mmHg In Women Research Articles

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 (> or =210 mmHg for men and > 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 <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<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.

Significant intraocular pressure associated with open-angle glaucoma: Korea National Health and Nutrition Examination Survey 2010-2011.

ObjectivesTo investigate significant intraocular pressure (IOP) levels associated with the risk of open-angle glaucoma (OAG) in the treatment-naïve Korean population.MethodsParticipants ≥20 years of age in Korea National Health and Nutrition Examination Survey 2010–2011 were divided into two groups, those with higher and lower IOP values, compared with the reference IOP value. We compared the risk of OAG in each group using regression analyses. The IOP value that yielded the highest statistical significance was determined as an IOP significantly associated with the OAG risk.ResultsA total of 7,650 participants (7,292 control, 358 OAG) were included. The mean IOP was significantly higher in OAG group (14.4 ± 2.9 mmHg), compared to control group (13.9 ± 2.7 mmHg, P = 0.022). In association with an increased risk of OAG, the significant IOP value was 18 mmHg (Odds ratio [OR] = 1.79, 95% confidence interval [CI] 1.14–2.80, P = 0.011). Additionally, sex-difference was identified and they were 19 mmHg (OR = 2.79, 95% CI 1.27–6.16, P = 0.011) in men and 18 mmHg (OR = 2.65, 95% CI 1.32–5.33, P = 0.006) in women. The IOP values associated with significantly decreased risk of glaucoma were determined to be 14 mmHg in men (OR = 0.68, 95% CI 0.47–0.99, P = 0.042) and 16 mmHg in women (OR = 0.47, 95% CI 0.27–0.81, P = 0.007).ConclusionsIn consideration of the risk to benefit ratio, the reference IOP level for screening or setting the target IOP for treatment could be considered different from traditional 21 mmHg in Korean population.

Cross-sectional centiles of blood pressure by age and sex: a four-hospital database retrospective observational analysis

ObjectivesNational guidelines for identifying physiological deterioration and sepsis in hospitals depend on thresholds for blood pressure that do not account for age or sex. In populations outside hospital, differences in...

Pulse wave velocity is related to exercise blood pressure response in young adults. The Cardiovascular Risk in Young Finns Study

Purpose: High pulse wave velocity (PWV), a marker of increased arterial stiffness, and an exaggerated exercise blood pressure (EEBP) response during an exercise test have both been related to an increased risk of hypertension and cardiovascular events. Contradictory results have been published about the association between these two parameters, and their relation in healthy young adults is unknown.Materials and methods: This study consisted of 209 young adults (mean age 38 years) who participated in the ongoing Cardiovascular Risk in Young Finns Study between 2007 and 2009. We measured resting PWV with impedance cardiography in 2007, and participants performed a maximal cardiopulmonary exercise test with blood pressure (BP) measurements at rest, during exercise and during recovery in 2008–2009.Results: High PWV (≥age- and sex-specific median) at baseline was associated with EEBP (SBP >210 mmHg for men and >190 mmHg for women) an average of 14 months later and with systolic BP during different stages of exercise from rest to peak and recovery (during peak exercise, β ± SE was 4.1 ± 1.1, p < 0.001). The association between high PWV and systolic BP remained after adjustment for traditional cardiovascular risk factors and other exercise parameters (during peak exercise, β ± SE was 2.3 ± 1.1, p = 0.04).Conclusions: Increased arterial stiffness predicts EEBP during a maximal exercise test in young adults during all stages of exercise from rest to peak and recovery. PWV could provide an additional tool for EEBP risk evaluation.

P5466Exaggerated exercise blood pressure response is accompanied by increased sympathetic activity and arterial stiffness in subjects with high normal blood pressure

Abstract Background/Introduction The clinical importance of a hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) is not fully elucidated, while sympathetic overactivity and arterial stiffening are linked with adverse cardiovascular prognosis. Purpose The aim of this study was to assess the relation of HRE with sympathetic drive as assessed by muscle sympathetic nerve activity (MSNA) and arterial stiffness in subjects with high normal BP. Methods 42 subjects with high normal office BP [defined as office systolic BP=130–139 mmHg and office diastolic BP=85–89 mmHg (age: 53±9 years, 29 males, office BP: 134/84 mmHg, 24-hour BP: 114/72 mmHg)] with a negative treadmill exercise test (Bruce protocol) were divided into those with HRE (n=12) (peak exercise systolic BP ≥210mmHg in men and ≥190 mmHg in women) and those without HRE (n=30). Arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV) values. In all participants sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography). Results Subjects with a HRE compared to those without exhibited higher waist circumference (108.2±5.3 vs 94.7±9.2 cm, p=0.001) and were characterized by greater levels of carotid to femoral PWV (8.5±0.8 vs 7.0±0.9 m/sec, p&lt;0.001) and sympathetic nerve traffic as reflected by MSNA levels (41.1±1.5 vs 32.1±1.9 bursts per 100 heart beats, p&lt;0.001), while did not differ regarding metabolic profile and left ventricular mass index (p=NS). In the total population, peak exercise systolic BP was related to 24-h systolic BP (r=0.229, p&lt;0.05), PWV (r=0.218, p=0.002), and MSNA (r=0.214, p&lt;0.05). Moreover, MSNA was related to waist circumference (r=0.33, p=0.004) and office systolic BP levels (r=0.31, p&lt;0.05) but there was no association with PWV values (p=NS). Conclusion In subjects with high normal BP, a HRE identifies a state of arterial stiffening and sympathetic overdrive, as reflected by increased PWV and MSNA levels respectively. These finding suggest that exercise testing provides additional clinical information regarding the vascular status and modulation of sympathetic tone in this setting.

P5467Gender related differences in the clinical significance of elevated pulse pressure in the young. Results from the HARVEST study

Abstract Background Elevated pulse pressure (PP) is a well known cardiovascular risk factor in the elderly. Whether PP is a harbinger of adverse outcome also in young individuals is still a matter of debate. Moreover, the prognostic significance of elevated PP in the young seems to differ according to gender. Recently, we showed that PP was a predictor of adverse outcome only in young women while in men PP even had a protective effect. Aim The aim of the present study was to identify clinical, metabolic and haemodynamic characteristics associated with high PP in young hypertensive adults and to investigate whether these associations differed according to gender. Methods We investigated 1207 young stage I hypertensives (878 males) from the HARVEST Study, a long-term observational study involving 17 centres in the North-East of Italy. Mean age was 33.1±8.5 years and BP 145.5±10.6/93.5±5.7 mmHg. At the baseline patients underwent office and ambulatory blood pressure measurements and biochemical analyses and were followed at 6-month intervals until they developed hypertension requiring pharmacological treatment. For the analysis patients were divided into PP tertiles. All comparisons between males and females were tested with age-adjusted two-way ANCOVA using PP and sex as predictors. Results PP was 52.8±11.4 mmHg in men and 49.4±9.4 mmHg in women (p&lt;0.001). Metabolic data did not differ between the two genders. Echocardiographic stroke volume was higher in men than women (82.1±15.7 ml vs 70.8±16.4 ml, p&lt;0.001). No between-sex difference was found for peripheral resistance. Twenty-four-hour urinary norepinephrine/creatinine was higher in women than men (68.2±59.6 vs 54.4±66.5 mcg/mg, p=0.023), whereas no difference was found for epinephrine. Stratification by PP tertile showed that men in the top tertile were younger and had lower BMI than those in the bottom tertile (p&lt;0.001 and p=0.002), while the opposite trend was found for women (p&lt;0.001 and p=0.002) with a significant PP-sex interaction (p&lt;0.001 for both). Heart rate and systolic white coat effect progressively increased across PP tertiles in both genders (p&lt;0.001 for both). Glucose and triglycerides increased with increasing PP among women while the opposite was found for men, with a significant trend for glucose (p=0.025). At the end of follow-up (mean 7.9 years) females in the top PP tertile presented higher systolic BP (p=0.004), diastolic BP (p=0.071) and heart rate (&lt;0.001), compared to males of the corresponding tertile. Conclusions Young hypertensive women were characterized by increased sympathetic activity whereas men showed a hyperkinetic state. High PP was associated with greater BMI and worse metabolic profile in women, and with better metabolic data in men. This different pathogenetic background may account for the worse time-course of isolated systolic hypertension in women compared to men shown by previous studies. Acknowledgement/Funding None

Risk and Blood Pressure Control Rates Across the Spectrum of Coronary Artery Disease in Hypertensive Women: An Analysis from The INternational VErapamil SR-Trandolapril STudy (INVEST).

Background: Hypertension is a major modifiable risk factor for coronary artery disease (CAD), the main cause of death in women. While association between the two is frequent, limited data exist regarding the feasibility of blood pressure (BP) management and outcomes in women across the spectrum of CAD. Accordingly, we analyzed patient characteristics, BP control rates, and outcomes among hypertensive women with CAD, enrolled in The INternational VErapamil SR-trandolapril STudy (INVEST). Methods: The 11,770 hypertensive women with CAD in INVEST were studied based on presence (n = 3,879) or absence (n = 7,891) of history of myocardial infarction (MI) or coronary revascularization, to evaluate outcomes across risk groups based on severity of CAD. Results: Women with prior MI or revascularization were older (4 years, p < 0.0001), were predominantly white (62% vs. 29%), and had more associated comorbidities than women without these events. At 24 months, JNC VI (sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) BP control rates were lower in women with prior MI or revascularization (57% vs. 64%, p < 0.0001), despite more intensive antihypertensive therapy. The primary outcome (first occurrence of all-cause death, nonfatal MI, or nonfatal stroke) was also more frequent in women with prior MI or revascularization (adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.34-1.74), who were 42% more likely to die (adjusted HR 1.42; 95% CI 1.22-1.64), twice as likely to have a nonfatal MI (adjusted HR 2.4, 95% CI 1.64-3.51), and 56% more likely to have a nonfatal stroke (adjusted HR 1.56, 95% CI 1.1-2.21). Conclusions: In a prospective, multinational cohort of hypertensive women with CAD, those with prior MI or revascularization comprised a group at higher risk for death, nonfatal MI, and nonfatal stroke, and were less likely to have their BP controlled, despite more aggressive therapy. The feasibility and benefit of reducing BP to <130/80 mmHg in women, particularly with more severe CAD, warrant further investigation.

Changes in conventional cardiovascular risk factors and the estimated 10-year risk of acute myocardial infarction or cerebral stroke in Sami and non-Sami populations in two population-based cross-sectional surveys: the SAMINOR Study

ObjectiveTo describe changes in cardiovascular risk factors and in the estimated 10-year risk of acute myocardial infarction (AMI) or cerebral stroke (CS) between SAMINOR 1 (2003–2004) and SAMINOR 2 (2012–2014),...

ELEVATED PULSE PRESSURE IN HYPERTENSION OF THE YOUNG

Objective: The prognostic significance of elevated pulse pressure (PP) in the young is still a matter for debate. Previous studies suggest that high PP carries an increased risk of cardiovascular disease in women but not in men. We aimed to identify clinical, metabolic and haemodynamic characteristics associated with raised PP in young hypertensive adults and to investigate whether these associations differed according to gender. Design and method: We investigated 1207 young stage I hypertensives (878 males) from the HARVEST Study. Mean age was 33.1 ± 8.5 years and blood pressure (BP) 145.5 ± 10.6/93.5 ± 5.7 mmHg. For the analysis patients were divided into PP tertiles. All comparisons between males and females were tested with two-way ANCOVA using PP and sex as predictors, adjusting for age Results: Echocardiographic stroke volume was higher in men than women (82.1 ± 15.7 ml vs 70.8 ± 16.4 ml, p < 0.001). No between-sex difference was found for peripheral resistance. Twenty-four-hour urinary norepinephrine/creatinine was higher in women than men (68.2 ± 59.6 vs 54.4 ± 66.5 mcg/mg, p = 0.023) whereas no difference was found for epinephrine. PP was 52.8 ± 11.4 mmHg in men and 49.4 ± 9.4 mmHg in women (p < 0.001). Men in the top PP tertile were younger and had lower BMI than those in the bottom tertile (p < 0.001 and p = 0.002), while the opposite trend was found for women (p < 0.001 and p = 0.002; p for PP-sex interaction < 0.001 for both). Heart rate and systolic white coat effect progressively increased across PP tertiles in both genders (p < 0.001 for both). Glucose and triglycerides increased with increasing PP among women while the opposite was found for men, with a significant trend for glucose (p = 0.025). At the end of follow-up (mean 7.9 years) females in the top PP tertile presented higher systolic BP (p = 0.004), diastolic BP (p = 0.071) and heart rate (<0.001), compared to males of the corresponding tertile. Conclusions: Young hypertensive women are characterized by increased sympathetic activity whereas men show a hyperkinetic state. High PP is associated with greater BMI and worse metabolic profile in women, and with better metabolic data in men. This different pathogenetic background may account for the worse prognosis of isolated systolic hypertension in women compared to men.

Exercise Hypertension – A Review

The actual significance and definition of hypertensive response to exercise (HRE) is still debated. Up to now, there is consensus in defining it as a systolic blood pressure value of either ≥ 210 mmHg in men and ≥ 190 mmHg in women or a diastolic blood pressure ≥ 110 mmHg during maximal exercise stress test. The mechanisms underlying an exaggerated blood pressure response to exercise are poorly understood; however, there are studies suggesting that HRE may represent a preclinical stadium of essential hypertension, which shares several common pathological mechanisms mostly related to an endothelial dysfunction and vascular stiffness. In this article we review the present knowledge with particular respect to prognostic significance and diagnostic and therapeutic strategies in different populations. A separate section is dedicated to athletes with HRE.

Non-Invasive Blood Pressure Monitoring Underestimates Exercise-Induced Hypertension in Heart Failure with Preserved Ejection Fraction (HFpEF)

Hypertensive response to exercise (HTR - peak systolic blood pressure (BP) ≥190 mmHg in women; ≥220 mmHg in men during exercise) contributes to the development of HFpEF and subsequent exercise intolerance. This study assesses the reliability of non-invasive (NI) BP monitoring for the diagnosis of HTR in suspected HFpEF patients undergoing exercise right heart catheterisation (ExRHC). Methods: Data from 12 patients with suspected HFpEF undergoing ExRHC were retrospectively analysed. BP was recorded simultaneously from invasive radial arterial monitoring (IBP) and NI cuff measurements. 6 patients met HTR criteria from IBP monitoring, and 6 did not (non-HTR). BP at rest and peak exercise in the HTR and non-HTR subgroups were correlated and also analysed for agreement using the Bland-Altman method and plotted graphically as shown. Results: NIBP monitoring detected HTR in only 2 of 6 (33%) cases. Poor correlation between IBP and NIBP at exercise in HTR is demonstrated from Pearson correlation coefficient analysis: Non-HTR – rest r = 0.88; exercise r = 0.87 – HTR: rest r = 0.81; exercise r = 0.44. Agreement between measurement techniques diverges at peak exercise; with this discrepancy exaggerated in patients with HTR. Conclusion: Invasive BP monitoring may be required to accurately diagnose HTR in this patient cohort, and its use could be considered during ExRHC.

National prevalence of hypertension, treatment and control, in France in 2015 and temporal trends since 2006

Hypertension is a major risk factor for cardiovascular diseases. The aims of this public-funded study were to assess prevalence, diagnosis, treatment and control of hypertension in the adult population in France in 2015 and to describe temporal trends between 2006 and 2015. A cross-sectional survey (Esteban) based on a multistage sampling design was conducted in France in 2015–2016. The design was the same as the one of the 2006-survey. Both samples were representative of the French adult population (18–74 years). Blood pressure (BP) was measured during a health examination. Sociodemographic characteristics and risk factors were collected by questionnaires. Reimbursements of pharmacological treatments came from the national health insurance inter-scheme information system. Hypertension was defined by systolic blood pressure > 140 mmHg, diastolic blood pressure > 90 mmHg, or a reimbursement of BP-lowering drugs. 2169 adults (men: 42.2%) had a least two BP measurements. Mean age was 46.9 years. Mean BP was 131.2/78 in men and 121.8/74.9 mmHg in women. The BP was > 140 mmHg or > 90 mmHg in 29.5% of men and in 17.7% of women. The prevalence of hypertension was 30.6% [28.1–33.2] (36.5% in men and 25.1% in women). Among hypertensive adults, 47.3% [42.3–52.2] were treated with BP-lowering drugs. Among hypertensive treated adults, 49.6% were controlled (41.4% in men and 60.1% in women). Since 2006, even though the prevalence, awareness and control of this disease remained stable, the proportion of women treated decreased significantly ( P = 0.008). Considering the threshold of 130/80 mmHg, the prevalence of hypertension would increase up to 48.8% and control rate would decrease down to 19.2%. During the past decade, despite production of several guidelines and incentives, the prevalence of hypertension remained high and the treatment and the control of hypertension didn’t significantly improve in France.

Cardiovascular Autonomic Profile in Women With Premenstrual Syndrome

Introduction: The premenstrual syndrome (PMS) is a constellation of somatic and psychogenic symptoms that appear during late luteal (LL) phase of the menstrual cycle. Since many symptoms could be related to the autonomic nervous system, we hypothesized that the sympathetic nervous system is perturbed in PMS.Methods: The cardiovascular autonomic profile of nine women with PMS (30.4 ± 2.5 years) were compared to that of nine healthy controls (30 ± 2.5 years) during their early follicular (EF) and LL phases of the menstrual cycle. Plasma norepinephrine (NE) concentrations, power spectral analysis of heart rate and systolic blood pressure (BP), and baroreflex sensitivity (BRS) were assessed during recumbency and a head-up tilt (HUT). Cardiovascular responsiveness to α1- and β-adrenoreceptor agonists (phenylephrine and isoproterenol, respectively) were also assessed.Results: In the LL phase, the plasma NE concentrations in women with PMS during recumbency and a HUT were lower than those in women without PMS [180 ± 30 vs. 320 ± 50 pg/ml; p = 0.04 (recumbent), and 480 ± 70 vs. 940 ± 180 pg/ml: p = 0.02 (HUT)]. In the LL phase, the dose of phenylephrine required to increase systolic BP by 15 mmHg in women with PMS was significantly greater than that in women without PMS (202 ± 30 μg vs. 138 ± 20 μg; p = 0.02). Sympathetic and vagal cardiac control indices were comparable in the two groups in the menstrual phases. In women with PMS, the value of LFSBP in the LL phase was lower than that in the EF phase (0.98 ± 0.2 vs. 1.77 ± 0.4 mmHg2, p = 0.04). The increase in LFSBP in women with PMS in the LL phase during HUT was greater than that in the controls, 5.2 ± 0.9 vs. 3.1 ± 0.5 mmHg2, p = 0.045, and this increase was associated with a significant decrease in BRS.Conclusion: In women with PMS without psychogenic symptoms, the sympathetic control of their circulation is not dominant during the LL phase of their menstrual cycle.

Annals for Educators - 21 August 2018.

Annals for Educators - 21 August 2018.

From Rest to Stressed: Adults with Type 2 Diabetes Exhibit a Greater Exercise‐Induced Increase in Arterial Stiffness and Vessel Hemodynamics

ObjectiveIndividuals with type 2 diabetes mellitus (T2DM) are known to have a greater blood pressure (BP) response to acute maximal exercise. The nature of this exaggerated response is likely a function of vascular abnormalities; therefore, we aimed to examine the exercise‐induced response of carotid‐femoral pulse wave velocity (cfPWV), the gold‐standard measure of arterial stiffness, and other vessel hemodynamic parameters in adults with and without T2DM.MethodsAdults with T2DM (n=77) and without T2DM (n=105) underwent an exercise test to volitional exhaustion on a treadmill (following a modified Bruce protocol). Using applanation tonometry (SphygmoCor), cfPWV and augmentation index corrected for a heart rate (HR) of 75 beats/min (AIx75) were assessed at rest, and immediately following exercise termination. At the same time points, peripheral BP, and HR were measured with an automated oscillometric BP monitor (BPTru). Linear regression models were used to evaluate between‐group differences in parameters at rest, as well as the absolute change of each parameter in response to exercise, with adjustments for exercise time and the baseline value.ResultsMean age was 59.0±11.0 years and body mass index was 31.5±4.0 kg/m2 (non‐significantly different between groups). All subjects had hypertension and were taking anti‐hypertensive medication (mean BP 130±14/80±9 mmHg). At rest, subjects with T2DM had significantly higher cfPWV (10.2±2.5 vs. 9.3±1.8 m/s), HR (70±12 vs. 66±10 beats/min), and lower diastolic BP (80±9 vs. 83±9 mmHg), but no significant difference in systolic BP (118±14 vs. 121±12 mmHg) or AIx75 (23±9 vs. 23±10%). In response to exercise, subjects with T2DM had a significantly greater increase in cfPWV by 1.3 m/s (95% CI 0.1, 2.4), systolic BP by 11.2 mmHg (95% CI 2.9, 19.5) and pulse pressure (PP) by 5.63 mmHg (95%CI 0.19, 11.08). A greater number of subjects with T2DM had a hypertensive (systolic BP&gt;210 mmHg in men, and &gt;190 mmHg in women) response to exercise (n=31, 30%) compared to subjects without T2DM (n=14, 18%). The increase in AIx75 was significantly lower in subjects with T2DM by 2.6% (95% CI −4.9, −0.2).ConclusionBy incorporating exercise as a vascular stressor, we provide evidence of a greater increase in arterial stiffness, independently of exercise time and resting arterial stiffness. Despite no differences in systolic BP or PP at rest, we observed an exaggerated systolic BP response in subjects with T2DM, and importantly an altered arterial stiffness response to acute exercise. Therefore, evaluating the exercise‐induced response of arterial stiffness and hemodynamic parameters may serve as a useful model for evaluating vascular impairment and CVD risk in adults with T2DM.Support or Funding InformationThis work was funded by the Canadian Institutes of Health Research (CIHR). KD and SSD hold salary awards from the Fonds de recherche du Québec‐Santé. ABC holds a PhD award from CIHR.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Seasonal variation in home blood pressure: findings from nationwide web-based monitoring in Japan

ObjectivesOur aim was to assess seasonal variation in home blood pressure (BP) among free-living nationwide participants using home BP values accumulated from a web-based healthcare platform established in Japan.SettingsAn observational...

Homocysteine, visceral adiposity-related novel cardiometabolic risk factors, and exaggerated blood pressure response to the exercise treadmill test.

Exaggerated blood pressure response to exercise is a risk factor for the development of future hypertension. In this study, we aimed to investigate the association between homocysteine, epicardial fat thickness, nonalcoholic hepatic steatosis, and exaggerated blood pressure response to exercise. We included 44 normotensive and 40 patients with exaggerated blood pressure response to exercise who have normal resting blood pressure and without a previous diagnosis of hypertension. All patients underwent treadmill exercise test and clinical, ultrasonographic, and echocardiographic evaluation. Exaggerated blood pressure response to exercise is defined as peak exercise systolic blood pressure of at least 210 mmHg in men and at least 190 mmHg in women. Homocysteine and other biochemical parameters were determined with standardized automated laboratory tests. Mean age of all participants is 47.9±8.5 years, and 36 of 84 participants were female. The frequency of diabetes mellitus in both groups was similar (P=0.250). Homeostasis model assessment index-insulin resistance had a statistically insignificant trend to be higher in a patient with exercise hypertension (P=0.058). The nonalcoholic fatty liver was more frequent in patients with exercise hypertension (13.6 vs. 47.5%, P=0.002). Epicardial fat thickness was increased in patients with exercise hypertension (5.5±1.5 vs. 7.3±1.1 mm; P=0.001). However, homocysteine levels did not significantly differ between normotensive and exercise hypertensive patients [12.3 μmol/l (5.7-16.9 μmol/l) vs. 13 μmol/l (5.9-28.3 μmol/l); P=0.883]. In our study, homocysteine levels were not associated with exaggerated blood pressure response to exercise; however, fatty liver and epicardial fat thickness as visceral adiposity-related cardiometabolic risk factors were significantly related with exaggerated blood pressure response to exercise in patients without a previous diagnosis of hypertension.

Mean blood pressure among the adults in China 2010-2012: based on the results of mercury sphygmomanometer and converted electronic sphygmomanometer

Objective: To analyze the average systolic blood pressure (SBP) and diastolic blood pressure (DBP) among adults aged 18 years old and above in China between 2010 and 2012; and to compare the difference in the results measured by mercury sphygmomanometer and converted electronic sphygmomanometer. Methods: The data was collected from Chinese Nutrition and Health Surveillance in 2010-2012. 120 428 adults aged 18 years old and above were selected from 150 survey counties (districts) of 31 provinces in China Mainland, by multi-stage stratified and probability proportion to size (PPS) cluster randomization sampling method. The average blood pressure value was calculated from three systolic and diastolic blood pressure readings measured by mercury sphygmomanometer. The value of Electronic Sphygmomanometer was converted by regression formula. Age-standardized results were calculated incorporating a complex sample weighting using the population data from the National Bureau of Statistics in 2009. Results: The overall adjusted mean of SBP based on the value of mercury sphygmomanometer among Chinese adults aged 18 years old and above was 122 mmHg (1 mmHg=0.133 kPa), 124 mmHg in men and 120 mmHg in women. The average SBP value was separately 115, 127, and 137 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average SBP was 122 mmHg in urban and 122 mmHg in rural areas. Mean DBP was 78 mmHg, 79 mmHg in men and 76 mmHg in women. The average DBP was separately 75, 81, and 81 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average DBP was 78 mmHg in urban and 77 mmHg in rural areas. The overall adjusted mean of SBP based on converted electronic device was 129 mmHg,130 mmHg in men and 127 mmHg in women, respectively. The mean of SBP was separately122, 134, and 143 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. Mean SBP was both 129 mmHg in urban and in rural areas. Mean DBP was 76 mmHg, 78 mmHg in men and 75 mmHg in women, respectively. The average DBP was separately 74, 79, and 79 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average DBP was both 76 mmHg in urban and rural areas. Conclusion: The average SBP and DBP was different between the mercury sphygmomanometer and converted electronic device. However, the results from both measures showed that the blood pressure was higher in men than in women, the blood pressure increased with the increase of age, and there was no difference between urban and rural areas.

Cardiovascular Risk Associated With White-Coat Hypertension: Con Side of the Argument.

Cardiovascular Risk Associated With White-Coat Hypertension: Con Side of the Argument.