Normotensive Participants Research Articles

Elevated cerebrospinal fluid sodium in hypertensive human subjects with a family history of Alzheimer’s disease

High salt (sodium) intake leads to the development of hypertension despite the fact that plasma sodium concentration ([Na+]) is usually normal in hypertensive human patients. Increased cerebrospinal fluid (CSF) sodium contributes to elevated sympathetic activity and high blood pressure (BP) in rodent models of hypertension. However, whether there is an increased accumulation of sodium in the CSF of humans with chronic hypertension is not well defined. Here, we investigated CSF [Na+] from hypertensive and normotensive human subjects with family histories of Alzheimer's disease in samples collected in a clinical trial, as spinal tap is not a routine clinical procedure for hypertensive patients. The [Na+] and osmolality in plasma and CSF were measured by flame photometry. Daytime ambulatory BP was monitored while individuals were awake. Participants were deidentified and data were analyzed in conjunction with a retrospective analysis of patient history and diagnosis. We found that CSF [Na+] was significantly higher in participants with high BP compared with normotensive participants; there was no difference in plasma [Na+], or plasma and CSF osmolality between groups. Subsequent multiple linear regression analyses controlling for age, sex, race, and body mass index revealed a significant positive correlation between CSF [Na+] and BP but showed no correlation between plasma [Na+] and BP. In sum, CSF [Na+] was higher in chronic hypertensive individuals and may play a key role in the pathogenesis of human hypertension. Collectively, our findings provide evidence for the clinical significance of CSF [Na+] in chronic hypertension in humans.

DNA Methylation of Endoglin Pathway Genes in Pregnant Women With and Without Preeclampsia.

Objective:We compared blood-based DNA methylation levels of endoglin (ENG) and transforming growth factor beta receptor 2 (TGFβR2) gene promoter regions between women with clinically-overt preeclampsia and women with uncomplicated, normotensive pregnancies.Methods:We used EpiTect Methyl II PCR Assays to evaluate DNA methylation of CpG islands located in promoter regions of ENG (CpG Island 114642) and TGFβR2 (CpG Island 110111). Preeclampsia was diagnosed based on blood pressure, protein, and uric acid criteria. N = 21 nulliparous preeclampsia case participants were 1:1 frequency matched to N = 21 nulliparous normotensive control participants on gestational age at sample collection (±2 weeks), smoking status, and labor status at sample collection. Methylation values were compared between case and control participant groups [(ENG subset: n = 20 (9 cases, 11 controls); TGFβR2 subset: n = 28 (15 cases, 13 controls)].Results:The majority of the preeclampsia cases delivered at ⩾34 weeks’ gestation (83%). Average methylation levels for ENG ([M ± (SD)]; Case Participant Group = 6.54% ± 4.57 versus Control Participant group = 4.81% ± 5.08; P = .102) and TGFβR2 (Case Participant Group = 1.50% ± 1.37 vs Control Participant Group = 1.70% ± 1.40; P = .695) promoter CpG islands did not differ significantly between the participant groups. Removal of 2 extreme outliers in the ENG analytic subset revealed a trend between levels of ENG methylation and pregnancy outcome (Case Participant Group = 5.17% ± 2.16 vs Control Participant Group = 3.36% ± 1.73; P = .062).Conclusion:Additional epigenetic studies that include larger sample sizes, investigate preeclampsia subtypes, and capture methylation status of CpG island shores and shelves are needed to further inform us of the potential role that ENG and TGFβR2 DNA methylation plays in preeclampsia pathophysiology.

The association between salt intake and arterial stiffness is influenced by a sex-specific mediating effect through blood pressure in normotensive adults: The ELSA-Brasil study.

High salt intake is known to increase blood pressure (BP) and also to be associated with carotid-femoral pulse wave velocity (cf-PWV). However, recent data showed a sex-specific pattern in the salt-induced rise of BP. Thus, we aimed to investigate whether the association between salt intake and arterial stiffness also has a sex-specific pattern. A total of 7755 normotensive participants with a validated 12-h overnight urine collection in which daily salt intake was estimated were included. cf-PWV, as well as clinical and anthropometric parameters, was measured. Salt intake positively correlated with cf-PWV, in which the linear regression was steeper in women than in men (0.0199±0.0045 vs 0.0326±0.0052m/s per gram of salt, P<.05). cf-PWV increases over the salt quartiles in men and women. However, after adjustment for confounders, the association remained significant only for men. In the path analysis, the direct path (men: 0.048 P<.001, women: 0.029 P=.028) was higher in men while that mediated by SBP (men: 0.020 P<.001, women: 0.034 P<.001) was higher in women. We clearly demonstrated that high salt intake has a direct and independent effect increasing arterial stiffness regardless of sex. Also, the association between salt intake and arterial stiffness is more dependent on BP in normotensive women than it is in normotensive men. These results highlight the need for a sex-specific approach in the evaluation of cardiovascular risk associated with dietary habits.

Diurnal blood pressure loads are associated with lower cognitive performances in controlled-hypertensive elderly individuals.

Hypertension in midlife adults is associated with cognitive decline later in life. In individuals treated for hypertension, blood pressure (BP) loads have been associated with end organ damages. This study examines whether BP load inversely correlates with performance in cognitive tasks in normotensive or controlled hypertensive (CHT) individuals. Participants between 60 and 75 years old were divided into normotensive participants who did not receive antihypertensive treatment (n = 49) and CHT patients (n = 28). They were evaluated for BP using ambulatory blood pressure monitoring and cognitive functions with tests assessing cognitive flexibility, working and episodic memory, and processing speed. Analysis of covariance between normotensive and CHT participants revealed lower cognitive performances on immediate and delayed recall and total number of words of the Rey Auditory Verbal Learning Test (P < 0.001). Spearman's correlations between BP loads and cognitive performances revealed inversed associations between diurnal systolic (SBP) loads and performances on the Trail Making Test Part B (TMTB) (P = 0.009), the TMTB-TMT Part A (P = 0.013), the Switching Cost of the color-word interference test (P = 0.020) and the Digit-Symbol Substitution Score tests (P = 0.018) in CHT. Diurnal diastolic (DBP) loads were inversely correlated to the TMTB (P = 0.014) and TMTB-TMT Part A (P = 0.006). In normotensive subjects, diurnal SBP loads were associated with the delayed recall of the Rey Auditory Verbal Learning Test (P = 0.031) and to the three components of the digit span (P < 0.05). Diurnal BP loads are associated with lower cognitive performances in CHT individuals. These results suggest a lowering of target levels of diurnal BPs and/or its variability.

Measuring Blood Pressure: from Cuff to Smartphone.

For measurement of blood pressure, using inflatable cuff-based technology can be inconvenient, uncomfortable, and requires special equipment. These issues could be overcome by using a contactless technology that measures blood pressure with the ubiquitous smartphone. In a proof of concept study involving normotensive participants, Luo et al. demonstrated brachial blood pressure measurements from video of the face with accuracy comparable to traditional automated blood pressure monitors. There is still some way to go before contactless blood pressure measurement technology is sufficiently accurate and robust for clinical use. For example, variations in skin tone and lighting conditions must be addressed. Further, new predictive features will be necessary to reveal added information about blood pressure and thus improve prediction accuracy. New tools are likely to encourage blood pressure measurements in more people, in more places, and with more regularity than ever before.

Polymorphisms within vitamin D binding protein gene within a Preeclamptic South African population

ABSTRACTObjectives: The vitamin D binding protein encoded by the GC gene contains two single nucleotide polymorphisms (rs4588 and rs7041) that have been associated with disease outcome, these include periodontitis coronary heart disease and hypertension. In pregnancy, these SNPs influence vitamin D metabolism that could result in hypertensive disorders such as PE. The etiology of PE, still remains elusive. The aim of this study was to evaluate the distribution of rs4588 and rs7041 within the GC gene among PE and normotensive pregnant women, residing in Durban, KwaZulu-Natal, South Africa.Study design: Our study consisted of n = 600 participants (normotensive (n = 246, N); early onset PE (n = 167, EOPE); and late-onset PE (n = 246, LOPE)). We extracted DNA from whole blood and genotyped for rs4588 and rs7041 SNPs using the TaqMan assay.Results: Regardless of HIV status, we observed the rs4588 (CC genotype) more frequently in PE (EOPE+LOPE) compared to the normotensive participants with an OD ratio of 0.74 (95% CI, 0.35–1.5; p < 0.001). We report a significant difference in the frequency of rs7041 (GT genotype) in the EOPE group compared to the normotensive group with an OD ratio of 11.48 (95% CI, 2.6–103.7; p < 0.001). The rs7041 GT genotype had a higher frequency in the EOPE compared to the LOPE group, with an OD ratio of 15.15 (95% CI, 2.3–639.2; p < 0.001).Conclusion: This is the first study to describe the prevalence of SNPs of the rs4588 and rs7041 within the GC gene in women with PE within the high HIV endemic area of KZN, South Africa. Notably, a significant association of the rs7041 (TT genotype) and rs4588 (CC genotype) occurred at a higher frequency in PE compared to the normotensive cohort. Future studies will examine the functional effect of the GC region in relation to pregnancy and vitamin D deficiency.

Abstract 062: Elevated Cerebrospinal Fluid Sodium Concentration in Hypertensive Humans

High salt intake has been linked to the pathogenesis of hypertension and increased sympathetic activity, considered a hallmark of human hypertension. Recent studies showed that high-salt diets may lead to sequestration of sodium into interstitial tissues. Increased CSF sodium contributes to elevated sympathetic activity and high blood pressure (BP) in rodent models of hypertension. However, it is not known if there is an enhanced sequestration of sodium into cerebrospinal fluid (CSF) of chronic hypertensive humans. To address this question, we obtained CSF and plasma samples from 43 middle-aged, normotensive (n=26) and hypertensive (n=17) individuals. The sodium concentration ([Na + ]) in plasma and CSF were measured using flame photometer. Ambulatory BP was monitored every 20 minutes while the participant was awake and once per hour while the participant was asleep over 24-hour period. Participants were deidentified and data were analyzed in conjunction with a retrospective analysis of patient history and diagnosis. Participants with uncontrolled hypertension had higher BP levels compared with the normotensive participants (systolic BP: 135.5±2.7 mmHg vs. 114.3±1.5 mmHg; diastolic BP: 81.9±2.1 mmHg vs. 71.6±1.2 mmHg, P &lt;0.0001). Importantly, we found that CSF [Na+] was significantly higher in participants with uncontrolled hypertension (149.3±3.5 mM) compared with those of normotensive (139.5±2.12 mM, P =0.0156); while there was no difference in plasma [Na+] between groups (136±0.76 mM vs. 135.5±1 mM, P =0.73). Further multiple linear regressions analysis controlling for age, sex, race and body mass index revealed a significant positive correlation between CSF [Na + ] and blood pressure levels (sBP: R 2 =0.4189, P= 0.0007; dBP: R 2 =0.205, P =0.032), but showed no correlation between plasma [Na + ] and BP. Furthermore, we found that plasma and CSF [Na + ] were not correlated with each other (R 2 =0.0002174, P =0.9252), suggesting that increases in CSF [Na + ] in hypertensive humans do not reflect simple passive diffusion from the circulation. In sum, CSF [Na + ] was higher in chronic hypertensive humans and CSF sodium may play a key role in the pathogenesis of human hypertension.

Increased Respiratory Modulation of Blood Pressure in Hypertensive Patients.

ObjectiveAlthough the important role of respiratory modulation of the cardiovascular system in the development of hypertension has been demonstrated in animal studies, little research has assessed this modulation in essential hypertensive patients. We aimed to explore whether respiratory-related variations in cardiovascular variables are changed in hypertensive patients and their potential relationships with the respiratory pattern.MethodsRespiration, ECG, and beat-to-beat blood pressure (BP) were simultaneously measured in 46 participants (24 hypertensive patients and 22 normotensive participants) during rest and a mental arithmetic task (MAT). Respiratory-triggered averaging and orthogonal subspace projection methods were used to assess the respiratory modulations of BP and heart rate (HR). Respiratory parameters including inspiratory time, expiratory time, respiratory rate and their variabilities were also characterized.ResultsThe inspiratory time, expiratory time, respiratory rate and their variabilities were not different between hypertensive and normotensives. Additionally, the modulation of HR by respiration was also similar between the two groups. Hypertensive patients exhibited an amplified respiratory modulation of systolic BP (SBP), as assessed from the amplitude of respiratory-related changes and the percentage of the power of respiratory-related variation, and also reflected from the temporal pattern of respiratory modulation of SBP. The exaggerated respiratory-related variation of SBP in hypertensive patients accounted for ≈23% of the total power of SBP, producing an absolute change of ≈4.5 mmHg in SBP. MAT was characterized by decreased inspiratory time and increased variabilities of expiratory time and respiratory rate with no changes in the amplitude of respiratory modulations.ConclusionHypertensive patients had excessive respiratory modulation of SBP, despite having similar respiratory pattern with normotensives. These findings highlight the importance of respiratory influence in BP variation and suggest that respiratory modulation of SBP may have prognostic information for cardiovascular events in hypertensive patients.

Levels of Systolic and Diastolic Blood Pressure and Their Relation to Incident Metabolic Syndrome

Background: Elevated blood pressure (BP) is a component of the metabolic syndrome (MetS), and one third of individuals with hypertension simultaneously have MetS. However, the evidence is still unclear regarding the predictive ability of BP for incident MetS. Methods: In total, 5,809 Koreans without baseline MetS were grouped by baseline systolic (SBP) and diastolic BP (DBP) and monitored for 10 years to identify incident MetS. A Cox proportional hazards model was used to evaluate the HR and 95% CI for MetS according to SBP and DBP. Subgroup analysis was conducted in the normotensive population based on a new guideline of the American College of Cardiology and the American Heart Association. Results: High-BP groups tended to have worse metabolic profiles than the lowest-BP group in both SBP and DBP categories. In all of the participants, elevated SBP and DBP levels were significantly associated with the increased HR for MetS, even after adjusting for covariates. Subgroup analysis for normotensive participants indicated that the HR for MetS increased proportionally to both SBP (<110 mm Hg: reference, 110–119 mm Hg: HR = 1.60 [95% CI 1.40–1.84], and 120–129 mm Hg: HR = 2.12 [95% CI 1.82–2.48]) and DBP levels (<70 mm Hg: reference, 71–74 mm Hg: HR = 1.31 [95% CI 1.09–1.58], and 75–79 mm Hg: HR = 1.51 [95% CI 1.25–1.81]). Conclusion: The risk of incident MetS increased proportionally to baseline SBP and DBP, and this was identically observed even in normotensive participants.

Allium vegetable consumption and health: An umbrella review of meta-analyses of multiple health outcomes.

Previously, our meta‐analysis and other studies have suggested that allium vegetable consumption is beneficial for health, but no umbrella review has been conducted to assess the evidence of the various health benefits of allium vegetable consumption. Therefore, we conducted this umbrella review on this topic. This umbrella review included a total of 16 meta‐analyses with 50 unique outcomes. The most beneficial cancer‐related outcome was shown for gastric cancer (risk ratio 0.78; 95% confidence interval [CI] 0.67–0.91). In addition, only 8 weeks of garlic consumption significantly decreased serum total cholesterol (weighted mean differences −17.20 mg/dl; 95% CI −23.10 to −11.30), and patients with dyslipidemia who consumed garlic experienced more benefits than the whole population. Diabetic patients with longer durations of garlic intake experienced more benefits in terms of fasting blood glucose (FBG), HbA1c, and serum fructosamine than healthy participants, and garlic intake was associated with blood pressure reduction in hypertensive patients but not in normotensive participants. Limited side effects of garlic, such as garlic odor and gastrointestinal complaints, were reported among the included meta‐analyses. Our results suggested that allium vegetables might be beneficial for cancer prevention. In particular, garlic was comparatively safe and is recommended as a long‐term dietary component for patients with dyslipidemia, diabetes, and hypertension.

Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes: An Umbrella Review and Evidence Map.

The role of nutritional supplements and dietary interventions in preventing mortality and cardiovascular disease (CVD) outcomes is unclear. To examine evidence about the effects of nutritional supplements and dietary interventions on mortality and cardiovascular outcomes in adults. PubMed, CINAHL, and the Cochrane Library from inception until March 2019; ClinicalTrials.gov (10 March 2019); journal Web sites; and reference lists. English-language, randomized controlled trials (RCTs) and meta-analyses of RCTs that assessed the effects of nutritional supplements or dietary interventions on all-cause mortality or cardiovascular outcomes, such as death, myocardial infarction, stroke, and coronary heart disease. Two independent investigators abstracted data, assessed the quality of evidence, and rated the certainty of evidence. Nine systematic reviews and 4 new RCTs were selected that encompassed a total of 277 trials, 24 interventions, and 992129 participants. A total of 105 meta-analyses were generated. There was moderate-certainty evidence that reduced salt intake decreased the risk for all-cause mortality in normotensive participants (risk ratio [RR], 0.90 [95% CI, 0.85 to 0.95]) and cardiovascular mortality in hypertensive participants (RR, 0.67 [CI, 0.46 to 0.99]). Low-certainty evidence showed that omega-3 long-chain polyunsaturated fatty acid (LC-PUFA) was associated with reduced risk for myocardial infarction (RR, 0.92 [CI, 0.85 to 0.99]) and coronary heart disease (RR, 0.93 [CI, 0.89 to 0.98]). Folic acid was associated with lower risk for stroke (RR, 0.80 [CI, 0.67 to 0.96]; low certainty), whereas calcium plus vitamin D increased the risk for stroke (RR, 1.17 [CI, 1.05 to 1.30]; moderate certainty). Other nutritional supplements, such as vitamin B6, vitamin A, multivitamins, antioxidants, and iron and dietary interventions, such as reduced fat intake, had no significant effect on mortality or cardiovascular disease outcomes (very low- to moderate-certainty evidence). Suboptimal quality and certainty of evidence. Reduced salt intake, omega-3 LC-PUFA use, and folate supplementation could reduce risk for some cardiovascular outcomes in adults. Combined calcium plus vitamin D might increase risk for stroke. None.

Hypertension is associated with increased post‐exercise albuminuria, which may be attenuated by an active lifestyle

Albuminuria is a known marker for endothelial dysfunction and cardiovascular events, even below the threshold of moderately increased albuminuria (MIA). Post-exercise increased albuminuria may precede the appearance of rest MIA, enabling detection of early injury. Modifying lifestyle for a population at risk for MIA is therefore of interest. Our aim was to evaluate post-exercise albuminuria in hypertensive compared with normotensive individuals and to analyze the effect of an active lifestyle on rest and post-exercise albumin excretion. The study cohort consisted of 3931 adults who participated in a health-screening program. Albuminuria was measured as urine albumin-to-creatinine ratio (ACR). Lifestyle was divided into three groups: non-active, less-active, and active according to regular sport activity, categorized as follows: none, <2.5 and ≥2.5hours per week. Mean age was 47.7years, and 31.2% (n=1228) were diagnosed with hypertension. Both rest and post-exercise ACR were higher in hypertensive compared to normotensive participants. Rest ACR was higher in non-active compared to less-active and active hypertensive participants. Hypertensive participants with an active lifestyle had significantly lower post-exercise and delta ACR compared to less-active and non-active hypertensive participants. Parameters related to delta ACR in hypertensive participants were increased age, BMI, and diabetes, while active lifestyle and fitness (measured as METS achieved by a stress test) were protective. In conclusion, there is an association between hypertension and increased albumin excretion post-exercise, which can be attenuated with an active lifestyle.

Relationship among long-term aircraft noise exposure, blood pressure profile, and arterial stiffness.

To assess the impact of long-term exposure to aircraft noise on blood pressure (BP), prevalence of arterial hypertension, and indices of asymptomatic organ damage. Using acoustic maps, we selected and further compared people living (average 35 years) in areas exposed to high, more than 60 dB (n = 101), and low aircraft noise, less than 55 dB (n = 100). Medical history taking, office BP measurement, ambulatory BP monitoring, and echocardiographic and arterial stiffness measurements were performed. Exposure to aircraft noise did not increase the prevalence of arterial hypertension (50%, both groups) but was associated with higher office (88.3 ± 11.4 vs. 79.8 ± 8.6 mmHg, P < 0.001) and night-time DBP (66.6 ± 9.5 vs. 63.6 ± 7.3 mmHg, P < 0.01). Participants exposed to a high aircraft noise level had a higher carotid-femoral pulse wave velocity (PWV) (10.3 ± 1.8 vs. 9.4 ± 1.4 m/s, P < 0.01) and lower early mitral annulus velocity (e') (8.4 ± 2.9 vs. 9.2 ± 3.4 cm/s, P = 0.047). These differences were independent of age, sex, BMI, education, time spent at home, smoking status, alcohol consumption, and antihypertensive treatment. Higher office and night-time DBP, PWV, and e' values were explicitly observed in exposed normotensive participants. PWV in aircraft noise-exposed normotensive participants was equal to that of two decades older unexposed normotensive participants and was significantly associated with noise annoyance. Long-term aircraft noise exposure is related to higher office and night-time DBP, more advanced arterial stiffness, and unfavourable left ventricle diastolic function changes. Accelerated arterial stiffening was observed in those exposed to aircraft noise, even normotensive participants, to a degree depending on noise annoyance.

Sex Differences in Autonomic Function Following Aerobic Exercise

Heart rate variability (HRV), blood pressure variability (BPV) and baroreceptor sensitivity (BRS) provides insight into cardiovascular regulation in different physiological settings. Pre-menopausal females have been shown to exhibit a cardioprotective autonomic profile compared to males following maximal exercise, but it is unknown if there are sex differences in autonomic recovery following submaximal aerobic exercise. PURPOSE: To determine the effects of sex on autonomic function at rest and following an acute bout of submaximal aerobic exercise. METHODS: Forty-three (males n=22, age = 22 ± 1 yrs, BMI = 25.9 ± 0.7 kg/m2; females n=21, age = 22 ± 1 yrs, BMI = 23.7 ± 0.5 kg/m2) healthy, normotensive participants completed a 45-min moderate intensity aerobic exercise session. Beat-to-beat BP was recorded using finger plethysmography for 5 min prior to exercise (REST), at 30 min (P30), 60 min (P60) and 90 min (P90) following exercise. Frequency domain measurements of HRV and BRV were calculated. The low frequency power of BPV (BPV_LF) was used as an estimation of sympathetic vasomotor tone and the ratio of low- (LF) and high-frequency (HF) bands in HRV (LF/HF) has been used to quantify the degree of sympathovagal balance. BRS was estimated by the alpha coefficient method (Alpha_LF). Repeated measures analysis of variance (ANOVA) (2 x 4; sex x time-point) was performed. RESULTS: Data were presented in Table 1 as mean ± standard error. CONCLUSION: Forty-five min of submaximal aerobic exercise results in sustained disturbance of cardiovascular homeostasis as manifested by elevated sympathovagal balance and increased cardiovagal baroreceptor sensitivity 90 min after exercise. In addition, young, healthy women exhibited lower sympathetic tone at rest and during recovery from aerobic exercise compared to age-matched males.Table 1: Autonomic function variables at rest and 30,60, and 90 mins following aerobic exercise

The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension

BackgroundPrediabetes is a well-established risk factor for progression to overt diabetes mellitus (DM), which is in turn associated with development of hypertension (HTN) and vice versa. However, the role of prediabetes and HbA1c in particular as an independent risk factor for the development of hypertension is unclear.AimIn this current study, we aimed to evaluate the association between both fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels in the prediabetes range and development of HTN among a large cohort of normotensive subjects.Design and methodsWe investigated 5016 normotensive participants without DM and other cardiovascular risk factors who were annually screened in a tertiary medical center. Subjects were divided into normoglycemic and prediabetic groups. Normoglycemia was defined as HbA1c < 5.7% and FPG < 100 mg/dl. Prediabetes was defined according to the ADA criteria, i.e., 6.5% > HbA1c ≥ 5.7% or impaired fasting glucose (IFG):126 mg/dl > FPG ≥ 100 mg/dl. Subgroup analysis was made by dividing participants into four groups according to FPG and HbA1C levels, i.e., normoglycemia, impaired HbA1c only, IFG only, and both parameters impaired.ResultsDuring a follow-up of 3.7 ± 2.9 years, 318 (6.3%) subjects developed HTN. A cumulative hazard function for the development of hypertension showed a 2.89-fold ([95% CI 2.19–3.83], p < .0001) increased risk for HTN in the prediabetic population. In a multivariable Cox proportional hazard regression model adjusted to common confounding risk factors for HTN, prediabetes was found to be independently associated with a 1.95-fold ([95%, CI 1.43–2.52] p < .0001) increased risk for hypertension. Impaired HbA1C only was not found to be independently associated with HTN, while IFG only showed a 2.13-fold (95%, [CI 1.46–3.11] p < .0001) increased risk for HTN compared to normoglycemic, and a 2.55-fold ([95% CI 1.85–3.51] p < .0001) increased risk for HTN when both parameters impaired.ConclusionOur study demonstrates that FPG in the prediabetes range, albeit not glycated hemoglobin, is independently and significantly associated with future development of HTN. Therefore, our findings further highlight the pivotal predictive role of IFG for HTN development as opposed to the limited independent role of abnormal HbA1c levels.

Effects of herbs and spices on blood pressure: a systematic literature review of randomised controlled trials.

: Hypertension is a major risk factor for cardiovascular disease, affecting 1 billion people worldwide. Literature suggests some herbs and spices have cardiovascular benefits, such as decreasing blood pressure; yet evidence is inconsistent. This article reviewed randomized controlled trials investigating effects of herbs and spices on blood pressure in normotensive, pre-hypertensive and hypertensive participants. Ovid Medline, Embase, Biological abstracts, CINAHL and Cochrane Collaboration were systematically searched. After inclusion and exclusion criteria were applied, nine articles were included for analysis. Overall, three of the nine studies reported statistically significant results, including one of the two studies on hypertensive participants and two of the six studies on pre-hypertensive participants. The remaining study was conducted on normotensive participants and reported no change in blood pressure. There is evidence to suggest certain herbs and spices can reduce blood pressure in a hypertensive and pre-hypertensive population and may not induce hypotension in a normotensive population.

The Impact of Dental Treatments on Blood Pressure Variations

Objectives: The aim was to determine whether there are alterations in the fluctuations of systolic and diastolic blood pressure or the heart rate of normotensive versus hypertensive participants undergoing antihypertensive treatment during surgical and non-surgical dental treatments, regarding whether or not anaesthetics were used with a vasoconstrictor.Materials and methods: A prospective, observational, epidemiological study was conducted in a sample of 200 participants older than 65 years (100 normotensive and 100 hypertensive participants on antihypertensive treatment). Five periods for evaluation were established. Demographic information was obtained regarding whether or not anaesthetics were used (with or without a vasoconstrictor) and whether or not the participants underwent surgical treatment. The statistical analysis consisted of a doubly multivariate analysis of repeated measures for multiple dependent variables.Results: Significant differences were observed in the evolution of systolic blood pressure, with an initial increase in participants undergoing surgical treatment and those without a vasoconstrictor. On the other hand, systolic blood pressure decreased with non-surgical treatments, but it remained stable with the use of a vasoconstrictor. Diastolic blood pressure showed no interaction effect in participants undergoing surgical or non-surgical treatments; with the use of a vasoconstrictor, it initially decreased, while in the absence of a vasoconstrictor, it increased. Heart rate initially decreased in participants undergoing surgical and non-surgical treatments and was analogous whether or not a vasoconstrictor was used.Conclusions: During blood pressure monitoring, blood pressure variations occur, but there is no clinical repercussion in participants because once the treatment is completed, the initial values are recovered. Arterial hypertension is a pathology of high prevalence that tends to increase with age. The blood pressure response to surgical and non-surgical dental treatments and the effect of local anaesthetics is important because follow-up and blood pressure control in older patient cohorts can improve dental and clinical management.

High Normal Blood Pressure and Left Ventricular Hypertrophy Echocardiographic Findings From the PAMELA Population.

Cross-sectional and longitudinal data analysis of the PAMELA (Pressioni Monitorate E Loro Associazioni) population was performed to assess the association between prehypertension and left ventricular hypertrophy (LVH) at entry and the risk of new-onset LVH associated to this condition in the subset of participants with normal LV mass index (LVMI). A total of untreated 1397 participants with measurable echocardiographic parameters at baseline were considered in the cross-sectional analysis. The longitudinal analysis included 880 participants without LVH at baseline and with measurable LVMI at follow-up examination performed 10 years later. At entry, after adjustment for major confounders LVH prevalence rates (LVM/body surface area) showed a significant, progressive increase from the normotensive (2.1%), to prehypertension (6.7%), and hypertension group (18.3%). The incidence of LVH increased progressively from the normotensive to prehypertension and hypertension group (9.0%, 23.2%, and 36.5%, respectively). The risk of new LVH was significantly greater in prehypertension who progressed to sustained hypertension (odds ratio, 4.21; CI, 1.64-10.83; P=0.003) than in those with persistent prehypertension (odds ratio, 1.89; CI, 0.77-5.11; P=0.21) compared with persistent normotensive participants after adjustment for age, sex, baseline LVMI, obesity, glucose, creatinine, total cholesterol and the use of antihypertensive drugs at follow-up. Further adjustments for changes in body mass index, metabolic variables, and creatinine during the follow-up did not modify the strength of association between prehypertension and new-onset LVH. Our findings offer a new piece of evidence on the association of prehypertension with LVH and support the view that preventive actions for this condition affecting a large fraction of the general population should be intensified.

Blood Pressure Response During Resistance Training of Different Work-to-Rest Ratio.

Paulo, AC, Tricoli, V, Queiroz, ACC, Laurentino, G, and Forjaz, CLM. Blood pressure response during resistance training of different work-to-rest ratio. J Strength Cond Res 33(2): 399-407, 2019-Changes in the work-to-rest ratio (W:R) of resistance training protocols (RTPs) (i.e., decreasing work or increasing rest) reduce the marked elevation in blood pressure (BP) that occurs during RTP execution. However, whether changes in RTP structure without changing W:R can change BP responses to RTP is unknown. To investigate the effect of different structures of rest intervals and number of repetitions per set on BP response among RTP equated and nonequated for W:R, 20 normotensive participants (25 ± 4 years) performed 4 different RTP of the leg extension exercise with the same work but different W:R structures. Two protocols followed the recommendations for cardiovascular disorders: (a) HIGHW:R-3×15:44s-3×15:44s (set×reps:rest between sets), which has high W:R (45reps:88s) and (b) LOWW:R-3×15:88s-3×15:88s, which has low W:R (45reps:176s). The other 2 protocols were W:R-equated to LOWW:R (45reps:176s): (c) LOWW:R-9×5:22s and (d) LOWW:R-45×1:4s. Systolic BP (ΔSBP) and diastolic BP (ΔDBP) were assessed by finger photoplethysmography. There were significant main effects for ΔSBP after RTP (p ≤ 0.05): HIGHW:R-3×15:44s = LOWW:R-3×15:88s > LOWW:R-45×1:4s > LOWW:R-9×5:22s (+87 ± 5 and +84 ± 5 vs. +61 ± 4 vs. 57 ± 4 mm Hg). For ΔDBP, there was a significant interaction between RTP and moment (p ≤ 0.05). Thus, HIGHW:R-3×15:44 > LOWW:R-3×15:88s > LOWW:R-45×1:4s > LOWW:R-9×5:22s (+53 ± 5 vs. +49 ± 5 vs. +44 ± 4 vs. +38 ± 3 mm Hg). HIGHW:R-3×15:44s produced the highest increase in ΔDBP, and LOWW:R-9×5:22s produced the lowest increase in ΔSBP and ΔDBP. Our findings may help the development of RTP protocols that may mitigate pressure peaks without changing important exercise variables (i.e., volume or duration).

Arterial Stiffness Assessment by Shear Wave Elastography and Ultrafast Pulse Wave Imaging: Comparison with Reference Techniques in Normotensives and Hypertensives

Shear wave elastography and ultrafast imaging of the carotid artery pulse wave were performed in 27 normotensive participants and 29 age- and sex-matched patients with essential hypertension, and compared with reference techniques: carotid–femoral pulse wave velocity (cfPWV) determined via arterial tonometry and carotid stiffness (carPWV) determined via echotracking. Shear wave speed in the carotid anterior (a–SWS) and posterior (p-SWS) walls were assessed throughout the cardiac cycle. Ultrafast PWV was measured in early systole (ufPWV–FW) and in end-systole (dicrotic notch, ufPWV-DN). Shear wave speed in the carotid anterior appeared to be the best candidate to evaluate arterial stiffness from ultrafast imaging. In univariate analysis, a-SWS was associated with carPWV (r = 0.56, p = 0.003) and carotid-to-femoral PWV (r = 0.66, p < 0.001). In multivariate analysis, a–SWS was independently associated with age (R² = 0.14, p = 0.02) and blood pressure (R² = 0.21, p = 0.004). Moreover, a–SWS increased with blood pressure throughout the cardiac cycle and did not differ between normotensive participants and patients with essential hypertension when compared at similar blood pressures.