Lower Blood Pressure Readings Research Articles

Using 15-Minute Serial Blood Pressures as an Alternative to Measuring a Single Blood Pressure.

Thirty-minute office blood pressure (OBP-30) is an alternative to ambulatory blood pressure (BP) measurement, yet is impractical to implement. This study aimed to determine whether unattended BP readings over 15 minutes would result in a similar probability of obtaining a BP of <140/90. Sixty-seven adults self-described as having high BP were analyzed. BP was measured at baseline and every 5 minutes for 15 minutes with the initial reading compared to the average of the last three readings (OBP-15). Compared to baseline, there was a decline in both average systolic (4.2 points) and diastolic (2.8 points) BP. The probability of BP control predicted by multivariate model was 71.6% at baseline and 78.0% using OBP-15 (p=0.011). The increase in BP control from initial to OBP-15 measurement was significant for indigenous or persons of color compared to whites, and men compared to women. OBP-15 is convenient and results in lower BP readings and higher probability of BP control compared to the initial reading.

PS-C30-8: PREGNANT WOMEN WITH STRUGGLING WITH HIGH BLOOD PRESSURE IN PREGNANCY AND ROLE OF NITRIC OXIDE SUPPLEMENTS L-ARGININE FOR PROLONG PERIOD

Nitric oxide is a compound in the body to relax and widen blood vessels Some scientists believe that nitric oxide stimulates the release of certain hormones, such as insulin and human growth hormone. Researchers have performed multiple clinical trials related to nitric oxide supplements that includes L-citrulline and L-arginine and their effectiveness, often with mixed results. Taking nitric oxide supplements offers several heart boosting effects. Reducing arterial stiffness, blood pressure, and improving carotid artery blood flow, by enhancing blood flow in the body they improve performance in sports, promote healing, enhance heart health, and provide many other potential benefits. Preeclampsia, which is a form of high blood pressure that can occur in pregnancy, can be dangerous for both the woman and baby. A 2005 study in the European Journal of Clinical Investigation Trusted Source found that pregnant women who took L-arginine supplements for a prolonged period had lower blood pressure readings than pregnant women who did not take L-arginine. Although researchers need to conduct more studies, the results are promising for women struggling with high blood pressure in pregnancy. However, there are no studies that establish how much nitric oxide supplements people should take to achieve the results.

Matchmaking and the Future of Hypertension Management.

Matchmaking and the Future of Hypertension Management.

Relationship between aerobic fitness, blood pressure and life satisfaction

Background: ‪The aim of this work was to examine the extent to which cardiorespiratory fitness, blood pressure, and optimism/pessimism predict adults’ satisfaction with life. Material and methods: ‪Sixty-eight adults seeking cardiovascular health screening in a private clinic were tested. Participants’ blood pressure, optimism/pessimism, and satisfaction with life were recorded. The YMCA cycle ergometer test was used for estimating participants’ aerobic fitness (VO2 max). Based on 140/90 mm Hg blood pressure cut-off value, participants were classified into two groups. Results: ‪A bootstrapped hierarchical multivariate regression analysis revealed that VO2 max, systolic blood pressure, optimism, and pessimism jointly accounted for 46% of the variance (R2 = 0.501, R2 adjusted = 0.462) in life satisfaction. Furthermore, a bootstrapped multivariate analysis of covariance indicated that Stage 2 hypertensives reported lower life satisfaction (p = 0.007) than the others with lower blood pressure readings. Conclusions: ‪This study is the first to reveal that almost half of the total variance in life satisfaction is accounted by cardiorespiratory fitness, systolic blood pressure, optimism, and pessimism. The present work also shows that individuals in Stage 2 hypertension are less satisfied with their lives than individuals with lower blood pressure values. These preliminary findings should stimulate both epidemiological and longitudinal research in the area.

Hypotension in small preterms: what does it mean?

Introduction: Small preterms often have low blood pressure readings in the first few days of life. However, what is hypotension in preterms? Should there be an aggressive approach to its management? What are the immediate and long-term side effects of powerful medications? Alternatively, could a low blood pressure be accepted instead?Materials and methods: Data were collected from files of all live babies with gestational age (GA) between 230/7 and 316/7 weeks over two different periods: years 2000–2004 and 2008–2012.Results: Our data show that, despite extremely low gestational age (ELGA)/extremely low birth weight (ELBW) neonates, almost half of these tiny babies have neither low mean arterial pressure (MAP) readings nor clinical signs of impaired perfusion. Yet, many of them are, variously treated or not, depending on individual decisions, rather than on sound evidence.Discussion: We suggest, should it be required to treat persistent hypotension, rather than treating just a low MAP recording, to address the whole issue of hypotension in the overall picture of clinical settings; we to assess organ dysfunction caused by low output and use the least aggressive measures, preferably within written protocols, tailored to the given unit, but equally, sufficiently flexible to individual babies. Furthermore, allow for “permissive hypotension” especially if transient, in the absence of clinical signs of hypoperfusion, with normal superior vena cava (SVC) flow, normal cardiac output, and normal brain scanning with normal cerebral Doppler flows. Whether treating hypotension, by whichever definition, “per se”, will make any difference to both, immediate and late outcomes; in the end, treating remains open to questioning and calls for careful follow-up of these very susceptible preterms.

Thirty-Minute Office Blood Pressure Monitoring in Primary Care.

Automated office blood pressure monitoring during 30 minutes (OBP30) may reduce overtreatment of patients with white-coat hypertension in primary health care. OBP30 results approximate those of ambulatory blood pressure monitoring, but OBP30 is much more convenient. In this study, we compared OBP30 with routine office blood pressure (OBP) readings for different indications in primary care and evaluated how OBP30 influenced the medication prescribing of family physicians. All consecutive patients who underwent OBP30 for medical reasons over a 6-month period in a single primary health care center in the Netherlands were enrolled. We compared patients' OBP30 results with their last preceding routine OBP reading, and we asked their physicians why they ordered OBP30, how they treated their patients, and how they would have treated their patients without it. We enrolled 201 patients (mean age 68.6 years, 56.7% women). The mean systolic OBP30 was 22.8 mm Hg lower than the mean systolic OBP (95% CI, 19.8-26.1 mm Hg). The mean diastolic OBP30 was 11.6 mm Hg lower than the mean diastolic OBP (95% CI, 10.2-13.1 mm Hg). Considerable differences between OBP and OBP30 existed in patients with and without suspected white-coat hypertension, and differences were larger in individuals aged 70 years or older. Based on OBP alone, physicians said they would have started or intensified medication therapy in 79.1% of the studied cases (95% CI, 73.6%-84.6%). In fact, with the results of OBP30 available, physicians started or intensified medication therapy in 24.9% of cases (95% CI, 18.9%-30.9%). OBP30 yields considerably lower blood pressure readings than OBP in all studied patient groups. OBP30 is a promising technique to reduce overtreatment of white-coat hypertension in primary health care.

The Relationship Between Cognitive Functioning and the JNC-8 Guidelines for Hypertension in Older Adults.

Guidelines for hypertension treatment by the Eighth Joint National Committee (JNC-8) in 2014 recommended a target systolic blood pressure (BP) of <150/<90 mmHg in persons older than 60 years, in contrast to the 2003 JNC-7 recommendations of systolic BP <140 mmHg. This study evaluated the implications of raising the BP target on cognitive functioning and conversion from normal cognition to mild cognitive impairment (MCI). This was a longitudinal study of individuals older than 60 years enrolled in the NIH-NIA Alzheimer's Disease Centers. All had normal cognition at baseline. 453 participants were taking BP medications and had readings of <140/<90 mmHg at four annual visits (reference group). Two other groups consisted of participants with either systolic BP of 140-149 mmHg (n = 112) or ≥150 mmHg (n = 280) on three or four annual visits. Compared with the reference and the 140-149 mmHg groups, those with BP ≥150 mmHg exhibited poorer cognitive status by Year 4 on the Mini-Mental State Exam, and they had a higher risk of conversion to MCI. The 140-149 mmHg exhibited poorer performance than the reference group on domains assessing attention and executive functioning. In contrast, their performance was not significantly different from those with BP ≥150 mmHg. Persons with BP ≥150 mmHg show a faster global cognitive decline and transition to MCI than those with lower BP readings. However, the poor cognitive performance in the attention and executive functioning domains for the 140-149 mmHg group indicates the need for further research evaluating the newer recommended cutoff.

Under-recognition of Low Blood Pressure Readings in Patients with Duchenne Muscular Dystrophy.

Duchenne muscular dystrophy (DMD), a recessive sex-linked hereditary disorder, is characterized by degeneration, atrophy, and weakness of skeletal and cardiac muscle. The purpose of this study was to document the prevalence of abnormally low resting BP recordings in patients with DMD in our outpatient clinic. The charts of 31 patients with DMD attending the cardiology clinic at Rush University Medical Center were retrospectively reviewed. Demographic data, systolic, diastolic, and mean blood pressures along with current medications, echocardiograms, and documented clinical appreciation and management of low blood pressure were recorded in the form of 104 outpatient clinical visits. Blood pressure (BP) was classified as low if the systolic and/or mean BP was less than the fifth percentile for height for patients aged ≤17 years (n = 23). For patients ≥18 years (n = 8), systolic blood pressure (SBP) <90 mmHg or a mean arterial pressure (MAP) <60 mmHg was recorded as a low reading. Patients with other forms of myopathy or unclear diagnosis were excluded. Statistical analysis was done using PASW version 18. BP was documented at 103 (99.01 %) outpatient encounters. Low systolic and mean BP were recorded in 35 (33.7 %) encounters. This represented low recordings for 19 (61.3 %) out of a total 31 patients with two or more successive low recordings for 12 (38.7 %) patients. Thirty-one low BP encounters were in patients <18 years old. Hispanic patients accounted for 74 (71.2 %) visits and had low BP recorded in 32 (43.2 %) instances. The patients were non-ambulant in 71 (68.3 %) encounters. Out of 35 encounters with low BP, 17 patients (48.6 %) were taking heart failure medication. In instances when patients had low BP, 22 (66.7 %) out of 33 echocardiography encounters had normal left ventricular ejection fraction. Clinician comments on low BP reading were present in 11 (10.6 %) encounters, and treatment modification occurred in only 1 (1 %) patient. Age in years (p = .031) and ethnicity (p = .035) were independent predictors of low BP using stepwise multiple regression analysis. Low BP was recorded in a significant number of patient encounters in patients with DMD. Age 17 years or less and Hispanic ethnicity were significant predictors associated with low BP readings in our DMD cohort. Concomitant heart failure therapy was not a statistically significant association. There is a need for enhanced awareness of low BP in DMD patients among primary care and specialty physicians. The etiology and clinical impact of these findings are unclear but may impact escalation of heart failure therapy.

Association and moderation of self-reported hypotension with traffic noise exposure: A neglected relationship

In a short-term experimental study about one-third of subjects exposed to noise shows both increases and decreases in blood pressure. While the association of noise with hypertension is established it is not yet known whether hypotension is associated with noise in field studies. In a cross-sectional study the association of self-reported hypotension and low blood pressure readings with traffic noise was examined in adults (age 25-65, N = 1989, participation = 62%). Noise exposure was based on both, short and long-term day/night recordings and standard noise mapping. Questionnaire data on socio-demographics, housing, life-style, noise and weather sensitivity, health status, mental and physical symptoms were available to adjust for potential confounding and testing for moderation. Non-linear multiple regression was applied to estimate the association between the two outcomes and overall noise exposure. We did not observe a stable relation between noise and low blood pressure readings since the number of subjects based on the recommended cut-off points (5 th percentile or 110 (100)/60 mmHg) was too small. However, self-reported hypotension was non-linearly associated with noise exposure ( P = 0.044) in the presence of a strong sex × age effect modification ( P < 0.0001). Another significant moderation by noise were observed with reported symptoms of exhaustion ( P = 0.03). Weather sensitivity showed a significant interaction with noise sensitivity ( P = 0.02) and also a non-linear interaction with age ( P = 0.02). The results remained stable after adjustment for variables known to be associated with constitutional hypotension. The exposure-effect curve ascends around sound levels of 55 dBA. The results suggest a novel moderated association of noise with self-reported hypotension, predominantly in weather sensitive women with symptoms of exhaustion. Further and larger studies are needed to replicate the potential moderating effect of noise on persons with constitutional hypotension.

NewsCAP: Trauma teams should pay attention to single, isolated, low blood pressure readings

NewsCAP: Trauma teams should pay attention to single, isolated, low blood pressure readings

The Reliability of Patient Self‐Reported Blood Pressures

Self-monitoring of blood pressure actively involves patients in hypertension management. However, the usefulness of self-monitoring of blood pressure may be limited by inaccurate patient reporting. The study objective was to assess reliability of patient blood pressure reporting over 6 months. Forty-nine subjects with Joint National Committee stage 1 or 2 hypertension were enrolled. Unaware that the monitors electronically store readings, the subjects were asked to check and record outpatient blood pressures twice weekly. Stored and written readings were compared. On average, patient-recorded blood pressures were equivalent to stored monitor values 80% or more of the time. Reliability of patient self-reporting was sustained over the 6-month study period. Notably, patients did not selectively report lower blood pressure readings. The overall mean self-reported and stored monitor blood pressures were nearly identical: blood pressure (+/-SD) 134+/-16.8/78+/-11.6 mm Hg and 135+/-19.6/80+/-13.3 mm Hg, respectively. The reliability of self-reporting of blood pressures for many patients supports the potential usefulness of self-monitoring of blood pressure in hypertension management.

Profile of the Well-Controlled, Well-Adjusted Hypertensive Patient

The study purpose was to identify discriminant predictors of blood pressure control and adjustment to chronic illness in 450 hypertensive patients. Hypertension control was determined by physician judgment, and adjustment was assessed by Derogatis' (1977) Psychosocial Adjustment to Illness Scale. Potential predictors of the outcome variables were measured by structured interview, formal instruments, and chart review. Well-controlled hypertensive patients had better health adjustment scores, reported more illness-related job problems and less illness-related sexual problems, were more satisfied with health care, knew what to do about medication side effects, were on medications longer, and had lower blood pressure readings on chart review. Well-adjusted hypertensive patients had fewer hypertension-related problems; had their blood pressure under control; were less likely to eat, smoke, or use drugs to handle tension; had no recent weight gain; knew what to do about medication side effects and that there is no cure for hypertension; were less pessimistic and less likely to worry; rated their stress level lower and their quality of life higher; felt that their health was under their own control; tried to problem solve when coping with stress; were on hypertensive medications a shorter time and on fewer medications overall; did not like to be alone when feeling stressed; and ate fewer high sodium foods.

BLOOD-PRESSURE RESPONSE TO MODERATE SODIUM RESTRICTION AND TO POTASSIUM SUPPLEMENTATION IN MILD ESSENTIAL HYPERTENSION

To determine whether moderate restriction of dietary sodium content or supplementation of potassium intake reduces blood-pressure in patients with mild essential hypertension, twelve patients were put on three different diets—a control diet (180 mmol sodium/day), a sodium restricted diet (80 mmol/day), and a potassium supplemented diet (200 mmol potassium/day). Each diet was taken for at least 4 weeks and the sequence of the regimens was randomised. At the completion of each regimen intraarterial pressure was recorded continuously, and vasoactive hormones were measured hourly, for 24 h, under standardised conditions, in hospital. Compared with the control diet, sodium restriction was associated with lower blood-pressure readings in seven patients, higher levels in five, and an overall reduction in mean pressures of only 4·0/3·0 mm Hg (not significant). Individual differences in blood-pressure between these two diets correlated closely with concomitant differences in plasma renin activity (r=0·75). Potassium supplementation also resulted in variable changes in arterial pressure, and the mean difference in pressure recordings (0·1/0·8 mm Hg) was insignificant. The results show that moderate restriction of sodium intake or supplementation of dietary potassium has variable effects on arterial pressure in individuals with mild essential hypertension, and that overall the blood-pressure changes induced are very small. Responsiveness of the renin-angiotensin system may limit the fall in blood-pressure induced by sodium restriction.

The Relationship Among Type A Behavior, Styles Used in Coping with Racism, and Blood Pressure

The relationship between six cognitive styles used in coping with racism and blood pressure in 32 Black students was studied. It was hypothesized that an apathetic style would be associated with lower blood pressure readings. Also, the relationship between the Type A coronary-prone behavior pattern and blood pressure was examined. As expected, weight was shown to have a strong relationship with blood pressure. The Type A dimension was positively related to diastolic pressure at rest and during mental arithmetic (mild stress). A style associated with a proactive and flexible orientation to the problems of racism was positively cor related with resting systolic blood pressure and the recovery of a diastolic pressure after stress.