High Blood Pressure Group Research Articles

Short-Term Effects of Beraprost Sodium on the Markers for Cardiovascular Risk Prediction in Type 2 Diabetic Patients with Microalbuminuria.

BackgroundTo evaluate the changes in cardiovascular risk markers including pulse wave velocity (PWV), microalbuminuria, inflammatory cytokines, and adhesion molecules after treatment with beraprost sodium (BPS) in patients with diabetic nephropathy.MethodsThis was a multicenter, prospective, randomized, double-blind, placebo-controlled trial. Type 2 diabetes mellitus patients with microalbuminuria were included. The primary endpoints were changes in microalbuminuria in spot urine and PWV after BPS or placebo (PCB) treatment for 24 weeks. The secondary endpoints were changes in clinical and metabolic parameters.ResultsA total of 52 patients completed the 24-week trial. Changes in PWV were not different significantly in the BPS and PCB groups (right, P=0.16; left, P=0.11). Changes in microalbuminuria were 14.2±157.0 and 34.5±146.6 (µg/mg Cr) in the BPS and PCB groups, respectively (P=0.63). Subgroup analysis in the high blood pressure (BP) group (baseline systolic BP >120 mm Hg and diastolic BP >80 mm Hg), showed that microalbuminuria decreased by −47.6 in the BPS group compared with an increase by 116.4 (µg/mg Cr) in the PCB group (P=0.04). Also, in the large waist circumference group (>95 cm), microalbuminuria decreased significantly in the BPS group (P=0.04).ConclusionShort-term treatment of BPS for patients with diabetic nephropathy did not show significant improvement in various cardiovascular risk factors. However, BPS significantly decreased microalbuminuria in study subjects with higher cardiovascular risk such as high BP or large waist circumference.

Possible Role of CYP450 Generated Omega-3/Omega-6 PUFA Metabolites in the Modulation of Blood Pressure and Vascular Function in Obese Children.

Obesity is often accompanied by metabolic and haemodynamic disorders such as hypertension, even during childhood. Arachidonic acid (AA) is metabolized by cytochrome P450 (CYP450) enzymes to epoxyeicosatrienoic acids (EETs) and 20-hydroxyeicosatetraenoic acid (20-HETE), vasoactive and natriuretic metabolites that contribute to blood pressure (BP) regulation. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) omega-3 polyunsaturated fatty acids may compete with AA for CYP450-dependent bioactive lipid mediator formation. We aimed at investigating the role of AA, EPA and DHA and their CYP450-dependent metabolites in BP control and vascular function in 66 overweight/obese children. Fatty acid profile moderately correlated with the corresponding CYP450-derived metabolites but their levels did not differ between children with normal BP (NBP) and high BP (HBP), except for higher EPA-derived epoxyeicosatetraenoic acids (EEQs) and their diols in HBP group, in which also the estimated CYP450-epoxygenase activity was higher. In the HBP group, EPA inversely correlated with BP, EEQs inversely correlated both with systolic BP and carotid Intima-Media Thickness (cIMT). The DHA-derived epoxydocosapentaenoic acids (EDPs) were inversely correlated with diastolic BP. Omega-3 derived epoxymetabolites appeared beneficially associated with BP and vascular structure/function only in obese children with HBP. Further investigations are needed to clarify the role of omega-3/omega-6 epoxymetabolites in children’s hemodynamics.

Increases in Peripheral Systolic Pressure Levels and Z-score Associate Gradual Aortic Pressure Increase and Functional Arterial Impairment in Children and Adolescents.

Arterial changes associated with children and adolescents high blood pressure (HBP) states would vary depending on the arterial type, arterial indexes considered and/or on blood pressure (BP) levels. To determine in children and adolescents: 1) if there is gradual structural-functional arterial impairment associated with gradual peripheral (brachial) systolic BP (pSBP) level or z-score increases, and 2) whether subjects with HBP levels and those with normal BP differ in the profiles of arterial changes associated with pSBP deviations. 1005 asymptomatic children and adolescents were included. Clinical, anthropometric and arterial non-invasive evaluations were performed. Heart rate, brachial BP, aortic BP and wavederived parameters (i.e. augmentation index), carotid and femoral diameters, blood velocities and elastic modulus, carotid intima-media thickness and aortic pulse wave velocity, were obtained. Two groups were assembled: Reference (without cardiovascular risk factors (CVRFs); n=379) and HBP (n=175). Additionally, subjects were ascribed to groups according to their pSBP z-scores (z-score ≤ 0, 0< z-score < 1 or z-score ≥ 1). Age and sex-related mean and standard deviation equations were obtained for each variable (Reference group). Using those equations, data (entire population) were converted into z-scores. Groups were compared (absolute and z-scored variables) before and after adjusting for cofactors (ANOVA/ANCOVA). Linear regression analyses were done considering: pSBP and z-pSBP (independent) and absolute levels and z-scores for hemodynamic and arterial indexes (dependent variables). Differences in hemodynamic and arterial levels and z-scores variations (dependent) associated with variations in pSBP and z-pSBP (independent variable) were assessed. The slopes of the models for Reference and HBP groups were compared. HBP states associate hemodynamic and arterial changes not explained by exposure to other CVRFs, anthropometric or demographic factors. The higher the pSBP deviations from ageand sex-expected mean value in the Reference group, the higher the hemodynamic and arterial indexes deviation. The pSBP-related variations in hemodynamic and arterial indexes would not differ depending on whether HBP states are present or not.

Uncontrolled Hypertension Is Common in Glaucoma Clinics.

To determine the magnitude of uncontrolled hypertension and smoking among patients visiting an eye clinic, and ascertain if referral to care providers is effective. Information on smoking status and blood pressure (BP) was collected among patients ≥18 years visiting an eye clinic. Those with high BP (systolic: ≥140 mm Hg and/or diastolic: ≥90 mm Hg) received a pamphlet on harms of hypertension on vision and were referred to a primary care physician. Smokers received a pamphlet on negative effects of smoking on vision and were offered referral to a tobacco quitline. Patients were followed up for referral outcome within 10 weeks from screening. Screening: A total of participants screened included 140 (29.5%) with high BP and 31 (6.6%) current smokers. In the high BP group, 92 (66%) subjects were previously diagnosed with hypertension. Follow-up: Of the 140 participants with elevated BP, 84 (60%) responded to follow-up. Among these 84 participants, 57 (67.9%) had consulted primary care, of whom 5 (8.8%) reported being newly diagnosed with hypertension, and 11 (19.3%) reported a change in their antihypertensive prescription. Among the 31 smokers, 24 (77.4%) were willing for quitline referral. Sixteen (66.7%) of these patients responded to follow-up, 8 (50%) of whom reported participation in a smoking-cessation program with 1 patient (6.3%) successfully quitting smoking. Nearly one-third of patients attending an eye clinic had elevated BP, and a smaller, but substantial, number of patients were current smokers. Eye clinics may serve as point for identification and referral of these patients with unmet needs.

Comparison of hemodynamic responses between normotensive and untreated hypertensive men under simulated long working hours.

Objectives The present study examined hemodynamic responses of normotensive and untreated hypertensive participants under simulated long working hours (LWH) - 13 hours - in an experimental laboratory study. Methods Thirty-five men participated in this study. Twenty-two of these participants were categorized into the normotensive group (systolic blood pressure (SBP) ≤140 mmHg and diastolic blood pressure (DBP) ≤90 mmHg); one participant was excluded due to missing data, leaving twenty-one participants with a mean age of 49.2 years. Another thirteen participants were categorized into the high blood pressure group (SBP=140-160 mmHg or DBP=90-100 mmHg) with a mean age of 51.9 years. The hemodynamic responses at the resting state from 09:00-09:10 hours (baseline) and during LWH from 09:10-22:00 hours (12 sessions) were measured. In each session, participants performed mental tasks. Changes in the hemodynamic response (Δ) were calculated by subtracting the individual values at each session from the baseline values. Results The values for the ΔSBP, ΔDBP, and Δmean arterial pressure increased with work time. Additionally, we found a significant interaction between the group and sessions for the ΔSBP (P<0.05, partial η 2=0.086). Although ΔSBP values did not differ between the groups at first (09:10-14:30 hours), the values in later sessions (14:40-21:50 hours) were significantly higher in the high blood pressure compared to the normotensive group. Conclusions Our study found that LWH increases BP, with a larger increase in SBP in the later working hours among individuals with untreated hypertension, whereas other hemodynamic responses did not differ between groups as a function of the LWH.

Blood pressure predicts endothelial function and the effects of ethinyl estradiol exposure in young women.

Hypertension, obesity, and endothelial function predict cardiovascular disease in women, and these factors are interrelated. We hypothesized that hypertension and obesity are associated with endothelial dysfunction in young women and that short-term ethinyl estradiol exposure mitigates this dysfunction. We examined flow-mediated dilation (FMD) responses before and during 7 days of oral ethinyl estradiol (30 µg/day) in 19 women (25 ± 5, 18-35 yr). We divided our sample into two groups based on two criteria: blood pressure and obesity. Women were divided into normal blood pressure (NBP; mean arterial pressure range: 78-91 mmHg, n = 7) and high blood pressure (HBP; mean arterial pressure range: 95-113 mmHg, n = 9) groups. We also stratified our subjects by body composition (lean: 18-31%, n = 8; obese: 38-59%, n = 9). We evaluated brachial FMD after two distinct shear stress stimuli: occlusion alone and occlusion with ischemic handgrip exercise. Obesity was unrelated to both FMD responses. Before ethinyl estradiol administration, the HBP group had blunted ischemic exercise responses relative to the NBP group (8.0 ± 3.5 vs. 12.3 ± 3.2%, respectively, P = 0.05). However, during ethinyl estradiol administration, ischemic exercise responses increased in the HBP group (12.8 ± 6.1%, P = 0.04) but decreased in the NBP group (5.6 ± 2.4%, P = 0.01). Standard FMD did not reveal differences between groups. In summary, 1) moderate HBP predicted endothelial impairment, 2) ethinyl estradiol administration had divergent effects on FMD in women with NBP versus HBP, and 3) enhanced FMD (ischemic handgrip exercise) revealed differences in endothelial function, whereas standard FMD (occlusion alone) did not. NEW & NOTEWORTHY We are the first to show that mild hypertension is a stronger predictor of endothelial dysfunction than obesity in healthy women without overt cardiovascular dysfunction. Importantly, the standard 5-min flow-mediated vasodilation stimulus did not detect endothelial dysfunction in our healthy population; only an enhanced ischemic handgrip exercise shear stress stimulus detected endothelial impairment. Estradiol administration increased flow-mediated dilation in women with high blood pressure, so it may be a therapeutic intervention to improve endothelial function.

Role of autonomic nervous activity, as measured by heart rate variability, on the effect of mortality in disabled older adults with low blood pressure in long-term care.

Previous studies have shown the relationship between low blood pressure and high mortality in frail, disabled older adults in long-term care. However, the mechanism of this relationship is still unclear. We hypothesized that autonomic nervous activity decline is involved in the relationship between low blood pressure and high mortality. The present prospective cohort study recruited 61 participants aged ≥75 years. The data from 24-h Holter monitoring and blood pressure recorded by ambulatory blood pressure monitoring were collected. Measured data were divided into three categories: 24-h, daytime and night-time. From power spectral density in the electrocardiogram, low frequency, high frequency and low frequency/high frequency ratio were calculated. The primary end-point was death. High blood pressure was connected to both high daytime low frequency and high frequency (partial correlation coefficients: 0.42, P < 0.05 and 0.35, P < 0.05, respectively). In addition, the low blood pressure group had higher mortality than the high blood pressure group, and disabled older adults in long-term care and those with elevated daytime systolic and diastolic blood pressure had less risk of mortality compared with those without (systolic: hazard ratio 0.89, 95% confidence interval 0.83-0.96, P = 0.003; diastolic: hazard ratio 0.98, 95% confidence interval 0.79-1.00, P = 0.049). The average blood pressures in the high blood pressure groups were approximately 140/80 mmHg and were connected to low mortality. Attenuated autonomic nervous activity might lead to low blood pressure in the daytime and high mortality in disabled older adults in long-term care. Geriatr Gerontol Int 2018; 18: 1153-1158.

Association between polymorphism of rs10185316 in insulin-induced gene 2 and blood pressure among children and adolescents

Objective: To examine the association between polymorphism of rs10185316 in insulin-induced gene 2 (INSIG2) and blood pressure among children and adolescents. Methods: 9 junior middle schools in Dongcheng District of Beijing and 5 schools (3 primary junior middle schools, 2 primary schools) in Haidian District of Beijing were chosen in 2005 and 2007, respectively. According to the Chinese BMI percentile criteria for screening overweight and obesity in school children, we recruited 1 425 overweight or obese children and 605 normal weight children. A total of 2 018 students with complete data of blood pressure and genotype data were included in this study. According to the blood pressure criterion of children and adolescents, 702 participants were categorized into high blood pressure group and 1 316 into normal blood pressure group. Participants' information of gender, age, height, weight and blood pressure were collected by questionnaire and physical examination. Genomic DNA was extracted from peripheral blood sample for genotyping of INSIG2 rs10185316 polymorphism. Multiple linear regression was conducted to analyze the associations between rs10185316 polymorphism in INSIG2 and SBP, DBP, mean arterial pressure (MAP) and pulse pressure. Results: The age, BMI, SBP and DBP of the high blood pressure group were separately (14.3±1.4) years old, (27.3±4.2) kg/m(2), (130.5±10.9) and (76.7±13.3) mmHg (1 mmHg=0.133 kPa), all higher than that of the normal blood pressure group, which were (12.2±2.9) years old, (22.0±4.0) kg/m(2), (104.4±10.9) and(54.6±15.2) mmHg, respectively (all P values<0.001). After age, sex, district and BMI adjusted, compared with the participants carrying INSIG2 rs10185316 CC genotype, CG/GG genotype carriers had lower DBP (β(95%CI):-1.67(-2.84--0.50), P=0.005), higher PP(β(95%CI): 1.91(0.61-3.20), P=0.004), and lower MAP(β(95%CI):=-1.03(-2.01--0.05), P=0.039). Conclusion: INSIG2 rs10185316 polymorphism was associated with DBP, PP and MAP among children and adolescents in an independent way from BMI.

PP.21.02] MENTAL STRESS, PH AND PCO2 AND SYSTOLIC HYPERTENSION

Objective: Resilence is known to be a major risk factor for the development of primary hypertension. Persisting overcompensation during mental irritation increases pH values and oxygen binding in blood samples by respiratory overcompensation. Is this metabolic effect dependent on blood pressure values? Design and method: 23 healthy young officer trainees were tested for pCO2, O2 saturation, pH values (PhOX-M, TECOM, Austria) and blood pressure values (Beurer, Ulm, Germany) during the sympatho-adrenal anticipation phase before their first parachute jump. Both, the entire group as well as two subgroups, consisting of systolic blood pressure values above average and below average (normal values) have been investigated. Results: The relation pH/pCO2, indicative of breathing frequency and acid management shows a rather weak negative linear correlation in the entire group (r = 0.329). The normal systolic blood pressure group shows no correlation at all, the high systolic blood pressure group developed a highly significant negative correlation of pH/CO2 (r = 0.656, p < 0.001). At the same time, O2 saturation increases with increasingly alkaline blood and decreasing pCO2 (p < 0.05). Conclusions: Mental stimulation increases blood pH by respiratory overcompensation and thereby increases O2 binding. Consequently, less O2 reaches e.g. heart tissue at higher demand during a sympatho-adrenal anticipation phase, which is by no means uncommom during day-to-day exertions. This symptom is much less significant at normal blood pressure values, but highly significant at higher systolic blood pressure values. Therefore, increased systolic blood pressure values institute an integral part of significantly negative metabolic effects upon the heart during even commonplace mental stimulation or irritation.

Associations of risk factors in childhood with arterial stiffness 26 years later: the Hanzhong adolescent hypertension cohort.

The relationship between childhood risk factors and long-term arterial stiffness was explored. A baseline survey was conducted in 4623 school children aged 6-15 years in rural areas of Hanzhong city, Shaanxi, in 1987. According to three independent measurements of SBP in 1987, 1989, and 1992, cases of the same age and sex with continuous SBP at least 75 percentile were classified as the high-blood pressure (BP) group, whereas those with SBP less than 50 percentile were classified as the normal-BP group. The cohort was followed up again after 26 years (in 2013). Blood biochemistry indexes, including fasting glucose, uric acid, and blood lipid, were measured. Brachial-ankle pulse wave velocity (baPWV) was recorded by noninvasive automatic waveform analyzer. Follow-up rate was 71.6%. The high-BP group had a higher incidence of hypertension (39.5 vs. 18.0%, P < 0.01) and baPWV (1337.2 ± 198.3 vs. 1271.7 ± 204.3 cm/s, P = 0.028) than the normal-BP group during the follow-up period. Positive correlation was found during follow-up between baPWV and childhood SBP, as well as SBP, DBP, BMI, heart rate, total cholesterol, low-density lipoprotein cholesterol, triacylglycerol, fasting glucose, and uric acid in adulthood (all P < 0.05). Results from stepwise multivariate regression analysis showed that men, family history of hypertension, SBP at both baseline and follow-up, fasting glucose, and uric acid in adulthood are independent impact factors of baPWV in adults. Higher SBP in children and adolescents, family history of hypertension, and male sex may increase the risk of developing long-term arterial stiffness.

Excessive Exercise Habits in Marathoners as Novel Indicators of Masked Hypertension.

Background. Excessive exercise such as marathon running increases the risk of cardiovascular events that may be related to myocardial infarction and sudden death. We aimed to investigate that the exercise characteristics can be used as a novel indicator of masked hypertension. Methods. A total of 571 middle-aged recreational male marathoners were assigned to a high blood pressure group (HBPG; n = 214) or a normal blood pressure group (NBPG; n = 357). A graded exercise test was used to examine the hemodynamic response and cardiac events, and the personal exercise characteristics were recorded. Results. Systolic blood pressure and diastolic blood pressure were higher in the HBPG than in the NBPG (p < 0.05, all). The marathon history, exercise intensity, and time were longer and higher, whereas the marathon completion duration was shorter in the HBPG than in NBPG (p < 0.05, all). HBPG showed a higher frequency of alcohol consumption than NBPG (p < 0.05). Conclusion. More excessive exercise characteristics than the normative individuals. If the individuals exhibit high blood pressure during rest as well as exercise, the exercise characteristics could be used as a novel indicator for masked hypertension.

PS 14-12 CLINICAL SIGNIFICANCE OF AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH CARDIOVASCULAR DISEASES WHO UNDERWENT CARDIAC REHABILITATION

Objective: Though optimal blood pressure (BP) control is crucial in the treatment of patients with cardiovascular diseases (CVDs), the usefulness of ambulatory BP monitoring (ABPM) in cardiac rehabilitation remains unclear. The aim of the present study was to investigate the association between BP evaluated by ABPM and adverse symptoms or events in patients who underwent cardiac rehabilitation. Design and Method: Sixty patients (mean age; 80 ± 10 years, mean ± s.d. female; 51.7%, heart failure as a cause of index hospitalization, 72%) who could walk by themselves were studied BP levels, circadian rhythm using ABPM before discharge, symptoms due to hypotension from clinical records during admission, and they were followed up until a year after. Results: Among the subjects, mean 24-hour BP was 128 ± 18/72 ± 8 mmHg on 2.6 ± 1.3 anti-hypertensive drugs, and the majority of them represented non-dipper (48%) or riser (33%) pattern. When the subjects were categorized into the low, medium, and high BP group based on the tertiles of the mean 24-hour systolic BP (SBP), the prevalence of hypotensive symptoms were 5%, 5%, and 10% respectively. During the follow-up period (median, 375 days), 23 composite adverse events occurred. The prevalence of the composite events was highest in the high BP group, and there was a significant difference among the event-free survival curves of these three groups (p < 0.01) by Kaplan–Meier method and log-rank test. The adjusted relative hazard ratio of mean 24-hour SBP for the composite events was 9.32 (95%CI; 1.13–81.2, p < 0.01) with a 1 s.d. increment by Cox proportional hazard model. There was no significant difference in the prevalence of hypotensive symptoms or the composite adverse events among circadian rhythms. Conclusions: These results suggest that mean value of 24-hour BP was associated with the adverse events in patients who underwent rehabilitation for CVDs. There were no significant relations among BP levels, circadian rhythms, and hypotensive symptoms.

OS 04-08 THE RELATIONSHIP BETWEEN CHILDHOOD RISK FACTORS AND LONG-TERM ARTERIAL STIFFNESS — A 26-YEAR FOLLOW-UP STUDY

Objective: To explore the relationship between childhood risk factors and long-term arterial stiffness. Design and Method: A baseline survey was carried out in 4623 school children aged 6–15 years in rural areas of Hanzhong city, Shaanxi in 1987. According to three measurements of systolic blood pressure (SBP) in 1987,1989 and 1992, high blood pressure group (HBP group) was defined as SBP ≥ 75 percentile at same age and gender, with SBP < 50 percentile as normal blood pressure group (NBP group). The cohort was followed up again 26-years later (in 2013), At the same time, Blood biochemistry indexes were measured, including fasting glucose, uric acid and blood lipid. Brachial-ankle pulse wave velocity (baPWV) was recorded by noninvasive automatic waveform analyzer. Results: The follow-up rate was 71.6%. HBP group versus NBP group had higher incidence of hypertension (39.5% vs.18.0%, P = 0.001) and baPWV [(1337.2 ± 198.3) vs. (1271.7 ± 204.3) cm/s, P = 0.028] in this follow-up period. Correlation analysis indicated that the follow-up baPWV was positively correlated with childhood SBP and SBP, DBP, body mass index, heart rate, TC, LDL-C, TG, fasting glucose, uric acid in adulthood (all P < 0.05). In stepwise multivariate regression analysis, gender, family history of hypertension, SBP at both baseline and follow-up, fasting glucose and uric acid in adulthood were independent predictive factors of baPWV in adults. Conclusions: Higher SBP in children and adolescents, family history of hypertension and male gender may increase the risk of developing long-term arterial stiffness.

PP.19.09] APELIN AND VISFATIN PLASMA LEVELS IN HEALTHY INDIVIDUALS WITH HIGH NORMAL BLOOD PRESSURE

Objective: High normal blood pressure (BP)(130–139/85–89 mmHg) seems to be related with increased cardiovascular risk compared to normal BP (120–129/80–84 mmHg) or/and optimal BP (<120/80 mmHg). Low apelin plasma levels have been associated with arterial hypertension and atherosclerosis while high visfatin plasma levels may promote vascular inflammation and atherosclerotic plaque destabilization and have been evaluated as a marker for identifying stages of essential hypertension. We sought to compare the apelin and visfatin plasma levels between subjects with high normal BP and subjects with normal or optimal BP matched for age, gender, smoking, and body mass index (BMI). Design and method: Twenty-five subjects with high normal BP (office BP 136 ± 3/88 ± 2 mmHg, age 57 ± 4 years, 76% males, 32% smokers, BMI 24.0 ± 1.7 kg/m2) and 35 subjects with normal or optimal BP (office BP 118 ± 2/78 ± 2 mmHg, age 55 ± 7 years, 63% males, 29% smokers, BMI 23.2 ± 1.4 kg/m2) were studied. The apelin and visfatin plasma levels were determined with the enzyme-linked immunosorbent assay. Results: Compared to normal or optimal BP subjects, apelin levels were significantly lower (205 ± 108 vs. 325 ± 152 pg/ml, p < 0.001) and visfatin levels significantly higher (11.0 ± 2.0 vs. 7.2 ± 0.9 ng/ml, p = 0.002) in high normal BP subjects. No significant differences were found between the 2 groups (p = NS) regarding the basic clinical characteristics, the glycemic/lipid profile and the renal function parameters. Conclusions: The emerging, from the present study, lower apelin and higher visfatin plasma levels in high normal BP subjects compared to normal or optimal BP individuals may partially explain the higher cardiovascular risk of the high normal BP group.

Dietary patterns, nutrition knowledge and lifestyle: associations with blood pressure in a sample of Australian adults (the Food BP study).

This study examined the association between dietary patterns, nutrition knowledge and lifestyle with blood pressure (BP) in a sample of Australian adults. Adults with normal and high BP were included in a cross-sectional study. Dietary intake data was collected using a Food Frequency Questionnaire. Nutrition knowledge and lifestyle surveys were included in the questionnaire. Dietary patterns were extracted using factor analysis followed by cluster analysis. Associations were analysed using logistic regression. Four hundred and seven participants were included. Three dietary patterns were identified: Western; Snack and alcohol; and Balanced. Participants with high BP had a higher intake of Western and a lower intake of Balanced dietary pattern. A significant and higher frequency of discretionary foods and oils consumption, as well as lower nutrition knowledge score and activity frequency, were observed in the high BP group. Regression analysis indicated that the intake of Western and Snack and alcohol dietary patterns increases the likelihood of having high BP by 2.40 (95% confidence interval (CI): 1.28-4.49) and 2.76 (95% CI: 1.52-5.00), respectively, when nutrition knowledge and lifestyle were controlled for as moderator variables. The likelihood of high BP was not associated with nutrition knowledge, but increased with physical inactivity. This study indicates that poor dietary patterns and inactivity are associated with increases in the likelihood of high BP, and the association is not influenced by nutrition knowledge. These findings indicate the importance of developing public health strategies with an emphasis on improving the dietary patterns of individuals to prevent and control high BP in Australian adults.

중·노년의 대사증후군과 구강질환 관련성

Objectives: The purpose of the study was to identify the relationship between metabolic syndrome and oral diseases in the middle aged and elderly in Korea. Methods: The study subjects were 6,390 people over 40 years old from 2010 and 2012 Korea National Health and Nutrition Examination Survey. The survey questionnaire consisted of health, nutrition, and oral examination surveys. The independent variables included general characteristics, health behavior, oral health behavior, and metabolic syndrome. The dependent variables included dental caries experience and periodontal disease. The oral examination was carried out by the dentist based on World Health Organization standard. Results: The average prevalence rate of metabolic syndrome MS was 23.79%, including 54.84% of risk group and 21.37% of normal group. The missing teeth rate was 82.38%, DMFT rate was 90.28% and the periodontal disease rate was 33.15%. Those having abnormal fasting blood glucose had 1.17 fold(95% CI: 1.00~1.37) higher periodontal disease than the normal group. The abnormal HDL cholesterol group had 1.25 times higher odds ratio(95% CI: 1.07~1.46) and the obese group had 1.27 times higher odds ratio(95% CI: 1.07~1.51). The risk group had 1.20 times higher odds ration(95% CI: 1.00~1.44) and that of the metabolic syndrome group was 1.60 times higher(95% CI: 1.29~1.97) in periodontal disease. The high blood pressure group had 1.25 times of missing teeth prevalence rate(95% CI: 1.00~1.37). The metabolic syndrome group had 1.47 times of missing teeth prevalence rate(95% CI: 1.11~1.94). Conclusions: The middle aged and elderly people in Korea had higher rate of metabolic syndrome and oral disease. It is necessary to implement the preventive oral health examination for the control of metabolic syndrome and oral diseases prevalence.

Clinical Implications

HomeHypertensionVol. 66, No. 6Clinical Implications Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBClinical Implications Originally published1 Dec 2015https://doi.org/10.1161/HYPERTENSIONAHA.115.06698Hypertension. 2015;66:1089Systolic Blood Pressure Trajectories (p 1108)Download figureDownload PowerPointIdentifying people in early life who are at the greatest risk of developing adult hypertension might permit effective risk reduction via age-appropriate prevention and intervention strategies, thereby reducing the burden of blood pressure-related disease in later life. There are conflicting recommendations on routine screening for primary hypertension in children, and better information is needed for medical decision-making around risk assessment. In this issue of Hypertension, results from the Dunedin Multidisciplinary Health and Development Study, a longitudinal representative birth cohort study (n=975), show that subgroups within the population who are on trajectories toward developing prehypertension or hypertension by early midlife can be identified as early as 7 years of age. Early life risk factors for high blood pressure trajectory group membership were identified, including male sex, having a family history of hypertension, being the first born, and lower birth weight. Having a higher body mass index and cigarette smoking over time resulted in increasing blood pressure levels, especially among individuals in the higher blood pressure groups. Many early midlife cardiovascular correlates, including a composite index of metabolic abnormalities, were associated with prehypertensive and hypertensive blood pressure trajectory group membership, demonstrating the broader clinical utility of these trajectories. These data suggest that estimating risk for future hypertension (and cardiovascular disease more generally) can begin in childhood before blood pressure reaches prehypertensive or hypertensive levels in adulthood.Cerebrospinal Fluid NaCl Increases Sympathetic Nerve Activity via Rostral Ventrolateral Medulla (p 1184)Download figureDownload PowerPointEvidence from both salt-sensitive humans and animal models indicates that the ingestion of excess dietary salt produces discrete increases in cerebrospinal fluid NaCl concentrations by ≈2 to 5 mmol/L. This central hypernatremia subsequently activates the sympathetic nervous system to raise arterial blood pressure. Although changes in cerebrospinal fluid NaCl concentrations are sensed by specialized neurons in the hypothalamus, it is not clear how these changes translate into activation of the sympathetic nervous system and hypertension. In this issue of Hypertension, Stocker et al identified several novel mechanisms, including a distinct population of hindbrain neurons that mediate the sympathoexcitatory actions of NaCl. The authors demonstrated for the first time that intracerebroventricular infusion of hypertonic NaCl increases sympathetic outflow to the hindlimb vasculature and adrenal gland but decreases renal or does not alter splanchnic sympathetic nerve activity. This pattern results in a sympathetically mediated increase in blood pressure. Additional neurophysiological recordings suggest that these complex responses to central hypernatremia are mediated by a glutamatergic activation of bulbospinal, and likely C1 (or catecholaminergic), neurons of the rostral ventrolateral medulla (Figure). These findings have several important implications: (1) the brain selectively regulates sympathetic outflow to various end organs, (2) a discrete population of hindbrain neurons via glutamatergic input mediates the sympathoexcitatory response to central hypernatremia, and (3) both findings may represent future clinical targets for the treatment of salt-sensitive hypertension.Soluble fms-Like Tyrosine Kinase-1 e15a: Serum Levels and Bioactivity (p 1251)Download figureDownload PowerPointIn preeclampsia, there is excess secretion of the antiangiogenic factor soluble fms-like tyrosine kinase (sFLT-1) into the maternal circulation, leading to endothelial dysfunction, hypertension, and multiorgan injury. sFLT-1 e15 is by far the dominant placental sFLT-1 variant, and given preeclampsia is undoubtedly a placental disease (because delivery resolves the condition), sFLT-1 e15a may be the main sFLT-1 variant causing preeclampsia. Surprisingly, sFLT-1 e15a protein has been poorly characterized. In this issue of Hypertension, Palmer et al characterized sFLT-1 e15a protein bioactivity and reported circulating levels in pregnant women. It is conceivable that an sFLT-1 e15a ELISA may be better at predicting preeclampsia than the existing sFLT-1 ELISA (which indiscriminately detects all sFLT-1 variants). The team raised antibodies and developed a sFLT-1 e15a ELISA. Using this, they reported that circulating sFLT-1 e15a concentrations increased across gestation and were 10-fold higher in women with preterm preeclampsia compared with controls (Figure). They also showed that sFLT-1 e15a is bioactive. sFLT-1 e15a blocked vascular endothelial growth factor activation of its own receptor, decreased endothelial cell migration and invasion, and decreased endothelial tube formation. Furthermore, sFLT-1 e15a blocked vascular endothelial growth factor–induced sprouting from mouse aortic rings. The development of therapeutics should take sFLT-1 e15a into account. Identifying medications that decrease placental sFLT-1 e15a secretion or neutralize its biological activity may be a therapeutic strategy. Furthermore, it is possible that an sFLT-1 e15a ELISA has potential as a biomarker test to predict preeclampsia. Previous Back to top Next FiguresReferencesRelatedDetails December 2015Vol 66, Issue 6 Advertisement Article InformationMetrics © 2015 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.115.06698 Originally publishedDecember 1, 2015 PDF download Advertisement

Apelin and Visfatin Plasma Levels in Healthy Individuals With High Normal Blood Pressure.

High normal blood pressure (BP; 130-139/85-89 mm Hg) is related with increased cardiovascular (CV) risk compared to normal BP (120-129/80-84 mm Hg) or/and optimal BP (<120/80 mm Hg). Low apelin plasma levels have been associated with arterial hypertension and atherosclerosis, while high visfatin plasma levels may promote vascular inflammation and atherosclerotic plaque destabilization and have been evaluated as a marker for identifying stages of essential hypertension. We sought to compare the apelin and visfatin plasma levels between subjects with high normal BP and subjects with normal or optimal BP matched for age, gender, smoking, and body mass index (BMI). Twenty-five subjects with high normal BP (office BP 136±3/88±2 mm Hg, age 57±4 years, 76% males, 32% smokers, BMI 24.0±1.7 kg/m2) and 35 subjects with normal or optimal BP (office BP 118±2/78±2 mm Hg, age 55±7 years, 63% males, 29% smokers, BMI 23.2±1.4 kg/m2) were studied. The apelin and visfatin plasma levels were determined with the enzyme-linked immunosorbent assay. Compared to normal or optimal BP subjects, apelin levels were significantly lower (205±108 vs. 325±152 pg/ml, P < 0.001) and visfatin levels significantly higher (11.0±2.0 vs. 7.2±0.9 ng/ml, P = 0.002) in high normal BP subjects. No significant differences were found between the 2 groups (P = NS) regarding the basic clinical characteristics, the glycemic/lipid profile, and the renal function parameters. The emerging, from the present study, data raise the hypothesis that lower apelin and higher visfatin plasma levels in high normal BP subjects compared to normal or optimal BP individuals could partially explain the higher CV risk of the high normal BP group.

Abstract W P224: Higher Pre-Hospital Blood Pressure Prolongs Door to Needle Thrombolysis Times

Background: Per American Heart Association guidelines, blood pressure (BP) should be &lt; 185/110 to be eligible for intravenous tissue plasminogen activator (tPA). It is shown that door to needle (DTN) time is prolonged in patients who require anti-hypertensive medications prior to thrombolysis in the emergency department (ED). To our knowledge, no studies have focused on pre-hospital BP and its impact on DTN times. We hypothesize that DTN times are longer for patients with higher pre-hospital BP. Methods: We conducted a retrospective review of acute ischemic stroke patients who presented between 1/2010 and 12/2010 to our ED through Emergency Medical Services (EMS) within 3-hrs of symptom onset. Patients were identified from our registry and categorized into two groups: Pre-hospital BP ≥ 185/110 (Pre-hsp HBP) and &lt; 185/110 (Pre-hsp LBP). BP records were abstracted from EMS sheets. Two groups were compared using two-sample t-test or Wilcoxon rank sum test for continuous variables and Chi-square test or Fisher’s exact test for categorical variables. Results: A total of 107 consecutive patients were identified. Out of these, 75 patients (70%) were treated with tPA. Among the patients who received thrombolysis, 35% had pre-hospital BP ≥ 185/110 (n= 26/75). Greater number of patients required anti-hypertensive medications in ED in high BP group compared to low BP group (Pre-hsp HBP n= 14/26, 54%; Pre-hsp LBP n= 13/49, 27%, p &lt; 0.02). Mean door to needle times were significantly higher in Pre-hsp HBP group. (mean ± SD 87.5± 34.2 Vs. 59.7±18.3, p&lt;0.0001). Analysis of patients only within the Pre-hsp HBP group (n= 26) revealed that DTN times were shorter if patients received pre-hsp BP medications compared to patients in the same group who did not receive pre-hsp BP medication (n= 10 vs 16; mean ± SD 76.5 ± 25.7 Vs. 94.3 ± 37.7, p = 0.20) Conclusion: Higher pre-hospital BP is associated with prolonged DTN times and it stays prolonged if pre-hospital high BP remains untreated. Although the later finding was not statistical significant due to small sample size, pre-hospital blood pressure control could be a potential area for improvement to reduce door to needle times in acute ischemic stroke.

Vasopressin V2 receptor antagonist tolvaptan is effective in heart failure patients with reduced left ventricular systolic function and low blood pressure.

Diuresis is a major therapy for the reduction of congestive symptoms in acute decompensated heart failure (ADHF) patients. Carperitide has natriuretic and vasodilatory effects, and tolvaptan produces water excretion without electrolyte excretion. We previously reported the usefulness of tolvaptan compared to carperitide in ADHF patients with fluid volume retention. The purpose of this study was to examine whether the efficacy of tolvaptan was altered in ADHF patients with reduced left ventricular systolic function and in those with hypotension. A total of 109 hospitalized ADHF patients were randomly assigned to either a tolvaptan or a carperitide treatment group. Baseline clinical characteristics were not different between the two groups. We divided these patients based on the left ventricular ejection fraction (EF) by echocardiography, and blood pressure (BP) at the time of admission. Daily urine volume between the tolvaptan and carperitide groups in patients with preserved EF (≥ 50%) was not different, however, in those with reduced EF (< 50%), the urine volume was significantly higher in the tolvaptan group than in the carperitide group (day 2, 3, 4, P < 0.05 for all). Daily urine volume did not differ between these two groups in the high blood pressure group (BP ≥ 140 mmHg), but was significantly higher in the tolvaptan group than in the carperitide group (day 1, P = 0.021; day 3, P = 0.017) in the low blood pressure group (BP < 140 mmHg). The present study reveals that tolvaptan is more effective than carperitide, especially in ADHF patients with reduced left ventricular systolic function and without hypertension.