interactions in humans and to elucidate the mechanisms of action behind these interactions.

Dietary interventions and blood pressure in overweight or obese individuals: A systematic review and meta-analysis

Increased fruit and vegetable consumption (FVC) beneficially impacts hypertension, yet researchers have not synthesized the effects of FVC interventions on blood pressure (BP) among overweight or obese individuals. Therefore, we aimed to examine if diets with increased FVC decrease BP in overweight and obese persons and explore effects of moderators, study methods, participants, intervention, and source characteristics. A thorough literature search was conducted in CINAHL, ProQuest Dissertation & Theses, Scopus, PubMed, The Cochrane Library, and Web of Science. Last search was conducted on February 28, 2020. Inclusion criteria consisted of randomized controlled trials, an increased FVC intervention, and a body mass index (BMI) ≥25. Studies were independently coded and evaluated for bias using Cochrane Collaboration's tool for assessing study bias. The Grading of Recommendations Assessment, Development and Evaluation tool was used to evaluate the body of evidence, which was found to be moderate. Data was analyzed using Stata 16SE Software. We used a random effects model, comparing mean differences. Moderator analysis was conducted using meta-regression for continuous variables and meta-analytic ANOVA analog for categorical variables. Publication bias was assessed using funnel plot symmetry, Begg and Mazumdar's rank and correlation, Egger's test of the intercept, and Duval and Tweedie's trim and fill. Ten studies met criteria, which included 6862 participants. Overall, effects of FVC interventions on systolic blood pressure (SBP) was 2.16mmHg (p<0.001) and-0.55mmHg (p=0.39) for diastolic blood pressure (DBP). Moderator analyses showed greater drops in SBP from samples recruited from the community and medical schools (vs. health care/programs), interventions that used the DASH diet, and measured intake with food diaries. When concealed allocation was used and fidelity checked, there were less decreases in SBP than when it was not used. The amount of FVC significantly moderated the effects of SBP and DBP with greater increased FVC leading to greater decreases in SBP and DBP. Our findings are encouraging in that FVC improves blood pressure. However, outcomes are limited by the small number of studies that met inclusion criteria, significant heterogeneity, possible publication bias, and several studies had quality concerns. Tests for publication bias indicated none and most heterogeneity among studies was explained with moderator analysis our findings should be interpreted with caution. Increased FVC decreased SBP and DBP in obese and overweight individuals which may lower the risk of cardiovascular events. In the future, researchers might conduct higher quality studies and report quality indicators. Researchers might examine the effects of interventions for specific subgroups (overweight vs obese, younger vs older) and explore the impacts of diet-assisted technologies.

The Impact of Chromium Supplementation on Blood Pressure: A Systematic Review and Dose-Response Meta‑Analysis of Randomized‑Controlled Trials.

Potential effects of chromium supplementation on blood pressure (BP) have been examined in several interventional studies. Nevertheless, findings in this context are controversial. Therefore, the current systematic review and meta-analysis aimed to comprehensively assess the impact of chromium supplementation on BP. Five online databases including Web of Science, Scopus, Embase, Google Scholar, and PubMed were systematically searched from inception to March 2020. We included all randomized clinical trials (RCTs) evaluating the effects of chromium supplementation on systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) in humans. The random-effects meta-analysis of 11 eligible RCTs with 637 participants demonstrated the significant decline in both SBP (WMD - 2.51 mmHg; 95% CI - 4.97 to - 0.05, p = 0.04) and DBP (WMD - 1.04 mmHg; 95% CI - 1.96 to - 0.12, p = 0.026) following supplementation with chromium. In subgroup analysis, studies that were administered chromium yeast and brewer's yeast, showed greater decrease in SBP. Also, in stratification based on participants' health status, significant reduction in SBP only was seen in diabetic patients with chronic heart disease (CHD). Nonlinear dose-response analysis revealed a significant influence of chromium dosage on SBP changes. The current meta-analysis, indicated that supplementation with chromium significantly decrease SBP and DBP. In subgroup analysis, administration of chromium yeast and brewer's yeast resulted in greater reduction in SBP. Further large-scale RCTs with better design are needed to confirm these findings.

Effects of supervised exercise therapy on blood pressure and heart rate during exercise, and associations with improved walking performance in peripheral artery disease: Results of a randomized clinical trial

ObjectiveSupervised exercise therapy (SET) improves walking ability in people with peripheral artery disease (PAD). However, the effects of SET on cardiovascular health in PAD remain unclear. Using data from a randomized clinical trial, this post hoc analyses investigated the effects of a 6-month SET intervention, compared with a control group, on changes in blood pressure (BP) and heart rate (HR) during a graded treadmill exercise test in people with PAD. MethodsWe randomized 210 participants with PAD to either SET (3× weekly) or control (1× weekly health lectures) for 6 months. A graded treadmill exercise test, 6-minute walk test, and Walking Impairment Questionnaire were completed at baseline and the 6-month follow-up. BP and HR were measured at the end of each 2-minute stage of the graded treadmill exercise test. Mixed effects regression models compared the overall mean 6-month change in systolic BP, diastolic BP, pulse pressure (PP), and HR during the first 5 stages of the graded treadmill exercise test between groups. ResultsOf the 210 randomized participants with PAD, 176 (67 ± 9 years; 72 [41%] female, 115 [65%] Black) completed the graded treadmill exercise test at baseline and the 6-month follow-up. Compared with the control group at the 6-month follow-up, SET significantly decreased overall mean systolic BP (–12 mm Hg; P < .001), PP (–9 mm Hg; P < .001), and HR (–7 b/min; P < .01) during a graded treadmill exercise test but not diastolic BP. Among participants randomized to SET, a greater decrease in systolic BP, PP, and HR during a graded treadmill exercise test was significantly associated with a greater improvement in 6-minute walk distance (systolic BP, r = –0.19 [P = .03] and PP, r = –0.23 [P < .01]; and HR, r = –0.21 [P < .01]) and with maximal treadmill walking distance (systolic BP, r = –0.21 [P < .01] and PP, r = –0.17 [P = .03]) at the 6-month follow-up. A greater decrease in the HR during a graded treadmill exercise test was significantly associated with a better WIQ distance score (r = –0.27; P = .03) at the 6-month follow-up. ConclusionsIn people with PAD, compared with a control group, SET improved cardiovascular health, measured by changes in BP and HR during exercise. The degree of improvement in cardiovascular health correlated with the degree of improvement in walking performance in people with PAD. NCT: 01408901.

EVIDENCE OF A BLOOD PRESSURE REDUCTION DURING THE COVID-19 ASSOCIATED LOCKDOWN: A PLAUSIBLE EXPLANATION FOR THE OBSERVED DECLINES IN ACUTE CARDIOVASCULAR DISEASES?

Objective: The Covid-19 pandemic has been associated with a marked reduction in the incidence of cardiovascular diseases. The main objective of the study was to quantify the changes in blood pressure (BP) and heart rate (HR) prior to and after initiation of the lockdown. Design and method: A big data analysis of BP and HR measurements recorded during the lockdown period versus measurements during the Covid-19 period prior to confinement as well as versus measurements recorded in 2019. All participants were from the Paris urban area. Subjects used a Withings connected home blood pressure monitor and had at least one measurement prior to and during the lockdown and in 2019. Results: A total of 297,089 BP recordings were available from 2273 participants (age 56.3 ± 12.8 years, 81.1% male). Recording frequency was similar before and during the lockdown. BP gradually decreased during the first 4 weeks of confinement, reaching a decrease of 3 mmHg (-2.4 to -3.9) in systolic BP (SBP) and 1.5 mmHg (-1.4 to -2.2) in diastolic BP (DBP) from week 4 to week 7 (all p &lt; 0.001). Age and sex-adjusted comparisons yielded similar results. Participants with higher SBP and DBP had a greater decrease in SBP and DBP during the lockdown (p &lt; 0.0001 each); age and gender had no significant effect. No significant variation in HR was detected during the studied periods. Conclusions: Our study demonstrates a progressive decrease in SBP and DBP during the lockdown that may partly explain the concomitant reported reduction in the incidence of acute cardiovascular diseases.

Effects of garden cress, fenugreek and black seed on the pharmacodynamics of metoprolol: an herb-drug interaction study in rats with hypertension

Context Garden cress (GC), fenugreek (FG), and black seed (BS) are traditional herbal medicine for managing hypertension. Objective The effects of the three herbs on the pharmacodynamics of metoprolol tartrate (MT) in hypertensive rats were investigated. Materials and methods Wistar rats were divided in five groups (n = 6). Group I served as normal control group and Group II (hypertensive control group) had rats treated orally with N-nitro L-arginine methyl ester (L-NAME, 40 mg/kg/day) only. Groups III, IV, and V rats were orally treated with L-NAME (40 mg/kg/day) + GC (300 mg/kg, once daily), L-NAME (40 mg/kg/day) + FG (300 mg/kg, once daily) and L-NAME (40 mg/kg/day) + BS (300 mg/kg, once daily), respectively, for 2 weeks, and on the 14th day, blood pressure and heart rate were recorded using a tail-cuff blood pressure-measuring system. On the 16th day, a single dose of MT (10 mg/kg) was orally administered, and the rats’ blood pressure and heart rate were recorded. Results GC, FG, and BS decreased systolic blood pressure (SBP) by 8.7%, 8.5%, and 8.7%, respectively, in hypertensive rats. A greater decrease in SBP by 14.5%, 14.8%, and 16.1% was observed when hypertensive rats were treated with L-NAME + GC + MT, L-NAME + FG + MT, and L-NAME + BS + MT, respectively. Similarly, hypertensive rats treated with the combination of herbs and MT had significantly lower diastolic blood pressure (DBP) than those treated with herbs alone and those treated with L-NAME alone. Conclusions The combination of investigated herbs and MT had a beneficial effect on hypertension. However, the concurrent administration of drugs, particularly those predominantly cleared through CYP450 2D6-catalyzed metabolism, with the three investigated herbs should be considered with caution.

Effectiveness of self-management support in maintenance haemodialysis patients with hypertension: A pilot cluster randomized controlled trial.

Uncontrolled hypertension is an independent risk factor for cardiovascular disease and is the leading cause of mortality in haemodialysis patients. The aim of this study was to examine the effectiveness of self-management support (SMS) for blood pressure (BP) control and health behaviours. We conducted a cluster randomized controlled trial (RCT) in which 90 adult haemodialysis patients were assigned to either an SMS or common intervention (CI) group. The SMS group received an intervention consisting of self-management education and motivational interviewing. The CI group received standard care and routine health education. The primary outcome was the BP monitored before each haemodialysis. Secondary outcomes included salt intake (measured using a balance formula), home BP monitoring (HBPM) (assessed using two self-administered questions), and medication adherence (measured using the Medication-taking Behavior Scale). Data were collected at baseline and at 1, 3 and 6 months post-intervention. The SMS group showed continuous reductions in systolic BP from baseline: -9.2, -8.7, and -8.4 mmHg at 1, 3 and 6 months after the intervention, respectively (P < 0.01). Compared with the CI group, the SMS group had a greater decrease in systolic BP at 1 month: -5.9 mmHg (P = 0.0388), but no significant difference was found at 3 or 6 months (P > 0.05). SMS patients showed an improvement in health behaviours relative to baseline (less salt intake, more consistent HBPM, and greater medication adherence) (P < 0.05). Self-management support obtained short-term success in improving salt restriction, regular performance of HBPM and medication adherence, which led to better BP control.

Exploring detailed characteristics of autonomic dysreflexia

Objectives: Identify clinical and pathophysiologic insights into autonomic dysreflexia (AD) in patients with spinal cord injury (SCI). Study Design: Analysis of prospectively gathered AD dataset. Setting: Inpatient Veterans Affairs SCI unit. Participants: 78 male patients with SCI who experienced AD. Methods: Statistical methods were utilized to identify the frequency of relative bradycardia vs. tachycardia during AD, the effectiveness of supplemental opioids in managing suspected nociceptive pain mediated AD, the effect of chronicity of SCI on response to pharmacological management of AD, and the response to nitroglycerin ointment in suspected bladder related AD. Results: 445 episodes of AD were analyzed. The frequency of relative bradycardia and tachycardia with AD were 0.3% and 68.0% respectively. The addition of opioids to an antihypertensive medication protocol did not significantly decrease AD episode duration or magnitude of systolic blood pressure (SBP) change. A strongly matched positive linear correlation was identified between the duration of pharmacologically treated AD episodes and chronicity of SCI (R2=0.83). Bladder related AD episodes treated with nitroglycerin ointment had a faster onset of action (10.8 minutes vs. 15.9 minutes), faster time to reach a safe target blood pressure (16.5 minutes vs 20.9 minutes), and greater decrease in SBP (84.3mmHg vs. 68.6mmHg) than non-bladder related episodes (P=0.19, 0.23, and 0.02 respectively). Conclusions: AD may commonly occur with relative tachycardia. While further investigation is needed on the effects of chronicity of SCI and pharmacologic management, this study raises multiple directions for future research to understand clinical signs and treatment variables of AD following SCI.

The association between openness and physiological responses to recurrent social stress

The association between openness (assessed by shortened Chinese version of NEO Five-Factor Inventory, NEOFFI) and physiological reactivity to, and recovery from, social stress (a video-recorded, timed public speaking task with evaluators present in the room), and physiological adaptation to repeated social stress was examined in the present study. Subjective and physiological data were collected from 70 college students across five laboratory stages: baseline, stress exposure period 1, post-stress period 1, stress exposure period 2, and post-stress period 2. Results indicated that higher openness was associated with lesser heart rate (HR) reactivity to the first and second stress exposure, and lesser systolic blood pressure (SBP) reactivity to the second stress exposure. Higher openness was associated with higher resting respiratory sinus arrhythmia (RSA), lesser RSA withdrawals to the first stress exposure, and more complete RSA recovery after the first stress exposure. Moreover, higher openness was associated with pronounced systolic and diastolic blood pressure (SBP, DBP) adaptation with greater decreases in SBP and DBP reactivity across the two successive stress exposures. These findings might shed light on the biological basis linking openness to health.

Sustained effect of health insurance and facility quality improvement on blood pressure in adults with hypertension in Nigeria: A population-based study

BackgroundHypertension is a leading risk factor for death in sub-Saharan Africa. Quality treatment is often not available nor affordable. We assessed the effect of a voluntary health insurance program, including quality improvement of healthcare facilities, on blood pressure (BP) in hypertensive adults in rural Nigeria. MethodsWe compared changes in outcomes from baseline (2009) to midline (2011) and endline (2013) between non-pregnant hypertensive adults in the insurance program area (PA) and a control area (CA), through household surveys. The primary outcome was the difference between the PA and CA in change in BP, using difference-in-differences analysis. ResultsOf 1500 eligible households, 1450 (96.7%) participated, including 559 (20.8%) hypertensive individuals, of which 332 (59.4%) had follow-up data. Insurance coverage increased from 0% at baseline to 41.8% at endline in the PA and remained under 1% in the CA. The PA showed a 4.97mm Hg (95% CI: −0.76 to +10.71mm Hg) greater decrease in systolic BP and a 1.81mm Hg (−1.06 to +4.68mm Hg) greater decrease in diastolic BP from baseline to endline compared to the CA. Respondents with stage 2 hypertension showed an 11.43mm Hg (95% CI: 1.62 to 21.23mm Hg) greater reduction in systolic BP and 3.15mm Hg (−1.22 to +7.53mm Hg) greater reduction in diastolic BP in the PA compared to the CA. Attrition did not affect the results. ConclusionAccess to improved quality healthcare through an insurance program in rural Nigeria was associated with a significant longer-term reduction in systolic BP in subjects with moderate or severe hypertension.

Abstract P165: Incident and Associated Factors of Restenosis After Percutaneous Transluminal Renal Angioplasty in Renovascular Hypertensive Patients

Background: Percutaneous transluminal renal angioplasty (PTRA) is one of the standard treatments for renal artery stenosis (RAS). Restenosis after PTRA may influence disease prognosis, but little is unknown about the frequency or its associated factors. Methods: This study included 174 renovascular hypertensive patients (mean age= 59.5 years; 33.9% women) who underwent PTRA and were followed more than 12 months after PTRA. Data collection including blood pressure (BP), intensity of antihypertensive medication, and duplex ultrasonography (DUS) was performed before and 3, 6, and 12 months after PTRA. Cure of hypertension was defines as a BP below 140/90mmHg without antihypertensive medication. Diagnosis of restenosis was based on DUS, by applying a renal aortic ratio &gt;3.5 in conjunction with a renal artery peak systolic velocity &gt; 250cm/s. Results: At 12 months after PTRA, BP (156±25/82±15 to 133±16/75±13mmHg) as well as antihypertensive medications (2.5±1.2 to 2.1±1.3 types) decreased significantly (p&lt;0.01, respectively), and the incident of restenosis was 34 (19.5%). Compared with patients without restenosis, baseline clinical characteristics in those with restenosis showed significantly younger (46.1±23.6 vs 62.8±16.3 years), higher prevalence of female (50.0 vs 30.0%), fibromuscular dysplasia (FMD) diagnosed by angiography (58.8 vs 23.6%), and balloon PTRA without stenting (44.1 vs 18.6%), and lower numbers of antiplatelet and/or anticoagulant agents administrated after PTRA (1.3±0.6 vs 1.7±0.6 types of drug) (p&lt;0.05, respectively). Compared with atherosclerotic RAS patients (n=121), the rates of cured (25.9 vs 9.0%) and the cumulative incident rates of restenosis at 3 (20.8 vs 0 %), 6 (35.9 vs 6.6%), and 12 (37.7 vs 11.6%) months after PTRA were significantly higher in FMD (p&lt;0.01, respectively). FMD without restenosis showed a significantly greater decrease in systolic BP than that with (159±21 to 131±17 vs 154±28 to 141±25 mmHg, p&lt;0.05), whereas no significant difference was found in atherosclerotic RAS. Conclusions: Incident of restenosis after PTRA was higher in FMD than in atherosclerotic, and its incident pattern seemed to be different by causes. Especially for FMD, assessment of restenosis is important for treatment success.

Common variants of the G protein-coupled receptor type 4 are associated with human essential hypertension and predict the blood pressure response to angiotensin receptor blockade.

Non-synonymous GRK4 variants, R65L, A142V and A486V, are associated with essential hypertension in diverse populations. This study replicated the association of GRK4 variants, including GRK4(142V), with human essential hypertension in a Japanese population (n=588; hypertensive, n=486 normotensive controls) and determined whether the presence of GRK4 variants predicted the blood pressure (BP) response to angiotensin receptor blockers (ARBs) in patients with essential hypertension. We analyzed 829 patients and compared the response to ARBs between individuals with no GRK4 variants (n=136) and those with variants at one or any of the three loci (n=693). Carriers of hGRK4(142V) had a greater decrease in systolic BP in response to ARBs than non-carrier hypertensive patients. By contrast, those with variants only at GRK4(486V) were less likely to achieve the BP goal in response to an ARB than those with no variants. These studies showed for the first time the association between GRK4(142V) and a larger decrease in BP with ARBs in hypertensive patients.

Effects of music on systolic blood pressure, diastolic blood pressure, and heart rate: a meta-analysis

There are a handful of studies that have been done investigating the effect of music on various vital signs, namely systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Many studies have also assessed effects of music on self-reported anxiety level, attributing some degree of music-induced anxiety relief to the beneficial impacts of music on vital signs. Several randomised studies have shown varying effects of music on these vital parameters and so a metaanalysis was done to compare the effect of music on them. The fixed effects model was used as studies were homogenous. A two-sided alpha error < 0.05 was considered to be statistically significant. Compared to those who did not receive music therapy, those who did receive music therapy had a significantly greater decrease in SBP before and after (difference in means, −2.629, confidence interval (CI), −3.914 to −1.344, P < 0.001), a significantly greater decrease in DBP (difference in means, −1.112, CI, −1.692 to −0.532, P < 0.001), and a significantly greater decrease in HR (difference in means, −3.422, CI, −5.032 to −1.812, P < 0.001).

Influences of Family Environment and Meditation Efficacy on Hemodynamic Function among African American Adolescents

This study examined the impact of breathing awareness meditation (BAM) compared to health education (HE) and lifeskills training (LS) upon resting systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) within the context of potential moderating factors of family environment and expectancy of benefit. 186 African American adolescents (mean age: 15.1±0.7 yrs) were randomly assigned by school to three-month BAM, LS, or HE interventions. Laboratory resting blood pressure (BP), Family Relations Index (FRI) and expectancy of benefit evaluations were conducted at pre- and post-intervention. Higher expectancy of benefit from any of the three interventions resulted in greater reductions in SBP. A two-way interaction indicated that BAM group subjects who came from positive family environments exhibited greater decreases in SBP. A two-way interaction indicated that BAM and LS subjects who came from positive family environments exhibited greater DBP decreases. A two-way interaction indicated that BAM subjects who came from positive family environments exhibited a greater HR decrease (all p<.05). Expectancy of intervention benefits beneficially impacted success of behavioral interventions aimed at reducing SBP. Positive family environments in combination with either BAM or LS appear to have a beneficial impact upon hemodynamic function in AA adolescents.

Blood Pressure Responses Following Continuous Versus Fractionalized Exercise In Young Adults

Training with multiple short bouts of exercise may be effective for improving some measures of health and fitness. Little is known about the acute effects of fractionalized exercise vis-à-vis traditional single bout exercise. PURPOSE: We compared the effects of continuous vs. fractionalized exercise (Ex) on blood pressure (BP) responses in lean (L) and obese (O) young adults. (Males- Lean n=8, age=23.3 yr, BMI=23.7, VO2 peak=38.3 ml/kg/min; Obese n=8, age=30.6 yr, BMI=33.3, VO2 peak=28.5 ml/kg/min; Females- Lean n=7, age=25.7 yr, BMI=22.6, VO2 peak=31.4 ml/kg/min; Obese n=7, age=28.8 yr, BMI=36.6, VO2 peak=18.2 ml/kg/min). METHODS: Subjects were admitted to the General Clinical Research Center on 3 randomly assigned occasions: control (C), one 30 min bout of Ex (0900-0930h, 1X30) and three 10 minute bouts of Ex (0920-0930h, 1320-1330h, 1520-1530h, 3X10) (Ex intensity= 50% of the difference between lactate threshold and VO2 peak). Identical meals were served at 1000h, 1400h, and 1800h. BP and HR were measured hourly from 0900h-2100h. BP values were collapsed and analyzed in three time blocks. (0900-1200, 1300-1600, 1700-2000). Data were analyzed with 2-way REANOVA with multiple comparison adjustment. RESULTS: For systolic blood pressure (SBP), significant main effects were observed for gender, with women exhibiting lower SBP than men (P<0.001) and condition, with the 3x10 exercise condition resulting in lower SBP than the 1x30 and control conditions (p=0.05) with SBP decreasing over the course of the day (p=0.04). A trend for a main effect of obesity was also observed (p=0.16) with obese subjects having higher SBP than non-obese subjects. A condition-by-time interaction was observed (p=0.02) with greater decreases in SBP observed in the 3x10 exercise condition than the 1x30 and control conditions. No significant differences were observed for diastolic blood pressure or heart rate across the three exercise conditions. CONCLUSION: Fractionalized exercise may have utility in the reduction of systolic blood pressure in some young adults. Supported in part by a NIH grant to the General Clinical Research Center RR-00847

A greater decrease in blood pressure after spinal anaesthesia in patients with low entropy of the RR interval

The objective of this study was to determine whether pre-operative heart rate variability (HRV) estimated using the newly developed MemCalc method predicts hypotension after spinal anaesthesia (SA). Fifty-two patients with American Society of Anesthesiologists physical status I or II, aged 38-84 years, scheduled to undergo elective transurethral surgery were investigated in this study. Ultra short-term entropy (UsEn) as a non-linear index of HRV was estimated before and after SA using the MemCalc method. The patients were then assigned to two groups (Group LO and HI) according to pre-operative UsEn. SA was performed by intrathecal injection of 17.5 mg of isobaric bupivacaine via interlumbar spaces L3-4 or L4-5. After SA, the haemodynamic fluctuations were recorded and compared between the two groups. SA significantly decreased LF/HF (a ratio of the low frequency component of HRV to that of the high frequency component) but did not affect UsEn. The percentage decrease in systolic blood pressure (SBP) after SA was 11.4 (9.9)% in group HI, whereas it was 17.5 (9.8)% in group LO (P < 0.05). Furthermore, the number of patients who developed hypotension was significantly higher in group LO. SA significantly decreased LF/HF without affecting UsEn. Patients with a low UsEn developed a greater decrease in SBP after SA. Furthermore, the incidence of hypotension after SA was higher in patients with a low UsEn.

Sleep-disordered breathing and hypotension.

We investigated the presence of low blood pressure (BP) in 4,409 subjects referred for overnight polysomnography. A low resting arterial BP (systolic BP < 105 mm Hg, diastolic BP < 65 mm Hg) was present in 101 subjects (2.3%). Low BP was more prevalent in subjects with upper airway resistance syndrome (UARS) (23%) than in subjects with obstructive sleep apnea syndrome (OSAS) (0.06%), parasomnia (0.7%), restless leg syndrome (0.9%), or psychological insomnia (0.9%). In order to investigate BP homeostasis, we conducted polysomnography followed by tilt-table testing on 15 subjects with orthostatic intolerance (OI) and UARS, five normotensive subjects with UARS, five subjects with insomnia and low BP, 15 subjects with OSAS, and 15 healthy control subjects. Fifteen subjects with UARS and OI and 15 healthy controls also underwent 24-h ambulatory BP monitoring. Subjects with OI and UARS had lower mean daytime systolic (119 +/- 28 mm Hg) and diastolic (75 +/- 18 mm Hg) BP than did control subjects (131 +/- 35 mm Hg and 86 +/- 19 mm Hg, respectively) (p < 0.05). During tilt-table testing, subjects with UARS and a history of OI had a greater decrease in systolic BP (27 +/- 3 mm Hg) than did control subjects (7.5 +/- 1.6 mm Hg), subjects with OSAS (6.8 +/- 1.2 mm Hg), normotensive subjects with UARS (7.2 +/- 0.84 mm Hg), or hypotensive insomniacs (7.4 +/- 1.1 mm Hg) (p < 0.01). We conclude that approximately one fifth of subjects with UARS have low BP and complain of OI. Tilt-table testing may be indicated to confirm orthostatic intolerance in subjects with UARS.

Acute effects of transcendental meditation on hemodynamic functioning in middle-aged adults.

Increased peripheral vasoconstriction (ie, total peripheral resistance, or TPR) has been implicated as playing an important role in the early development of essential hypertension. Some studies have demonstrated that Transcendental Meditation (TM) reduces high blood pressure, but the hemodynamic adjustments behind these blood pressure reductions have not been elucidated. The aim of this study was to provide a preliminary investigation of the acute effects of TM on TPR. Subjects were 32 healthy adults (16 women and 16 men; 30 white and two African American; mean age, 46.4 +/- 3.9 years). Subjects were divided into a TM group of long-term TM practitioners (eight white women, nine white men, and one African American man; mean years of twice-daily TM practice, 22.4 +/- 6.7) and a control group (eight white women, five white men, and one African American man). Hemodynamic functioning was assessed immediately before and during three conditions: 20 minutes of rest with eyes open (all subjects), 20 minutes of TM (TM group), and 20 minutes of eyes-closed relaxation (control group). During eyes-open rest, the TM group had decreases in systolic blood pressure (SBP) and TPR, compared with increases in the control group (SBP: -2.5 vs. +2.4 mm Hg, p < .01; TPR: -0.7 vs. +0.5 mm Hg/liter per minute, p < .004). During TM, there was a greater decrease in SBP due to a concomitantly greater decrease in TPR compared with the control group during eyes-closed relaxation (SBP: -3.0 vs. +2.1 mm Hg, p < .04; TPR: -1.0 vs. +0.3 mm Hg/liter per minute, p < .03). TPR decreased significantly during TM. Decreases in vasoconstrictive tone during TM may be the hemodynamic mechanism responsible for reduction of high blood pressure over time. The results of this study provide a preliminary contribution to the understanding of the underlying hemodynamic mechanisms responsible for the beneficial influence of TM on cardiovascular risk factors.