Hypertensive Postmenopausal Women Research Articles

Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis.

Heart failure is the most frequent cause of death among patients affected by rheumatoid arthritis(RA), in which high prevalence is independent of traditional risk factors. An early diagnosis of subclinical heart failure may be made by assessing left ventricular diastolic dysfunction (LVDD) by Doppler Echocardiography. Our study aims to early identify LVDD in RA patients. We enrolled 207 consecutive postmenopausal women (PMW) with normal electrocardiography and physical examination with a confirmed diagnosis of RA, for over one year, 200 PMW free from RA served as the control group (CG). All women underwent M-mode and two-dimensional Doppler echocardiography. A total of 72 women were affected by LVDD among 207 women with RA (34.8%), 46 among 200 women in the CG (23%), chi-squared 6.8, OR 1.8, confidence interval (CI) 95%, p < 0.009. For our RA women, the chance of being affected by LVDD has almost doubled. There were 70 women affected by LVDD among 72 hypertensive women with RA (97.2%). A total of 32 women were affected by LVDD among 98 hypertensive women in the CG (32.7%), chi-squared 72.1, OR 7.2, CI 95%, p < 0.009. Among hypertensive PMW in our population, the chance of being affected by LVDD has more than tripled. All LVDD subjects had abnormal diastolic function for all different degrees. We propose that PMW, affected by RA, have a significantly higher prevalence than CG of LVDD without clinical evidence of heart disease. Since the prevalence is even higher if they are hypertensive, we suggest a Doppler echocardiography examination for all women with a diagnosis of RA.

Acute effect of interval step exercise versus continuous walk exercise on cardiovascular parameters in hypertensive postmenopausal women: A clinical, controlled, and randomized study

Aiming the prevention and treatment of hypertension, regular physical exercise has become important to reduce blood pressure. The present experiment compared the effect of interval step exercise with continuous walking exercise on cardiovascular parameters of post-menopausal hypertensive women. The volunteers were submitted to three experimental sessions: control (CO), interval exercise (IE) and continuous exercise (CE), in randomized order. The sessions lasted 120 min and during this period, resting blood pressure was evaluated after 10min of siting rest before exercise, and 30, 40 and 60min of siting rest position after exercise. Heart rate variability (HRV) were estimated at rest before exercise and 30min after exercise. Blood pressure reactivity (BPR) to the Stroop Color-Word test was measured at rest before exercise and 60min after exercise. Twelve women finished the study (59 ± 4 years and BMI of 29.78 ± 4.10 kg/m2). The One way ANOVA showed that systolic blood pressure (SBP) area under the curve over time were lower (p = 0.014) in both exercise sessions comparing with control session. The Generalized estimation equations (GEE) showed that SDNN and RMSSD indices of HRV decreases (p < 0.001) in both exercises session as well, comparing with CO. Maximal SBP during Stroop test were lower after both IE and CE exercises session comparing with CO session. We conclude that interval step exercise can reduce blood pressure responses and improve HRV acutely after its performance and these responses are similar to continuous walking exercise.

Establishment of an Individual-Specific Nomogram for Predicting the Risk of Left Ventricular Hypertrophy in Chinese Postmenopausal Hypertensive Women.

Background and Objectives: The physiological phenomenon peculiar to women, namely menopause, makes the occurrence of left ventricular hypertrophy (LVH) in postmenopausal hypertensive women more characteristic. Less is known about the risk of developing LVH in Chinese postmenopausal hypertensive women. Thus, the present study was intended to design a nomogram for predicting the risk of developing LVH in Chinese postmenopausal hypertensive women. Materials and Methods: Postmenopausal hypertensive women aged between 49 and 68 years were divided into either the training set (n = 550) or the validation set (n = 284) in a 2:1 ratio. Patients in the validation set were followed up for one year. A stepwise multivariable logistic regression model was used to assess the predictors of LVH in postmenopausal women with hypertension. The best-fit nomogram was executed using R software. The calibration and decision curve were employed to verify the predictive accuracy of the nomogram. The results were evaluated in the validation set. Results: Menopause age (OR = 0.929, 95% CI 0.866-0.998, p = 0.044), BMI (OR = 1.067, 95% CI 1.019-1.116, p = 0.005), morning systolic blood pressure (SBP: OR = 1.050, 95% CI 1.032-1.069, p = 0.000), morning diastolic BP (DBP OR = 1.055, 95% CI 1.028-1.083, p = 0.003), angiotensin II receptor blocker (ARB) utilization rate (OR = 0.219, 95% CI 0.131-0.365, p = 0.000), LDL-C (OR = 1.460, 95% CI 1.090-1.954, p = 0.011) and cardio-ankle vascular index (CAVI) (OR = 1.415, 95% CI 1.139-1.757, p = 0.028) were associated with LVH in postmenopausal hypertension patients. The nomogram model was then developed using these variables. The internal validation trial showed that the nomogram model described herein had good performance in discriminating a C-index of 0.881 (95% CI: 0.837-0.924) and high quality of calibration plots. External validation of LVH-predictive nomogram results showed that the area under the ROC curve was 0.903 (95%CI 0.900-0.907). Conclusions: Our results indicate that the risk prediction nomogram model based on menopausal age, BMI, morning SBP, morning DBP, ARB utilization rate, LDL-C and CAVI has good accuracy and may provide useful references for the medical staff in the intuitive and individualized risk assessment in clinical practice.

Effects of exercise training on metabolic syndrome risk factors in post-menopausal women – A systematic review and meta-analysis of randomised controlled trials

Alterations in the hormonal profiles as women transition to the menopause predisposes individuals to the metabolic syndrome (MetS). In post-menopausal women, this can be exacerbated by sedentary behaviour and physical inactivity. Physical activity can convey many health benefits including improvement in MetS risk factors. However, it remains to be elucidated how differing exercise intensities and its mode of delivery can ameliorate MetS risk factors and resultant progression amongst post-menopausal women. The purpose of this systematic review and meta-analysis was to investigate the effects and efficacy of exercise training on MetS risk factors in post-menopausal women. Database searches using PubMed, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials were conducted from inception to December 2021 for randomised controlled studies (RCTs) investigating exercise training (>8 weeks) in at least one of the MetS risk factors in post-menopausal women. Utilising the random-effects model, appropriate standardised mean differences (SMD) or mean differences (MD) with 95% confidence interval (CI) for each MetS risk factor were used to calculate the overall effect size between the exercise and control groups. Sub-group analyses were performed for exercise intensity, modality, and duration for each risk factor. Meta-regression was performed for categorical (health status) and continuous (body mass index) covariates. 39 RCTs (40 studies) involving 2132 participants were identified as eligible. Overall, the meta-analysis shows that exercise training significantly improved all MetS risk factors: waist circumference (WC) [MD:-2.61cm; 95% CI:-3.39 to-1.86cm; p<0.001; 21 studies]; triglycerides (TG) [SMD:-0.40mmol/L; 95% CI:-0.71 to-0.09mmol/L; p=0.01; 25 studies]; high-density lipoprotein (HDL) [SMD: 0.84mmol/L(95% CI: 0.41-1.27mmol/L; p<0.001; 26 studies]; fasting glucose (BG) [SMD:-0.38mmol/L (95% CI:-0.60 to-0.16mmol/L; p<0.001; 20 studies]; systolic blood pressure (SBP) [MD:-5.95mmHg (95% CI:-7.98 to-3.92mmHg; p<0.001; 23 studies]; and diastolic blood pressure (DBP) [MD:-4.14mmHg (95% CI:-6.19 to-2.08mmHg; p<0.001; 23 studies]. Furthermore, sub-group analyses identified that moderate intensity and combined exercise training significantly improved MetS risk factors (p<0.05) except for HDL, with combined exercise being the most effective. Long duration (≥12 weeks) training also significantly improved MetS risk factors except for TG. Meta-regression revealed no moderating effects on any MetS risk variables. This study reinforces the importance of regular physical activity as a non-pharmacological tool in the reduction of MetS risk in post-menopausal women, with significant metabolic improvements seen in interventions spanning 8-10 weeks. Moderate intensity and combined training significantly benefitted abdominal obesity, dyslipidaemia, dysglycaemia and hypertension in post-menopausal women. Improvements in at least one MetS risk were also seen with other exercise modalities and intensities.

PS-B02-10: MTOR INHIBITOR IMPROVES TESTOSTERONE-INDUCED MYOCARDIAL HYPERTROPHY IN HYPERTENSIVE RATS

Compelling evidence have described the incidence of hypertension and left ventricular hypertrophy in postmenopausal women is significantly increased worldwide. Our team previous research identified that androgen was an underlying factor contributing to increased blood pressure and LVH in postmenopausal women. However, little is known about how androgens affect LVH in postmenopausal hypertensive women. The purpose of this study was to evaluate the role of mTOR signaling pathway in myocardial hypertrophy in androgen-induced postmenopausal hypertension and whether mTOR inhibitors can protect the myocardium from androgen-induced interference to prevent and treat cardiac hypertrophy. For that, ovariectomized spontaneously hypertensive rats aged 12 weeks were used to study the effects of testosterone T 2.85 mg/kg/weekly im on blood pressure and myocardial tissue. On the basis of antihypertensive therapy chlorthalidone 8 mg/kg/day ig, the improvement of blood pressure and myocardial hypertrophy in rats treated with different dose gradients of rapamycin 0.8 mg/kg/day Vs 1.5 mg/kg/day Vs 2 mg/kg/day ip in OVX+ estrogens E 9.6 mg/Kg/day, ig+T group was further evaluated. After T intervention, the OVX female rats exhibited significant increments in the heart weight / tibial length, cross-sectional area of cardiomyocytes and the mRNA expressions of atrial natriuretic peptide, myosin heavy chain and matrix metalloproteinase 9 accompanied by a significant reduction in the uterine weight/TL and issue inhibitor of metalloproteinase 1. Mammalian rapamycin receptor mTOR, ribosomal protein S6 kinase S6K1, 4E-bindiong protein 1 4EBP1 and eukaryotic translation initiation factor 4E in myocardial tissue of OVX+E+T group were expressed at higher levels than those of the other four groups. On the other hand, rapamycin abolished the effects of T-induced cardiac hypertrophy, decreased the systolic and diastolic blood pressure of SHR, and inhibited the activation of mTOR/ S6K1/4EBP1 signaling pathway in a concentration-dependent manner. Collectively, these data suggest that the mTOR/S6K1/4EBP1 pathway is an important therapeutic target for the prevention of LVH in postmenopausal hypertensive women with high T levels. Our findings also support the standpoint that the mTOR inhibitor, rapamycin, can eliminate T-induced cardiomyocyte hypertrophy.

5 ADHERENCE TO PHARMACOTHERAPY IN POSTMENOPAUSAL WOMEN AFFECTED BY HYPERTENSION OR METABOLIC SYMDROME: REAL WORLD EXPERIENCE

Abstract Objectives The aim of our study is to assess the adherence to pharmacological therapy in two different setting of patients, referred to our Heart Stations by General Practitioners and to value the relationship between different levels of cardiovascular prevention and adherence. In our study, medication adherence was estimated by calculating the proportion of days covered (PDC) for all classes of drugs after the index date. The PDC calculation is made based on the fill dates and days supplied for each fill of a prescription and has been validated as a measure of medication adherence. Methods We enrolled 6833 consecutive postmenopausal women, menopause was diagnosed with cessation of menstruation for almost one year. 5857 were hypertensive (85.7%) and 976 (14.3%) were affected by metabolic syndrome (MetS) a cluster of risk factors associated with increased cardiovascular morbidity and mortality. Diagnosis of hypertension was performed according to 2018 European Guidelines for the treatment of high blood pressure and diagnosis of MetS was done according to the National Cholesterol Education Program Adult Treatment Panel III. Exclusion criteria were ventricular ejection fraction &amp;lt; 45% and coronary, valvular and pericardial heart disease. All women were aged 50 to 69 years, data on age, sex, blood pressure and blood test results were collected at baseline. In our study, medication adherence was estimated by calculating the proportion of days covered (PDC) for all classes of drugs after the index date. Results Among 5857 postmenopausal hypertensive women 3752 were affected by hypertensive cardiomyopathy (64%). Among 976 postmenopausal with MetS 550 were affected by metabolic cardiomyopathy (56%). Non-adherent hypertensive women were 297 (5%) on 5857, non-adherent women with MetS were 73 (7.4%) on 976, Chi-squared 9.5, Odds ratio 1.5, c.i.95%, p&amp;lt;0.02. Taking into consideration only women with cardiomyopathy non-adherent were 234 on 4302 (5.4%), while without cardiomyopathy non-adherent were 136 on 2531 (5.3%), Chi-squared 0,1, Odds ratio 1.0, c.i.95%, p n.s.. Taking in account only women with cardiomyopathy non-adherent hypertensive were 194 (5.2%) on 3752, non-adherent with MetS were 40 (7.2%) on 550, Chi-squared 4.2, Odds ratio 1.4, c.i.95%, p&amp;lt;0.04. Finally taking into consideration only women without cardiomyopathy non-adherent hypertensive were 103 (4.9%) on 2105, non-adherent with MetS were 33 (7.7%) on 426, Chi-squared 6, Odds ratio 1.6, c.i.95%, p&amp;lt;0.01. Discussion and Conclusion In our study the rate of nonadherence is much lower, however, there is an increased rate of non-adherence in women with MetS, when compared with hypertensive, regardless of the presence of cardiomyopathy, that in both cases doesn't impact adherence. The analysis of the causes of non-adherence is beyond the scope of this study, we know that nonadherence is due to many factors, but we can suppose that it is more difficult to adhere to the complex therapeutic approach needed in MetS. Perhaps the first step to improving adherence is the awareness of the problem by physicians. Otherwise, we can affirm that there is no difference in adherence to hypertension therapy between patients on primary or secondary prevention when there is an efficient connection among prescriber cardiologists, general practitioners, and hypertensive patients.

Long-term aircraft noise exposure and risk of hypertension in postmenopausal women

BackgroundStudies of the association between aircraft noise and hypertension are complicated by inadequate control for potential confounders and a lack of longitudinal assessments, and existing evidence is inconclusive. ObjectivesWe evaluated the association between long-term aircraft noise exposure and risk of hypertension among post-menopausal women in the Women's Health Initiative Clinical Trials, an ongoing prospective U.S. cohort. MethodsDay-night average (DNL) and night equivalent sound levels (Lnight) were modeled for 90 U.S. airports from 1995 to 2010 in 5-year intervals using the Aviation Environmental Design Tool and linked to participant geocoded addresses from 1993 to 2010. Participants with modeled exposures ≥45 A-weighted decibels (dB [A]) were considered exposed, and those outside of 45 dB(A) who also did not live in close proximity to unmodeled airports were considered unexposed. Hypertension was defined as systolic/diastolic blood pressure ≥140/90 mmHg or inventoried/self-reported antihypertensive medication use. Using time-varying Cox proportional hazards models, we estimated hazard ratios (HRs) for incident hypertension when exposed to DNL or Lnight ≥45 versus <45 dB(A), controlling for sociodemographic, behavioral, and environmental/contextual factors. Results/discussionThere were 18,783 participants with non-missing DNL exposure and 14,443 with non-missing Lnight exposure at risk of hypertension. In adjusted models, DNL and Lnight ≥45 db(A) were associated with HRs of 1.00 (95% confidence interval [CI]: 0.93, 1.08) and 1.06 (95%CI: 0.91, 1.24), respectively. There was no evidence supporting a positive exposure-response relationship, and findings were robust in sensitivity analyses. Indications of elevated risk were seen among certain subgroups, such as those living in areas with lower population density (HRinteraction: 0.84; 95%CI: 0.72, 0.98) or nitrogen dioxide concentrations (HRinteraction: 0.82; 95%CI: 0.71, 0.95), which may indicate lower ambient/road traffic noise. Our findings do not suggest a relationship between aircraft noise and incident hypertension among older women in the U.S., though associations in lower ambient noise settings merit further investigation.

Evaluation of Health-related Quality of Life among Hypertensive Post-menopausal Women Using EQ-5D in India During COVID-19 Pandemic

Abstract: Background: Hypertension and menopause are interrelated factors to determine the quality of life (QOL) in women. Covid-19 was related to massive public anxiety, it is critical to know the level of influence in such pandemics on QOL. So this present study was aimed to evaluate the variables related with poor HRQOL in hypertensive post-menopausal women during Covid-19 pandemic in India. Materials and Methods: Hypertensive postmenopausal women visiting the general medicine department were recruited in this study. Socio-demographics and clinical data were obtained by medical records and oral interview. EQ-5D-3L scale was included to evaluate the HRQOL and multivariate logistic regression model used to analyze the health dimensions. Results: The patient was shown the mean EQ-5D-3L index score of 0.409 and the visual analogue scale score of 78.9, respectively. The most commonly reported problem was anxiety/depression (80%) and pain/ discomfort (75.2%). The Logistic regression models analyzed that the severity of anxiety/depression with number of co morbidities (OR=0.487, 95% CI: 0.276- 0.854) and fear about to get covid-19 (OR=0.169, 95% CI: 0.051-0.569) increased significantly. Conclusion: Our study findings revealed the need of pharmaceutical care intervention programs for improving the mental health status in post-menopausal women during covid-19 pandemic. Keywords: COVID-19, Hypertension, Post-menopausal women, QOL, EQ-5D, Anxiety.

Sex differences in hypertension. Do we need a sex-specific guideline?

Hypertension is the most prevalent cardiovascular disorder and the leading cause of death worldwide in both sexes. The prevalence of hypertension is lower in premenopausal women than in men of the same age, but sharply increases after the menopause, resulting in higher rates in women aged 65 and older. Awareness, treatment, and control of hypertension are better in women. A sex-pooled analysis from 4 community-based cohort studies found increasing cardiovascular risk beginning at lower systolic blood pressure thresholds for women than men. Hormonal changes after the menopause play a substantial role in the pathophysiology of hypertension in postmenopausal women. Female-specific causes of hypertension such as the use of contraceptive agents and assisted reproductive technologies have been identified. Hypertensive disorders in pregnancy are associated with increased risk of maternal, fetal, and neonatal morbidity and mortality, as well as with a greater risk of developing cardiovascular disease later in life. Hypertension-mediated organ damage was found to be more prevalent in women, thus increasing the cardiovascular risk. Sex differences in pharmacokinetics have been observed, but their clinical implications are still a matter of debate. There are currently no sufficient data to support sex-based differences in the efficacy of antihypertensive treatment. Adverse drug reactions are more frequently reported in women. Women are still underrepresented in large clinical trials in hypertension, and not all of them report sex-specific results. Therefore, it is of utmost importance to oblige scientists to include women in clinical trials and to consider sex as a biological variable.

Association between body fat percentage and H-type hypertension in postmenopausal women

BackgroundPrevious studies have explored the relationship between body fat percentage (BFP) and hypertension or homocysteine. However, evidence on the constancy of the association remains inconclusive in postmenopausal women. The aim of this study was to investigate the association between BFP and H-type hypertension in postmenopausal women.MethodsThis cross-sectional study included 1,597 eligible female patients with hypertension. Homocysteine levels ≥10 mmol/L were defined as H-type hypertension. BFP was calculated by measuring patients' physical parameters. Subjects were divided into 4 groups according to quartiles of BFP (Q1: 33.4% or lower, Q2: 33.4–36.1%, Q3: 36.1–39.1%, Q4: >39.1%). We used restricted cubic spline regression models and logistic regression analysis to assess the relationship between BFP and H-type hypertension. Additional subgroup analysis was performed for this study.ResultsAmong 1,597 hypertensive patients, 955 (59.8%) participants had H-type hypertension. There were significant differences between the two groups in age, BMI, educational background, marital status, exercise status, drinking history, WC, TG, LDL, Scr, BUN, and eGFR (P < 0.05). The prevalence of H-type hypertension in the Q1 to Q4 groups was 24.9, 25.1, 24.9, and 25.1%, respectively. After adjusting for relevant factors, we found that the risk of H-type hypertension in the Q4 group had a significantly higher than the Q1 group (OR = 3.2, 95% CI: 1.3–7.5).ConclusionBFP was positively associated with the risk of H-type hypertension in postmenopausal women. Postmenopausal women should control body fat to prevent hypertension.

Investigation of the Changes in Serum Intercellular and Vascular Adhesion Molecules (ICAM-1 and VCAM-1) and Nitric Oxide Levels in Response to Exercise Training and L-arginine Supplementation in Postmenopausal Hypertensive Women

Introduction: The positive effects of exercise training in modulating cardiovascular risk factors in individuals with hypertension have been reported. The present study aimed to investigate the effects of 8 weeks of combined training and L-arginine supplementation on the serum levels of intercellular and vascular adhesion molecules (ICAM-1 and VCAM-1) and nitric oxide (NO) in postmenopausal hypertensive women. Method: The postmenopausal women with hypertension were assigned into four groups consisting of 12 individuals, including placebo (P), L-arginine (L), training (T), and training+Larginine (TL) groups. The combined training program (resistance-endurance) was conducted 3 sessions per week for 8 weeks. The L-arginine ingestion was 6 g daily. Blood sampling was performed at the beginning and the end of 8 weeks of intervention, and the levels of ICAM-1, VCAM-1, and NO were measured. The collected data were analyzed in SPPSS software (version 24), one-way ANOVA, and Tukey post hoc test. Results: The levels of ICAM-1 and VCAM-1 in the T and TL groups compared to the P and L groups significantly decreased (P&lt;0.05). Significant increases of NO levels in the L (P=0.003), T (P&lt;0.001), and TL (P&lt;0.001) groups compared to the P group, and also a significant decrease in systolic and diastolic blood pressure were observed in all intervention groups in comparison to the P group (P&lt;0.05). Conclusion: Based on the findings of the present study, L-arginine ingestion and combined training alone or combined together are effective in the reduction of blood pressure in hypertensive patients. Moreover, L-arginine was associated with amplifying combined training effectiveness in decreasing systolic blood pressure. Blood pressure reduction in the above-mentioned groups is probably exerted partly by the upregulation of NO levels

Association of Leu432Val (rs1056836) polymorphism of the CYP1B1 gene with lipid profile in hypertensive Slovak women

Leu432Val (rs1056836) polymorphism of the CYP1B1 gene was examined in relationship with lipid profile in hypertensive Slovak women according to their menopausal status. The entire study sample comprised 255 women suffering from hypertension aged from 39 to 65 years who were recruited from different localities in the western, southern, and middle parts of Slovakia. The participants provided a saliva or blood sample for DNA genotyping and a blood sample for biochemical analysis. The Leu432Val genotypes demonstrated statistically significant associations with all monitored atherogenic indices – total cholesterol-to-HDL-Cholesterol (AI1), Non-HDL-Cholesterol (AI2), LDL-Cholesterol-to-HDL-Cholesterol (AI3), and the logarithm of the ratio of plasma concentration of triglycerides to HDL-cholesterol (AIP log) in hypertensive pre/perimenopausal women. The mean values were significantly lower in women carrying the Val/Val genotype. In early postmenopausal hypertensive women the Leu432Val genotypes were statistically significant and associated with LDL-cholesterol (LDL-C) and AI2. The mean values of LDL-C and AI2 were significantly lower in women carrying the Leu/Leu genotype. In conclusion, the Leu432Val polymorphism may be associated with the atherogenic indices and LDL-C in hypertensive women.

Postmenopausal Hypertension and Blood Pressure Target Achievements using Monotherapy in a Tertiary Care Teaching Hospital, South India

Background: Prevalence of hypertension and scanty of evidences related to the clinical efficacy and safety of antihypertensive regimens among post menopausal women were almost negligible in India. So, the aim of the present study was aimed to evaluate the efficacy of antihypertensive as monotherapy in hypertensive postmenopausal women. Materials and Methods : A prospective observational study was conducted in Department of General Medicine at Karuna Medical College Hospital, Palakkad, Kerala for a period of November 2019 to October 2020. The patients were divided in to four groups according to the class (Angitensin Receptor Blockers (ARBs) or Calcium Channel Blockers (CCBs) or Diuretics or Beta Blockers) as monotherapy and their BP values were noted. Results: A total of 250 post menopausal hypertensive women were enrolled in this study. The patients achieved the goal on ARBs with 78% and CCBs with 69.5% was higher compared than BB (54.3%) and Diuretics (45.7%). ARBs and CCBs treated patients showed statistically significant differences in reduction of systolic blood pressure, Diastolic blood pressure, Pulse Pressure and Mean Arterial Pressure in hypertensive women. Conclusion: The twothirds of hypertensive post menopausal women are not being achieved the BP goal; those have more risk for cardiovascular disease and stroke.

MTOR INHIBITOR IMPROVES TESTOSTERONE-INDUCED MYOCARDIAL HYPERTROPHY IN HYPERTENSIVE RATS

Objective: Compelling evidence have described the incidence of hypertension and left ventricular hypertrophy (LVH) in postmenopausal women is significantly increased worldwide. Our team’s previous research identified that androgen was an underlying factor contributing to increased blood pressure and LVH in postmenopausal women. However, little is known about how androgens affect LVH in postmenopausal hypertensive women. The purpose of this study was to evaluate the role of mTOR signaling pathway in myocardial hypertrophy in androgen-induced postmenopausal hypertension and whether mTOR inhibitors can protect the myocardium from androgen-induced interference to prevent and treat cardiac hypertrophy. Design and method: For that, ovariectomized (OVX) spontaneously hypertensive rats (SHR) aged 12 weeks were used to study the effects of testosterone (T 2.85 mg/kg/weekly im) on blood pressure and myocardial tissue. On the basis of antihypertensive therapy (chlorthalidone 8 mg/kg/day ig), the improvement of blood pressure and myocardial hypertrophy in rats treated with different dose gradients of rapamycin (0.8 mg/kg/day Vs 1.5 mg/kg/day Vs 2 mg/kg/day ip) in OVX+ estrogens (E 9.6 mg/Kg/day, ig)+T group was further evaluated. Results: After T intervention, the OVX female rats exhibited significant increments in the heart weight / tibial length (TL), cross-sectional area of cardiomyocytes and the mRNA expressions of atrial natriuretic peptide, B- myosin heavy chain and matrix metalloproteinase 9 accompanied by a significant reduction in the uterine weight/TL and issue inhibitor of metalloproteinase 1. Mammalian rapamycin receptor (mTOR), ribosomal protein S6 kinase (S6K1), 4E-bindiong protein 1(4EBP1) and eukaryotic translation initiation factor 4E in myocardial tissue of OVX+E+T group were expressed at higher levels than those of the other four groups. On the other hand, rapamycin abolished the effects of T-induced cardiac hypertrophy, decreased the systolic and diastolic blood pressure of SHR, and inhibited the activation of mTOR/ S6K1/4EBP1 signaling pathway in a concentration-dependent manner. Conclusions: Collectively, these data suggest that the mTOR/S6K1/4EBP1 pathway is an important therapeutic target for the prevention of LVH in postmenopausal hypertensive women with high T levels. Our findings also support the standpoint that the mTOR inhibitor, rapamycin, can eliminate T-induced cardiomyocyte hypertrophy.

ASSOCIATION OF FREE ANDROGEN INDEX AND SEX HORMONE BINDING GLOBULIN AND LEFT VENTRICULAR HYPERTROPHY IN POSTMENOPAUSAL HYPERTENSIVE WOMEN

Objective: The aim of the present study was to explore the relationship between androgen and LVH in postmenopausal hypertensive women. Design and method: Enrolled in this study were 378 postmenopausal hypertensive women who were admitted to the department of cardiology between December 2018 and December 2020. Results: According to left ventricular mass index (LVMI) evaluated by echocardiography, the patients were divided into LVH group (n = 172) and non-LVH group (n = 206). Their clinical characteristics were collected. Based on the result of propensity score matching analysis, 160 cases in each group were matched successfully. After correcting for confounding factors by various models, the results showed that free androgen index (FAI)and sex hormone-binding globulin (SHBG)were the influencing factors of LVH in postmenopausal women with hypertension. Patients with elevated SHBG were 5% less likely to develop LVH than those without elevated SHBG (OR:0.950, 95%CI 0.922–1.578). Postmenopausal hypertensive patients with elevated FAI were 16% more likely to have LVH than those without elevated FAI (OR:1.608, 95%CI 0.807–3.202). Multiple linear regression showed that LVMI increased by 61.82 g/m2 for every 1 unit increase in FAI. In addition, SHBG decreased by 1 nmol/l, and LVMI increased by 0.177 g/m2. Subgroup analysis showed that patients in the controlled BP group had a lower risk of LVH for every additional unit of SHBG compared with the uncontrolled BP group. The risk of LVH for each additional unit of FAI in the uncontrolled BP group was higher than that in the controlled BP group. Conclusions: The results of this present study showed that the occurrence of LVH was positively correlated with FAI and negatively correlated with SHBG in postmenopausal women with hypertension. The increase of FAI level and the decrease of SHBG level may be related to the occurrence and development of LVH in postmenopausal hypertension.

Mat Pilates training reduces blood pressure in both well-controlled hypertensive and normotensive postmenopausal women: a controlled clinical trial study

ABSTRACT Aim The aim of this study was to compare the Mat Pilates training-induced responses in resting and ambulatory blood pressure monitoring (ABPM), blood pressure variability (BPV), and heart rate variability (HRV) in well-controlled hypertensive and normotensive postmenopausal women. Methods Forty-seven postmenopausal women were allocated in well-controlled hypertensive (HT) and normotensive (NT) groups. The exercise program was performed three times a week for 12 weeks. Before and after the intervention resting, blood pressure (BP), ABPM, HRV, and BPV were analyzed. Results Student’s t-test showed no difference in baseline anthropometric and resting BP values between groups. The generalized estimation equation (GEE) showed no interactions (group*time), but time (p < .05) reductions in resting systolic, diastolic and mean BP after training in both groups. Sleep ambulatory systolic, diastolic and mean BP were higher overall in the HT group (p < .05 in group effect). We also found a time effect (p < .05) with significant increases in BPV in the mean diurnal and nocturnal deviations weighted for the duration of the daytime and nighttime interval (SDdn) in systolic, diastolic and mean BP, and in the average real variability (ARV) in diastolic and mean in both groups. In addition, HRV increases (p < .05 in time effect) through the percentage of pairs of adjacent RR intervals with a difference of at least 50 ms (pNN50) after training in both groups. Conclusion Both normotensive and well-controlled hypertensive postmenopausal women may have similar Mat Pilates exercise training-induced responses in ambulatory BP, BPV and HRV.

Different cardiovascular responses to exercise training in hypertensive women receiving β-blockers or angiotensin receptor blockers: A pilot study

ABSTRACT Aim To verify the influence of β-blockers or angiotensin receptor blockers on cardiovascular responses to exercise training in hypertensive post-menopausal women. Methods Postmenopausal women were allocated into: healthy control group (CON; n = 9); angiotensin receptor blockers users (ARB; n = 19); and β-adrenergic blockers users (BB; n = 19). Before and after 12 weeks of combined (aerobic and resistance) exercise training they were evaluated by: heart rate (HR) and its variability (HRV), blood pressure (BP) under stress (Cold pressor and Stroop color tests), and ambulatorial BP and its variability. Results In ambulatorial BP analysis only in ARB group awake systolic BP decreased (p = .011; ARB: From 122 ± 11 to 117 ± 9; BB: From 118 ± 7 to 114 ± 5; CON: From 121 ± 7 to 127 ± 11 mmHg). There were time effects in BP reactivity to stress, where BP reactivity after Stroop color and Cold pressor test decreased in all groups. In BP variability analysis, only BB group has significative decreased values in systolic SD24 (p = .007; ΔARB = −0.3 ± 2.0; ΔBB = −1.3 ± 2.0; ΔCON = 0.8 ± 1.7 mmHg) and SDdn (p = .006; ΔARB = −0.2 ± 1.6; ΔBB = −1.3 ± 2.0; ΔCON = 0.4 ± 2.1 mmHg). HRV analysis demonstrated that post-training, only in BB group LF/HF decreased (p = .001; ΔARB = 0.1 ± 0.8; ΔBB = −0.4 ± 1.5; ΔCON = 1.0 ± 1.7). Conclusion ARB present pronounced responses in awake ambulatorial systolic BP, while β-blockers users present greater responses in BP variability. Besides that, exercise can mitigate BP reactivity to stress with no differences between groups. Lastly, there were no major differences in HRV. Trial registry at “Clinicaltrials.gov” NCT03529838

Mat Pilates training and blood pressure reactivity responses to psychological stress: comparison between normotensive and hypertensive postmenopausal women.

The aim of this study is to compare resting blood pressure and blood pressure reactivity responses to psychological stress in normotensive and hypertensive postmenopausal women after 12 weeks of Mat Pilates training. Twenty-three hypertensive and 24 normotensive postmenopausal women, performed Mat Pilates training 3× a week for 12 weeks. Before and after the intervention, resting blood pressure, heart rate, and blood pressure reactivity to psychological stress through the electronic version of Stroop test protocol (3 minutes) were measured. We calculated the variation (Δ) of blood pressure (peak of blood pressure during the Stroop stress test minus resting blood pressure before test). The two-way ANOVA showed that the Δ of systolic blood pressure, diastolic blood pressure, and the mean blood pressure was reduced ( P < 0.05) after training only in the hypertensive. The resting systolic, diastolic, and mean blood pressures decreased by ( P < 0.05) over time in both groups with no interaction or difference. Mat Pilates was able to reduce resting blood pressure in both hypertensive and normotensive, and blood pressure reactivity after psychological stress in hypertensive but not in normotensive postmenopausal women.

Oral Microbiome Is Associated With Incident Hypertension Among Postmenopausal Women.

BackgroundOral microbiota are thought to influence blood pressure (BP) regulation. However, epidemiological data supporting this hypothesis are limited. We examined associations between oral microbiota, BP, and incident hypertension in postmenopausal women.Methods and ResultsBaseline (1997–2001) examinations were completed on 1215 women (mean age, 63 years) during which subgingival plaque was collected, BP was measured, and medical and lifestyle histories and medication inventory were obtained. Microbiome composition of subgingival plaque was measured using 16S ribosomal RNA gene amplicon sequencing. Baseline measured BP was defined as normotensive (systolic <120 mm Hg and diastolic <80 mm Hg, no BP medication use; n=429); elevated (systolic ≥120 mm Hg or diastolic ≥80 mm Hg, no medication use; n=306); or prevalent treated hypertension (history of physician diagnosis treated with medications; n=480). Incident hypertension (375 cases among 735 without baseline treated hypertension) was defined as newly physician‐diagnosed hypertension treated with medication reported on annual health surveys (mean follow‐up, 10.4 years). Cross‐sectional analysis identified 47 bacterial species (of 245 total) that differed significantly according to baseline BP status (P<0.05). Prospective analysis identified 15 baseline bacterial species significantly (P<0.05) associated with incident hypertension: 10 positively (age‐adjusted hazard ratios [HRs], 1.10–1.16 per SD in bacterial abundance) and 5 inversely (HRs, 0.82–0.91) associated. Associations were materially unchanged after further adjustment for demographic, clinical, and lifestyle factors; were similar when analysis was restricted to the normotensive group; and were of consistent magnitudes between strata of baseline age, smoking, body mass index, and BP categories.ConclusionsSpecific oral bacteria are associated with baseline BP status and risk of hypertension development among postmenopausal women. Research to confirm these observations and elucidate mechanisms is needed.

Characterization of Potassium-Induced Natriuresis in Hypertensive Postmenopausal Women During Both Low and High Sodium Intake.

Potassium-induced natriuresis may contribute to the beneficial effects of potassium on blood pressure but has not been well-characterized in human postmenopausal hypertension. We determined the time course and magnitude of potassium-induced natriuresis and kaliuresis compared with hydrochlorothiazide in 19 hypertensive Hispanic postmenopausal women. We also determined the modulating effects of sodium intake, sodium-sensitivity, and activity of the thiazide-sensitive NCC (sodium-chloride cotransporter). Sixteen-day inpatient confinement: 8 days low sodium followed by 8 days high sodium intake. During both periods, we determined sodium and potassium excretion following 35 mmol oral KCl versus 50 mg hydrochlorothiazide. We determined sodium-sensitivity as change in 24-hour systolic pressure from low to high sodium. We determined NCC activity by standard thiazide-sensitivity test. Steady-state sodium intake was the key determinant of potassium-induced natriuresis. During low sodium intake, sodium excretion was low and did not increase following 35 mmol KCl indicating continued sodium conservation. Conversely, during high sodium intake, sodium excretion increased sharply following 35 mmol KCl to ≈37% of that produced by hydrochlorothiazide. Under both low and high sodium intake, 35 mmol potassium was mostly excreted within 5 hours, accompanied by a sodium load reflecting the steady-state sodium intake, consistent with independent regulation of sodium/potassium excretion in the human distal nephron. Potassium-induced natriuresis was not greater in sodium-sensitive versus sodium-resistant hypertensives or hypertensives with higher versus lower basal NCC activity. We studied an acute KCl challenge. It remains to further characterize potassium-induced natriuresis during chronic potassium increase and when potassium is administered a complex potassium-containing meal.