Significant Differences In Pulse Pressure Research Articles

The Effects of Auricular Acupressure on Physiological Index, Depression, Anxiety, and Stress for Elders With Hypertension.

The purpose of the study was to examine the effects of auricular acupressure (AA) on physiological index, depression, anxiety, and stress in elderly people with hypertension. The verum group received verum AA therapy for 8 weeks. Five different acupressure sites were applied in each group. There was a significant difference in systolic blood pressure between the 2 groups after 8 weeks of AA, whereas a significant difference in pulse pressure was found between the 2 groups after 6 weeks of AA. This study is meaningful in comparing intervention and sham groups, verifying the effects by using physiological and psychological variables, and confirming the effects of repetitive measurement. AA therapy is expected to be a practical and efficient health care intervention for elderly people with hypertension.

GENDER DIFFERENCES IN THE REGULATION OF BLOOD PRESSURE ASSESSED BY AMBULATORY BLOOD PRESSURE MONITORING – A SINGLE-CENTER EXPERIENCE

Objective: It has been shown a significant difference in clinical characteristics of HTN and treatment response to antihypertensive therapy between males and females. The purpose of our article was to examine gender differences in the regulation of blood pressure (BP) by using ambulatory blood pressure monitoring (ABPM). Design and method: Two hundred seventy-five consecutive hypertensive patients were included in the study (146 females, mean age 64.11 ± 10.47 and 129 males, mean age 61.69 ± 13.59). All patients were on antihypertensive treatment for more than one year (average duration of HTN was 11.07 ± 8.24 years for women, and 10.31 ± 7.5 years for men). In all pts, AMBP was performed. The values obtained by AMBP were compared between the two groups. Results: There were no significant differences in the presence of coronary artery disease, obesity, diabetes mellitus, or heredity between the groups. There were more smokers among male patients (p = 0.007), while dyslipidemia was more present in female pts (p = 0.005). Male pts had higher values of systolic (124.05 ± 13.89 vs. 119.5 ± 16.58, p = 0.015) and diastolic BP (72.77 ± 8.42 vs. 69.24 ± 8.23, p = 0.001) and larger burden of high BP during the night (56.54 ± 35.52 vs. 33.11 ± 35.27, p = 0.000) compared to female pts. There were no significant differences in pulse pressure (PP) values between the male and female groups (51.17 ± 11.33 vs. 50.72 ± 10.38, p = 0.730). However, pathological values of PP (<40 mmHg or > 60 mmHg) were found in almost 1/3 of pts (34.92% in men and 28.57% in women). Also, there was no significant difference in dipping pattern but only 40 (31.01%) male and 50 (34.25%) female patients had dipper status. There was no statistically significant difference in antihypertensive therapy between the groups. The most commonly used drugs were the angiotensin-converting enzyme inhibitors (82.21% of all pts) and beta blockers (78.78%), while the angiotensin receptor blockers were the least used (15.98%). Conclusions: Results indicate that women have better BP control than men. However, a high frequency of pathological PP values and disturbed dipping status detected by ABPM, in women as well as men, should highlight the importance of better BP management in both genders.

POS0562 PULSE PRESSURE AS AN INDICATOR OF SUBCLINICAL ATHEROSCLEROSIS IN RHEUMATOID ARTHRITIS

Background:Pulse pressure (PP) is defined as the difference between systolic and diastolic blood pressure and represents arterial compliance and reflective properties of blood flow (1). It is well known that gender, age, and race / ethnicity are intrinsic factors of the patient that influence PP. Brachial PP has recently been associated with markers of subclinical cardiovascular disease after adjustment with traditional cardiovascular risk factors in the general population (2). However, this relationship has not been studied in patients with rheumatoid arthritis (RA) and its identification would allow earlier adjustments of cardiovascular therapies in this high-risk group.Objectives:The aim of the study is to analyze the difference in PP between patients with RA and healthy controls. Additionally, to analyze the difference between patients with carotid plaque (CP) and without CP.Methods:A cross-sectional, observational, and comparative study of ninety-two patients with RA aged 40-75 years and who fulfilled ACR/EULAR 2010 classification criteria. Also, we included ninety-two controls without RA, matched by gender, age and comorbidities. A carotid ultrasound was performed in patients with RA and it was divided into two subgroups, with the presence of CP and without CP. A blood pressure measurement was taken after 15 minutes of rest on the right arm of all patients. Distribution was evaluated with the Kolmogorov-Smirnov test. Descriptive analysis was done using measures of central tendency. Chi square, Student’s t test and Mann-Whitney U test were used for comparations between groups. A p value <0.05 was considered statistically significant.Results:We found no statistical difference between groups regarding age, gender and, comorbidities (type 2 diabetes mellitus, hypertension, dyslipidemia and, active smoking) (Table 1). There was a significant difference in PP between patients with RA and controls (50 mmHg vs 41 mmHg respectively, p = 0.032). Patients with RA had a significant difference in PP of patients with CP and without CP (50 mmHg vs 44 mmHg respectively, p = 0.008) (Figure 1). When performing a binary logistic regression, it was found that PP was the only independent factor for the presence of CP in patients with RA, OR 1.054 (95% CI 1.008-1.101, p = 0.020).Conclusion:Patients with RA had a higher PP than controls. Binary logistic regression showed PP as the only independent factor for the presence of subclinical atherosclerosis in patients with RA. PP is a parameter that all rheumatologists should consider when evaluating cardiovascular risk in patients with RA.

Could Cardiovascular Parameters Be Affected by Dental Impression?

Background: The frequency of cardiovascular disease increases with age. Dental procedures as stressful triggers may cause unpredictable changes in the function of the cardiovascular system. Impression is an inevitable dental procedure. Objectives: Since upper jaw impression stimulates the sensory terminals of nerves, especially vagus, this study was conducted to evaluate the changes in blood pressure, heart rate, and pulse pressure due to dental impression. Methods: This observational study was performed on individuals who referred to the Prosthetic Department of Yazd Dental School. The sample was composed of 46 individuals, including 26 women and 20 men, who fulfilled the inclusion criteria and signed written consent forms. The severity of gag reflex was measured and just individuals with moderate gag reflex entered the study. Impression was carried out in the upper jaw in the upright position and rest condition. Blood pressure, pulse rate, and pulse pressure were measured and compared before and immediately after impression procedure. Taking into account the significance level of 5%, the test power of 80%, and blood pressure standard deviation of 4, and to achieve a significant difference of at least 2 mmHg in the groups, 46 people were needed in the study. Data were analyzed by SPSS 18 and t test. Results: Systolic and diastolic blood pressure, heart rate, and pulse pressure were measured before and after dental impression. The difference between men and women was significant only for pulse pressure at both stages (P = 0.02). There was also a statistically significant difference in pulse pressure before and after impression only in women (P = 0.049). There was no significant difference in men. Conclusions: Common dental procedures such as impression could not significantly alter blood pressure and pulse rate.

Pulse pressure and diabetes treatments: Blood pressure and pulse pressure difference among glucose lowering modality groups in type 2 diabetes.

Type 2 diabetes is associated with higher pulse pressure. In this study, we assessed and compared effects of classic diabetes treatments on pulse pressure (PP), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in patients with type 2 diabetes.In a retrospective cohort study, 718 non-hypertensive patients with type 2 diabetes were selected and divided into 4 groups including metformin, insulin, glibenclamide+metformin, and metformin+insulin. They were followed for 4 consecutive visits lasting about 45.5 months. Effects of drug regimens on pulse and blood pressure over time were assessed separately and compared in regression models with generalized estimating equation method and were adjusted for age, duration of diabetes, sex, smoking, and body mass index (BMI).Studied groups had no significant change in PP, SBP, and DBP over time. No significant difference in PP and DBP among studied groups was observed (PP:P = 0.090; DBP:P = 0.063). Pairwise comparisons of PP, SBP, and DBP showed no statistically significant contrast between any 2 studied groups. Interactions of time and treatment were not different among groups.Our results demonstrate patients using metformin got higher PP and SBP over time. Averagely, pulse and blood pressure among groups were not different. Trends of variation in pulse and blood pressure were not different among studied diabetes treatments.

Effectiveness of the Direct Renin Inhibitor, Aliskiren, in Patients With Resistant Hypertension

Currently there is no consensus regarding which add-on therapy to use in resistant hypertension. We have conducted an open observational study of the use of aliskiren in resistant hypertensive patients. Forty-three patients with resistant hypertension were included in the study. The inclusion criteria were as follows: 1) office blood pressure (BP) > 140/90 mmHg despite treatment with at least three or more antihypertensive drugs; 2) no prior therapy with aliskiren; and 3) no renal insufficiency. Follow-up BP was determined at 1 and 3 months. Baseline BP was 153 ± 12/79 ± 12 mmHg. After 3 months, systolic BP (SBP) and diastolic BP (DBP) dropped significantly: 140 ± 19/73 ± 13 mmHg (P < 0.0001). Twenty-one patients (49%) had an office BP < 140/90 mmHg, and these patients were assigned to the good BP control group. Another 22 were placed into the poor BP control group. BP reductions from baseline in the good BP control group (SBP/ DBP: 19 ± 11/8 ± 7 mmHg) were larger than those in the poor BP control group (5 ± 15/3 ± 9 mmHg, P < 0.05). Mean BP (MBP) values at baseline, 1, and 3 months were higher in the poor BP control group. There was no significant difference in pulse pressure at baseline between the 2 groups. In multivariate analysis, only MBP at baseline correlated with lack of BP control. Aliskiren administration to resistant hypertensive patients was effective in reducing BP. The present findings suggest aliskiren may be useful as a fourth-line or fifth-line treatment added to other drugs in the treatment of resistant hypertension.

Estimation of individual biological aging and individualized evaluation of biomarkers of aging in healthy people

To estimate the degree of biological aging for healthy people by the biological age score equation and observe the differences of various aging biomarkers so as to provide targets for clinical anti-aging intervention. A total of 2876 subjects aged 30 - 98 years old were recruited from 3 Chinese cities in 2003. After screening, 852 healthy subjects were finally selected and assigned into 4 groups according to ages: young group (< 45 yr), middle-aged group (45 - 59 yr), young-elder group (60 - 74 yr) and elder group (≥ 75 yr). They received a total of 108 physical, morphological, physiologic and biochemical examinations. The biological age score equation was employed to compute the individual biological age scores for all subjects. Then the biological age score was taken as a dependent variable and the chronological age as an independent variable for linear regression. Based on the confidence interval with ± 1 standard deviation of regression line, they were divided into 3 groups (delayed aging, normal aging and early aging). According to the chronological ages and degrees of aging, two-way analysis of variance was conducted for the following 7 biomarkers: end diastolic velocity (EDV), intima-media thickness (IMT), ratio of peak velocity of early filling to atrial filling (E/A), mitral valve annulus lateral wall of peak velocity of early filling (MVEL), arterial pulse pressure (PP), fibrinogen (FIB) and cystatin C (CYSC). At the same time, the differences of 7 biomarkers were observed in different aging groups in 4 age groups. (1) A comparison of biological age score: there were no significant differences in chronological age among 3 biological aging groups in same chronological age groups. However, there were some significant differences in biological age score (young group: F = 91.8, P < 0.01; middle-aged group: F = 134.5, P < 0.01; young-elder group: F = 199.5, P < 0.01; elder group: F = 82.1, P < 0.01). (2) Two-way analysis of variance (aging groups and chronological age groups for biomarkers): there were significant differences of 7 biomarkers in different chronological age groups and different aging groups. (3) A comparison of biomarkers among aging groups: there were significant differences in PP among 3 aging groups in 4 age groups. PP increased significantly in early aging group to normal aging group and delayed aging group (young group: 49.0 ± 6.9, 37.6 ± 6.4, 30.8 ± 7.6 mm Hg, F = 93.2, P < 0.01; middle-aged group: 52.9 ± 7.3, 44.3 ± 5.9, 32.7 ± 8.4 mm Hg, F = 125.7, P < 0.01; young-elder group: 61.9 ± 7.6, 51.6 ± 6.6, 37.1 ± 8.7 mm Hg, F = 196.5, P < 0.01; elder group: 72.2 ± 13.7, 61.1 ± 6.8, 43.8 ± 10.8 mm Hg, F = 60.2, P < 0.01). There were significant differences in EDV among 3 aging groups in 4 age groups. EDV increased significantly in early aging group to normal aging group and delayed aging group. There were significant changes in IMT, MVEL, E/A, CYSC and FIB among aging groups in different age groups. (1) Biological age score plays an essential role in the evaluation of aging. Based on individual evaluation of biological age score, the degrees of aging can be categorized by grouping so that a clinician may provide clinical anti-aging interventions within the target groups. (2) The above 7 biomarkers are competent for the evaluation of aging. They can not only be used to construct biological age score equation, but also provide clinical targeted interventions for aging.

Gender differences in blood pressure and heart rate in spontaneously hypertensive and Wistar‐Kyoto rats

1. In general, premenopausal women are known to have lower blood pressure than men and animal models have shown a similar sexual dimorphism. However, many studies in animals have been performed using anaesthetized or restrained models. Current experiments were conducted to investigate the relationships among resting heart rate, blood pressure and gender in conscious, unrestrained normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR). 2. Biotelemetry transmitters were implanted in 6-month-old animals. Values for heart rate, diastolic blood pressure, systolic blood pressure and pulse pressure were recorded continuously at 10 min intervals after all animals recovered completely from surgery. 3. Normal circadian rhythms in heart rate were found in all rats, with no significant differences among the four groups; the circadian variation in blood pressure was evident in all groups, although much smaller. Heart rate was found to be higher in WKY female rats than in the other three groups. Male WKY rats, male SHR and female SHR had similar heart rates. Male SHR had significantly higher systolic and diastolic blood pressures than female SHR. Male and female WKY rats had similar diastolic blood pressure, but males had slightly higher systolic pressure than females. No significant difference in pulse pressure was found in WKY male and female rats. Male SHR showed significantly higher pulse pressure than female SHR at most times during the day. 4. In conclusion, these results indicate that hypertension is exacerbated in male SHR compared with females under conscious resting conditions and demonstrate that the higher heart rate observed in WKY female rats is not present in the SHR model.

Assessment of effect of angiotensin II receptor antagonist losartan on aortic distensibility in patients with essential hypertension by echocardiography.

The effects of angiotensin II receptor antagonist losartan on elastic properties of aorta in patients with mild to moderate essential hypertension were assessed. The ascending aortic distensibility in 26 patients (48 +/- 3 years) with mild to moderate essential hypertension before and after 12 weeks of treatment with losartan (50 mg/day) was evaluated by using two-dimensional echocardiography. M-mode measurements of aortic systolic (Ds) and diastolic diameter (Dd) were taken at a level approximately 3 cm above the aortic valve. Simultaneously, cuff brachial artery systolic (SBP) and diastolic (DBP) pressures were measured. Aortic pressure-strain elastic modulus (Ep) was calculated as Dd x (SBP-DBP)/(Ds-Dd) x 1333 and stiffness index beta (beta) was defined as Dd x Ln (SBP/DBP)/(Ds-Dd). Blood pressure significantly decreased from 148 +/- 13/95 +/- 9 mmHg to 138 +/- 12/88 +/- 8 mmHg (systolic blood pressure, P = 0.001; diastolic blood pressure, P = 0.003). There was no significant difference in pulse pressure before and after treatment with losartan (53 +/- 10 mmHg vs 50 +/- 7 mmHg). The distensibility of ascending aorta increased significantly as showed by the significant decrease in pressure-strain elastic modulus from 4.42 +/- 5.79 x 10(6) dynes/cm2 to 1.99 +/- 1.49 x 10(6) dynes/cm2 (P = 0.02) and stiffness index beta from 27.4 +/- 32.9 to 13.3 +/- 9.9 (P = 0.02). Although there was a weak correlation between the percent changes in pressure-strain elastic modulus and stiffness index beta and that in diastolic blood pressure after losartan treatment (r = 0.40, P = 0.04 and r = 0.55, P = 0.004, respectively), no correlation was found between the percent changes in pressure-strain elastic modulus and stiffness index beta and that in systolic blood pressure (r = 0.04, P = 0.8 and r = 0.24, P = 0.2, respectively). Our study demonstrated that angiotensin II receptor antagonist losartan has a beneficial effect on aortic distensibility in patients with mild to moderate essential hypertension and this effect is partly independent of blood pressure reduction.

In reply

Dr. Safar suggests appropriately that pulse pressure, an indicator of arterial stiffness, is an important risk factor of coronary heart disease. The patients using nifedipine or other drugs might have higher or lower pulse pressure levels than those using β-blockers, and, therefore, pulse pressure could be a confounder of the findings of our study. This issue has been examined in additional analyses. Pulse pressure was calculated by subtracting diastolic from systolic arterial pressure. The mean pulse pressure was 67 mm Hg, and there were no significant differences in pulse pressure among patients using specific antihypertensive agents. However, pulse pressure values before treatment were not known. When pulse pressure was entered into the multivariate Cox proportional hazards models shown in Table 2,1 after adjusting for systolic blood pressure as a continuous variable and all other covariates listed in the Table, the associations of medication use with various outcomes remained unchanged. The relative risk (95% CI) associated with a 10-mm Hg increase in pulse pressure was 1.09 (0.91–1.32) for all-cause mortality, 1.25 (0.89–1.75) for coronary heart disease mortality, 1.35 (1.00–1.82) for congestive heart failure hospitalization, 1.27 (0.93–1.73) for incident coronary heart disease events, and 0.74 (0.44–1.25) for acute myocardial infarction events. These results suggest that pulse pressure may be an independent risk factor of cardiovascular outcomes in older patients treated for hypertension, and further analyses in a larger sample of patients are warranted. Finally, pulse pressure was not a confounder of the findings of our study.

The Effect of Verapamil on Carotid Artery Distensibility and Cross-Sectional Compliance in Hypertensive Patients

The effect of chronic administration of verapamil, following a double-blind, crossover protocol, on the distensibility and cross-sectional compliance of the common carotid artery was investigated in 19 patients with essential hypertension. Distensibility was significantly increased during verapamil treatment as compared to placebo for both left and right common carotid artery (p less than 0.01 and p less than 0.05, respectively). The cross-sectional compliance was significantly increased during verapamil treatment for the right common carotid artery (p less than 0.05). For the left common carotid artery, the difference did not reach the level of significance (p = 0.16). The common carotid artery diameter and the arterial pulse pressure were not significantly different during verapamil treatment as compared with placebo. The results of this study indicate that chronic treatment with verapamil increases distensibility and cross-sectional compliance of the common carotid artery in hypertensive subjects. These improvements have to be considered as changes in arterial wall properties because no significant differences in pulse pressure and diameter could be detected between the verapamil and placebo periods. Improved arterial wall properties could result in a better management of the flow jet from the heart, and might protect the patients from atherosclerotic complications of hypertension.