Increment Of Diastolic Blood Pressure Research Articles

Effect of recommendations of breakfast and late-evening snack habits on body composition and blood pressure: A pilot randomized trial

ABSTRACT Breakfast skipping and late-evening snack are prevalent in young adults. This randomized controlled intervention aimed to evaluate the influence of meal habit recommendations on young adults’ body composition and blood pressure. Nonpregnant adults (≥20 y old) who were eligible for bioelectrical impedance analysis examination (neither pacemaker installed nor medications that would affect body composition, like diuretics or corticosteroids) were enrolled after they provided informed consent (n = 125). Subjects were randomized into three groups, every group receiving one of the following recommendations: (a) daily breakfast consumption (within 2 h after waking up), (b) avoidance of late-evening snacks (after 21:00h or within 4 h before sleep, with the exception of water), and (c) both recommendations. Body composition and blood pressure were measured before randomization at baseline and at the follow-up 1 y later. Intent-to-treat analysis showed that the recommendation of daily breakfast may contribute to a lower increment of diastolic blood pressure by 3.23 mmHg (95% CI: 0.17–6.28). Receiving the breakfast recommendation was associated with more reduction of total body fat percent by 2.99% (95% CI: 0.23–5.74) and percent trunk fat by 3.63% (95% CI: 0.40–6.86) in inactive youths. Recommendation of avoiding late-evening snack did not significantly affect the outcome measures (ClinicalTrials.gov Identifier: NCT03828812).

Long-term impact of COVID-19 pandemic on secular changes in metabolic parameters in Japanese workers : Tokushima Cohort Study.

The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented changes in people's lifestyles. Since then, our lifestyle has remained different from what it used to be in the pre-pandemic era. This study investigated the long-term impact of the COVID-19 pandemic on secular changes in metabolic parameters in Japanese workers. A total of 519 eligible subjects completed fiscal year (FY) 2017, FY2019 and FY2021 surveys. Comparison between pre-COVID-19 (Δpre-covid19 : FY2019-2017) and during COVID-19 (Δcovid19 : FY2021-2019) was performed in each sex. Increment of diastolic blood pressure (DBP) in Δcovid19 was significantly greater than that in Δpre-covid19 (Δpre-covid19 to Δcovid19 : 0.22 ± 6.17 to 2.59 ± 6.69 mmHg, p = 0.0002 in males, -0.18 ± 6.26 to 2.16 ± 6.60 mmHg, p = 0.01 in females). In females, increments of waist circumference and fasting plasma glucose in Δcovid19 were also significantly greater than those in Δpre-covid19 (both p < 0.05). Conversely, increments of BMI and body fat in Δcovid19 were significantly smaller than those in Δpre-covid19 in males (both p < 0.05). Our findings suggest that there was an apparent metabolic impact of the COVID-19 pandemic on DBP increment in Japanese workers. In addition, COVID-19 may have influenced males and females differently in relation to glucose metabolism and anthropometric measurements related to obesity / adiposity. J. Med. Invest. 71 : 47-53, February, 2024.

Focusing on testosterone levels in male: A half-longitudinal study of polycyclic aromatic hydrocarbon exposure and diastolic blood pressure in coke oven workers

Polycyclic aromatic hydrocarbons (PAHs) can interfere with testosterone levels, and low levels of testosterone are associated with increased cardiovascular events. To explore the role of testosterone in PAHs exposure and cardiovascular health, we used data from the 2011–2016 National Health and Nutrition Examination Survey (NHANES) and a longitudinal database of 332 male coke oven workers from China. The urine PAHs, tobacco metabolites and plasma testosterone levels of coke oven workers were measured. There were inverse associations between serum (plasma) testosterone concentrations and the risk of dysarteriotony and dyslipidemia among the NHANES participants and coke oven workers. The results of the cross-lagged panel analysis among workers showed that the decrease in testosterone preceded the increase in diastolic blood pressure (DBP), and the absolute value of the path coefficient from baseline testosterone to follow-up DBP (β2 = −8.162, P = 0.077) was significantly larger than the absolute value of the path coefficient from baseline DBP to follow-up testosterone (β1 = −0.001, P = 0.781). Results from the half-longitudinal mediation analysis showed that baseline hydroxyfluorene predicted significant decreases in plasma testosterone from baseline to follow-up (path a: 0.71, 95% CI: 1.26, −0.16), whereas plasma testosterone at baseline also predicted significant increments in DBP from baseline to follow-up (path b: 9.22, 95% CI: 17.24, −1.19). The indirect effect of PAHs on DBP via plasma testosterone level was marginally significant (test for indirect effects a*b (P = 0.08)).In conclusion, testosterone level is a longitudinal precursor to increased DBP and plays an essential role in the association between PAHs exposure and damage to the cardiovascular system. Coke oven workers with low plasma testosterone levels are more likely to experience adverse changes in blood pressure and lipid levels after exposure to PAHs.

Association of Blood Pressure With Rates of Macular Ganglion Cell Complex Thinning in Patients With Glaucoma

There are scarce data on the association of blood pressure measures with subsequent macular structural rates of change in patients with glaucoma. To investigate the association of baseline blood pressure measures with rates of change of the macular ganglion cell complex in patients with central or moderate to advanced glaucoma damage at baseline. This prospective cohort study, conducted from August 2021 to August 2022, used data from patients in the Advanced Glaucoma Progression Study at the University of California, Los Angeles. Participants were between 39 and 80 years of age and had more than 4 macular imaging tests and 2 or more years of follow-up. A diagnosis of glaucoma with either central damage or a visual field mean deviation worse than -6 dB. The main outcome was the association of blood pressure measures with ganglion cell complex rates of change. Macular ganglion cell complex thickness rates of change were estimated with a bayesian hierarchical model. This model included relevant demographic and clinical factors. Blood pressure measures, intraocular pressure, and their interactions were added to the model to assess the association of baseline blood pressure measures with global ganglion cell complex rates of change. The cohort included 105 eyes from 105 participants. The mean (SD) age, 10-2 visual field mean deviation, and follow-up time were 66.9 (8.5) years, -8.3 (5.3) dB, and 3.6 (0.4) years, respectively, and 67 patients (63.8%) were female. The racial and ethnic makeup of the cohort was 15 African American (14.3%), 23 Asian (21.9%), 12 Hispanic (11.4%), and 55 White (52.4%) individuals based on patient self-report. In multivariable analyses, female sex, history of taking blood pressure medications, higher intraocular pressure, thicker central corneal thickness, shorter axial length, higher contrast sensitivity at 12 cycles per degree, and higher baseline 10-2 visual field mean deviation were associated with faster ganglion cell complex thinning. Lower diastolic blood pressure was associated with faster rates of ganglion cell complex thinning at higher intraocular pressures. For intraocular pressures of 8 and of 16 mm Hg (10% and 90% quantiles, respectively), every 10 mm Hg-lower increment of diastolic blood pressure was associated with 0.011 μm/y slower and -0.130 μm/y faster rates of ganglion cell complex thinning, respectively. In this cohort study, a combination of lower diastolic blood pressure and higher intraocular pressure at baseline was associated with faster rates of ganglion cell complex thinning. These findings support consideration of evaluating and addressing diastolic blood pressure as a therapeutic measure in patients with glaucoma if supported by appropriate clinical trials.

Abstract P013: Associations Between Diastolic Blood Pressure With Cognitive Functioning: Differences By Systolic Blood Pressure Among US Adults.

Introduction: While elevated systolic blood pressure (BP) is a known contributor to cognitive decline, the role of elevated diastolic BP (DBP) as an independent risk factor for cognitive decline is less clear, especially in relationship to systolic BP (SBP) levels. Objectives: To characterize the association between DBP and cognitive functioning at differing levels of SBP. Methods: The National Health and Nutrition Examination Survey is a nationally representative survey of U.S. adults conducted annually. Our sample included data from participants of the 1999-2002 and 2011-2014 cycles, age 60+, with measured BP and cognition (N=5,480). BP was measured three times manually with a standardized sphygmomanometer and averaged. Cognitive functioning was measured using the digit symbol substitution test (DSST), a measure of executive functioning (with higher scores indicating better performance: range 0-100). We tested for a statistical interaction between SBP and DBP. To determine whether DBP was associated with DSST score, we used linear regression analyses and stratified by categories of SBP. Models were adjusted for: age, sex, race, education, income, insurance, marital status, BMI, diabetes, BP medication, and cholesterol. All analyses accounted for the complex survey design. Results: Almost half (48.9%, SE=1.1) of the sample was aged 60-69 with 55.3% (SE=0.7) female. The association between DBP and cognitive functioning differed by SBP (p&lt;0.01), leading to stratified analyses. Every 5 mmHg increment of DBP was associated with significantly higher DSST scores among individuals with SBP 110-119 mmHg only (beta: 0.76, 95% CI: 0.24, 1.27). Results were not significant among participants with SBP &lt; 110mmHg (beta: 0.84, 95% CI: -0.09, 1.77), SBP 120-129 mmHg (beta: 0.09, 95% CI:-0.49, 0.69), SBP 130-140 mmHg (beta: 0.29, 95% CI: -0.10, 0.69), SBP 140-159 mmHg (beta: 0.23, 95% CI: -0.15, 0.61), or SBP ≥160mmHg (beta: -0.08, 95% CI: -0.56, 0.39). Conclusion: In a population-based sample of older US adults, higher DBP was associated with greater executive functioning only among individuals with normal SBP. The results suggest that at non-hypertensive levels of SBP, higher DBP may not be detrimental for cognitive performance.

Adherence to a Plant-Based Diet and Consumption of Specific Plant Foods-Associations with 3-Year Weight-Loss Maintenance and Cardiometabolic Risk Factors: A Secondary Analysis of the PREVIEW Intervention Study.

Plant-based diets are recommended by dietary guidelines. This secondary analysis aimed to assess longitudinal associations of an overall plant-based diet and specific plant foods with weight-loss maintenance and cardiometabolic risk factors. Longitudinal data on 710 participants (aged 26–70 years) with overweight or obesity and pre-diabetes from the 3-year weight-loss maintenance phase of the PREVIEW intervention were analyzed. Adherence to an overall plant-based diet was evaluated using a novel plant-based diet index, where all plant-based foods received positive scores and all animal-based foods received negative scores. After adjustment for potential confounders, linear mixed models with repeated measures showed that the plant-based diet index was inversely associated with weight regain, but not with cardiometabolic risk factors. Nut intake was inversely associated with regain of weight and fat mass and increments in total cholesterol and LDL cholesterol. Fruit intake was inversely associated with increments in diastolic blood pressure, total cholesterol, and LDL cholesterol. Vegetable intake was inversely associated with an increment in diastolic blood pressure and triglycerides and was positively associated with an increase in HDL cholesterol. All reported associations with cardiometabolic risk factors were independent of weight change. Long-term consumption of nuts, fruits, and vegetables may be beneficial for weight management and cardiometabolic health, whereas an overall plant-based diet may improve weight management only.

Linear and Nonlinear Mendelian Randomization Analyses of the Association Between Diastolic Blood Pressure and Cardiovascular Events: The J-Curve Revisited.

Recent clinical guidelines support intensive blood pressure treatment targets. However, observational data suggest that excessive diastolic blood pressure (DBP) lowering might increase the risk of myocardial infarction (MI), reflecting a J- or U-shaped relationship. We analyzed 47 407 participants from 5 cohorts (median age, 60 years). First, to corroborate previous observational analyses, we used traditional statistical methods to test the shape of association between DBP and cardiovascular disease (CVD). Second, we created polygenic risk scores of DBP and systolic blood pressure and generated linear Mendelian randomization (MR) estimates for the effect of DBP on CVD. Third, using novel nonlinear MR approaches, we evaluated for nonlinearity in the genetic relationship between DBP and CVD events. Comprehensive MR interrogation of DBP required us to also model systolic blood pressure, given that the 2 are strongly correlated. Traditional observational analysis of our cohorts suggested a J-shaped association between DBP and MI. By contrast, linear MR analyses demonstrated an adverse effect of increasing DBP increments on CVD outcomes, including MI (MI hazard ratio, 1.07 per unit mm Hg increase in DBP; P<0.001). Furthermore, nonlinear MR analyses found no evidence for a J-shaped relationship; instead confirming that MI risk decreases consistently per unit decrease in DBP, even among individuals with low values of baseline DBP. In this analysis of the genetic effect of DBP, we found no evidence for a nonlinear J- or U-shaped relationship between DBP and adverse CVD outcomes; including MI.

Variation of uncoupling protein 2 (–866G/A), dietary fat intake and blood pressure: an Indonesian Nutrigenetic Cohort

Abstract Background/Introduction The uncoupling protein 2 (UCP2) is recently being recognized as an important molecule involved in the development of cardiovascular diseases such as vascular dysfunction, atherosclerosis, and hypertension. It was previously reported that the UPC2 –866 G/A gene variation was associated with obesity and hypertension. Purpose The objective of this study was to investigate the association between UCP2 –866 G/A gene variation on changes in blood pressure after 2 years of follow up. Additionally, we investigate the interaction between UCP2 –866G/A and dietary fat on changes in blood pressure. Methods This was a cohort study conducted in 503 men and women without chronic diseases in the city of Yogyakarta, Indonesia. Bodyweight, systolic (SBP) and diastolic blood pressure (DBP) were measured at baseline and after 2 years while the dietary intake was recorded once within 2 years period using a semi-quantitative food frequency questionnaire. Subjects were divided based on UCP2 gene variations: GG genotype and GA+AA genotypes. Results There was no difference in blood pressure at baseline between UCP2 genotypes (SBP AA+GA vs. GG: 130.5±26.3 vs. 127.2±24.9 mmHg, p=0.178; DBP AA+GA vs. GG: 80.9±16.1 vs. 78.9±13.8 mmHg, p=0.171). After 2 years, a total of 310 individuals were followed and measured (AA+GA n=197; GG n=113). In all subjects, there was a significant reduction in SBP (from 130.6±26.3 to 126.4±22.8 mmHg, p&amp;lt;0.001) and increment in DBP (from 80.9±15.5 to 82.2±13.7 mmHg, p=0.013). Subjects in GA + AA genotype group had a greater reduction in SBP (−5.3±15.4 vs. −1.5±18.0 mmHg, p=0.018) and lesser increment in DBP (0.7±10.6 vs. 2.7±12.2 mmHg, p=0.045). In this study, we showed that sex and age were not associated with changes in blood pressure (all p&amp;gt;0.05) but changes in body weight were positively correlated with SBP (r=0.219, p&amp;lt;0.001) and DBP (r=0.227, p&amp;lt;0.001). In all subjects, energy, protein, and carbohydrate intake were not correlated with changes in SBP and DBP (all p&amp;gt;0.05). By contrast, total fat intake (B=0.137, p=0.017), saturated fat (B=0.123, p=0.032) and MUFA (B=0.142, p=0.014) were positively correlated with increased SBP while PUFA, trans fat, and cholesterol were not correlated with SBP. There was no correlation between dietary intake and changes in DBP. Among subjects with GA+AA genotype, total fat, saturated fat and MUFA were positively correlated with changes in SBP (all p&amp;lt;0.05) but these correlations were not seen among subjects with GG genotype (all p&amp;gt;0.05). Conclusion We concluded that UCP2 –866G/A gene variation was associated with changes in blood pressure and those who have an A allele were more protected towards increased blood pressure. Total fat, saturated fat, and MUFA were positively correlated with blood pressure and those with A allele were more responsive to the hypertensive effect of dietary fat. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Universitas Gadjah Mada

Associations of Left Ventricular Structure and Function With Blood Pressure in Heart Failure With Preserved Ejection Fraction: Analysis of the TOPCAT Trial.

BackgroundData on the association of systolic and diastolic blood pressure with the structure and function of failing hearts with preserved ejection fraction (EF) are sparse.Methods and ResultsThis analysis included 935 patients with heart failure (49.4% women; mean age, 69.9 years) with preserved EF (≥45%) enrolled in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial before initiation of randomized therapy. Left ventricular (LV) structure (dimensions, wall thickness, and mass index), diastolic function (left atrial volume index, transmitral blood flow, and mitral annular velocities), and systolic function (EF and longitudinal strain) were assessed echocardiographically. In multivariable‐adjusted analyses, association sizes expressed per 1‐SD (14.8–mm Hg) increment in systolic blood pressure were 0.020 cm (P=0.003) and 0.018 cm (P=0.004) for LV septal and posterior wall thickness, respectively, and 2.42 mg/m2 (P=0.018) for LV mass index. The corresponding associations with diastolic blood pressure were nonsignificant (P≥0.067). In similarly adjusted analyses, the association sizes expressed per 1‐SD (10.7–mm Hg) increment in diastolic blood pressure were −0.15 for E/A (P<0.001), −0.76 for E/e′ (P=0.006), and −0.62% for EF (P=0.024). These findings were consistent, if models including systolic blood pressure were additionally adjusted for diastolic blood pressure and vice versa, albeit that the relation of EF with diastolic blood pressure weakened (−0.54%; P=0.10).ConclusionsIn diastolic heart failure, LV wall thickness and LV mass index increased with higher systolic blood pressure, but not with higher diastolic blood pressure, whereas functional measures reflecting diastolic LV function decreased with higher diastolic blood pressure, independent of systolic blood pressure. These observations highlight the importance of controlling both systolic and diastolic blood pressure as modifiable risk factors to reduce the risk of LV remodeling and diastolic LV dysfunction.

Diastolic blood pressure changes during episodes of autonomic dysreflexia

Objective: The current diagnostic criteria of autonomic dysreflexia (AD) is based solely on systolic blood pressure (SBP) increases from baseline without regard to changes in diastolic blood pressure (DBP). During urodynamics in persons with SCI at or above the sixth thoracic level (T6), we evaluated diastolic blood pressure (DBP) changes related with AD episodes. Design: Retrospective review of blood pressures recorded during urodynamics. Setting: Outpatient SCI urology program in a free standing rehabilitation center. Participants: Persons with spinal cord injury at or above the T6 level. Interventions: Urodynamic procedures performed between August 2018 to January 2019, as well as their prior testing for up to 10 years. Outcome Measures: Systolic and diastolic blood pressures were recorded during the procedure and episodes of AD defined as SBP >20 mmHg above baseline. Results: Seventy individuals accounting for 282 urodynamic tests were reviewed. AD occurred in 43.3% (122/282) of all urodynamics tests. The mean maximum SBP and DBP increase from baseline for those with AD were 35.5 ± 10.9 mmHg and 19.0±9.4 mmHg, respectively. There was a concomitant rise of DBP >10 mmHg with a SBP rise of >20 mmHg in 76.2% (93/122) of urodynamic tests. An elevation of DBP >10 mmHg was recorded in 23.8% (38/160) of urodynamics that did not have AD by the SBP definition. Conclusion: DBP increments of >10 mmHg with concurrent SBP increases of >20 mmHg occurs in the majority of AD episodes. Given the significance of cardiovascular complications in chronic SCI, further work is warranted to determine the significance of DBP elevations for defining AD.

Blood pressure, hypertension and the risk of sudden cardiac death: a systematic review and meta-analysis of cohort studies

Cardiovascular disease is the leading cause of death worldwide, while sudden cardiac death (SCD) accounts for over 60% of all cardiovascular deaths. Elevated blood pressure and hypertension have been associated with increased risk of SCD, but the findings have not been consistent. To clarify whether blood pressure or hypertension is associated with increased risk of SCD and to quantify the size and the shape of any association observed. PubMed and Embase databases were searched for published prospective studies on blood pressure or hypertension and SCD up to 30 April 2018. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random effects model. The meta-analysis included 2939 SCDs among 418,235 participants from 18 studies. The summary RRs were 2.10 (95% CI 1.71–2.58, I2 = 56.7%, pheterogeneity = 0.018, n = 10) for prevalent hypertension, 1.28 (95% CI 1.19–1.38, I2 = 45.5%, pheterogeneity = 0.07, n = 10) per 20 mmHg increment in systolic blood pressure (SBP) and 1.09 (95% CI 0.83–1.44, I2 = 83.4%, pheterogeneity = 0.002, n = 3) per 10 mmHg increment in diastolic blood pressure (DBP). A nonlinear relationship was suggested between SBP and SCD. The results persisted in most subgroup and sensitivity analyses. There was no evidence of publication bias. This meta-analysis found an increased risk of SCD with hypertension diagnosis and increasing SBP. Future studies should clarify the association for DBP and the shape of the dose–response relationship between blood pressure and SCD.

Elevated blood pressure and risk of aortic valve disease: a cohort analysis of 5.4 million UK adults.

AimsTo test two related hypotheses that elevated blood pressure (BP) is a risk factor for aortic valve stenosis (AS) or regurgitation (AR).Methods and resultsIn this cohort study of 5.4 million UK patients with no known cardiovascular disease or aortic valve disease at baseline, we investigated the relationship between BP and risk of incident AS and AR using multivariable-adjusted Cox regression models. Over a median follow-up of 9.2 years, 20 680 patients (0.38%) were diagnosed with AS and 6440 (0.12%) patients with AR. Systolic BP (SBP) was continuously related to the risk of AS and AR with no evidence of a nadir down to 115 mmHg. Each 20 mmHg increment in SBP was associated with a 41% higher risk of AS (hazard ratio 1.41, 95% confidence interval 1.38–1.45) and a 38% higher risk of AR (1.38, 1.31–1.45). Associations were stronger in younger patients but with no strong evidence for interaction by gender or body mass index. Each 10 mmHg increment in diastolic BP was associated with a 24% higher risk of AS (1.24, 1.19–1.29) but not AR (1.04, 0.97–1.11). Each 15 mmHg increment in pulse pressure was associated with a 46% greater risk of AS (1.46, 1.42–1.50) and a 53% higher risk of AR (1.53, 1.45–1.62).ConclusionLong-term exposure to elevated BP across its whole spectrum was associated with increased risk of AS and AR. The possible causal nature of the observed associations warrants further investigation.

Elevated blood pressure and risk of mitral regurgitation: A longitudinal cohort study of 5.5 million United Kingdom adults.

BackgroundMitral regurgitation in people without prior cardiac disease is considered a degenerative disease with no established risk factors for its prevention. We aimed to test the hypothesis that elevated systolic blood pressure (SBP) across its usual spectrum is associated with higher risk of mitral regurgitation.Methods and findingsWe used linked electronic health records from the United Kingdom Clinical Practice Research Datalink (CPRD) from 1 January 1990 to 31 December 2015. CPRD covers approximately 7% of the current UK population and is broadly representative of the population by age, sex, and ethnicity. About 5.5 million UK patients with no known cardiovascular or valve disease at baseline were included in this cohort study. We investigated the relationship between blood pressure (BP) and risk of mitral regurgitation using Cox regression models. Our primary exposure variable was SBP and our primary outcome was incident reports of mitral regurgitation, which were identified from hospital discharge reports or primary care records.Of the 5,553,984 patients in the CPRD that met our inclusion criteria, during the 10-year follow-up period, 28,655 (0.52%) were diagnosed with mitral regurgitation and a further 1,262 (0.02%) were diagnosed with mitral stenosis. SBP was continuously related to the risk of mitral regurgitation with no evidence of a nadir down to 115 mmHg (p < 0.001). Each 20 mmHg increment in SBP was associated with a 26% higher risk of mitral regurgitation (hazard ratio [HR] 1.26; CI 1.23, 1.29). The observed association was partially mediated by diseases affecting the left ventricle during follow-up (myocardial infarction [MI], ischaemic heart disease [IHD], cardiomyopathy, and heart failure). However, the percentage of excess risk mediated (PERM) by these proximate causes of secondary mitral regurgitation was only 13% (CI 6.1%, 20%), and accounting for them had little effect on the long-term association between SBP and mitral regurgitation (mediator-adjusted HR 1.22; CI 1.20, 1.25; p < 0.001). Associations were similar for each 10 mmHg increment in diastolic blood pressure (DBP) (p < 0.001) or each 15 mmHg increment in pulse pressure (PP) (p < 0.001). By contrast, there was no association between SBP and risk of mitral stenosis (HR per 20 mmHg higher SBP 1.03; CI 0.93, 1.14; p = 0.58). These analyses are based on routinely collected data from health records which may be sensitive to measurement errors, and the observed associations may not be generalizable to less severe and subclinical cases of mitral regurgitation.ConclusionsLong-term exposure to elevated BP across its whole spectrum is associated with an increased risk of primary and secondary mitral regurgitation. These findings suggest that BP control may be of importance in the prevention of mitral regurgitation.

Cardiovascular Responses to Different Resistance Exercise Protocols in Elderly.

Increase in muscle mass and strength through resistance exercise (RE) has been highly recommended for healthy aging. On the other hand, RE could lead to acute cardiovascular risks prompted mainly by intense blood pressure elevations and cardiac autonomic imbalance. We compared the cardiovascular responses to three different RE protocols performed by 21 healthy elderly on a leg press machine. The protocols tested were high load (80% 1RM) until muscular failure (HL); low load (30% 1RM) until muscular failure (LL); low load, 30 repetitions followed by 3 sets of 15 repetitions, with 50% blood flow restriction (LL-BFR); and a control session (CON). Based on heart rate variability analysis, only LL kept parasympathetic indexes lower than CON at 30 min recovery. By finger photoplethysmography, LL-BFR prompted higher systolic and mainly diastolic blood pressure increments in many sets. The heart rate and cardiac output increase, and total peripheral resistance reduction following exercise were not different among RE protocols. There was no significant post-exercise hypotension and carotid arterial compliance changes. HL seems to be the safer protocol to be recommended for the healthy elderly, because it induces lower blood pressure increments and faster parasympathetic recovery compared to LL and LL-BFR.

Differences of age and gender in orthostatic hypertension-a single-center study

To explore the differences of Chinese people's age and gender in orthostatic hypertension (OHT) by a single-center experience study. A total of 2 994 patients with unexplained syncope and dizziness, who were outpatients or had been hospitalized in Second Xiangya Hospital, Central South University from January 2000 to August 2012, were chosen and subjected to the head-up tilt table test (HUTT). Their ages ranged from 2.00 to 78.00 years old, with an average at 19.07±14.78 years old. There were 1 406 and 1 588 cases for male and female, respectively. A total of 745 patients were OHT, who were divided into a adult group (≥18 years old, 247/904 cases) and a children group (<18 years old, 498/2 090 cases). The difference of the occurrence rate, classification, and 3 min quantity of blood pressure were analyzed. 1) The incidence of OHT in HUTT was 24.88% (745/2 994 cases). There was no statistical difference between the males and the females(25.75% vs 24.12%, χ2=1.058, P>0.05), but it was higher in the adult group compared with that in the children group (27.05% vs 23.83%, χ2=4.125, P=0.042). There were 52 cases (6.98%) of high systolic and high diastolic blood pressure (sOHT merge dOHT), 16 cases (2.15%) of simple high systolic blood pressure OHT (sOHT), and 677 cases (90.87%) of simple high diastolic blood pressure OHT (dOHT) in the 745 patients with OHT. The incidence of dOHT and sOHT merge sOHT in the adults group were significantly higher than those in the children group (1.11% vs 0.29%, χ2=7.965, P<0.01; 2.88% vs 1.24%, χ2=9.849, P<0.01, respectively); there was no statistical difference in simple dOHT between males and females (23.56% vs 22.20%, χ2=0.668, P>0.05); there was also no statistical difference in sOHT plus dOHT and dOHT between males and females (sOHT merge dOHT: 1.71% vs 1.76%, χ2=0.014, P>0.05; dOHT: 23.68% vs 21.66%, χ2=1.742, P>0.05; 1.71% vs 1.76%, χ2=0.014, P>0.05, respectively); but the dOHT was significantly higher in the males than that in the females in the children group (24.53% vs 19.74%, χ2=6.933, P>0.05). 2) There was no difference in the increment of systolic blood pressure in sOHT plus dOHT [(25.62±4.96) mmHg vs (23.54±5.83) mmHg, t=1.385, P>0.05] and the increment of diastolic blood pressure in dOHT [(13.46±3.49) mmHg vs (13.23±3.22) mmHg, t=0.840, P>0.05] between the adults group and the children group. There was no difference in the increment of systolic blood pressure in sOHT [(25.44±4.96) mmHg vs (23.68±5.35) mmHg, t=1.411, P>0.05] and the increment of diastolic blood pressure in dOHT [(14.09±4.28) mmHg vs (13.05±3.82) mmHg, t=1.887, P>0.05] between the adults group and the children group. The incidence of OHT is higher in the adults group than that in the children group. There is no difference in systolic and diastolic blood pressure increment within 3 minutes during HUTT between the adults and children.

Blood Pressure Components and Decline in Kidney Function in Community-Living Older Adults: The Cardiovascular Health Study

Although hypertension contributes to kidney dysfunction in the general population, the contributions of elevated systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) to kidney function decline in community-dwelling older adults are unknown. We used linear and logistic regression to examine the separate and combined associations of SBP, DBP, and PP at baseline with kidney function decline among 4,365 older adults in the Cardiovascular Health Study. We used cystatin C to estimate glomerular filtration rate on 3 occasions over 7 years of follow-up. We defined rapid decline ≥ 3ml/min/year. Average age was 72.2 and mean (standard deviation) SBP, DBP, and PP were 135 (21), 71 (11), and 65 (18) mm Hg, respectively. SBP and PP, rather than DBP, were most significantly associated with kidney function decline. In adjusted linear models, each 10-mm Hg increment in SBP and PP was associated with 0.13ml/min/year (-0.19, -0.08, P < 0.001) and 0.15-ml/min/year faster decline (-0.21, -0.09, P < 0.001), respectively. Each 10-mm Hg increment in DBP was associated with a nonsignificant 0.10-ml/min/year faster decline (95% confidence interval, -0.20, 0.01). In adjusted logistic models, SBP had the strongest associations with rapid decline, with 14% increased hazard of rapid decline (95% confidence interval, 10% to 17%, P < 0.01) per 10mm Hg. In models combining BP components, only SBP consistently had independent associations with rapid decline. Our findings suggest that elevated BP, particularly SBP, contributes to declining kidney function in older adults.

Hemodynamic changes occurring with tracheal intubation by direct laryngoscopy compared with intubating laryngeal mask airway in adults: A randomized comparison trial

BackgroundHemodynamic changes are major problems due to general anesthesia. We designed a prospective randomized study to compare the hemodynamic responses due to direct laryngoscopy (DL) and intubating laryngeal mask airway (ILMA).MethodsSeventy adult ASA-I and ASA-II patients referred to anesthesia department were randomly divided into two groups: direct laryngoscopy (Macintosh laryngoscope) and ILMA. Systolic, diastolic and mean arterial blood pressure and heart rate were recorded at baseline, preintubation, 1, 3 and 5 min after intubation following intubation. Also some complications including sore throat, laryngospasm, hoarseness and cough were evaluated.ResultsMean age of studied patients in DL group (including 11 (31.4%) male) was 35.5 ± 12.2 and 35.5 ± 9 years old in ILMA group (including 16 (45.7%) male). There was no significant difference between two studied groups about measured hemodynamic indices (P < 0.05, CI = 95%). The results showed that the just difference between increment of diastolic blood pressure and mean arterial pressure after 5 min interval of two studied groups was significant (P = 0.04; P = 0.034). There was no significant difference between the number of patients with positive complications and those without them (P < 0.05).ConclusionLaryngoscoy through the intubating laryngeal mask airway was associated with lesser mean arterial pressure and diastolic blood pressure when compared to intubation by direct laryngoscope. Thus this technique seems to reduce hemodynamic response to tracheal intubation.

BP reactivity to public speaking in stage 1 hypertension: Influence of different task scenarios

Aim. To investigate the blood pressure (BP) reaction to public speaking performed according to different emotionally distressing scenarios in stage 1 hypertension. Methods. We assessed 64 hypertensive and 30 normotensive subjects. They performed three speech tasks with neutral, anger and anxiety scenarios. BP was assessed with the Finometer beat-to-beat non-invasive recording system throughout the test procedure. Results. For all types of speech, the systolic BP response was greater in the hypertensive than the normotensive subjects (all p < 0.001). At repeated-measures analysis of covariate (R-M ANCOVA), a significant group-by-time interaction was found for all scenarios (p ≤ 0.001). For the diastolic BP response, the between-group difference was significant for the task with anxiety scenario (p < 0.05). At R-M ANCOVA, a group-by-time interaction of borderline statistical significance was found for the speech with anxiety content (p = 0.053) but not for the speeches with neutral or anger content. Within the hypertensive group, the diastolic BP increments during the speeches with anxiety and anger scenarios were greater than those during the speech with neutral scenario (both p < 0.001). Conclusions. These data indicate that reactivity to public speaking is increased in stage 1 hypertension. A speech with anxiety or anger scenario elicits a greater diastolic BP reaction than tasks with neutral content.

IMPACT OF POSTURES ON BLOOD PRESSURE IN HEALTHY SUBJECTS

Background: Controversies exist on the nature of infl uence of body position on the level of blood pressure. This study was designed to investigate the impact of postures on blood pressures in healthy subjects.Methods: Blood pressure was measured in 6,485 healthy subjects in both supine and sitting positions, using a standard mercury sphygmomanometer.Results: The average systolic and diastolic blood pressure in all age groups in the supine position was higher than in the sitting position (P<0.001). There was a reduced systolic pressure increment but enhanced diastolic pressure increment with aging (P<0.05). The levels of sitting blood pressure were inversely correlated to the pressure increments in supine positions (P<0.001). Multivariate regression analysis showed that age is an independent factor for the systolic pressure increment in the supine position (P<0.001), whereas sex, age, body height and body mass index are independent predictors for the increment in diastolic blood pressure (P<0.001).Conclusions: In healthy subjects, blood pressure in the supine position is higher than in the sitting position and age plays an important part in this posture-related pressure increment.

Blood pressure and its correlates in Tobagonian adolescents

To determine age-specific patterns and correlates of blood pressure (BP) in Tobagonian adolescents. Blood pressure, weight and heights were measured using standardized procedures. Age-height and gender-specific BP levels were established and compared with those established for adolescents in the United States of America, the United Kingdom and Jamaica. Of the available population, 3749 or 84.9% participated in the study. Among Tobagonian adolescents, the mean one-year age increment in systolic blood pressure (SBP) was 3.6 (95% CI: 3.2, 3.9) mmHg in males and 1.5 (95% CI: 1.2, 1.8) mmHg in females. Likewise, the mean one-year increment in diastolic blood pressure (DBP) was 2.1 (95% CI: 1.7, 2.4) mmHg in males and 1.2 (95% CI: 0.9, 1.4) mmHg in females. There was an inversion of mean BP with age. Females 12-13 years having significantly higher mean SBP while those 15-18 years had lower SBP than their male counterparts. Similarly, females 12-14 years had significantly higher mean DBP while those 16-18 years had lower DBP than their male counterparts. Approximately, 6.1% (95% CI: 5.4, 7.0) and 8.2% (95% CI: 7.4, 9.1) of participants had elevated SBP and DBP based on the US reference standards. Adolescents from the UK had average SBP and DBP that were 10 mmHg higher and lower respectively than their Tobagonian counterparts while Jamaican adolescents had diastolic BP consistently lower than Tobagonian adolescents of similar age. Elevated BP was associated with overweight and family history of hypertension. Growth and maturational factors are important determinants of blood pressure levels in this population. Furthermore, the wide variation in these key variables among possible BP referent populations necessitates the development of local blood pressure reference standards for Tobagonian adolescent populations.