mmHg In Men Research Articles

THE EFFECT OF DIETERY CHANGES ON WEIGHT AND BLOOD PRESSURE IN MIDDLE AGE PATIENTS WITH OVERWEIGHT/OBESITY AND HIGH NORMAL BLOOD PRESSURE

Objective: To evaluate the effects of dietary weight loss intervention in middle age with high normal blood pressure and overweight/obesity. Design and method: Men and women aged 25–54 was from working population were observed within the prospective epidemiological study: in subjects with BMI more than 25 kg/m2and BP 130–139/85–89 mm Hg. Was found a strong correlation of systolic BP and BMI was revealed: p = 0.0001 in women and p = 0.0045 in men. The same was true for diastolic BP: p = 0.0001 in women and p = 0.0001 in men. Two groups were formed and followed for 3 years: Intervention and Control groups consisted of 455 subjects (203 and 252 respectively). Dietician’s consultations were used in intervention group. Results: An increase of BMI by 1 kg/m2was associated with increase of systolic BP in women and men (by 1.3 and 0.7 mmHg respectively), (p < 0.05). For diastolic BP increase of BMI by 1 kg/m2was associated with increase in men and women (by 0.7 and 0.9 mm Hg respectively). In stepwise regression analysis body mass explains 27% of systolic BP variability and 11% of diastolic BP variability in men. In women it was 19% and 17% respectively. Last follow up visit attended more than 76% of the participants. After 3 years of intervention a weight loss was noted in the intervention group on an average at 1.17 kg in women (p < 0.05) and 0.63 kg (p < 0.05) in men. In controls body weight increased in women and in men (at 3.08 and 2.89 kg respectively) (all p < 0.05). BP decreased in the intervention group - 3.27 for systolic BP and – 2.09 mm Hg for diastolic BP in women; - 1.92 and – 1.91 mm Hg in men respectively. In control group BP increased: 2.97 mm Hg systolic BP and 1.29 mm Hg for diastolic Bp in women and 2.56 mm Hg and 2.39 mm Hg in men respectively (all p < 0.05). Conclusions: Dietary approach to weight loss is effective tool in middle age men and women with high normal BP and overweight/obesity for prevention of hypertension.

Sex-Specific Risk Factors Associated with Helicobacter pylori Infection Among Individuals Undergoing Health Examinations in China.

PurposeHelicobacter pylori is one of the most common causes of peptic ulcers, gastritis, and gastric cancers. This study investigated sex-specific differences in the prevalence of H. pylori infection and its associated factors among individuals undergoing hospital-based health examinations in southern China.MethodsThis study enrolled consecutive healthy individuals who underwent regular health examinations at a hospital physical examination center between September 2020 and September 2021. Anthropometric characteristics and biochemical profiles were measured. All individuals underwent carbon-13 urea breath tests. Univariate and multivariate analyses were used to evaluate the factors associated with H. pylori infection.ResultsA total of 5035 individuals (men, 59.1%; women, 40.9%) were included in the analyses. The total rate of H. pylori infection was 35.0% (men, 35.5%; women, 34.3%). In the multivariate analysis, the risk factors identified for H. pylori infections were high fasting blood glucose levels and blood pressure ≥160 mmHg in men and older age, high body mass index, and low albumin levels in women.ConclusionThese findings suggest that physicians must be aware of the metabolic factors associated with H. pylori infections in the Chinese population. Early detection of these factors and timely intervention are expected to reduce H. pylori infections and provide a theoretical basis for the primary prevention of several gastrointestinal diseases.

Hypertensive response to exercise in adult patients with repaired aortic coarctation

ObjectiveThe clinical and prognostic implications of a hypertensive response to exercise after repair of coarctation of the aorta (CoA) remain controversial. We aimed to determine the prevalence of a hypertensive...

Does exercise stress testing carry an incremental prognostic value beyond resting office blood pressure?

Does exercise stress testing carry an incremental prognostic value beyond resting office blood pressure?

Cardiovascular risk stratification: how important is the hypertensive response to exercise?

Cardiovascular risk stratification: how important is the hypertensive response to exercise?

Blood pressure response during treadmill exercise testing and the risk for future cardiovascular events and new-onset hypertension

Abstract Background Although there is a diminishing role of exercise stress testing (EST) in the diagnostic assessment of coronary heart disease, the physiologic response to exercise may provide valuable prognostic information. We aimed to investigate the association of repeated blood pressure (BP) measurements during EST with long-term risk of myocardial infarction, stroke or death (MACE), as well as the development of new-onset hypertension. Methods Retrospective analysis of EST performed between the years 2005–2019 in a single center according to Bruce protocol. Included were patients aged 35–75 years without a history of cardiovascular disease (n=14,792; 48% women). BP was documented at rest, submaximal exercise (Bruce stage-2), peak exercise and recovery (2 minutes). Association of BP measures with study outcomes during a median follow-up of 78 months was investigated. Results An increment of 10-mmHg in rest, submaximal, peak and recovery systolic BP was each associated with a significant increase in the hazard ratio (HR) and 95% confidence interval (CI) for MACE: 1.09 (1.04–1.14), 1.06 (1.01–1.10), 1.04 (1.01–1.08), and 1.06 (1.02–1.10), respectively, after adjustment including exercise capacity, medications and resting BP. The association between SBP at submaximal exercise and recovery with MACE had a J-shaped appearance (Figure). Among non-hypertensive patients without BP lowering medications (n=8,529), 13% were diagnosed with new-onset hypertension during follow-up. Excessive systolic BP response to peak exercise (≥190 mmHg in women and ≥210 mmHg in men) was an independent predictor of future hypertension [HR (95% CI)]: 1.87 (1.41–2.48), as were systolic BPs during submaximal exercise [>160 vs. ≤130 mmHg: 2.44 (1.97–3.03)] and recovery [≥140 vs. ≤120 mmHg: 1.65 (1.37–1.98)], showing gradual, incremental association with the risk for developing hypertension. Conclusions BP measurement during exercise and recovery phases of treadmill testing provides incremental prognostic information regarding long-term risk for cardiovascular events and the probability for developing future hypertension. Funding Acknowledgement Type of funding sources: None.

Long-Term Health Outcomes of Korean Adults With Classic Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency.

There is a lack of studies regarding the long-term outcomes of Asian adults with classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. We hypothesized that adults with CAH are at higher metabolic risk than their age-, and sex-matched controls. We further investigated the long-term health outcome-related factors in adults with CAH. We compared metabolic risk between adults with CAH (71 men, 93 women) and age-, and sex-matched controls (190 men, 261 women) from the Korean National Health and Nutrition Examination Survey data. The presence of obesity, testicular adrenal rest tumors (TARTs), and menstrual irregularity was assessed. Hormone status and treatment regimens were compared according to the presence of adverse outcomes. The median age was 27.0 y and 28.0 y for men and women, respectively. Adults with CAH had a higher waist circumference (88.0 vs. 82.3 cm in men, and 83.5 vs. 72.3 cm in women), and blood pressure (125.0 vs. 113.0 mmHg in men, and 120.0 vs. 104.0 mmHg in women) than age- and sex-matched controls (P<0.05 for all). The 2.7-fold increased risk for hypertension (men) and 2.0-fold increased risk for obesity (women) was significant in patients with CAH (P<0.05 for both). Obese adults with CAH showed significantly higher adrenal limb thicknesses (men) and 17-hydroxyprogesterone and dehydroepiandrosterone sulfate levels (women) (P<0.05 for both). TARTs occurred in 58.1% of men and did not differ by hormone or treatment regimen. Irregular menstruation was observed in 57.1% of women, with higher dehydroepiandrosterone sulfate levels in those with irregular periods. Adults with CAH had a higher metabolic risk than the general population. Poor disease control may increase their risk of metabolic morbidity and menstrual irregularity.

Blood pressure response during treadmill exercise testing and the risk for future cardiovascular events and new-onset hypertension.

The physiologic response to exercise may provide valuable prognostic information. We investigated the association of blood pressure (BP) measurements during exercise stress testing (EST) with long-term risk of myocardial infarction, stroke or death (major adverse cardiovascular event, MACE), as well as the development of new-onset hypertension. A retrospective analysis of treadmill ESTs (years 2005-2019) performed by the Bruce protocol in patients aged 35-75 years without a history of cardiovascular disease (n = 14 792; 48% women). BP was documented at rest, submaximal exercise (Bruce stage-2), peak exercise and recovery (2 min). Association of SBP measures with study outcomes during median follow-up of 6.5 years was investigated. Highest vs. lowest SBP quartile at rest (≥140 vs. <120 mmHg), submaximal-exercise (≥170 vs. <130 mmHg), peak-exercise (≥180 vs. ≤145 mmHg) and recovery (≥160 vs. <130 mmHg) was associated with an increase in the adjusted hazard ratio and 95% confidence interval (CI) for MACE: 1.53 (1.23-1.88), 1.33 (1.01-1.76), 1.30 (1.05-1.61), 1.35 (1.09-1.68), respectively. The association between SBP at submaximal exercise and recovery with MACE displayed a J-shaped pattern. Among nonhypertensive patients (n = 8529), excessive SBP response to peak exercise (≥190 mmHg in women and ≥210 mmHg in men) was an independent predictor of hypertension [hazard ratio (95% CI)]: 1.87 (1.41-2.48), as were SBPs during submaximal exercise [>160 vs. ≤130 mmHg: 2.44 (1.97-3.03)] and recovery [≥140 vs. ≤120 mmHg: 1.65 (1.37-1.98)]. BP measurement during rest, exercise and recovery phases of EST provides incremental prognostic information regarding long-term risk for cardiovascular events and the probability for developing hypertension.

Hypotension and survival: diagnostic criteria in Russian and United States population

Aim. Based on Russian and United States population studies, to determine the criterion for distinguishing between normal and low blood pressure (BP), which is the most significant for predicting all-cause mortality.Material and methods. We used data from prospective Russian studies of 14730 men aged 19-82 years (9307 deaths per 342309 person-years of followup) and 6141 women aged 18-72 years (2101 deaths per 158727 person-years of follow-up), and two United States population studies: the First National Health and Nutrition Examination Survey (NHANES I) in conjunction with the NHANES I Epidemiologic Followup Study, and the Second National Health and Nutrition Examination Survey (NHANES II) in conjunction with the NHANES II Mortality Study. The total American cohort included only white subjects: 8618 men aged 25-75 years (3130 deaths per 121794 person-years of follow-up) and 11135 women 25-75 years (2465 deaths per 176676 person-years of follow-up). Primary examinations were carried out in 1971-1982, while the latest information on the subjects’ survival status was obtained in 2017 (Russia) and 1992 (USA). KaplanMeier curves and Cox proportional hazards models were created; all-cause death was taken into account as an outcome.Results. Survival analysis using Cox models, in which, in addition to BP levels, sex, age and risk factors were taken into account, showed that in persons with a pronounced BP decrease, survival is worse in comparison with those with normal BP. Mean dynamic BP, unfavorable for all-cause mortality, was below 70 and 68 mm Hg and 76 and 72 mm Hg in men and women in the Russian and US cohorts, respectively.Conclusion. Not only hypertension, but also severe hypotension is associated with increased all-cause mortality compared to normal BP. Survival decrease is manifested in severe hypotension, subject to sex and adjustment for age and risk factors.

Hypertensive response in exercise - a tool to predict stroke risk?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction There is some evidence suggesting that exaggerated hypertensive response to exercise (HRE) may be associated with higher risk of future cardiovascular events, however the relationship between systolic blood pressure (SPB) during exercise test and stroke is not fully understood. Purpose To evaluate the ability to predict the risk of stroke in patients with HRE in exercise test. Methods Single-center retrospective study of consecutive patients submitted to exercise test from 2012 to 2015 with HRE to stress test. HRE was defined as a peak systolic blood pressure (PSBP) &amp;gt; 210 mmHg in men and &amp;gt; 190 mmHg in women, or a rise of the SBP of 60 mmHg in men or 50 mmHg in women or as a diastolic blood pressure &amp;gt; 90 mmHg or a rise of 10 mmHg. Patient’s demographics, baseline clinical characteristics, vital signs during the stress test and the occurrence of stroke during follow-up were analysed Results We included 458 patients with HRE (76% men, 57.5 ± 10.83 years). The most frequent comorbidities were hypertension (83%), dyslipidaemia (61%), previously known coronary disease (32%), diabetes (28%) and smoking (38%). Atrial fibrillation was present in 5.9% of patients. During a mean follow-up of 60 ± 2 months, the incidence of stroke was 2.1% (n = 8), all with ischemic origin. Considering the parameters analysed on exercise test, only PSBP demonstrated to be an independent predictor of stroke (HR 1.042, CI95% 1.002-1.084, p = 0.039,) with moderate ability to predict stroke (AUC 0.735, p = 0.0016) with a most discriminatory value of 203 mmHg (sensibility 56%, specify 67%). Regarding baseline characteristics, after age, sex and comorbidities adjustment, previously controlled hypertension was found to be an independent protective factor of stroke (OR 4.247, CI 95% 0.05-0.9, p = 0.036) and atrial fibrillation was an independent predictor of stroke occurrence (HR 8.1, CI95% 1.4-46.9, p = 0.018). Atrial fibrillation was also associated with hospitalization of cardiovascular cause and major cardiovascular events occurrence (mortality, coronary syndrome and stroke). Baseline SBP was associated with atrial fibrillation development (p = 0.008). Conclusion According to our results, PSBP during exercise test is an independent predictor of stroke occurrence and should be considered as a potencial additional tool to predict stroke occurrence, particularly in high risk patients. The identification of diagnosed hypertension as a protective factor of stroke may be explained by the cardioprotective effect of antihypertensive drugs.

Should we redifine Hypertensive response in stress test to better predict cardiovascular risk?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Systolic blood pressure (SBP) rise during exercise is normal, but some patients present with hypertensive response to exercise (HRE). The clinical implication of such phenomenon is not fully elucidated, and treatment strategies are still uncertain. Purpose To evaluate the relationship between HRE and the development of major cardiovascular events (MACE) - death, acute coronary syndrome (ACS) and stroke. Methods Single-center retrospective study of consecutive patients submitted to exercise test (ET) from 2012 to 2015. Patient’s demographics, baseline clinical characteristics, vital signs during ET and MACE occurrence during follow-up were analysed. HRE was defined as a peak systolic blood pressure (PSBP) &amp;gt;210 mmHg in men and &amp;gt;190 mmHg in women, or a rise of the SBP of 60 mmHg in men or 50 mmHg in women or as a diastolic blood pressure &amp;gt;90 mmHg or a rise of 10 mmHg. Results We included 458 patients with HRE (76% men, 57.5 ± 10.83 years). The most frequent comorbidities were hypertension (83%) and dyslipidaemia (61%). During a mean follow-up of 60 ± 2 months, the incidence of MACE was 9.2% with ACS being the most frequent (4.2%), followed by mortality (3.8%) and stroke (2.1%). Patients with inconclusive ET had a fourfold higher risk of acute coronary events (OR 4.1, CI 95% 1.55-11.14, p = 0.005). Baseline SBP and PSBP were predictors of MACE occurrence (OR 1.022, CI 95% 1.004-1.04, p = 0.016, OR 1.031 CI 95% 1.012-1.051, p = 0.001, respectively) and were both associated with cardiovascular hospitalization (p = 0.006; p &amp;lt; 0.001, respectively). PSBP had moderate ability to predict hospitalization of cardiovascular (CV) cause (AUC 0.71, p &amp;lt; 0.001) with a cut-off of 193 mmHg (sensibility 91%, specify 40%) and had moderate ability to predict MACE (AUC 0.67, p &amp;lt; 0.001) with a cut-off of 198 mmHg (sensibility 78.6%, specify 46.1%). Regarding mortality, antihypertensive therapy prior to ET was protective (p = 0.042), with no difference between different classes of drugs. Conclusion Our data reveal a high rate of MACE occurrence between patients with HRE. The finding of diagnosed hypertension as a protective factor of stroke may be explained by the cardioprotective effect of antihypertensive drugs. An increased risk of ACS between patients with an inconclusive ET should lead to consider then for further investigation. HRE should be considered as part of CV risk assessment and adjusted lower HRE cut-off values should be considered in order to better predict MACE occurrence, particularly in high risk patients. Abstract Figure.

Hypertensive response to exercise - to treat or not to treat?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Hypertensive response to exercise (HRE) is often documented in individuals without known cardiovascular disease. However, its impact on patient prognosis and the necessity of treatment are still not clear. Objective We aimed to evaluate the impact of a hypertensive response (HRE) on exercise test (ET) on clinical prognosis and outcome. Methods This was a single-center retrospective study of patients with HRE on stress exercise testing (STE) performed between January 2012 and December 2015. In our center, we define HRE as systolic blood pressure (SBP) &amp;gt; 210mmHg in men and &amp;gt;190mmHg in women, diastolic blood pressure (DBP) &amp;gt; 90mmHg or an increase in baseline systolic BP at least 60 mmHg in men or 50 mmHg in women, during exercise. Demographic, clinical, echocardiographic, electrocardiographic data were collected, and results were obtained using Chi-square and Student-t tests; logistic regression. Results We evaluated 500 patients who underwent STE, 457 of which had hypertensive response vs 43 patients without HRE (mean age 57 ± 11 vs 61 ± 8 years, p = 0,01). Among the two groups there were no differences between gender (76.5% men vs 69.7%) and race nor between the cardiovascular risk factors, namely hypertension, diabetes and dyslipidaemia. We evaluated their responses in STE and their outcomes, with a mean follow-up of 60 ± 22 months. In the univariate and multivariate analysis, presence of Sokolow-Lion criteria of left ventricular hypertrophy in the ECG was associated with HRE during the exam (OR 5.26; CI95% 2.4-11.6; p &amp;lt; 0.001). In patients who had previously known hypertension, therapy with calcium channel blockers seemed to protect against hypertensive response prior to ET (OR 0.48, CI95% 0.24-0.97, p = 0.004) compared to other antihypertensive drugs. Regarding the clinical outcomes, patients with HRE were associated with an increased risk of developing heart failure (p = 0.027) (versus patients without HRE) during follow up but failed to predict adverse outcomes such as acute coronary syndrome, atrial fibrillation or stroke. Within the patients with HRE in ET, 78 patients did not have an established diagnosis of HTA (mean age 49 ± 12.16 years, 75.6% men). In these patients we observed initiation on antihypertensive therapy after ET on 27.6% patients, but on univariate and multivariate analysis, starting therapy with anti-hypertensives did not have a significant impact on incidence of stroke, AF, HF, hospitalization for cardiovascular events or death. Conclusions We did not observe any significant differences among the studied groups regarding prognosis, except for the highest incidence of heart failure in patients with HRE. Initiation of antihypertensive therapy in patients with HRE failed to modify outcomes, however our sample was underpowered, so, further studies are required in order to clarify the value of treatment in patients with HRE.

ASSOCIATION OF CHILDHOOD PHYSICAL EXAMINATION AND LABORATORY PARAMETERS WITH HIGH BLOOD PRESSURE IN JAPANESE YOUNG ADULTS

Objective: We aimed to identify childhood risk factors for high blood pressure (BP) in young adults. Design and method: Childhood data were obtained from medical checkups of Japanese male and female junior high school students aged 12-13 years during the period from 2008 to 2009. Childhood variables were sex, body weight, body mass index (BMI), systolic BP, complete blood count, uric acid, total cholesterol, high density lipoprotein cholesterol, and low density lipoprotein cholesterol. The 1129 participants were followed up for average 8.6 years with a range of 6.0 to 9.0 years. High BP was defined as elevated BP and hypertension of ACC/AHA BP category (systolic BP 120 mmHg or more and/or diastolic BP 80 mmHg or more). Results: At the follow-up, the prevalence of high BP was 42.2% in male young adults and 7.7% in female young adults. The mean systolic/diastolic BP was 117.8 [SD, 10.1] / 63.6 [SD, 6.1] mmHg in men and 105.2 [SD, 9.6] / 59.6 [SD, 5.5] mmHg in women. Univariable logistic regression analysis showed that systolic BP (odds ratio 1.56), body weight (1.50), uric acid (1.38), and red blood cell (1.31) at childhood baseline were significantly associated with high BP in male young adult, whereas variables associated with high BP were not found in female young adults because few women developed high BP. A logistic regression analysis with the stepwise method indicated that the regression model including systolic BP, body weight, WBC, platelet count, and uric acid had a high prediction power for high BP in male young adults (Area under curve 0.660, p &lt; 0.001). Conclusions: These results suggest that childhood medical checkup information including BP, anthropometric data, and laboratory parameter can contribute to the prediction of future high BP in young adults.

Global longitudinal strain and left ventricle dyssynchrony changes during stress echocardiography in response to antihypertensive treatment optimization

Abstract Funding Acknowledgements Type of funding sources: None. Background. The positive effect of blood pressure (BP) lowering medications on global longitudinal strain (GLS) and left ventricle (LV) dyssynchrony even in patients with narrow QRS complexes at rest has been established at rest. The dynamic changes of GLS and dyssynchrony markers on exertion are still remain underinvestigated, especially in patients with hypertensive response to exercise (HRE). Purpose. The aim of the study was to define if any changes in GLS and dyssynchrony markers assessed during exercise stress echocardiography (SE) can occur after the optimization of antihypertensive treatment. Methods. 18 patients without coronary artery stenosis on coronary angiography, underwent exercise SE on treadmill. All patients had arterial hypertension and HRE, defined as elevation of systolic BP ≥190 mmHg in women and ≥210 mmHg in men or ≥180 mmHg from the second stage of standard Bruce protocol. After optimization of BP lowering medications (addition/dose correction of ACEI/ARB, CCB or diuretics) we repeated SE within 138.5 ± 85.1 days. GLS and dyssynchrony markers at rest and on exertion from both tests were subsequently analyzed with the QLab and 3D-Q Advanced software. Results. The target systolic BP at rest was reached in all 18 patients (145.8 ± 21.8 mmHg vs. 126.1 ± 14.5 mmHg, p = 0.03), moreover exercise BP on exercise decreased significantly (209.4 ± 15.4 mmHg vs. 170.8 ± 14.4 mmHg, p = 0.003). We observed improvement in tolerance to exertion (7.2 ± 2.4 METs vs. 8.7 ± 3.0 METs, p = 0.0004), 2D and 3D-ejection fraction increase (4.7 ± 2.2% vs. 8.8 ± 2.1%, p = 0.0002 and 3.9 ± 4.9% vs. 10.8 ± 8.5, p = 0.03) and significant reduction of wall motion score index (1.21 ± 0.24 vs. 1.03 ± 0.11, p = 0.001). The speckle tracking analysis revealed increase in GLS on exertion (-20.4 ± 3.5 vs. -23.78 ± 3.2, p = 0.001) and its increment (-0.28 ± 2.1 vs. 3.17 ± 1.89, p = 0.0006), while the level of rest GLS remained unchanged (-20.61 ± 2.9 vs. -20.61 ± 2.6, p = 0.9) (Fig. 1). The dyssynchrony marker STE-TIME SD-IMPOST (standard deviation of time from QRS onset to peak segmental longitudinal strain on exertion) has also diminished (47.3 ± 18.4 vs. 33.8 ± 12.2, p = 0.005). Conclusions. Stress-induced wall motion abnormalities and poor increase/decrease in GLS observed in patients with HRE even in absence of coronary artery stenosis can resolve or diminish after antihypertensive treatment optimization. Speckle tracking LV-dyssynchrony markers in patients with narrow QRS complexes can also decrease in response to BP-lowering medications. Abstract Figure 1.

The Estimate of Relative Increase in Stroke Volume of a Heart under Influence of Low Frequency Mechanical Vibrations.

Background: An automatic massage produces health improving effects. After a single automatic massage, patients admit a feeling of invigoration, and a sense of relaxation. Some quantitative characteristics of physical effects produced by the automatic massage on the body, including the work of a heart were unavailable at that moment.Objective: This study aims to find a quantitative impact of periodic low frequency mechanical vibrations on the relative change in a heart stroke volume.Material and Methods: In this experimental study, the patients were exposed to the low frequency (12 Hz) planar mechanical vibrations. The blood pressures were measured before and after the automatic massage. Based on the measured values in the arterial blood pressure, a relative change in a stroke volume (SV) in patients was calculated. Results: The increased systolic blood pressure was 6.3±2.0 mm Hg in women and 11.1±2.7 mm Hg in men. The increased diastolic pressure was 1.9±1.2 mm Hg in women, and 4.9±1.5 mm Hg in men. The minor increase in heart rate for women was 1.2±1.0 beats per minute, and 1.2±2.0 beats per minute for men. The assessment of stroke volume changes provided 9.6% and 7.1% increase during systole and diastole in male patients, respectively, and corresponding 6.7% and 4.7% increases for female patients. Conclusion: The results of our work confirmed an increase in the systolic and diastolic blood pressures under the influence of periodic mechanical vibration of low frequency. We believe that the registered increase in blood pressure is a proof of the increase in a stroke volume (SV).

Association of lifetime blood pressure with adulthood exercise blood pressure response: the cardiovascular risk in young Finns study

Purpose Elevated blood pressure (BP) in childhood has been associated with increased adulthood BP. However, BP and its change from childhood to adulthood and the risk of exaggerated adulthood exercise BP response are largely unknown. Therefore, we studied the association of childhood and adulthood BP with adulthood exercise BP response. Materials and methods This investigation consisted of 406 individuals participating in the ongoing Cardiovascular Risk in Young Finns Study (baseline in 1980, at age of 6–18 years; follow-up in adulthood in 27–29 years since baseline). In childhood BP was classified as elevated according to the tables from the International Child Blood Pressure References Establishment Consortium, while in adulthood BP was considered elevated if systolic BP was ≥120 mmHg or diastolic BP was ≥80 mmHg or if use of antihypertensive medications was self-reported. A maximal cardiopulmonary exercise test with BP measurements was performed by participants in 2008–2009, and exercise BP was considered exaggerated (EEBP) if peak systolic blood pressure exceeded 210 mmHg in men and 190 mmHg in women. Results Participants with consistently high BP from childhood to adulthood and individuals with normal childhood but high adulthood BP had an increased risk of EEBP response in adulthood (relative risk [95% confidence interval], 3.32 [2.05–5.40] and 3.03 [1.77–5.17], respectively) in comparison with individuals with normal BP both in childhood and adulthood. Interestingly, individuals with elevated BP in childhood but not in adulthood also had an increased risk of EEBP [relative risk [95% confidence interval], 2.17 [1.35–3.50]). Conclusions These findings reinforce the importance of achieving and sustaining normal blood pressure from childhood through adulthood.

The gender-related peculiarities of the effects of telmisartan-based combined antihypertensive therapy on the dynamics of 24-hours profile of blood pressure

Objective — to evaluate the gender-related peculiarities of the effects of telmisartan-based combined antihypertensive therapy on the dynamics of 24-hours profile of blood pressure in patients with arterial hypertension depending on gender.Materials and methods. The study included 50 patients with arterial hypertension (AH), who received antihypertensive therapy and had uncontrolled arterial pressure as per the results of 24-hours ambulatory BP monitoring (DABPM). Among them were 23 men, average age (60.1 ± 2.7) years and 27 women, average age (64.4 ± 2.2) years. DABPM was performed to all patients before treatment and after 12 weeks of therapy. Prior to the study enrolment, all patients received combined antihypertensive therapy. After DABPM completion, the renin-angiotensin system (RAS) blocker used before enrolment was replaced by telmisartan in a dose of 40 — 80 mg.Results. It has been established that the average daily level of systolic blood pressure (SBP) after 12 weeks of therapy decreased significantly in men by 4.4 mm Hg and in women by 6.3 mm Hg. The average daily level of diastolic blood pressure (DBP) decreased in men by 7.1 mm Hg, in women — by 6.7 mm Hg. A decrease in the maximum SBP in the morning by 22.8 mm Hg in men and 23.4 mm Hg in women was determined. The maximal DBP in the morning decreased in men by 14.9 mm Hg, in women — by 19.1 mm Hg. The morning SBP index in men decreased by 41.5 %, in women — by 41.8 %, the morning DBP index — by 44.0 % and 33.7 %, respectively.Conclusions. After 12 weeks of telmisartan therapy, there was a significant decrease in mean daily SBP and DBP in men and women. Significant decrease in SBP and DBP in the active period was determined only in men, and decrease in SBP and DBP in the passive period was more pronounced in women. The positive effects of telmisartan therapy have been revealed in both men and women in terms of significant reduction of the maximal morning SBP and DBP, more than 40 % decrease of the morning SBP and DBP indices and the value of the morning SBP and DBP rise.

Exaggerated blood pressure response at mild exertional intensity is associated with lower exercise capacity and worsening of cardiac structural and functional profile

Abstract Even with normal blood pressure (BP) measured at rest, some individuals may experience excessive BP elevation with exercise, termed as an “exaggerated BP response to exercise” (ExBPR). The most common definition of ExBPR is SBP ≥210 mm Hg in men and ≥190 mm Hg in women at peak exercise intensity (ExBPR-PI). However, evidence exists that increase in SBP ≥150 mm Hg at an early stage of exercise stress test (i.e. at mild exercise intensity, ExBPR-MI) can effectively identify hypertension not diagnosed by conventional methods. No studies exploring the pathophysiological significance of ExBPR-MI have been undertaken to date. Aim To investigate the association of ExBPR-MI with exercise capacity and cardiac morpho-functional characteristics. Methods A group of 109 subjects (mean age 52±13 yrs) with and without a pre-established diagnosis of hypertension, having clinical indications for an exercise stress test, with seated clinic BP &amp;lt;140/90 mm Hg, underwent resting echocardiographic imagining and cardiopulmonary exercise testing using a ramped Bruce protocol. Results Based on the BP response at 3 minutes of exercise, the population was divided into two subsets: ExBPR-MI+ and ExBPR-MI− (SBP ≥ and &amp;lt;150 mmHg, respectively). The ExBPR-MI+ group was characterized by lower peak oxygen uptake, higher LV mass and left atrial size, and more impaired LV diastolic function (lower E/A and e', and higher E/e'). When the study cohort was stratified using peak BP response, significant differences indicating an adverse impact of ExBPR-PI were demonstrated only for LV diastolic parameters but not for peak VO2 and cardiac morphology indices (Table 1). Conclusions ExBPR-MI predisposes to reduced exercise capacity and detrimental alterations in cardiac morphology and function. As mild exercise intensity is more frequently present during routine daily activities than peak exercise intensity, ExBPR-MI may be a more important pathophysiological contributor to target organ damage than peak BP response, and may represent a potential new target for preventive and therapeutic measures. Table 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science Centre Poland

Blood pressure response in exercise is associated with future cardiac structural alterations in hypertensive patients

Abstract Background/Introduction Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) is often observed in individuals without known cardiovascular disease. Although it is generally considered as an abnormal response and a risk factor for hypertension development, its clinical significance remains controversial. On the other hand, regression of left ventricular hypertrophy (LVH) is independently associated with improved cardiovascular outcome. Purpose In this study we aimed to investigate the role of EBPR during exercise in LVH regression in hypertensive subjects over time. Methods 1413 hypertensive subjects, (mean age 57±11 years), 51% males, with baseline office blood pressure (BP) 144/89mmHg were followed for a mean period of 6.4±3.0 years. At baseline and last follow-up visit all patients underwent office BP, laboratory tests and echocardiographical determination of left ventricular mass index (LVMI). At baseline, all subjects underwent treadmill exercise testing (Bruce protocol) in order to identify the presence of EBPR based on the systolic BP elevation at peak exercise (&amp;gt; or =210 mmHg for men and &amp;gt; or =190 mmHg for women). Main outcome variable was LVH Regression/prevention (LVH Regr/prev), defined as: LVH at baseline visit with normal LVMI values at last visit or absence of LVH at baseline and last visit. BP control was considered optimal when the mean of office BP measurements during follow-up was &amp;lt;140/90mmHg. Results 46% of study population presented LVH Regr/prev during follow-up period. Cox-regression analysis, after adjustment for clinical and biochemical variables, revealed that low levels of baseline LVMI (HR=0.98, 95% CI 0.97–0.99, p&amp;lt;0.0001), absence of EBPR (HR=0.81, 95% CI 0.67–0.98, p=0.02) and optimal BP control during follow-up (HR=1.19, 95% CI 1.01–1.56, p=0.03) were independent predictors of LVH Regr/prev during follow-up. Conclusions Beyond optimal BP control, EBPR is a significant predictor of left ventricular mass changes overtime. Hence, ETT can provide clinical relevant information, including EBPR, which may help in the improvement of risk stratification of hypertensive subjects. Funding Acknowledgement Type of funding source: None

Recent status of self-measured home blood pressure in the Japanese general population: a modern database on self-measured home blood pressure (MDAS).

Despite the clinical usefulness of self-measured home blood pressure (BP), reports on the characteristics of home BP have not been sufficient and have varied due to the measurement conditions in each study. We constructed a database on self-measured home BP, which included five Japanese general populations as subdivided aggregate data that were clustered and meta-analyzed according to sex, age category, and antihypertensive drug treatment at baseline (treated and untreated). The self-measured home BPs were collected after a few minutes of rest in a sitting position: (1) the morning home BP was measured within 1 h of waking, after urination, before breakfast, and before taking antihypertensive medication (if any); and (2) the evening home BP was measured just before going to bed. The pulse rate was simultaneously measured. Eligible data from 2000 onward were obtained. The morning BP was significantly higher in treated participants than in untreated people of the same age category, and the BP difference was more marked in women. Among untreated residents, home systolic/diastolic BPs measured in the morning were higher than those measured in the evening; the differences were 5.7/5.0 mmHg in women (ranges across the cohorts, 5.3-6.8/4.7-5.4 mmHg) and 7.3/7.7 mmHg in men (ranges, 6.4-8.5/7.0-8.7 mmHg). In contrast, the home pulse rate in women and men was 2.4 (range, 1.5-3.7) and 5.6 (range, 4.6-6.6) beats per minute, respectively, higher in the evening than in the morning. We demonstrated the current status of home BP and home pulse rate in relation to sex, age, and antihypertensive treatment status in the Japanese general population. The approach by which fine-clustered aggregate statistics were collected and integrated could address practical issues raised in epidemiological research settings.