mmHg Increase In Blood Pressure Research Articles

Deciphering the causal relationship between blood pressure and regional white matter integrity: A two-sample Mendelian randomization study.

Elevated arterial blood pressure (BP) is a common risk factor for cerebrovascular and cardiovascular diseases, but no causal relationship has been established between BP and cerebral white matter (WM) integrity. In this study, we performed a two-sample Mendelian randomization (MR) analysis with individual-level data by defining two nonoverlapping sets of European ancestry individuals (genetics-exposure set: N = 203,111; mean age = 56.71 years, genetics-outcome set: N = 16,156; mean age = 54.61 years) from UK Biobank to evaluate the causal effects of BP on regional WM integrity, measured by fractional anisotropy of diffusion tensor imaging. Two BP traits: systolic and diastolic blood pressure were used as exposures. Genetic variant was carefully selected as instrumental variable (IV) under the MR analysis assumptions. We existing large-scale genome-wide association study summary data for validation. The main method used was a generalized version of inverse-variance weight method while other MR methods were also applied for consistent findings. Two additional MR analyses were performed to exclude the possibility of reverse causality. We found significantly negative causal effects (FDR-adjusted p < .05; every 10 mmHg increase in BP leads to a decrease in FA value by .4% ~ 2%) of BP traits on a union set of 17 WM tracts, including brain regions related to cognitive function and memory. Our study extended the previous findings of association to causation for regional WM integrity, providing insights into the pathological processes of elevated BP that might chronically alter the brain microstructure in different regions.

The Prognostic Role of Automated Office Blood Pressure Measurement in Hypertensive Patients with Chronic Kidney Disease.

The aim of this study was to evaluate the prognostic value of automated office blood pressure (AOBP) measurement in patients with hypertension and chronic kidney disease (CKD) stage 3-5 not on dialysis. At baseline, 140 patients were recruited, and blood pressure (BP) measurements with 3 different methods, namely, office blood pressure (OBP), AOBP, and ambulatory blood pressure measurement (ABPM), were recorded. All patients were prospectively followed for a median period of 3.4 years. The primary outcome of this study was a composite outcome of cardiovascular (CV) events (both fatal and nonfatal) or a doubling of serum creatine or progression to end-stage kidney disease (ESKD), whichever occurred first. At baseline, the median age of patients was 65.2 years; 36.4% had diabetes; 21.4% had a history of CV disease; the mean of estimated glomerular filtration rate (eGFR) was 33 mL/min/1.73 m2; and the means of OBP, AOBP, and daytime ABPM were 151/84 mm Hg, 134/77 mm Hg, and 132/77 mm Hg, respectively. During the follow-up, 18 patients had a CV event, and 37 patients had a renal event. In the univariate cox regression analysis, systolic AOBP was found to be predictive of the primary outcome (HR per 1 mm Hg increase in BP, 1.019, 95% CI 1.003-1.035), and after adjustment for eGFR, smoking status, diabetes, and a history of CV disease and systolic and diastolic AOBP were also found to be predictive of the primary outcome (HR per 1 mm Hg increase in BP, 1.017, 95% CI 1.002-1.032 and 1.033, 95% CI 1.009-1.058, respectively). In patients with CKD, AOBP appears to be prognostic of CV risk or risk for kidney disease progression and could, therefore, be considered a reliable means for recording BP in the office setting.

Optimal Blood Pressure Keeps Our Brains Younger.

Background: Elevated blood pressure (BP) is a major health risk factor and the leading global cause of premature death. Hypertension is also a risk factor for cognitive decline and dementia. However, when elevated blood pressure starts impacting cerebral health is less clear. We addressed this gap by estimating how a validated measure of brain health relates to changes in BP over a period of 12 years.Methods: Middle-age (44–46 years at baseline, n = 335, 52% female) and older-age (60–64 years, n = 351, 46% female) cognitively intact individuals underwent up to four brain scans. Brain health was assessed using a machine learning approach to produce an estimate of “observed” age (BrainAGE), which can be contrasted with chronological age. Longitudinal associations between blood pressures and BrainAGE were assessed with linear mixed-effects models.Results: A progressive increase in BP was observed over the follow up (MAP = 0.8 mmHg/year, SD = 0.92; SBP = 1.41 mmHg/year, SD = 1.49; DBP = 0.61 mmHg/year, SD = 0.78). In fully adjusted models, every additional 10 mmHg increase in blood pressure (above 90 for mean, 114 for systolic, and 74 for diastolic blood pressure) was associated with a higher BrainAGE by 65.7 days for mean, and 51.1 days for systolic/diastolic blood pressure. These effects occurred across the blood pressure range and were not exclusively driven by hypertension.Conclusion: Increasing blood pressure is associated with poorer brain health. Compared to a person becoming hypertensive, somebody with an ideal BP is predicted to have a brain that appears more than 6 months younger at midlife.

Pregnancy Outcomes and Blood Pressure Visit-to-Visit Variability and Level in Three Less-Developed Countries.

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Abstract P3035: Role of T Cells in Sex Differences in Blood Pressure Elevation and Adipose Tissue Expansion Following Chronic High Fat Diet Feeding in Dahl Rats

Diets high in saturated fats are increasingly linked to the development of hypertension, yet the mechanisms by which high saturated fat diet (HFD) increases blood pressure remain unclear. Although young women are typically protected from hypertension relative to age-matched men, recent studies suggest that the cardiovascular protection in young women is compromised by chronic consumption of a HFD. We hypothesize that chronic HFD treatment causes a greater increase in blood pressure in females via sex-specific activation and recruitment of T cells and adipocyte expansion. Male and female Dahl rats (n=4-5) were placed on HFD at 8 wks of age. After 4 wks of HFD, blood pressure (BP) significantly increased in male and female Dahl rats to a comparable degree. Although BP continued to increase over the course of 10 wks of HFD treatment, female rats have a greater increases in BP (~40 mmHg increase in BP) after 10 weeks of HFD vs. males (~20 mmHg increase in BP). Fat pad weight and adipose tissue expansion increased in WT rats of both sexes following 10 wks of HFD treatment, yet females exhibited greater increases in fat pad weight and adipose tissue expansion vs. males. To determine whether T cells contributes to sex differences in BP elevation in Dahl rats fed HFD, we utilized Dahl rats lacking CD247 which encodes the T cell receptor CD3 chain that is required for T cell signaling. 10 wks of HF feeding did not change BP in either sex of Dahl CD247 KO rats. There were attenuated increases in fat pad weight and adipocyte expansion in Dahl CD247 KO rats and females exhibited more pronounced attenuations than males. Flow cytometric analysis revealed that HFD decreased Tregs and increased Th17 cells in both sexes of Dahl WT rats and females on HFD had the most pro-inflammatory T cell profile indicted by the Th17 cells:Tregs ratio. Our data suggest that greater adipocyte expansion with a HFD feeding in female Dahl rats vs. male might result in greater recruitment and activation of pro-inflammatory T cells and larger increases in BP.

Abstract P146: Cytochrome B5 Reductase (CYB5R3) Function in Smooth Muscle Cells and Blood Pressure Regulation

Hypertension (HTN) is a major risk factor for cardiovascular-related morbidity and mortality. Dysregulation of nitric oxide (NO) signaling has been found in both human and mouse studies to impact the renin-angiotensin-aldosterone system (RAAS) and contribute to the vascular dysfunction leading to HTN. NO signals via soluble guanylyl cyclase (sGC) to generate cyclic guanosine monophosphate (cGMP) and downstream activation of protein kinase G (PKG) to induce vasodilation. However, the sGC heme iron needs to be in the reduced (Fe 2+ ) state for NO to bind as oxidized (Fe 3+ ) sGC is insensitive to NO signaling. We found that NADH cytochrome b5 reductase 3 (CYB5R3) is a sGC heme reductase that maintains sGC heme iron in its reduced state. Transient knockdown and pharmacological inhibition of CYB5R3 in smooth muscle cells (SMCs) blocks NO-mediated cGMP production and aortic relaxation. Taken together, we hypothesized that SMC CYB5R3 was important in blood pressure regulation. We created tamoxifen-inducible SMC-specific CYB5R3 knockout mice (SMC CYB5R3 KO) and found that they (n=8) had an ~5 mmHg increase in mean arterial blood pressure at baseline as compared to SMC CYB5R3 WT mice (n=9). In response to Angiotensin II (Ang II)-induced hypertension, SMC CYB5R3 KO mice (n=5) exhibited an ~14 mmHg increase in blood pressure and a significantly reduced heart rate as compared to SMC CYB5R3 WT mice (n=5). Lastly, ex vivo two-pin wire myography of Ang II-induced hypertensive SMC CYB5R3 KO (n= 6) mesenteric arteries treated with NO-independent sGC activator Bay 58-2667 showed increased vasodilation as compared to SMC CYB5R3 WT mice (n=10); Bay 58-2667 treatment at baseline showed no difference between groups. We predict that CYB5R3 regulation of SMC sGC heme iron redox state influences blood pressure in a NO-dependent manner. To test this, we will perform an intervention study where we will measure blood pressure in Ang II-induced hypertensive SMC CYB5R3 WT and SMC CYB5R3 KO mice treated with Bay 41-2272, a NO and heme dependent sGC stimulator, and Bay 58-2667. Also, we will assess the role of SMC CYB5R3 in protection against Ang II-induced vessel fibrosis and SMC dysfunction.

Abstract 503: Smooth Muscle Cell Cytochrome B5 reductase &lt; CYB5R3 &gt; expression modulates vascular tone

Hypertension is a major risk factor for cardiovascular-related morbidity and mortality. Nitric oxide (NO) resistance results in an inability of arterial blood vessels to relax contributing to hypertension. NO relaxes vascular smooth muscle cells (SMCs) by stimulating soluble guanylyl cyclase (sGC) to generate cyclic guanosine monophosphate (cGMP) which leads to downstream activation of protein kinase G (PKG) and vasodilation. Importantly, the sGC heme iron is required to be in the reduced (Fe 2+ ) state in order for NO to bind and activate sGC. When the sGC heme iron is oxidized (Fe 3+ ), sGC is insensitive to NO signaling for cGMP production, resulting in hypertension. We recently published evidence that NADH cytochrome b5 reductase 3 (CYB5R3) is a sGC heme reductase that maintains sGC in the reduced (Fe 2+ ), NO-sensitive state. Transient knockdown and pharmacological inhibition of CYB5R3 in SMCs blocks NO-mediated cGMP production and aortic relaxation. Combined, these data implicated CYB5R3 as a potential regulator of systemic blood pressure. To test this, we created tamoxifen-inducible SMC-specific CYB5R3 knockout mice (SMC CYB5R3 KO) and measured systemic blood pressure. We found SMC CYB5R3 KO mice have ~ 5 mmHg increase in mean arterial blood pressure at baseline relative to SMC CYB5R3 WT mice. Subsequently, Angiotensin II (Ang II) infusion resulted in a further ~ 15 mmHg increase in blood pressure respective to SMC CYB5R3 WT mice. Future studies will test whether SMC CYB5R3 may confer vascular protection against Ang II-induced HTN, vessel fibrosis, and SMC dysfunction by maintaining sGC in the reduced, NO sensitive state .

Hypertension

Hypertension is an independent risk factor for cardiovascular disease. The prevalence of hypertension in England is about 30%. The World Health Organization estimates that hypertension is responsible for ‘4.5% of current global disease burden’. Hypertension is asymptomatic in the majority of patients, making diagnosis and management more challenging. However, the associated mortality and morbidity from stroke and myocardial infarction is significant. Once blood pressure (BP) is over 115/70 mmHg, the risk of myocardial infarction or stroke doubles with each 20/10 mmHg increase in BP. The majority of hypertensive patients (90%) will have primary hypertension with no known cause. The term ‘essential hypertension’ has been used to describe primary hypertension, based on the assumption that an elevated BP was required to maintain adequate organ perfusion. A minority of hypertensive patients will have ‘secondary hypertension’ with an underlying pathological cause, such as chronic kidney disease or Conn’s syndrome.

Post-thrombolytic blood pressure and symptomatic intracerebral hemorrhage.

Most guidelines for intravenous thrombolysis (IVT) in acute ischaemic stroke patients advise keeping systolic blood pressure (BP) below 180/105 mmHg prior to the bolus injection. Less is known about optimal management of BP thereafter. We assessed temporal changes in post-thrombolytic systolic BP values and their impact on development of symptomatic intracerebral hemorrhage (sICH). The study cohort included 1868 consecutive acute ischaemic stroke patients treated with IVT at the Helsinki University Central Hospital. sICH was defined according to the European Cooperative Acute Stroke Study II (ECASS-II) (primary outcome), National Institute of Neurological Disorders and Stroke, and Safe Implementation of Thrombolysis in Stroke criteria. We evaluated BP at admission, prior to IVT and at 2, 4, 8, 12, 24 and 48 h after thrombolysis. We used univariate and multivariable models to test the effect of BP at various time-points on development of post-thrombolytic sICH. Prevalence of sICH in the cohort was 5.8% (ECASS-II). Patients with sICH had significantly higher systolic BP at several time-points after IVT compared with those without sICH (P < 0.01 at 2 and 4 h; P < 0.05 at 12 and 48 h). The odds ratios for development of sICH per 10 mmHg increase in BP were 1.14 [95% confidence interval (CI), 1.03-1.25], 1.14 (95% CI, 1.03-1.25), 1.12 (95% CI, 1.01-1.23) and 1.12 (95% CI, 1.01-1.23), respectively. At 8 h, we observed a trend (P = 0.07) for ECASS-II and a significant effect (P < 0.05) for National Institute of Neurological Disorders and Stroke, and Safe Implementation of Thrombolysis in Stroke criteria. Thus, the only time-point with no difference observed was 24 h. Patients with post-thrombolytic sICH have significantly higher systolic BP at several time-points compared with patients without sICH.

Cardiac resynchronization therapy: mechanisms of action and scope for further improvement in cardiac function.

AimsCardiac resynchronization therapy (CRT) may exert its beneficial haemodynamic effect by improving ventricular synchrony and improving atrioventricular (AV) timing. The aim of this study was to establish the relative importance of the mechanisms through which CRT improves cardiac function and explore the potential for additional improvements with improved ventricular resynchronization.Methods and ResultsWe performed simulations using the CircAdapt haemodynamic model and performed haemodynamic measurements while adjusting AV delay, at low and high heart rates, in 87 patients with CRT devices. We assessed QRS duration, presence of fusion, and haemodynamic response. The simulations suggest that intrinsic PR interval and the magnitude of reduction in ventricular activation determine the relative importance of the mechanisms of benefit. For example, if PR interval is 201 ms and LV activation time is reduced by 25 ms (typical for current CRT methods), then AV delay optimization is responsible for 69% of overall improvement. Reducing LV activation time by an additional 25 ms produced an additional 2.6 mmHg increase in blood pressure (30% of effect size observed with current CRT). In the clinical population, ventricular fusion significantly shortened QRS duration (Δ-27 ± 23 ms, P < 0.001) and improved systolic blood pressure (mean 2.5 mmHg increase). Ventricular fusion was present in 69% of patients, yet in 40% of patients with fusion, shortening AV delay (to a delay where fusion was not present) produced the optimal haemodynamic response.ConclusionsImproving LV preloading by shortening AV delay is an important mechanism through which cardiac function is improved with CRT. There is substantial scope for further improvement if methods for delivering more efficient ventricular resynchronization can be developed.Clinical Trial RegistrationOur clinical data were obtained from a subpopulation of the British Randomised Controlled Trial of AV and VV Optimisation (BRAVO), which is a registered clinical trial with unique identifier: NCT01258829, https://clinicaltrials.gov

From phenotype to genotype: a glimpse behind the scenes of an unending story

Mendelian conditions direct attention at basic mechanisms. In the 1990's DNA sequencing allowed elucidating such conditions. We embarked on an unexpected adventure to study a monogenic autosomal-dominant form of hypertension causing also a specific form of short fingers. The gene locus caused a 50 mmHg increase in blood pressure at age of 50. Our clinically based group stumbled to the finish line after 20 years of study. We remained together and proudly persevered. Our findings could be relevant for essential hypertension.

Cross-sectional association of volume, blood pressures, and aortic stiffness with left ventricular mass in incident hemodialysis patients: the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study.

BackgroundHigher left ventricular mass (LV) strongly predicts cardiovascular mortality in hemodialysis patients. Although several parameters of preload and afterload have been associated with higher LV mass, whether these parameters independently predict LV mass, remains unclear.MethodsThis study examined a cohort of 391 adults with incident hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study. The main exposures were systolic and diastolic blood pressure (BP), pulse pressure, arterial stiffness by pulse wave velocity (PWV), volume status estimated by pulmonary pressures using echocardiogram and intradialytic weight gain. The primary outcome was baseline left ventricular mass index (LVMI).ResultsEach systolic, diastolic blood, and pulse pressure measurement was significantly associated with LVMI by linear regression regardless of dialysis unit BP or non-dialysis day BP measurements. Adjusting for cardiovascular confounders, every 10 mmHg increase in systolic or diastolic BP was significantly associated with higher LVMI (SBP β = 7.26, 95 % CI: 4.30, 10.23; DBP β = 10.05, 95 % CI: 5.06, 15.04), and increased pulse pressure was also associated with higher LVMI (β = 0.71, 95 % CI: 0.29, 1.13). Intradialytic weight gain was also associated with higher LVMI but attenuated effects after adjustment (β = 3.25, 95 % CI: 0.67, 5.83). PWV and pulmonary pressures were not associated with LVMI after multivariable adjustment (β = 0.19, 95 % CI: −1.14, 1.79; and β = 0.10, 95 % CI: −0.51, 0.70, respectively). Simultaneously adjusting for all main exposures demonstrated that higher BP was independently associated with higher LVMI (SBP β = 5.64, 95 % CI: 2.78, 8.49; DBP β = 7.29, 95 % CI: 2.26, 12.31, for every 10 mmHg increase in BP).ConclusionsAmong a younger and incident hemodialysis population, higher systolic, diastolic, or pulse pressure, regardless of timing with dialysis, is most associated with higher LV mass. Future studies should consider the use of various BP measures in examining the impact of BP on LVM and cardiovascular disease. Findings from such studies could suggest that high BP should be more aggressively treated to promote LVH regression in incident hemodialysis patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0131-4) contains supplementary material, which is available to authorized users.

Novel Method for Investigating Impaired Blood Pressure Regulation Following Subarachnoid Hemorrhage in Conscious Rats

Despite 30,000 annual incidences in the US, treatment for subarachnoid hemorrhage (SAH) is limited. Several negative outcomes associated with SAH lead to high morbidity and mortality, including disrupted cardiac function and blood pressure (BP) regulation. Intervention during the acute phase of SAH is most crucial for longterm outcome; however, the mechanisms of cardiovascular dysfunction are unclear, as are the optimal methods to restore normal function. Current in vivo models are not suited to study the acute phase of SAH due to autonomic suppression by anesthesia. Therefore, we developed a novel model system to study acute and chronic cardiovascular effects of SAH in conscious animals. Rats are outfitted with radiotelemetry transmitters (DSI) for BP and heart rate (HR) recording. Guide cannulas are implanted to target the lateral ventricle and cisterna magna (CM) for intracranial pressure (ICP) recording and blood infusion, respectively. Following post-op recovery, baseline BP and HR are measured for one week, and on testing day 0.4 ml of arterial blood from a donor rat is infused directly into the CM. ICP and BP are recorded continuously for 2 hours following SAH via DSI calibrated output adapter and Powerlab 8.0 software (ADInstruments). BP is then recorded for 4 more weeks using telemetry. During blood infusion ICP rises by ~70-100 mmHg, BP increases ~30 mmHg and HR increases ~130 bpm. SAH rats then exhibit a sustained 15 mmHg increase in BP for 7 days. Control rats infused with saline exhibit similar acute changes but no longterm rise in BP. This model system will enable better testing of therapeutic strategies to improve cardiovascular control and longterm outcome following SAH. Supported by University of Vermont startup funds.

In depressed older persons higher blood pressure is associated with symptoms of apathy. The NESDO study.

In older persons, a relationship between both higher and lower blood pressure and depression has inconsistently been reported. Blood pressure may be differentially associated with distinct symptom domains of depression. We examined the cross-sectional relation of current systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) with different depressive symptom domains among depressed older persons. In the Netherlands Study of Depression in Older Persons (NESDO), 270 participants aged 60 years and above were diagnosed with depression in the past month. Using the three corresponding subscales of the Inventory of Depressive Symptoms-Self Report (IDS-SR), motivational, mood and somatic symptom domains were assessed. Additionally, symptoms of apathy were determined with the Apathy Scale. Multiple linear regression was used to examine the cross-sectional relationship between current SBP, DBP and MAP with both IDS-SR subscale and Apathy Scale scores. Unstandardized betas were calculated per 10 mmHg increase in blood pressure measures. Mean age of participants was 70.4 years (standard deviation 7.3). Higher SBP (Beta 0.33, t (254) = 2.01, p = 0.045), higher DBP (Beta 0.68, t (254) = 2.15, p = 0.03) and higher MAP (Beta 0.63, t (254) = 2.33, p = 0.02) were associated with higher Apathy Scale scores in the fully adjusted model. Furthermore, a higher SBP was associated with higher IDS-SR mood subscale scores (Beta 0.25, t (254) = 2.13, p = 0.03). Depressed older people with higher blood pressure measures had particularly more symptoms of apathy. To disentangle the relationship of blood pressure with late-life depression, it is important to pay attention to the role of apathy symptoms.

Office, home, and ambulatory blood pressures as predictors of cardiovascular risk.

Ambulatory blood pressure (BP) is considered as the gold standard of BP measurement although it has not been shown to be more strongly associated with cardiovascular risk than is home BP. Our objective was to compare the prognostic value of office, home, and ambulatory BP for cardiovascular risk in 502 participants examined in 1992 to 1996. The end point was a composite of cardiovascular mortality, myocardial infarction, stroke, heart failure hospitalization, and coronary intervention. We assessed the prognostic value of each BP in multivariable-adjusted Cox models. The likelihood χ2 ratio value was used to test whether the addition of a BP variable improved the model’s goodness of fit. After a follow-up of 16.1±3.9 years, 70 participants (13.9%) had experienced ≥1 cardiovascular event. Office (systolic/diastolic hazard ratio per 1/1 mm Hg increase in BP, 1.024/1.018; systolic/diastolic 95% confidence interval, 1.009–1.040/0.994–1.043), home (hazard ratio, 1.029/1.028; 95% confidence interval, 1.013–1.045/1.005–1.052), and 24-hour ambulatory BP (hazard ratio, 1.033/1.049; 95% confidence interval, 1.019–1.047/1.023–1.077) were predictive of cardiovascular events. When all 3 BP variables were included in the model simultaneously, only systolic/diastolic ambulatory BP was a significant predictor of cardiovascular events (P=0.002/<0.001). Home systolic/diastolic BP improved the fit of the model only marginally when added to a model including office BP (χ2=3.0/4.0, P=0.09/0.047). Ambulatory BP, however, improved the fit of model more clearly when added to office and home BP (χ2=9.0/12.3, P=0.001/<0.001). Our findings suggest that ambulatory BP is prognostically superior to office and home BP.

Prevalence of depression and associated risk factors among persons with type-2 diabetes mellitus without a prior psychiatric history: a cross-sectional study in clinical settings in urban Nepal

BackgroundDiabetes is a growing health problem in South Asia. Despite an increasing number of studies exploring causal pathways between diabetes and depression in high-income countries (HIC), the pathway between the two disorders has received limited attention in low and middle-income countries (LMIC). The aim of this study is to investigate the potential pathway of diabetes contributing to depression, to assess the prevalence of depression, and to evaluate the association of depression severity with diabetes severity. This study uses a clinical sample of persons living with diabetes sequelae without a prior psychiatric history in urban Nepal.MethodsA cross-sectional study was conducted among 385 persons living with type-2 diabetes attending tertiary centers in Kathmandu, Nepal. Patients with at least three months of diagnosed diabetes and no prior depression diagnosis or family history of depression were recruited randomly using serial selection from outpatient medicine and endocrine departments. Blood pressure, anthropometrics (height, weight, waist and hip circumference) and glycated hemoglobin (HbA1c) were measured at the time of interview. Depression was measured using the validated Nepali version of the Beck Depression Inventory (BDI-Ia).ResultsThe proportion of respondents with depression was 40.3%. Using multivariable analyses, a 1-unit (%) increase in HbA1c was associated with a 2-point increase in BDI score. Erectile dysfunction was associated with a 5-point increase in BDI-Ia. A 10mmHg increase in blood pressure (both systolic and diastolic) was associated with a 1.4-point increase in BDI-Ia. Other associated variables included waist-hip-ratio (9-point BDI-Ia increase), at least one diabetic complication (1-point BDI-Ia increase), treatment non-adherence (1-point BDI-Ia increase), insulin use (2-point BDI-Ia increase), living in a nuclear family (2-point BDI-Ia increase), and lack of family history of diabetes (1-point BDI-Ia increase). Higher monthly income was associated with increased depression severity (3-point BDI-Ia increase per 100,000 rupees, equivalent US$1000).ConclusionsDepression is associated with indicators of more severe diabetes disease status in Nepal. The association of depression with diabetes severity and sequelae provide initial support for a causal pathway from diabetes to depression. Integration of mental health services in primary care will be important to combat development of depression among persons living with diabetes.

Blood pressure-lowering effect of dietary (−)-epicatechin administration in L-NAME-treated rats is associated with restored nitric oxide levels

Epidemiological and intervention studies have shown that the intake of certain chocolates or cocoa products decreases blood pressure (BP) in humans. (−)-Epicatechin is the most abundant flavanol present in cocoa seeds and its derived foods. This work investigates the effects of dietary (−)-epicatechin on BP in rats that received Nω-nitro-l-arginine methyl ester (L-NAME) for 4 days. (−)-Epicatechin administration prevented the 42mm Hg increase in BP associated with the inhibition of NO production in a dose-dependent manner (0.2–4.0g/kg diet). This BP effect was associated with a reduction in L-NAME-mediated increase in the indexes of oxidative stress (plasma TBARS and GSSG/GSH2 ratio) and with a restoration of the NO concentration. At the vascular level, none of the treatments modified NOS expression, but (−)-epicatechin administration avoided the L-NAME-mediated decrease in eNOS activity and increase in both superoxide anion production and NOX subunit p47phox expression. In summary, (−)-epicatechin was able to prevent the increase in BP and in oxidative stress and restored NO bioavailability. The fact that (−)-epicatechin is present in several plants usually consumed by humans gives the possibility of developing diets rich in those plants or pharmacological strategies using that flavonoid to diminish BP in hypertensive subjects.

Plasma sodium and blood pressure in individuals on haemodialysis

To study the relationship between pre-dialysis plasma sodium and blood pressure (BP), we performed an audit of patients who were on stable haemodialysis at St Bartholomew's and The Royal London Hospital from 1 June 2009 to 15 June 2010. There were 651 patients with 7445 dialysis sessions where both plasma biochemistry and BP were measured before haemodialysis. We found a significant association between plasma sodium and both systolic and diastolic BP. A 1 mmol l(-1) increase in plasma sodium was related to 0.65/0.36 mm Hg increase in BP (P<0.001 for both systolic and diastolic BP) after adjusting for potential confounding factors, including weight gain between dialyses and plasma albumin, both of which are crude indices of extracellular fluid volume. A separate analysis excluding individuals who were on BP treatment showed a similar relationship, with a 1-mmol l(-1) increase in plasma sodium associated with 0.82/0.56 mm Hg increase in BP (P<0.001 for both, N=177). These results provide further support for the accumulating evidence that plasma sodium has an important role in regulating BP, which may be independent of extracellular volume. Our findings in conjunction with other evidence suggest that small changes in plasma sodium could be an important mechanism for the beneficial effects of lower dialysate sodium and lower salt intake on BP in haemodialysis patients.

Home systolic blood pressure on the morning of dialysis days has prognostic impact for hypertensive hemodialysis patients

BackgroundHypertension is a leading cause of cardiovascular (CV) disease in the general population. Although hypertension is very common in maintenance hemodialysis (HD) patients, adequate blood pressure (BP) values and measurement timing have not been defined.MethodsA total of 49 hypertensive HD patients were recruited. Average age was 63 ± 11 years, and duration of dialysis therapy was 6.2 ± 4.2 years. Dialysis unit BPs and various types of home BPs were separately measured, and which BPs were the most critical markers in evaluating the effect of hypertension on left ventricular hypertrophy and CV events was investigated.ResultsPredialysis systolic BPs were not correlated with any home BPs. Left ventricular mass index (LVMI) had a significant positive correlation with home BPs, especially morning systolic BPs on HD days (P < 0.01) and non-HD days (P < 0.05), on univariate and multivariate analysis. In contrast, predialysis BPs did not correlate with LVMI. During the follow-up period (47 ± 18 months), it was demonstrated that diabetes and home BPs, especially systolic BPs on the morning of HD days, were significant predictors of CV events on multivariate Cox regression analysis. A 10 mmHg increase in BP had a significantly elevated relative risk for CV events.ConclusionsHome BP, especially systolic BPs in the morning on HD days, can provide pivotal information for management of HD patients.

HOME-MEASURED BLOOD PRESSURE IS A STRONGER PREDICTOR OF CARDIOVASCULAR RISK THAN OFFICE BLOOD PRESSURE: THE FINN-HOME STUDY: 2A.02

Objective: Previous studies with some limitations have provided equivocal results for the prognostic significance of home-measured blood pressure (BP). We investigated whether home-measured BP is more strongly associated with cardiovascular events and total mortality than is office BP. Design and Methods: A prospective nationwide study was initiated in 2000–2001 on 2081 randomly selected subjects aged 45–74 years. Home and office BP were determined at baseline along with other cardiovascular risk factors. The primary endpoint was incidence of a cardiovascular event (cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, hospitalization for heart failure, percutaneous coronary intervention, and coronary artery bypass graft surgery). The secondary endpoint was total mortality. Results: After a mean follow-up of 6.8 years, 162 subjects had suffered a cardiovascular event and 118 subjects had died. In Cox proportional hazard models adjusted for other cardiovascular risk factors office BP (systolic/diastolic hazard ratio [HR] per 10/5 mmHg increase in BP, 1.13/1.13; systolic/diastolic 95% confidence interval [CI], 1.05–1.22/1.05–1.22) and home BP (HR, 1.23/1.18; 95% CI, 1.13–1.34/1.10–1.27) were predictive of cardiovascular events. However, when both BPs were simultaneously included in the models only home BP (HR, 1.22/1.15; 95% CI, 1.09–1.37/1.05–1.26), but not office BP (HR, 1.01/1.06; 95% CI, 0.92–1.12/0.97–1.16) was predictive of cardiovascular events. Systolic home BP was the sole predictor of total mortality (HR, 1.11; 95% CI, 1.01/1.23). Conclusions: Home-measured BP is prognostically superior to office BP. On the basis of the results from this and previous studies, it can be concluded that home BP measurement offers specific advantages over conventional office measurement.