Prehypertensive Subjects Research Articles

YKL-40 is a novel biomarker for predicting hypertension incidence among prehypertensive subjects: A population-based nested case-control study in China

Background and aimsThe previous study suggested that Human cartilage glycoprotein-39 (YKL-40) was positively associated with hypertension incidence in certain high-risk groups of hypertension. We aimed to investigate that whether YKL-40 is an effective biomarker for predicting hypertension incidence among prehypertensive subjects. MethodsIn a 1:1 matched case-control study of 700 pairs with available YKL-40 levels nested in a prospective cohort of initially healthy Chinese subjects, 294 pairs additionally have matched baseline BP status (prehypertensive or normotensive). Multivariable conditional logistic regression analyses were used to calculate the odds ratios (95% confidential intervals) of hypertension associated with higher levels of YKL-40 in both prehypertensive and normotensive subgroups, respectively. ResultsIn the prehypertensive subgroup, the subjects in the highest quartile of plasma YKL-40 levels had a significantly higher risk of hypertension incidence, compared with those in the lowest quartile. The odds ratio (95% confidential intervals) is 2.01 (1.05–3.85). A positive association between YKL-40 levels and hypertension incidence was found (P for trend<0.05). However, this significant association was not observed in the normotensive subgroup. ConclusionsHigher YKL-40 levels at baseline were positively associated with hypertension incidence among prehypertensive subjects. YKL-40 may represent a novel biomarker for predicting hypertension risk in prehypertension population.

Resistance training alone reduces systolic and diastolic blood pressure in prehypertensive and hypertensive individuals: meta-analysis.

The purpose of this study was to evaluate the effects of resistance training alone on the systolic and diastolic blood pressure in prehypertensive and hypertensive individuals. Our meta-analysis, followed the guidelines of PRISMA. The search for articles was realized by November 2016 using the following electronic databases: BIREME, PubMed, Cochrane Library, LILACS and SciELO and a search strategy that included the combination of titles of medical affairs and terms of free text to the key concepts: 'hypertension' 'hypertensive', 'prehypertensive', 'resistance training', 'strength training', and 'weight-lifting'. These terms were combined with a search strategy to identify randomized controlled trials (RCTs) and identified a total of 1608 articles: 644 articles BIREME, 53 SciELO, 722 PubMed, 122 Cochrane Library and 67 LILACS. Of these, five RCTs met the inclusion criteria and provided data on 201 individuals. The results showed significant reductions for systolic blood pressure (-8.2 mm Hg CI -10.9 to -5.5;I2: 22.5% P valor for heterogeneity=0.271 and effect size=-0.97) and diastolic blood pressure (-4.1 mm Hg CI -6.3 to -1.9; I2: 46.5% P valor for heterogeneity=0.113 and effect size=-0.60) when compared to group control. In conclusion, resistance training alone reduces systolic and diastolic blood pressure in prehypertensive and hypertensive subjects. The RCTs studies that investigated the effects of resistance training alone in prehypertensive and hypertensive patients support the recommendation of resistance training as a tool for management of systemic hypertension.

Relationships between blood pressure and blood glucose among offspring of parents with type 2 diabetes: Prediction of incident dysglycemia in a biracial cohort

AimsWe assessed blood pressure (BP) and blood glucose (BG) values in healthy subjects, and examined baseline BP as a predictor of incident prediabetes during follow-up. MethodsParticipants in the Pathobiology of Prediabetes in a Biracial Cohort (POP-ABC) study underwent screening assessments (anthropometry, BP, OGTT) and were stratified into normal BP (NBP), prehypertension, or hypertension, and normal glucose regulation (NGR), prediabetes (IFG/IGT), or type 2 diabetes (T2D) status. NGR subjects who met all inclusion criteria were enrolled in a 5-yr prospective study, with the primary outcome of incident prediabetes. ResultsWe screened 602 adults (341 black, 261 white) and enrolled 343 (193 black, 150 white) for prospective follow-up. Systolic and diastolic BP correlated significantly with fasting and nonfasting BG (P=0.003–<0.0001). Compared to NGR group, more prediabetic subjects had prehypertension (42.5% vs. 36.2%) and fewer had NBP (35.9% vs. 48.6%) (P=0.009). During ~5years of follow-up, 26.3% of NBP and 35.7% of prehypertensive subjects developed prediabetes (P=0.02). Kaplan-Meier analysis showed higher probability of incident prediabetes among participants with prehypertension compared to NBP during ~5years of follow-up (P=0.0012). ConclusionsIn our biracial cohort, BP and BG values were significantly correlated, and BP status predicted incident prediabetes among initially normoglycemic individuals. These findings suggest co-evolution of factors involved in the dysregulation of BP and BG.

Arterial stiffness is associated with target organ damage in subjects with pre-hypertension

IntroductionPresent study was to evaluate whether increased arterial stiffness was associated with target organ damage in pre-hypertensive subjects.Material and methodsPre-hypertensive subjects enrolled and echocardiography was used to evaluate left ventricular hypertrophy (LVH) and the first morning urine was collected to evaluate albumin and creatinine ratio (ALB/Cr ratio). Carotid-femoral pulse wave velocity (cf-PWV) was measured.ResultsA total of 420 subjects were recruited and mean age was 42.6 years. Mean systolic/diastolic blood pressure (SBP/DBP) were 130 ±9 mm Hg and 85 ±4 mm Hg. The prevalence of albuminuria and left ventricular hypertrophy was 8.6 % and 11.7 %. Mean cf-PWV was 9.2 ±1.0 m/s, with arterial stiffness prevalence was 8.8%. Subjects with arterial stiffness had higher cf-PWV value (10.6 ±0.4 m/s vs. 8.7 ±0.6 m/s, p < 0.05), and ALB/Cr ratio (28.3 ±13.2 µg/mg vs. 23.1 ± 11.4 µg/mg, p < 0.05). Overall, with multivariate regression analysis, aging and arterial stiffness were significantly associated with pre-hypertension. With stepwise adjusted for potential covariates including age, male gender, fasting plasma glucose, presence of current cigarette smoking, dyslipidemia, statins and SBP, increased cf-PWV remained independently associated with left ventricular hypertrophy and albuminuria, with an increased odds of 41 % and 24 % (p < 0.05), respectively.ConclusionsIn pre-hypertensive subjects, arterial stiffness is independently associated with LVH and albuminuria and cf-PWV may be a useful marker to identify target organ damage in pre-hypertensive subjects.

Plasma Potassium Levels in Healthy Prehypertension Subjects and the Role of A High Potassium Drink.

Most populations around the world consume less than the recommended levels of potassium. Long term low potassium intake could lead to decreased plasma potassium levels and induce hypokalemia. The increasing of plasma potassium levels 0,2-0,4 mmol/L by improving potassium intake decreased significantly blood pressure (BP). Assessing plasma potassium levels in healthy people related to potassium intake have not been studied. In this study, we analysed plasma potassium levels in prehypertension (PHT) subjects to evaluate the effect of tender coconut water (TCW) as a high potassium drink on plasma potassium levels in PHT adults. Thirthy-two female aged 25-44 years were randomly allocated to 14 days on TCW or water in a parallel randomized clinical trial. The treatment (T) group received TCW 300 ml twice daily and the control (C) group received water 300 ml twice daily too. At baseline, plasma potassium levels was 3.71±0.41 mmol/L, and 22.58% were categorized as hypokalemia. After 14 days treatment, potassium plasma level between T and C groups were not significantly different (p=0,247). The change of plasma potassium levels in both groups showed tendency to increase but not statistically significant difference was observed (p=0.166). In healthy prehypertension women, the low levels of potassium plasma may be caused by low potassium intake for long time and intervension with TCW 300 ml twice daily for 14 consecutive days has not proven yet to increase plasma potassium levels. It is necessary to give higher dose and longer time to increase potassium plasma in low potassium plasma level subjects.

Potential health impact and cost-effectiveness of drug therapy for prehypertension

BackgroundStudies have reported that pharmacologic interventions with candesartan or ramipril could reduce the risk of hypertension among prehypertensive subjects free of clinical cardiovascular disease (CVD), however, the cost-effectiveness and long-term cardiovascular risk of drug treatment among these population is unclear. MethodA Markov state-transition model was developed to simulate a hypothetical cohort of Chinese adults with high-range prehypertension (130–139/85–89mmHg) but without CVD. Data on the incidence of CVD and hypertension was obtained from corresponding risk equations. Utility and disease-related costs were obtained from published literatures. Robustness and uncertainty was evaluated using deterministic and probabilistic sensitivity analyses. ResultsCompared with placebo, drug treatment resulted in delaying the development of hypertension by nearly 12years and reducing the absolute incidence of hypertension by 32.01% over lifetime. The cumulative incidence of coronary heart disease, stroke and heart failure were reduced and survival was improved from 28.46 to 28.80years. The average incremental cost effectiveness ratio for drug treatment was $12,994 per quality-adjusted life-year and the value was mostly sensitive to the effect size of treatment and age starting treatment. At a willingness-to-pay threshold of >3×China gross domestic product per capita in 2014, there was a 30.48% chance that drug treatment would remain cost-effective and a low chance of being cost-effective if relative risk of treatment on hypertension was larger than 0.64. ConclusionDrug treatment for prehypertension may help stem the current epidemic of hypertension among Chinese adults free of CVD, which may in turn reduce CVD complications and potentially be cost effective.

Arterial Compliance Response To Aerobic Exercise With and Without Blood Flow Restriction In Pre-hypertensive Males

PURPOSE: The aim of the study was to assess the effects of acute aerobic exercise with and without blood flow restriction on arterial compliance in pre-hypertensive males. METHODS: Ten pre-hypertensive male subjects (age= 23.1±3.2) performed two randomized exercise sessions. Anthropometric measurements, questionnaires, and Bruce protocol were completed at screening. Baseline measurements were obtained each testing day following subjects reaching a normal hydration status. Subjects then ran at 65% VO2 for a 60 min or 20 min at 40% VO2 with blood flow restriction (BFR). Arterial elasticity was measured at 0, 10, 20, and 40 minutes and pulse wave velocity (PWV) was measured at 5, 15, 25, and 35 minutes post-exercise. RESULTS: There were no significant condition*time interactions or no main effects for condition and time for carotid to radial, carotid to femoral, femoral to distal PWV, small (SAE) or large arterial elasticity (LAE). Significant condition*time interaction (p<.03) and time main effect (p<.01) were found in systolic blood pressure (p<.03). There were also significant condition*time interaction (p<.03) and condition main effect (p<.03, BFR higher) in diastolic blood pressure (p<.03). Significant condition*time interaction (p<.01) and condition (p<.01, 60 min higher) and time main effects (p<.01) were found in heart rate (HR). Significant condition*time interaction (p<.01) and condition (p<.05, BFR higher) and time main effects (p<.01) were found in stroke volume (SV). Significant condition*time interaction (p<.01) and time main effects (p<.02) were found in cardiac output (CO). Significant condition*time interaction (p<.01) and condition (p<.01, 60 min lower) and time main effects (p<.02) were found in systemic vascular resistance (SVR). A significant condition main effect for total vascular impedance (TVI) was detected (p<.05, 60 min lower). CONCLUSIONS: Since subjects were in supine position for post-testing, significantly lower SV values could be due to lower venous return and/or sweat-related blood volume loss and lower SVR and TVI could be because of endothelium derived nitric oxide following the 60 min session. The findings also indicate that the 20 min with BFR session may not be intense and/or long enough to cause significant changes in variables tested.

Noninvasive evaluation of varying pulse pressures in vivo using brachial sphymomanometry, applanation tonometry, and Pulse Wave Ultrasound Manometry

The routine assessment and monitoring of hypertension may benefit from the evaluation of arterial pulse pressure (PP) at more central locations (e.g. the aorta) rather solely at the brachial artery. Pulse Wave Ultrasound Manometry (PWUM) was previously developed by our group to provide direct, noninvasive aortic PP measurements using ultrasound elasticity imaging. Using PWUM, radial applanation tonometry, and brachial sphygmomanometry, this study investigated the feasibility of noninvasively obtaining direct PP measurements at multiple arterial locations in normotensive, pre-hypertensive, and hypertensive human subjects. Two-way ANOVA indicated a significantly higher aortic PP in the hypertensive subjects, while radial and brachial PP were not significantly different among the subject groups. No strong correlation (r2 < 0.45) was observed between aortic and radial/brachial PP in normal and pre-hypertensive subjects, suggesting that increases in PP throughout the arterial tree may not be uniform in relatively compliant arteries. However, there was a relatively strong positive correlation between aortic PP and both radial and brachial PP in hypertensive subjects (r2 = 0.68 and 0.87, respectively). PWUM provides a low-cost, non-invasive, and direct means of measuring the pulse pressure in large central arteries such as the aorta. When used in conjunction with peripheral measurement devices, PWUM allows for the routine screening of hypertension and monitoring of BP-lowering drugs based on the PP from multiple arterial sites.

Excessive Respiratory Modulation of Blood Pressure Triggers Hypertension

The etiology of hypertension, the world's biggest killer, remains poorly understood, with treatments targeting the established symptom, not the cause. The development of hypertension involves increased sympathetic nerve activity that, in experimental hypertension, may be driven by excessive respiratory modulation. Using selective viral and cell lesion techniques, we identify adrenergic C1 neurons in the medulla oblongata as critical for respiratory-sympathetic entrainment and the development of experimental hypertension. We also show that a cohort of young, normotensive humans, selected for an exaggerated blood pressure response to exercise and thus increased hypertension risk, has enhanced respiratory-related blood pressure fluctuations. These studies pinpoint a specific neuronal target for ameliorating excessive sympathetic activity during the developmental phase of hypertension and identify a group of pre-hypertensive subjects that would benefit from targeting these cells.

Autonomic and Vascular Control in Prehypertensive Subjects with a Family History of Arterial Hypertension.

BackgroundIndividuals with a family history of systemic arterial hypertension (FHSAH) and / or prehypertension have a higher risk of developing this pathology.ObjectiveTo evaluate the autonomic and vascular functions of prehypertensive patients with FHSAH.MethodsTwenty-five young volunteers with FHSAH, 14 normotensive and 11 prehypertensive subjects were submitted to vascular function evaluation by forearm vascular conductance(VC) during resting and reactive hyperemia (Hokanson®) and cardiac and peripheral autonomic modulation, quantified, respectively, by spectral analysis of heart rate (ECG) and systolic blood pressure (SBP) (FinometerPRO®). The transfer function analysis was used to measure the gain and response time of baroreflex. The statistical significance adopted was p ≤ 0.05.ResultsPre-hypertensive individuals, in relation to normotensive individuals, have higher VC both at rest (3.48 ± 1.26 vs. 2.67 ± 0.72 units, p = 0.05) and peak reactive hyperemia (25, 02 ± 8.18 vs. 18.66 ± 6.07 units, p = 0.04). The indices of cardiac autonomic modulation were similar between the groups. However, in the peripheral autonomic modulation, greater variability was observed in prehypertensive patients compared to normotensive individuals (9.4 [4.9-12.7] vs. 18.3 [14.8-26.7] mmHg2; p < 0.01) and higher spectral components of very low (6.9 [2.0-11.1] vs. 13.5 [10.7-22.4] mmHg2, p = 0.01) and low frequencies (1.7 [1.0-3.0] vs. 3.0 [2.0-4.0] mmHg2, p = 0.04) of SBP. Additionally, we observed a lower gain of baroreflex control in prehypertensive patients compared to normotensive patients (12.16 ± 4.18 vs. 18.23 ± 7.11 ms/mmHg, p = 0.03), but similar delay time (-1.55 ± 0.66 vs. -1.58 ± 0.72 s, p = 0.90).ConclusionPrehypertensive patients with FHSAH have autonomic dysfunction and increased vascular conductance when compared to normotensive patients with the same risk factor.

Association between blood pressure, body mass index, eating habits, and physical activity in adolescents

Aims: This study sought to analyze blood pressure and its association with eating behavior, physical activity, and body mass index in high school students.Methods: A cross-sectional study was performed with high school students from midwestern Brazil. Blood pressure was measured according to the guidelines outlined by the Brazilian Society of Cardiology. Nutritional status was assessed in accordance with the Brazilian Food and Nutrition Surveillance System (Sistema de Vigilância Alimentar Nutricional, SISVAN), according to the standard reference of the National Health and Nutritional Examination Survey (NHANES II), and the level of physical activity was assessed by the International Physical Activity Questionnaire-Short Form. The chi-square test and the Mann-Whitney U test were used for characterization of the population and comparisons between genders and normotensive and prehypertensive subjects. Bivariate and multivariate regression analyses were performed to verify the relationship between blood pressure, physical activity, and eating behavior. The significance level was set at p&lt;0.05.Results: Prehypertension was detected in 26% of the students and overweight frequency was higher than the national average (38% for girls and 20% for boys). Concerning eating behavior, students’ nutritional habits were "very good" in 7%, "regular" in 68%, and "poor" in 24%. In bivariate analyses, systolic blood pressure and blood pressure percentile were positively associated with body mass index. In multivariate analyses, there were positive associations between eating behavior and body mass index with diastolic blood pressure: when body mass index was high and the eating behavior score was low (unhealthy eating habits), diastolic blood pressure was high. No relationship was observed between blood pressure and physical activity.Conclusions: The adolescents assessed in this study showed a high frequency of prehypertension. Body mass index was positively associated with high blood pressure, indicating that a high body mass index is a risk factor for the development of hypertension among adolescents. Therefore, early intervention to control body mass index may be a valuable strategy to prevent overweight, obesity, and hypertension.

Abstract 109: Association of Endothelial Dysfunction with Non-invasive Measures of Vascular Stiffness in Young-middle Aged Non-hypertensive Individuals

Arterial stiffness and enhanced wave reflections independently predict cardiovascular risk. Wave reflections augment central (aortic) pulse pressure (PP), an index of arterial stiffness, and systolic pressure. Increased wave reflections and PP have previously been associated with endothelial dysfunction in hypertensive and healthy middle-aged adults. The study objective was to determine whether endothelial dysfunction is associated with PP and other measures of vascular stiffness in young normotensive and prehypertensive subjects. We measured office, central, and 24-hour measurements in 102 (64 female, 38 male) non-hypertensive, non-diabetic participants. Endothelial function was assessed non-invasively using post-ischemic reactive hyperemia with strain-gauge plethysmography. The racially diverse subject pool was comprised of 60% Caucasians, 18% African Americans, and 24% Asians, with mean age 30, mean BMI 25.6, mean office SBP/DBP = 110 ± 13 mm Hg/70 ± 9 mm Hg. Endothelial function was highly associated with office (β= - 4.2 mm Hg, p&lt;0.001) and 24-hour PP (β= - 1.4 mm Hg, p=0.008), along with central measures of wave reflection: ((augmentation pressure (β= - 2.1 mm Hg), augmentation index (β= - 3.7): both p&lt;0.001). Beta values correspond to the change noted for one standard deviation in endothelial function. In conclusion, endothelial dysfunction is significantly and consistently associated with arterial stiffness and increased wave reflections in young non-hypertensive adults. Identification of endothelial dysfunction in otherwise healthy young individuals may provide an opportunity to reduce vascular stiffness and associated cardiovascular risk.

PP.03.07] PREDICTORS OF INCIDENT HYPERTENSION IN PREHYPERTENSIVES

Objective: Prehypertension (PHT) is associated ogeneous group but consists of susceptible subgroups some of which transition to HT. There is no consensus which factors predict progression which is of utmost pragmatic importance. Our aim was to examine IHT in PHT subjects and analyse predictive value of various risk factors. Design and method: In this analyzes we enrolleda subgroup of 279 PHT patients (m125, w154) from BrEna cohort which was formed from original cohorts of Brisighella Heart Study (Italy) and ENAH study (Croatia). They were followed-up for 84 months (IQ60–84) and a total of 1780 person-years of follow-up. PHT was defined as BP 120–139/80–89 mmHg. Exclusion criteria were antihypertensive medication, diabetes, pregnancy, eGFR<60 ml/min, cardiovascular or cerebrovascular incident, chronic terminal diseases, dementia, immobility and missing crucial data. BP was measured using Omron 6 device following the ESH guidelines. Fasting blood was analysed for glucose, lipids, uric acid, serum creatinine, leptin, adiponectin,hsCRP. HOMA index was used to calculate insulin resistance and Cocroft-Gault and MDRD formula to estimate GFR. Albumin to creatinine ratio (ACR) was determined from the first morning spot urine. Results: IHT was diagnosed in 134 PHT (48.2%, no between-gender difference) with incidence rate of 7.53% per year; 41.8% were treated and 26.8% controlled. At baseline, subjects who developed IHT vs. those who remained PHT at the end of follow-up differed in age (50 ± 12 vs. 39 ± 12), systolic BP (130 ± 13 vs. 125 ± 7), FBG (5.3 ± 0.7 vs. 4.9 ± 0.5), hsCRP (1.8 (IQ0.9–3.1) vs. 1.3 (IQ0.4–2.3),T-cholesterol (5.7 ± 1.1 vs. 5.4 ± 1.0),TG (1.3 (IQR 1.0–1.9) vs. 1.1 (IQR 0.8–1.6), ACR (5.0 (IQ3.6–6.9) vs. 4.2(IQ3.1–6.2), adiponectin (10.7 ± 4.1 vs. 16.5 ± 7.9), leptin (10.7 ± 6.0 vs. 8.1 ± 5.5), % of visceral obesity (47% vs. 31%),overweight (67% vs. 54%) and obesity (34% vs. 17%) all p < 0.05. Significant positive predictors of IHT were age, systolic BP and ACR. Conclusions: Incident rate of new-onset HT is high, and those subjects were poorly treated. Subgroup of PHT who developed IHT were older, had higher systolic BP, metabolic abnormalities and higher values of ACR. Lifestyle measures should be recommended to this subgroup early. Diagnostic and prognostic values of ACR for IHT in PHT should be further elaborated.

Effects of Potassium Magnesium Citrate Supplementation on 24-Hour Ambulatory Blood Pressure and Oxidative Stress Marker in Prehypertensive and Hypertensive Subjects

Diet rich in fruits, vegetables, and dairy products, known as the Dietary Approaches to Stop Hypertension (DASH) diet, is known to reduce blood pressure (BP) in hypertensive patients. More recently, the DASH diet was shown to reduce oxidative stress in hypertensive and nonhypertensive humans. However, the main nutritional components responsible for these beneficial effects of the DASH diet remain unknown. Because the DASH diet is rich in potassium (K), magnesium (Mg), and alkali, we performed a randomized, double-blinded, placebo-controlled study to compare effects of potassium magnesium citrate (KMgCit), potassium chloride (KCl), and potassium citrate (KCit) to allow dissociation of the three components of K, Mg, and citrate on 24-hour ambulatory BP and urinary 8-isoprostane in hypertensive and prehypertensive subjects, using a randomized crossover design. We found that KCl supplementation for 4weeks induced a significant reduction in nighttime SBP compared with placebo (116 ± 12 vs 121 ± 15mm Hg, respectively, p <0.01 vs placebo), whereas KMgCit and KCit had no significant effect in the same subjects (118 ± 11 and 119 ± 13mm Hg, respectively, p >0.1 vs placebo). In contrast, urinary 8-isoprostane was significantly reduced with KMgCit powder compared with placebo (13.5 ± 5.7 vs 21.1 ± 10.5ng/mgCr, respectively, p <0.001), whereas KCl and KCit had no effect (21.4 ± 9.1 and 18.3 ± 8.4, respectively, p >0.1 vs placebo). In conclusion, our study demonstrated differential effects of KCl and KMgCit supplementation on BP and the oxidative stress marker in prehypertensive and hypertensive subjects. Clinical significance of the antioxidative effect of KMgCit remains to be determined in future studies.

(186) Relationship between central pain mechanisms and arterial blood pressure in pain free subjects

Studies in humans suggest an interrelationship between blood pressure and pain regulation, where elevated resting blood pressure is associated with decreased pain sensitivity in pain free normotensives. However, it is still unclear whether: 1) this interrelationship involves peripheral and central arterial blood pressure, or 2) central pain mechanisms are involved. We classified 13 pain-free subjects (mean age = 47.46; SD= 7.32) as normotensive (n = 6) or prehypertensive (n = 7) using a systolic blood pressure >135 mm Hg as the cutoff. Heart rate (HR) and peripheral and central blood pressures were measured non-invasively before, during and after experimental pain procedures. Suprathreshold heat pain responses (SHPR) were generated with repeated thermal stimuli, and conditioned pain modulation (CPM) was assessed using SHPR as the experimental stimulus and cold pressor task (7 °C) as the conditioning stimulus. Repeated measures ANOVA showed significant increases (pre, during and post pain) in all measures of peripheral and central blood pressure; however, the time*group (normotensive vs prehypertensive) interaction was significant only for peripheral systolic pressure (F (2,18)=6.07, p=0.01) and central systolic pressure (F(2,18)=3.84, p=0.04). Significant positive associations were found between SHPR and arterial blood pressure (peripheral and central, p< 0.01) only in prehypertensive subjects. There was a significant positive association between the magnitude of CPM and HR difference in all subjects. These preliminary results imply that: 1) the acute response of peripheral and central systolic pressure differs between normotensive and prehypertensive individuals, where normotensives have a more pronounced response to pain induction, and 2) inhibitory (CPM) and facilitatory (SHPR) central pain mechanisms are related to different cardiovascular mechanisms in response to acute pain induction. Further analyses in a larger sample and in chronic pain patients will provide stronger evidence about the interrelationship between blood pressure and central pain mechanisms. Supported by Charlotte Zietlow Research Grant, Indiana State University.

The Effect of Low Volume Interval Training on Resting Blood Pressure in Pre-hypertensive Subjects: A Preliminary Study

ABSTRACTObjectives: Clinically pre-hypertensive adults are at a greater risk of developing hypertension, stiffened arteries, and other cardiovascular risks. Endurance exercise training has been shown to improve elevated resting blood pressure and C-reactive protein (CRP) levels. However, a primary barrier preventing individuals from engaging in regular physical activity is a lack of time. The purpose of our study was to determine if a high-intensity interval training (HIIT) protocol would be as effective as continuous aerobic endurance training (ET) on resting blood pressure in pre-hypertensive participants. Additionally, this study investigated the effects of HIIT vs. ET on CRP.Methods: Twelve pre-hypertensive participants (33.3±6.1 yrs; 3M/9W) participated in 8 weeks of cycle ergometer exercise training. The ET exercised for 30 continuous min/day, 4 days/week at 40% reserve. The HIIT exercised at a 1:1 work-to-rest for 20 min/day, 3 days/week at 60% peak power. Resting mean arterial pressure and CRP were compared throughout the study.Results: Both groups showed decreases (p<0.001) in mean arterial pressure (ET: -11.5 ± 5.9 mmHg; HIIT: -8.6 ± 4.8 mmHg) following the 8 weeks. For CRP, there was a significant decrease (p=0.014) as a main effect of time. increased (p<0.001) approximately 25% for both HIIT and ET.Conclusion: These preliminary data suggest HIIT and ET similarly decreased resting blood pressure and increased .

Watermelon extract reduces blood pressure but does not change sympathovagal balance in prehypertensive and hypertensive subjects

Previous studies have shown that watermelon extract reduces blood pressure through vasodilation. However, those studies have not verified whether sympathetic nervous activity is influenced by watermelon extract. This study aimed to evaluate the effect of supplementation with watermelon extract for 6 weeks on blood pressure and sympathovagal balance of prehypertensive and hypertensive individuals. Forty volunteers participated in a randomized, double-blind, experimental and placebo-controlled study. They consumed 6 g of watermelon extract daily (n = 20; age 48.7 ± 1.9 years, 10 men) or a placebo (n = 20; age 47.4 ± 1.2 years, 11 men) for 6 weeks. Blood pressure and cardiac autonomic modulation were measured. Watermelon extract promoted a significant reduction in systolic (137.8 ± 3.9 to 126.0 ± 4.0 mmHg, p < 0.0001) and diastolic (79.2 ± 2.2 to 72.3 ± 2.0 mmHg, p < 0.001) blood pressure, but showed no differences compared to the placebo group. This significant reduction in blood pressure occurred without a significant change in sympathovagal balance from the beginning (1.7 ± 0.1) to the end of the study (1.7 ± 0.4). In conclusion, supplementation with watermelon extract reduces systolic and diastolic blood pressure in prehypertensive and hypertensive individuals, but does not alter the cardiac autonomic modulation of these individuals.

Higher serum uric acid level increases risk of prehypertension in subjects with normal glucose tolerance, but not pre-diabetes and diabetes

Although the association between serum uric acid (SUA) levels and prehypertension has been reported in previous studies, it is unknown whether their relationship is similar in subjects with diabetes, pre-diabetes and normal glucose tolerance (NGT). This study thus aimed to investigate the relationship between SUA and prehypertension in subjects with different glycemic status, including NGT, pre-diabetes and diabetes. A total of 12 010 participants were included after excluding subjects with blood pressure ⩾140/90 mm Hg, history of hypertension, leukaemia, lymphoma, hypothyroidism, medication for hypertension and hyperuricemia and missing data. Subjects were divided into four groups based on SUA quartiles (male Q1: ⩽345.0, Q2: 345.0-392.6, Q3: 392.6-440.2, Q4: ⩾440.2 μmol l(-1) and female Q1: ⩽249.8, Q2: 249.8-285.5, Q3: 285.5-333.1, Q4: ⩾333.1 μmol l(-1)). Diabetes, pre-diabetes and NGT were assessed according to the 2010 American Diabetes Association diagnostic criteria. Normotension and prehypertension were defined according to the JNC-7 (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) criteria. The SUA was significantly higher in prehypertensive subjects as compared with normotensive subjects. SUA, as a continuous variable, was positively associated with prehypertension in subjects with NGT but not pre-diabetes and diabetes. Besides, NGT subjects with the highest quartile of SUA exhibited a higher risk of prehypertension after adjustment for other confounding factors. In pre-diabetes and diabetes groups, none of SUA quartiles was significantly related to prehypertension. SUA was significantly associated with an increased risk of prehypertension in subjects with NGT but insignificantly in subjects with pre-diabetes and diabetes.

Hemorheological profiles of subjects with prehypertension.

High blood viscosity is associated with increased peripheral resistance and high blood pressure (BP). Prehypertension refers to a systemic BP of 120-139 mm Hg systolic (SBP) and/or 80-89 mm Hg diastolic (DBP). Subjects with prehypertension have an increased risk of overt hypertension and incident cardiovascular disease compared with subjects who have optimal BP. In the present study, we investigated the hemorheological profiles of subjects with prehypertension. A total of 418 apparently healthy subjects were enrolled. BP, plasma lipids and glucose were measured using routine methods. Blood and plasma viscosity were measured using a cone-plate viscometer. The participants were grouped according to BP into the following categories: 'normotensive' (n=100), 'prehypertensive' (n=172), and 'hypertensive' (n=146). The blood viscosity, plasma viscosity and hematocrit of the prehypertensive subjects were higher than those of the normotensive subjects (P<0.01), but they were comparable to those of the hypertensive subjects. In simple correlation analyses, SBP and DBP were directly and significantly correlated with age, body mass index (BMI), blood glucose, hematocrit, plasma viscosity and blood viscosity. In multiple regression analyses, age, fasting blood glucose and plasma viscosity were independently related with SBP, whereas blood viscosity, fasting blood glucose and BMI significantly predicted DBP. These data demonstrate that BP in the range of so-called prehypertension is accompanied by important hemorheological changes, which are similar to those observed in people with overt hypertension. These results could explain the increased cardiovascular risk observed in these subjects as well as their susceptibility to hypertension.

Blood pressure-lowering effect of Korean red ginseng associated with decreased circulating Lp-PLA2 activity and lysophosphatidylcholines and increased dihydrobiopterin level in prehypertensive subjects.

We evaluated the effects of red ginseng consumption on blood pressure (BP) and the fasting plasma metabolome. This randomized, double-blind, placebo-controlled study included nonobese, nondiabetic, prehypertensive subjects consuming 10 capsules daily containing 5 g red ginseng (n=31) or placebo (n=31). Fasting plasma metabolome profiles were obtained using ultra performance liquid chromatography-linear trap quadrupole Orbitrap MS. After 12 weeks, participants consuming red ginseng showed reductions of 6.5 and 5.0 mm Hg in systolic and diastolic BP, respectively. Compared with controls, those consuming red ginseng showed greater reductions in changed values of systolic BP, diastolic BP and lipoprotein-associated phospholipase A2 (Lp-PLA2) activity, after adjusting for baseline values. In addition, the red ginseng group showed a greater increase in dihydrobiopterin levels and greater decrease in palmitic amide and lysophosphatidylcholines (lysoPCs). The change in diastolic BP positively correlated with changes in lysoPCs and Lp-PLA2 activity. The BP-lowering effect of red ginseng is associated with decreased Lp-PLA2 and lysoPCs and increased dihydrobiopterin levels in prehypertensive subjects (ClinicalTrials.gov: NCT02326766).