Increase In SBP Research Articles

Short- and Long-Term Effects of Inhaled Ultrafine Particles on Blood Pressure: A Systematic Review and Meta-Analysis

Background: Air pollution contributes to up to 60% of premature mortality worldwide by worsening cardiovascular conditions. Ultrafine particles (UFPs) may negatively affect cardiovascular outcomes, and epidemiological studies have linked them to short- and long-term blood pressure (BP) imbalance. Methods: We conducted a systematic review and meta-analysis of the short- and long-term effects of UFP exposure on systolic (SBP) and diastolic (DBP) blood pressure. Eligibility criteria were established using the Population, Exposure, Comparator, Outcome, and Study Design (PECOS) model, and literature searches were conducted in Web of Science, PubMed, Embase, and Scopus for studies published between 1 January 2013 and 9 October 2024. Risk of Bias (RoB) was assessed following World Health Organization (WHO) instructions. Separate meta-analyses were performed for the short- and long-term effects of UFP exposure on SBP and DBP. Additionally, we analyzed SBP and DBP imbalances across different timespans following short-term exposure. Results: The results showed an increase in BP during short-term UFP exposure, which returned to baseline values after a few hours. Changes in SBP were greater than in DBP following both short- and long-term exposure. Prolonged exposure to UFPs is associated with increased SBP and concurrently low DBP values. Chronic exposure to UFPs may lead to a persistent increase in SBP, even without a concurrent increase in DBP. Conclusions: The findings presented here highlight that UFPs may contribute to worsening cardiovascular outcomes in vulnerable populations living in air-polluted areas.

The Effect of Fludrocortisone on Ambulatory Blood Pressure Markers of Falls Risk Amongst Older People with Falls

Abstract Background Fludrocortisone is frequently used to raise blood pressure in older patients with falls due to hypotension, yet evidence to support its use is limited. The aim of this study was to assess changes in Ambulatory Blood Pressure Monitors (ABPM) markers of future falls risk seen after commencing/increasing Fludrocortisone in older people with falls due to orthostatic hypotension (OH) or vasovagal syncope. Methods A cohort of older patients (≥65 years) attending a tertiary-referral falls & syncope unit and prescribed Fludrocortisone were included. ABPM at index visit and follow-up (after commencing/increasing Fludrocortisone) were analysed, with specific focus on markers of future falls risk: overall Systolic Blood Pressure (sBP), minimum sBP, sBP variability & ‘dips’ in systolic sBP <100 mm Hg. These variables were compared pre and post Fludrocortisone using paired t-tests. Results Twenty-three patients (median age 74 years (SD 6.05), 3/4 with OH) were followed for median 4.5 (SD 6.53) months. Two-thirds were commenced on Fludrocortisone, with the dose increased in the rest. Patients commencing Fludrocortisone had a significant increase in overall sBP from 110.13mmHg (95% CI 104.26 – 116.00) to 127.93mmHg (95% CI 120.00 – 135.87) (p<0.001) at follow-up, and a significant increase in minimum sBP from 82.2mmHg (95% CI 76.25 – 88.15) to 99.87mmHg (95% CI 91.47 – 108.26) (p=0.001). There was also a significant reduction in the number of SBP ‘dips’ after commencing Fludrocortisone (9.6 pre to 2.67 post, (95% CI 0.08 – 5.25), p=0.004)), and after commencing/increasing Fludrocortisone dose (8.09 pre to 2.74 post (95% CI 0.62 – 4.85) (p=0.012)). Conclusion This study provides clinical data on the effectiveness of Fludrocortisone in older patients with falls due to hypotension, demonstrating significantly improved markers of future falls risk. Overall sBP increased significantly by 16% and minimum sBP increased by over 20% after starting Fludrocortisone. The number of SBP ‘dips’ also significantly reduced, by over 70% in those who commenced Fludrocortisone.

Twelve hot questions in the management of hypertension in patients aged 80+ years and their answers with the help of the 2023 European Society of Hypertension Guidelines.

Arterial hypertension is a major risk factor for cardiovascular morbidity and mortality, and highly prevalent in older age, underscoring the importance of its appropriate management. The population is ageing at an increasing rate, with those aged 80+ years being the fastest growing population characterized by high heterogeneity in terms of functionality and autonomy. The prevalence of hypertension rises with increasing age, due to a significant increase in SBP largely as a result of age-related stiffening of the aorta and other large arteries, affecting almost 80% of those aged 80+ years. Appropriate management of blood pressure in this population is a priority for clinicians. Frailty is a condition characterized by marked vulnerability to adverse health outcomes and is common among older adults including those with hypertension. Hypertension increases frailty level and at the same time, individuals with increasing frailty present with more drug-related adverse effects meaning they are less tolerant to blood pressure lowering by medication. Thus, frailty is a factor that should be integrated when treating hypertension in this population. The European Society of Hypertension 2023 Guidelines on the management of Hypertension are the first international guidelines to integrate the concept of adapting blood pressure management in older adults according to their frailty/functionality level, and to propose practical tools for the application of this concept in the daily practice of physicians and other healthcare professionals. The present article prepared by the European Society of Hypertension Working Group on Hypertension in Older Adults aims to further address some important aspects mentioned concisely in the 2023 European Society of Hypertension guidelines, in order to help physicians and other healthcare professionals including those practicing in primary care. To this end, this study discusses 12 'hot questions' which are answered with the help of the 2023 European Society of Hypertension Guidelines. We hope the present article and Working Group's actions will contribute to understanding and applying the ideal management of hypertension in this most vulnerable population.

Exposure to organophosphate ester flame retardants and plasticizers and associations with preeclampsia and blood pressure in pregnancy

BackgroundOrganophosphate esters (OPEs), flame retardants and plasticizers found widely in consumer products, may impact vascularization processes in pregnancy. Yet, the association between maternal exposure to OPEs and both preeclampsia and blood pressure during pregnancy remains understudied. MethodsWithin the LIFECODES Fetal Growth Study (N = 900), we quantified 8 OPE metabolites from maternal urine collected at up to 3 time points during pregnancy and created within-subject geometric means. Outcomes included diagnosis of preeclampsia and longitudinal systolic (SBP) and diastolic (DBP) blood pressure measurements (mean = 14 per participant). Cox proportional hazards models were used to estimate associations between OPE metabolites and preeclampsia. Associations between average OPE metabolite concentrations and repeated blood pressure measurements were estimated using generalized estimating equations. ResultsFive OPE metabolites were detected in at least 60% of samples; 3 metabolites detected less frequently (5–39%) were examined in an exploratory analysis as ever vs. never detectable in pregnancy. There were 46 cases of preeclampsia in our study population. Associations between OPE metabolites and preeclampsia were null. We noted several divergent associations between OPE metabolites and longitudinal blood pressure measurements. An interquartile range (IQR) difference in average bis(2-chloroethyl) phosphate concentrations was associated with a decrease in SBP (−0.81 mmHg, 95% confidence interval [CI]: −1.62, 0.00), and, conversely, bis(1-chloro-2-propyl) phosphate was associated with a slight increase in SBP (0.94 mmHg, 95% CI: 0.28, 1.61). We also noted a decrease in SBP in association with several metabolites with low detection frequency. ConclusionsWe observed null associations between OPE metabolites and preeclampsia, but some positive and some inverse associations with blood pressure in pregnancy. While our study was well-designed to assess associations with blood pressure, future studies with a larger number of preeclampsia cases may be better poised to investigate the association between OPE metabolites and phenotypes of this heterogenous hypertensive disorder of pregnancy.

Abstract P135: Evaluating the Impact of Cumulative Blood Pressure and Metabolic Indicators on Long-Term Cardiovascular Risk: Insights from a 9-year Nationwide Prospective Cohort Study

Background: Cardiovascular diseases (CVD) are a global health challenge, particularly for older adults. Blood pressure and the Triglyceride-Glucose (TyG) index, an insulin resistance indicator, are key predictors of cardiometabolic risks. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), this study followed participants without baseline CVD over 9 years. We stratified subjects by cumulative TyG and TyG-BMI indices, applying Cox proportional hazards adjusted by age and gender, and restricted cubic spline regression for CVD risk evaluation. Results: From 11,847 participants, 4,751 were analyzed, mainly females (55.25%), with a median age of 57. BMI, TyG, and TyG-BMI indices increased significantly (23.16 to 23.51 for BMI; 8.59 to 8.62 for TyG, 199.14 to 204.22 for TyG-BMI) over 4 years. Participants were categorized based on cumulative TyG and TyG-BMI medians at 25.84 and 606.43, respectively. In the lower TyG group, each SBP unit increment raised CVD risk by 0.5% at 4 years (HR = 1.005, 95% CI 1.003–1.007, p<0.001) and 9 years (HR = 1.005, 95% CI 1.004–1.006, p<0.001). Each 10-unit rise in cumulative DBP corresponded to an 8-9% higher CVD risk at the 4 and 9-year follow-ups. In the higher TyG group, SBP increases were significantly associated with CVD risk changes. Each 10-unit DBP rise corresponded to a non-significant 2% risk elevation at 4 years, but a significant 3% risk increase at 9 years (HR = 1.003, 95% CI 1.000–1.005, p=0.023). For those with a TyG-BMI below 606.43, minor SBP increases significantly impacted CVD risk at both 4 and 9 years. Meanwhile, each 10-unit DBP increment resulted in a 6-8% risk increase, which grew over time. Above a TyG-BMI of 606.43, SBP changes resulted in a notable 2% risk rise by 9 years, and 10-unit DBP increases resulted in a 2-3% risk rise by 9 years. Restricted cubic spline regression showed the 4 and 9-year CVD risk increased with each rise in cumulative SBP and DBP when cumulative TyG was <25.84 or cumulative TyG-BMI <606.43, and DBP had a more profound impact. In contrast, trends were unclear when cumulative TyG ≥25.84 or cumulative TyG-BMI ≥606.43. Conclusion: Cumulative SBP and DBP increases are linked to higher CVD risks, especially in individuals with lower cumulative TyG or TyG-BMI indices. DBP effects were more substantial, particularly noticeable over 9 years. This study underscores the nuanced impacts of blood pressure and metabolic indicators on long-term cardiovascular health.

Abstract P358: Interaction of Cytochrome P450 (CYP) 4A10 and CYP1B1 in the Paraventricular Nucleus in the Angiotensin II-induced Hypertension and Neuroinflammation in Female Mice

We have shown that 17β-estradiol (E2)-cytochrome P450 (CYP) 1B1 and catechol-ο-methyltrasnferase-generated metabolite 2-methoxyestradiol (2-ME) in the paraventricular nucleus (PVN) protects against angiotensin (Ang) II-induced hypertension and neuroinflammation. This study was conducted to determine the relationship between CYP4A10 that is expressed in the PVN and metabolizes arachidonic acid (AA) into prohypertensive eicosanoid, 20-hydroxyeicosatetraenoic acid (20-HETE), and CYP1B1 in Ang II-induced hypertension, neuroinflammation, and reactive oxygen species (ROS) production in female mice. Systemic Ang II infusion (700 ng/kg/min, s.c., two weeks) and transduction in the PVN with adenovirus (Ad)-GFP scrambled (Scr)-short hairpin (sh) RNA (200 nL bilaterally, 6.4×10 11 pfu/mL, single injection) produced a significant increase in systolic blood pressure (SBP, tail-cuff) at Day 12 compared to Day 0 (mmHg, 114±3 vs 151±3 respectively, P<0.05, n=6/group) in wild-type (WT) and a much larger increase in CYP1B1 knockout (KO) female mice having E2 but not 2-ME (119±4 vs 173±6 respectively, P<0.05, n=5/group). Ad-GFP-CYP4A10 shRNA (200 nL bilaterally, 1.0×10 12 pfu/mL, single injection) but not Ad-GFP Scr-shRNA transduced in the PVN diminished Ang II-induced increase in SBP at Day 12 in WT mice (mmHg, 119±2 vs 122±3 respectively, P<0.05, n=5/group), and CYP1B1KO mice (mmHg, 115±1 vs 133±2 respectively, P<0.05, n=5/group). Similar results were obtained with Ad-GFP-CYP4A10 shRNA compared to Ad-GFP Scr-shRNA transduced in the PVN on mean arterial pressure (MAP) measured by radiotelemetry (Day 12: mmHg, 121±4 vs 152±4 respectively, P<0.05, n=4/group) in CYP1B1 KO mice. The number of TMEM119 + microglia and GFAP + astrocytes, markers of neuroinflammation determined by immunofluorescence, and ROS production by dihydroethidium staining followed the changes in blood pressure produced by Ang II in the above groups. To determine the contribution of central AA-CYP4A10-generated 20-HETE to Ang II-induced hypertension, the effect of 20-HETE receptor GPR75 siRNA administered intracerebroventricularly (Dharmacon, SMARTpool: 0.4 nmol 2 μ l, single injection ) was examined in CYP1B1KO mice. GPR75 siRNA but not its non-target siRNA minimized Ang II-induced increase in SBP (Day 12: mmHg, 132±4 vs 171±3, P<0.05, n=6/group). These data suggest that the 20-HETE receptor antagonist could be useful in treating hypertension and associated neuroinflammation in females with ovarian dysfunction.

Abstract P422: Neuropeptide FF and Its Receptor NPFFR2 Decrease Renal Sodium Excretion and Increase Blood Pressure in Mice

The kidney is critical in the overall regulation of fluid and electrolyte balance and blood pressure. Neuropeptide FF (NPFF), a morphine-modulating peptide, regulates cardiovascular function through its interaction with two receptors, NPFFR1 and NPFFR2. We now report that NPFF and its receptors, mainly NPFFR2, are expressed in the kidney. NPFF (9.25 mmol, 0.5 mL/hr, 0.05 nmol/day, 7 days) chronically infused underneath the renal capsule, decreased renal sodium excretion (UNaV) from 0.68±0.07 mEq/day, n=5 to 0.43±0.06 mEq/day (n=6/group) in conscious C57BL/6 mice. This was accompanied by an increase in systolic blood pressure (SBP, 114.5±5.0 mm Hg, n=4); the infusion of vehicle (saline) did not affect the blood pressure (96.4±3.0 mm Hg, n=4). The renal subcapsular injection of a single dose (10 µg in 100 µL) of NPFF also increased SBP within 15-35 min (NPFF: 105.5±3.44 mm Hg, n=6); saline injection did not affect SBP (82.6±5.65 mm Hg, n=4). RF-9 (10 µg in 100 µL), an antagonist of NPFF receptors prevented the NPFF-mediated increase in SBP (NPFF alone: 105.5±3.44 mm Hg, n=6; RF+NPFF: 88.5±5.90 mm Hg, n=5), whereas RF-9, alone, had no effect (Baseline: 97.6±2.70 mmHg; RF-9: 90.9±4.70 mm Hg, n=5). The renal subcapsular injection of scrambled peptide (10 µg in 100 µL) had no effect on SBP (86.1±1.83 mm Hg, n=4). However, SBP was decreased by the renal subcapsular infusion of Npffr2 siRNA (98±4 vs 113±3 mmHg; P < 0.05; n=3-5/group) in C57Bl/6 mice fed with a high salt diet (4% NaCl). Furthermore, the SBP of conventional germline Npffr2 knockout (KO) mice fed a high salt (4% NaCl) diet was lower than the SBP of wild-type (WT) littermates (WT: 105.6±2.9 mm Hg, n=5; KO: 90.5±5.5 mm Hg, n=4, P < 0.05). By contrast, in mice fed normal salt (0.8% NaCl) diet, SBP was not different between Npffr2 KO mice and WT littermates (WT: 96.5±4.5 mm Hg, n=5; KO: 98.7±11.7 mm Hg, n=4, P > 0.05). Taken together, NPFF and its receptor, NPFFR2, in the kidney cause salt-sensitive hypertension in mice. Uncovering the functional relevance of renal NPFF in the dynamic regulation of renal sodium transport will lead to a better understanding of blood pressure homeostasis.

Abstract MP01: Clinical Characteristics of Morning Blood Pressure Surge in Patients with Autonomic Failure

Autonomic failure (AF) is characterized by orthostatic hypotension (OH), but most of these patients also have nocturnal supine hypertension (SH), which has been associated with end-organ damage, pressure natriuresis, and worsening of daytime OH. About 30% of patients with SH, however, have a preserved nocturnal BP dipping that is likely associated with a morning BP surge (MBPS). To determine the pattern of MBPS and its association with dipping, natriuresis, and morning OH, we studied 92 AF patients (67±1 yr, 59% males; 32 multiple system atrophy and 60 peripheral autonomic failure [pAF]). Patients were studied off BP medications and placed on a low monoamine, caffeine-free diet containing 150 mEq/d sodium and 70 mEq/d potassium. Nocturnal BP was assessed every 2 hours from 8pm-8am, followed by a 10-minute standing test. Urine was collected for 24 hours and divided into two 12-hour periods. As expected, we found that dipping (systolic BP [SBP] fall ≥10% during nighttime sleep [12am-6am] from baseline [8pm to 10pm]) occurred in 33% of patients, with an average decrease of 35±5 mmHg at 4am. The MBPS (SBP increase at 8am from the average of 3 nighttime SBPs centered on the lowest one) was 10±2 mmHg (range -83 to 77 mmHg; MBPS≥ 20 mmHg, 23%). MBPS was negatively correlated with the magnitude of dipping (r=-0.328, p<0.001; dippers 18±3 vs. nondippers 6±3 mmHg; p=0.010) and mean nighttime SBP (r=-0.230, p=0.028). The night-to-day ratio of sodium (r=-0.417, p=0.002) and urine (r=-0.292, p=0.037) excretion was also negatively correlated with MBPS, indicating that patients with greater MBPS had decreased natriuresis during the night compared to the day. In the morning, a greater MBPS was associated with a larger SBP drop on standing (r=-0.242, p=0.034). No associations were found between MBPS and age, sex, history of essential hypertension, or the underlying diagnosis of AF. To assess the hemodynamic mechanisms of the MBPS, we studied 17 AF patients (67±2 yr, 14 males, all pAF). We found that MBPS (13±5 mmHg, range -18 to 56 mmHg) was associated with an increase in systemic vascular resistance (SVR, r=0.777, p=0.01) and a higher augmentation index (Aix@75, r=0.516, p=0.049). In conclusion, a subset of AF patients had a preserved dipping pattern and an MBPS despite severe impairment of BP regulation. MBPS was associated with increased SVR, lower nighttime SBP, and lower night-to-day natriuresis, but the higher supine SBP in the morning was associated with worse OH.

Environmental Cadmium Exposure Induces an Increase in Systolic Blood Pressure by Its Effect on GFR

Chronic exposure to the nephrotoxic metal pollutant, cadmium (Cd), has been associated with hypertension, but the mechanism by which it raises blood pressure is not understood. We hypothesize that exposure to Cd reduces the glomerular filtration rate (GFR), which in turn causes a rise in blood pressure. Data were collected from 447 Thai subjects with a mean age of 51.1 years, of which 48.8% had hypertension, 15.4% had diabetes, and 6.9% had an estimated GFR (eGFR) below 60 mL/min/1.73 m2 (low eGFR). More than half (58.8%) and 23.9% had moderate and severe tubular proteinuria, respectively. The mean blood and urinary Cd concentrations were 2.75 and 4.23 µg/L, respectively. Doubling of body burden of Cd increased the prevalence odds ratios (POR) for low eGFR and severe tubular proteinuria 41% and 48%, respectively. The POR for hypertension rose twofold in those with blood Cd levels of 0.61–1.69 µg/L or urinary Cd excretion levels ≥ 0.98 µg/g creatinine. In the hypertensive group, the eGFR was inversely associated with age (β = −0.517), the Cd excretion rate (β = −0.177), and diabetes (β = −0.175). By mediation analysis, an increase in SBP was attributable totally to the effect of Cd on GFR. Thus, blood pressure appeared to rise as GFR fell. This finding is consistent with the well-known role of the kidney in long-term blood pressure regulation, and explains a universally high prevalence of hypertension among patients with low eGFR.

Indoor air pollution and hypertension disease burden among women using low-grade fuels

Exposures to indoor air pollution from the combustion of Low-grade Fuels (LgFs) is a leading risk factor for global disease burden. Emerging evidence suggest a potential role of PM2.5 exposures in Blood Pressure (BP) elevation. This study assessed the effects of Indoor Air Pollution (IAP) from the use of LgFs on hypertension disease burden among women in low-income settlements. We measured the kitchen concentrations and personal exposures to PM2.5 for users of LgFs compared with users of LPG in the city of Aba, Nigeria. The study also assessed hypertension markers for 328 adult women in the population. Association between PM2.5 exposures and BP was modelled with hierarchical multiple regression, adjusting for major covariates. The indoor PM2.5 concentrations for users of LgFs ranged from 47.5 to 800.0 μg/m3 while that for LPG users ranged from 33.0 to 112.5 μg/m3. The mean personal exposures were 152.3 μg/m3 and 58.3 μg/m3 for users of LgFs and LPG, respectively. The age-standardized hypertension prevalence in the population was 24.4 % and 15.6 % for users of LgFs and LPG, respectively. Exposures to PM2.5 moderately predicted SBP among users of LgFs but not among LPG users; the increase in 1 μg/m3 of PM2.5 exposure resulted to 0.44 mmHg increase in SBP among users LgFs. Long-term exposures to IAP from the use of low-grade fuels is associated with increased SBP and greater risks of systemic hypertension. These findings reinforce the need for public policies towards improving access to, and affordability of LPG as an alternative household fuel.

#730 Dialysis-induced changes in systolic, diastolic, and pulse pressure in maintenance hemodialysis patients

Abstract Background and Aims Hemodialysis (HD) therapy has a strong impact on cardiovascular function in both the short and long term. In the short term, the dialysis-induced changes in blood volume directly affect the arterial blood pressure (BP), frequently leading to intradialytic hypotension or hypertension, both associated with adverse outcomes. The aim of this study was to investigate the dialysis-induced changes in systolic (SBP), diastolic (DBP), and pulse pressure (PP) in maintenance HD patients and to assess their relationship with pre-HD BP. Methods 197 maintenance HD patients were studied during the middle dialysis session of the week. The mean pre-dialysis fluid overload was 2.0 ± 1.6 L (calculated as the difference between the pre-dialysis body weight and the target weight). All HD sessions lasted approximately 4 h and were performed using mainly low-flux dialyzers. SBP and DBP were measured pre-HD and post-HD using a sphygmomanometer. PP was calculated as SBP minus DBP. The patients were divided into two groups: A) patients with an intradialytic decline in SBP (∆SBP <0), and B) patients with an increase or no change in SBP during HD (∆SBP ≥0). Paired data were compared using the Student's t-test. Correlations between variables were assessed using Spearman's rho (ρ). Results During HD, SBP decreased in 120 (61%) patients (in 20 cases by more than 30 mmHg), remained unchanged in 11 (6%) patients, and increased in 66 (33%) patients (in 13 cases by more than 20 mmHg). DBP decreased in 94 (48%) patients, remained unchanged in 46 (23%) patients, and increased in 57 (29%) patients. In 76 (39%) patients both SBP and DBP decreased, whereas in 33 (17%) patients both SBP and DBP increased. In group A (n = 120), SBP, DBP, and PP decreased by 21 ± 16 mmHg (P < 0.001), 8 ± 11 mmHg (P < 0.001), and 13 ± 14 mm Hg (P < 0.001), respectively. In group B (n = 77), SBP, DBP, and PP increased by 12 ± 10 mmHg (P < 0.001), 4 ± 11 mmHg (P < 0.001), and 8 ± 13 mmHg (P < 0.001), respectively. Pre-HD SBP was 144 ± 23 mmHg in group A and 128 ± 25 mmHg in group B (P < 0.001). Pre-HD DBP was 80 ± 15 mmHg in group A and 68 ± 11 mmHg in group B (P < 0.001). In all patients combined, ∆SBP was similarly correlated with pre-HD SBP and pre-HD DBP (ρ = −0.42 in both cases, P < 0.001), whereas ∆DBP was more strongly correlated with pre-HD DBP (ρ = −0.52, P < 0.001) than with pre-HD SBP (ρ = −0.22, P < 0.01). ∆SBP was correlated with ∆DBP (ρ = 0.55, P < 0.001) and highly correlated with ∆PP (ρ = 0.78, P < 0.001). According to linear regression, SBP tended to increase during HD in patients with pre-HD SBP <118 mmHg (Fig. 1A), whereas DBP tended to increase in patients with pre-HD DBP <68 mmHg (Fig. 1B). Conclusions Patients with dialysis-induced decline in SBP (group A) had a significantly higher pre-HD BP (both SBP and DBP) compared with patients with an increasing or stable SBP (group B). This suggests that a high decline in SBP during HD appears to be more likely in patients with elevated pre-HD BP and that HD appears to have a pressure-normalizing effect in such patients. Similarly, a dialysis-induced increase in SBP or DBP appears to be more likely in patients with low values of pre-HD SBP or DBP, respectively.

Sex difference in nocturnal blood pressure dipping in adolescents with varying degrees of adiposity

BackgroundFor adolescents, abnormal dipping patterns in blood pressure (BP) are associated with early-onset organ damage and a higher risk of cardiovascular disorders in adulthood. Obesity is one of the most common reasons for abnormal BP dipping in young people. However, it is unknown whether the severity of obesity is associated with BP dipping status and whether this association is sex-dependent.Methods499 participants between 12 and 17 years old with overweight or obesity underwent ambulatory blood pressure monitoring (ABPM) between April 2018 and January 2019 in Beijing and Baoding. Participants were grouped by body mass index (BMI) into overweight (BMI 85th–95th percentile), obese (BMI ≥ 95th percentile) and severely obese (BMI ≥ 120% of 95th percentile or ≥ 35 kg/m2) groups. Non-dipping was defined as a < 10% reduction in BP from day to night. The interaction effect between sex and obesity degree was also analyzed.Results326 boys and 173 girls were included, of whom 130 were overweight, 189 were obese, and 180 were severely obese. Girls with severe obesity had a higher prevalence of non-dipping, but boys showed no significant differences in BP dipping status between obesity categories. In addition, as obesity severity went up, a more evident increase in night-time SBP was observed in girls than in boys.ConclusionsSeverely obese is associated with a higher prevalence of non-BP dipping patterns in girls than in boys, which suggests that the relationship between the severity of obesity and BP dipping status might be sex-specific.

Measuring blood pressure from Korotkoff sounds as the brachial cuff inflates on average provides higher values than when the cuff deflates

Objectives. In this study, we test the hypothesis that if, as demonstrated in a previous study, brachial arteries exhibit hysteresis as the occluding cuff is deflated and fail to open until cuff pressure (CP) is well below true intra-arterial blood pressure (IAPB), estimating systolic (SBP) and diastolic blood pressure (DBP) from the presence of Korotkoff sounds (KS) as CP increases may eliminate these errors and give more accurate estimates of SBP and DBP relative to IABP readings. Approach. In 62 subjects of varying ages (45.1 ± 19.8, range 20.6–75.8 years), including 44 men (45.3 ± 19.4, range 20.6–75.8 years) and 18 women (44.4 ± 21.4, range 20.9–75.3 years), we sequentially recorded SBP and DBP both during cuff inflation and cuff deflation using KS. Results. There was a significant (p < 0.0001) increase in SBP from 122.8 ± 13.2 to 127.6 ± 13.0 mmHg and a significant (p = 0.0001) increase in DBP from 70.0 ± 9.0 to 77.5 ± 9.7 mmHg. Of the 62 subjects, 51 showed a positive increase in SBP (0–14 mmHg) and 11 subjects showed a reduction (−0.3 to −7 mmHg). The average differences for SBP and DBP estimates derived as the cuff inflates and those derived as the cuff deflates were 4.8 ± 4.6 mmHg and 2.5 ± 4.6 mmHg, not dissimilar to the differences reported between IABP and non-invasive blood pressure measurements. Although we could not develop multiparameter linear or non-linear models to explain this phenomenon we have clearly demonstrated through ANOVA tests that both body mass index (BMI) and pulse wave velocity are implicated, supporting the hypothesis that the phenomenon is associated with age, higher BMI and stiffer arteries. Significance. The implications of this study are that brachial sphygmomanometry carried out during cuff inflation could be more accurate than measurements carried out as the cuff deflates. Further research is required to validate these results with IAPB measurements.

OVERWEIGHT AND OBESITY AND ITS ASSOCIATION WITH HYPERTENSION IN COLOMBIA: PURE COHORT

Objective: To assess the association between overweight and obesity with blood pressure levels and incident hypertension in a prospective cohort with 12 years of follow-up. Design and method: Individuals aged 35 to 70 years from the Prospective Urban Rural Epidemiology Colombia cohort study were included. Participants with a history of hypertension and diabetes at baseline were excluded. Overweight and obesity was defined as a body mass index (BMI) greater or equal to 25 kg/m2. Blood pressure (BP) was measured at baseline and every 3-year follow-up. Hypertension was defined as a self-reported history of hypertension, baseline systolic BP greater or equal to 140 mmHg, diastolic BP greater or equal to 90 mmHg, or use of BP-lowering medications. Overweight and obese participants were propensity score matched using a 1:1 ratio with non-overweight participants. We used conditional logistic regression to evaluate the association between overweight, obesity, and hypertension, calculating the odds ratio and a 95% CI. Systolic BP and diastolic BP were analyzed in a linear mixed model as response variables, with matching pairs as random effects. The regression models were adjusted by sex, age, physical activity, tobacco use, alcohol use, education, waist-hip ratio, the alternative healthy eating index score, grip strength adjusted by weight, triglyceride-glucose index, and systolic BP at baseline. We established a p-value of &lt;0.05 as significant. Results: Of 7500 participants, 1146 were matched, obtaining 573 pairs. The mean BMI was 25.2 kg/m2 (SD 4.02). The frequency of women was higher in the overweight group (68.1% vs. 60.9). The baseline SBP in overweight participants was 116.92 (SD 12.62) and 118.30 (SD 11.74) in non-overweight. 37.2% of overweight participants developed hypertension, but only 29.7% in non-overweight at follow-up. There was a 32% higher risk of hypertension in overweight participants (OR 1.32 95% CI:1.08-1.61). Being overweight and obese was associated with a higher increase in SBP of 2.53 mmHg (CI: 0.74-4.31) and DBP levels of 2.80 mmHg (CI: 1.68-3.93) at follow-up. Conclusions: Overweight and obesity, independently of other risk factors were associated with increased hypertension incidence and with higher SBP and DBP levels at 12 years of follow-up.

EFFECT OF RENAL DENERVATION ON 24H BLOOD PRESSURE PATTERN

Objective: Endovascular renal denervation (DRN) is a therapeutic approach for resistant arterial hypertension (RH). The aim of this study was to assess the effects of RDN on 24h blood pressure. Design and method: A retrospective evaluation of ABPM data at baseline and after 6 months from RDN in patients undergoing DRN between 01/01/2011 and 31/12/2021 in the Arterial Hypertension Center of Turin. Mean 24h, Daytime, Nighttime BP and HR values and short term 24h, daytime and nigthtime BP and HR varability parameters (standard deviation, dipping and coefficient of variation) were calculated. Results: The series included 14 subjects, of which 8 (57%) were female and with an average age 54±10 years. The number of antihypertensive drugs before renal denervation was 5.7±1.0. At baseline office BP was 188/113±22±18 mmHg and ABPM 24h BP was 150/92±21±16 mmHg. Patients were considered as responders if a reduction of least 10 mmHg in systolic blood pressure (PAS) at 24h Blood Pressure Monitoring at six months from RDN was obtained. From a safety point of view, there were no short-term or long-term complications. The responders at six months were 66%. Non-responders showed an increased blood pressure variability compared to responders at baseline and only one was dipper. The responders had a statistically significant redution of SD24h after DRN, an increased average nocturnal blood pressure drop and a lower pressure variability. While in non-responders no redution in SDnight, SDday and coefficient of variation was found, by contrast all of them become dippers because mean daytime SBP increase. Conclusions: In conclusion, pressure variability (SD24h and coefficient of variation) is globally reduced in the denerved patients, this trend is particularly present in responders. The non-responders have an increased BP variability at baseline without decreasing after DRN. These results suggest that, when effective, DRN can reduce both BP levels and BP variability, thus may have an important effect in reducing cardiovascular risk.

Peculiarities of the daily profile of blood pressure and heart activity in patients with arrhythmias depending on the severity of cognitive disordersPeculiarities of the daily profile of blood pressure and heart activity in patients with arrhythmias depending on the severity of cognitive disorders

Background. The purpose of our work was to reveal the dependence of changes in the cognitive sphere on the peculiarities of the daily profile of blood pressure (BP) and heart activity in patients with arrhythmias. Materials and methods. We examined 139 patients with different clinical forms of arrhythmias. All of them underwent extended neuropsychological testing, a study of the daily BP profile and heart activity. Hemodynamic status was assessed by daily BP and ECG monitoring. Average daily, average daytime and nighttime systolic (SBP), diastolic blood pressure (DBP) and heart rate (HR) were evaluated. The analysis of spectral indicators of heart rate variability was performed to assess the state of the autonomic nervous system. Correlations of hemodynamic indicators with the results of neuropsychological testing were determined. Results. In patients with cognitive disorders (CD), there was an increase in SBP in all periods of the day, most pronounced in patients with moderate CD (p = 0.049). In patients with mild CD and without CD, there were no significant intergroup differences in the level of average daily, daytime and night SBP, DBP and pulse pressure (p &gt; 0.05). Patients with moderate CD had significantly higher SBP and time index of SBP at the expense of average daytime and average night values of these indicators compared to those without CD (p &lt; 0.05). During the active period of the day, time index of DBP was significantly higher in patients with moderate CD (p = 0.002) who also had an increase in average daily, daytime and night SBP variability compared to participants without CD (p = 0.041). The differences between the groups were not significant in terms of DBP variability (р = 0.07). In 61 (54 %) patients with CD, non-dipper SBP prevailed in the structure of disorders of the daily BP profile, with the highest indicators in moderate CD (55.6 %). The presence of adverse daily DBP profiles — night-peaker (6.2 %) and over-dipper (8.8 %), which prevailed in patients with moderate CD, is hidden behind normal indicators of the daily BP index. Increased average SBP24 (odds ratio (OR) = 3.26, 95% confidence interval (CI): 1.45–5.35, p &lt; 0.001), DBP24 (OR = 3.06, 95% CI: 1.41–4.79, p &lt; 0.001), average HR24 (OR = 2.67, 95% CI: 1.32–4.14, p &lt; 0.001), average SBP24 variability (OR = 2.13, 95% CI: 1.11–3.32, p &lt; 0.001) are the main factors of central hemodynamic disorders that increase the risk of developing CD in patients with arrhythmias. Conclusions. The identified associations between cognitive dysfunction, indicators of daily BP monitoring and heart activity are important in the context of their comprehensive accounting for optimizing an individualized approach to patient management and predicting the development of CD.

Assessment and management of exaggerated blood pressure response to standing and orthostatic hypertension: consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability.

Recent evidence suggests that an exaggerated blood pressure (BP) response to standing (ERTS) is associated with an increased risk of adverse outcomes, both in young and old individuals. In addition, ERTS has been shown to be an independent predictor of masked hypertension. In the vast majority of studies reporting on the prognostic value of orthostatic hypertension (OHT), the definition was based only on systolic office BP measurements. This consensus statement provides recommendations on the assessment and management of individuals with ERTS and/or OHT. ERTS is defined as an orthostatic increase in SBP at least 20 mmHg and OHT as an ERTS with standing SBP at least 140 mmHg. This statement recommends a standardized methodology to assess ERTS, by considering body and arm position, and the number and timing of BP measurements. ERTS/OHT should be confirmed in a second visit, to account for its limited reproducibility. The second assessment should evaluate BP changes from the supine to the standing posture. Ambulatory BP monitoring is recommended in most individuals with ERTS/OHT, especially if they have high-normal seated office BP. Implementation of lifestyle changes and close follow-up are recommended in individuals with ERTS/OHT and normotensive seated office BP. Whether antihypertensive treatment should be administered in the latter is unknown. Hypertensive patients with ERTS/OHT should be managed as any other hypertensive patient. Standardized standing BP measurement should be implemented in future epidemiological and interventional studies.

The effect of different dialysate sodium concentrations on ambulatory blood pressure in hemodialysis patients: a prospective interventional study.

Hypertension is associated with increased morbidity and mortality in hemodialysis patients. Existing recommendations suggest reduction of sodium load, but the effect of dialysate sodium on blood pressure (BP) is not fully elucidated. The aim of the present study is to investigate the effect of different dialysate sodium concentrations on 72-h ambulatory BP in hemodialysis patients. This prospective study included patients on standard thrice-weekly hemodialysis. All patients initially underwent six sessions with dialysate sodium concentration of 137meq/L, followed consecutively by another six sessions with dialysate sodium of 139meq/L and, finally, six sessions with dialysate sodium of 141meq/L. At the start of the sixth hemodialysis session on each sodium concentration, 72-h ABPM was performed over the long interdialytic interval to evaluate ambulatory systolic and diastolic BP (SBP and DBP) during the overall 72-h, different 24-h, daytime and night-time periods. Twenty-five patients were included in the final analysis. A significant increase in the mean 72-h SBP was observed with higher dialysate sodium concentrations (124.8±16.6mmHg with 137meq/L vs 126.3±17.5mmHg with 139meq/L vs 132.3±19.31mmHg with 141meq/L, P=0.002). Similar differences were noted for DBP; 72-h DBP was significantly higher with increasing dialysate sodium concentrations (75.1±11.3mmHg with 137meq/L vs 76.3±13.7mmHg with 139meq/L vs 79.5±13.9mmHg with 141meq/L dialysate sodium, P=0.01). Ambulatory BP during the different 24-h intervals, daytime and night-time periods was also progressively increasing with increasing dialysate sodium concentration. This pilot study showed a progressive increase in ambulatory BP with higher dialysate sodium concentrations. These findings support that lower dialysate sodium concentration may help towards better BP control in hemodialysis patients.

Blood pressure levels and adverse cardiovascular outcomes in heart failure: A systematic review and meta-analysis.

Existing data on the association between blood pressure levels and adverse cardiovascular outcomes in patients with heart failure (HF) are inconsistent. The optimal blood pressure targets for patients with HF remain uncertain. This study sought to assess the associations between blood pressure (systolic and diastolic blood pressure, SBP and DBP) levels and adverse cardiovascular disease (CVD) outcomes in patients with HF. A systematic review and meta-analysis were conducted using MEDLINE, Embase, the Cochrane Library, and Web of Science databases up to 5 May 2023. The outcomes of interest included adverse cardiovascular events and all-cause mortality. Pooled relative risks (RRs) with corresponding 95% confidence intervals (CIs) were calculated. Forty-three unique observational cohort studies, comprising 120 643 participants with HF, were included. The pooled RRs (95% CIs) for SBP thresholds of ≥140 mmHg vs <140 mmHg were 0.92 (0.83-1.01) for all-cause mortality, 0.83 (0.67-1.04) for CVD death, and 0.98 (0.80-1.21) for HF hospitalization. The pooled RR (95% CI) for SBP thresholds of ≥160 mmHg vs <160 mmHg and all-cause mortality was 0.67 (0.62-0.74). SBP levels below <130, <120, and < 110 mmHg were each associated with an increased risk of various cardiovascular endpoints and all-cause mortality. The pooled RR (95% CI) for DBP thresholds of ≥80 mmHg vs <80 mmHg and all-cause mortality was 0.86 (0.67-1.10). A 10 mmHg increase in SBP or DBP was associated with a reduction in all-cause mortality and other cardiovascular endpoints. The findings suggest that lower and normal baseline SBP levels (<130, <120, and < 110 mmHg) may be associated with future risk of worse outcomes in patients with HF. Optimal baseline blood pressure levels for these patients may lie within the range of ≥140 mmHg for SBP. In the absence of observational studies with repeated blood pressure measurements or definitive trials evaluating optimal blood pressure targets, individualized blood pressure targets based on patients' unique circumstances are warranted in HF management.

Association between blood pressure and new brain white matter lesions in atrial fibrillation patients

Abstract Background Atrial fibrillation (AF) and hypertension (HTN) often occur together. A cross-sectional study in patients with AF has shown that blood pressure (BP) is associated with white matter lesions (WML), which are known to have a negative impact on cognitive function. Purpose We aimed to investigate the association of BP and new WML occurring in patients with AF during a follow-up of 2 years. Methods We enrolled 1129 patients with documented AF who underwent a standardized brain magnetic resonance imaging (bMRI) at baseline and after 2-years follow-up. Systolic and diastolic blood pressure (SBP and DBP) were measured at baseline in every patient. BP was categorized into the following groups: optimal BP (SBP &amp;lt;120 mmHg and DBP &amp;lt;80 mmHg); normal BP (SBP ≥120 and &amp;lt;130 mmHg or DBP ≥80 and &amp;lt;85 mmHg); high normal BP (SBP ≥130 and &amp;lt;140 mmHg or DBP ≥85 and &amp;lt;90 mmHg); HTN grade 1 (SBP ≥140 and &amp;lt;160 mmHg or DBP ≥90 and &amp;lt;100 mmHg); HTN grade 2 and 3 (SBP ≥160 or DBP ≥100 mmHg). We defined new WML as new lesions or preexisting lesions with an increased volume after a 2-year follow-up period. We performed logistic and linear regression analyses to examine the relationship of BP, BP categories and the presence and volume of new WML. Additionally, interaction analyses were performed to evaluate the potential modifying effect of AF type (paroxysmal vs. non-paroxysmal) and heart rhythm (AF/atrial flutter vs. sinus rhythm). Results The mean ± standard deviation age was 71.5 ±8.4 years, 909 (74%) patients were male, and the mean BP was 135/79 ±18/12 mmHg. At baseline, WML were present in 98.9% of patients, with a median (interquartile range) volume of 3362 (1241 – 8650) mm³. The overall prevalence of new WML after 2 years was 18.8%, with a median volume of 108 (46.5 – 264) mm³. The prevalence of new WML stratified by BP categories is presented in Figure 1. After adjusting for multiple covariates, the presence of new WML was not significantly associated with BP categories or continuous SBP (Table 1). Compared to patients with optimal BP, the adjusted odds ratios (OR) (95% Confidence Intervals) were 1.40 (0.86 to 2.29) for normal BP; 1.13 (0.69 to 1.85) for high normal BP; 1.09 (0.69 to 1.76) for HTN grade 1; and 1.20 (0.67 to 2.11) for HTN grade 2 and 3 (p for linear trend 0.86). Per 10 mmHg increase in SBP, the adjusted OR was 0.97 (0.89 to 1.05, p= 0.46). Similarly, BP was not associated with volume of new WML. AF type and heart rhythm did not show any significant interaction effect for the association between SBP and presence of new WML (p-value for interaction of p=0.16 and p=0.57, respectively). Conclusions In a large cohort of AF patients, we found no association between BP and the presence and volume of new WML after a follow-up of 2 years. Long-term follow-up is warranted to determine the impact of BP on the development of new WML over time.