Diastolic Blood Pressure Variability Research Articles

Past strong experiences determine acute cardiovascular autonomic responses to acoustic stress

Stress is a major risk factor for cardiovascular (CV) disease. We hypothesized that past strong experiences might modulate acute CV autonomic responses to an unexpected acoustic stimulus. A i m: The study's aim was to compare acute CV autonomic responses to acoustic stress between students with and without a past strong experience associated with the acoustic stimulus. Twenty five healthy young volunteers - medical and non-medical students - were included in the study. CV hemodynamic parameters, heart rate (HR), and blood pressure (BP) variability were assessed for 10 min at rest and for 10 min after two different acoustic stimuli: a standard sound signal and a specific sound signal used during a practical anatomy exam (so-called "pins"). Both sounds stimulated the autonomic nervous system. The "pins" signal caused a stronger increase in HR in medical students (69 ± 10 vs. 73 ± 13 bpm, p = 0.004) when compared to non-medical students (69 ± 6 vs. 70 ± 10, p = 0.695). Rises in diastolic BP, observed 15 seconds after sound stressors, were more pronounced after the "pins" sound than after the standard sound signal only in medical students (3.1% and 1.4% vs. 3% and 4.4%), which was also reflected by low-frequency diastolic BP variability (medical students: 6.2 ± 1.6 vs. 4.1 ± 0.8 ms2, p = 0.04; non-medical students: 6.0 ± 4.3 vs. 4.1 ± 2.6 ms2, p = 0.06). The "pins" sound, which medical students remembered from their anatomy practical exam, provoked greater sympathetic activity in the medical student group than in their non-medical peers. Thus, past strong experiences modulate CV autonomic responses to acute acoustic stress.

Food consumption by degree of processing is associated with nocturnal dipping and blood pressure variability: The ELSA-Brasil study

Background and aimsAmbulatory blood pressure monitoring (ABPM) allows the assessment of cardiovascular risk markers that cannot be obtained by casual measurements; however, the evidence on the association between food consumption and blood pressure (BP) assessed by ABPM is scarce. We aimed to evaluate the association between food consumption by degree of processing and ambulatory BP. Methods and resultsCross-sectional analysis (2012–2014) of data from a subsample (n = 815) of ELSA-Brasil cohort participants who performed 24-h ABPM was conducted. Systolic (SBP) and diastolic (DBP) BP means and variability during the 24 h and subperiods (sleep and wake), nocturnal dipping, and morning surge were evaluated. Food consumption was classified according to NOVA. Associations were tested by generalized linear models. The consumption of unprocessed, minimally processed foods, and culinary ingredients (U/MPF&CI) was 63.1% of daily caloric intake, 10.8% of processed (PF), and 24.8% of ultraprocessed (UPF). A negative association was found between U/MPF&CI consumption and extreme dipping (T2: odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.55–0.58; T3: OR = 0.55; 95% CI = 0.54–0.57); and between UPF consumption and nondipping (T2: OR = 0.68, 95% CI = 0.55–0.85) and extreme dipping (T2: OR = 0.63, 95% CI = 0.61–0.65; T3: OR = 0.95, 95% CI = 0.91–0.99). There was a positive association between PF consumption and extreme dipping (T2: OR = 1.22, 95% CI = 1.18–1.27; T3: OR = 1.34, 95% CI = 1.29–1.39) and sleep SBP variability (T3: Coef = 0.56, 95% CI = 0.03–1.10). ConclusionsThe high consumption of PF was associated with greater BP variability and extreme dipping, while the U/MPF&CI and UPF consumption were negatively associated with alterations in nocturnal dipping.

Long-Term Visit-To-Visit Blood Pressure Variability and Risk of Diabetes Mellitus in Chinese Population: A Retrospective Population-Based Study.

Objectives: To examine the association between visit-to-visit blood pressure variability (BPV) and incident diabetes mellitus (DM) risk in a Chinese population. Methods: Data comes from China Health and Nutrition Survey (n = 15,084). BPV was estimated as the average real variability (ARV) using at least three BP measurements from the year preceding the event and was divided into quartiles. Participants were also categorized into 9 groups on the basis of combinations of systolic BPV (SBPV) and diastolic BPV (DBPV) tertiles. Cox proportional hazards regression models were used. Results: During a median follow-up of 16.8years, 1,030 (6.8%) participants developed diabetes (incidence rate: 4.65/1,000 person-years). The HRs (95% CIs) for the highest quartile (vs. the lowest quartile) of SBPV and DBPV were 1.60 (1.30-1.97) and 1.37 (1.13-1.67), respectively. Participants with both highest SBPV and DBPV tertile had an ≈89% higher risk of DM (HR, 1.89; 95% CI, 1.47-2.42) compared with those in the both SBPV and DBPV tertile 1 group. Conclusion: Higher SBP ARV and DBP ARV were independently associated with increased risk of incident DM, which was augmented when both presented together.

24-hour blood pressure monitoring in patients with polycythemia vera

Aim. To study the parameters of 24-hour blood pressure monitoring in patients with polycythemia vera and to determine their informational value for the diagnosis of heart damage.Materials and methods. Blood pressure parameters were monitored daily in 63 patients with I–IIB stage polycythemia vera and 52 healthy individuals to determine the occurrence of their pathological types. The sensitivity and specificity of the studied parameters were evaluated using ROC analysis for early diagnosis of heart damage in polycythemia patients. The obtained information was processed in Statistica 25.0.Results. An analysis of blood pressure load showed that 47.6%, 30.1% and 34.9% of polycythemia patients suffer from systolic arterial hypertension (p = 0.012), daytime diastolic arterial hypertension (p = 0.03), and nocturnal diastolic arterial hypertension (p = 0.001), respectively. In comparison with healthy individuals, polycythemia patients experienced a higher variability of systolic (p<0.002) and diastolic (p<0.001) blood pressure, as well as the morning surge of systolic pressure (p = 0.014), more frequently. In 69.8% of polycythemia patients, pathological types of 24-hour blood pressure profile – with either insufficient or excessive nocturnal reduction – were observed. Informative parameters of heart damage in polycythemia patients were found to include blood pressure load, minimum daytime systolic and diastolic blood pressure, and the rate of nocturnal decrease in diastolic pressure.Conclusions. (1) Systolic-diastolic arterial hypertension was detected in half of polycythemia patients, with pathological types of 24-hour blood pressure profile observed in the majority of patients. (2) The parameters of 24-hour blood pressure monitoring can be used for early diagnosis of heart damage in patients with polycythemia vera.

Results of the prospective observation in routine practice of hypertensive patients with concomitant chronic respiratory diseases. Part II. Predictors of adverse events

Aim. To study the predictors of adverse events in hypertensive (HTN) patients, including those with chronic respiratory diseases (CRDs).Material and methods. Regression analysis evaluated clinical and anamnestic data and blood pressure (BP) in outpatients with stage II-III HTN (n=156): 49 patients had asthma, 20 — chronic obstructive pulmonary disease; age — 63,4±8,8 years, women — 72,4%, followup duration 29,3±8,0 months. The outcomes included in the composite primary endpoint (EP) were registered in 32 patients (death, major cardiovascular events and complications), while the secondary EPs were registered in 57 patients (hospitalizations, emergency calls, temporary disability due to cardiovascular disease/CRD, hypertensive crisis, exacerbation of CRD, pneumonia, respiratory failure), and tertiary EP — in 76 (other significant diseases/conditions, including increased blood pressure without hypertensive crisis, requiring correction of regular therapy).Results. Predictors of primary EPs were the decrease level of nocturnal diastolic BP (DBP) (β=-5,335, p=0,026), nocturnal DBP variability (β=1,796, p=0,007), blood leukocyte level (β=0,241, p=0,039); secondary EPs — systolic blood pressure ≥170 mm Hg in history (β=1,305-1,641, p=0,037-0,017), statin use (β=-0,997, p=0,037), CRD (β=0,734, p=0,023), blood platelet level (β=-0,008, p=0,022); tertiary EPs — only CRD (β=1,082, p<0,0001).Conclusion. Patients with HTN need complex multifactorial prevention. It is necessary to improve the control of office and ambulatory blood pressure, blood lipids, especially in the presence of CRD, to improve the control of CRDs themselves. The method of 24-hour blood pressure monitoring should be used more often in routine practice, including assessing the degree of nocturnal blood pressure reduction and its variability.

How aging couples’ emotional and physiological associations change across positive, supportive, and conflictual discussions: Roles of capitalization and responsive behaviors

BackgroundCouples’ emotions and physiology change across interactions and based on behaviors. Aging couples’ emotions and physiology may be closely related as they spend more time together and rely on each other for support. We examined aging couples’ emotional and physiological associations across multiple indices and marital interactions; we also assessed how couples’ capitalization and responsive behaviors during the first discussion were protective in subsequent emotional conversations. MethodsMarried couples (n = 107 couples, 214 individuals) engaged in positive event, social support, and conflict discussions. Emotional and physiological assessments across discussions included: positive and negative emotion, electrodermal activity, systolic and diastolic blood pressure, heart rate, and heart rate variability. We coded partners’ capitalization and responsive behaviors during the first discussion. ResultsThere were ties in spouses’ positive emotion, negative emotion, electrodermal activity, systolic blood pressure, heart rate, and heart rate variability during positive, supportive, and conflictual discussions. Emotional and physiological associations reflecting shared stress (negative emotion, electrodermal activity, systolic blood pressure) were stronger in couples who were less capitalizing or responsive earlier that day; associations reflecting physiological adaptation (heart rate variability) were stronger for more capitalizing and responsive couples. ConclusionAging couples’ emotions and physiology tracked together during discussions central to maintaining relationships, and their past behaviors carried over into future interactions and across contexts. Enthusiastic, caring, and understanding behaviors may protect partners from shared emotional and physiological stress; lacking such behaviors may increase emotional and physiological vulnerability. This research identifies behavioral, emotional, and physiological pathways connecting relationships to health in adulthood.

PS-P04-8: COMPARISON OF INDICES OF WITHIN-VISIT BLOOD PRESSURE VARIABILITY IN MAY MEASUREMENT MONTH 2019

Objective: There is a lack of consensus on the optimal mathematical indices for quantifying blood pressure variability (BPV). We sought to compare four established indices of BPV across six age strata among the substantial international population screened during May Measurement Month (MMM) 2019. Design and method: Within visit BPV of readings taken at 1 minute intervals was calculated for each of the 1,133,008 participants with three readings on a single occasion. Indices of BPV were the standard deviation (SD), absolute difference in BP from the first to the second reading (AR), coefficient of variation (CV), and variation independent of the mean (VIM). Mixed effects regression models were fit with a random intercept for country of screening site to account for clustering. Three models were created for each systolic (sbp) and diastolic (dbp) BPV metric: (1) unadjusted, (2) adjusted for average BP, and (3) adjusted for average BP, sex, and use of antihypertensive medication (multifactor). Results: Unadjusted models of sbpSD and sbpAR showed increased BPV with age from 40 to 49 years onwards. In average BP and multifactor adjusted models of all indices and unadjusted models of sbpVIM and sbpCV, systolic BPV decreased with age from 18 to 49 years but was similar across the remaining age categories (Fig.1A). Diastolic BPV displayed a “U shaped” association with age such that it was lowest in the 40 to 49 year group and relatively higher in the youngest and oldest age categories (Fig.1B). Adjustment for average BP significantly altered coefficient estimates for SD and AR (Fig.1). Compared to unadjusted models, adjustment for average BP modestly affected effect estimates for sbpCV, dbpCV, sbpVIM, and dbpVIM (Fig.1). Compared to models only adjusted for average BP, multifactor adjusted models resulted in increases in the relative differences in systolic within visit BPV across age categories but estimates for diastolic BPV across age categories were slightly attenuated on multifactor adjustment. Conclusions: Unlike AR and SD, CV and VIM were largely independent of average BP levels. Unlike VIM, to calculate CV for an individual solely requires parameters derived from their own BP readings. Models of CV produced similar outputs those produced by models of VIM, which suggests CV may have utility in clinical practice settings as an index of within visit BPV that is relatively independent of average BP while simple to calculate. The relative clinical utility and prognostic implications of these metrics of BPV remain to be assessed.

Correlation Between Short-Term Blood Pressure Variability After Primary Percutaneous Coronary Intervention and Adverse Cardiovascular Events in Patients With ST Segment Elevation Myocardial Infarction

Abstract Background To investigate the relationship between short-term blood pressure variability (BPV) after primary percutaneous coronary intervention (PPCI) and adverse cardiovascular outcomes 1 year after operation in patients with acute ST segment elevation myocardial infarction (STEMI). Methods The clinical and prognostic data of 331 patients with STEMI who underwent PPCI and drug-eluting stent implantation were collected retrospectively from 2016 to 2019. The correlation between BPV within 4 days and adverse cardiovascular outcome 1 year after operation was analyzed. Blood pressure SD was used to evaluate individual systolic blood pressure variability (SBPV) and diastolic blood pressure variability (DBPV). The high SBPV and DBPV groups were defined as SD ≥11.42 and ≥8.49 mm Hg, respectively. Multivariate bivariate logistic regression model was used to explore the correlation between SBPV, DBPV, and major adverse cardiovascular events (MACE) 1 year after operation. Results The incidence of heart failure in the high SBPV group (21.1% vs. 10.3%) was significantly higher than the low SBPV group. Also, the incidence of heart failure (23.5% vs. 7.9%) and the cumulative incidence of MACE (29.5% vs. 13.9%) in the high DBPV group were higher than those in the low DBPV group (all P < 0.05). After adjusting for age, sex, body mass index, antihypertensive drugs, left ventricular ejection fraction, Gensini score, and other influencing factors, multivariate binary logistic regression analysis showed that high SBPV was a risk factor for heart failure (odds ratio [OR] = 3.462, 95% confidence interval [CI] 1.476–8.117, P = 0.004), and high DBPV was a risk factor for heart failure and cumulative MACE (OR = 4.535, 95% CI 1.725–11.926, P = 0.002; OR = 3.412, 95% CI 1.627–7.152, P = 0.001, respectively) and in the subgroup hypertensives using oral antihypertensive drugs (OR = 4.328, 95% CI 1.619–11.572, P = 0.004), as well as high DBPV for heart failure and cumulative MACE (OR = 4.600, 95% CI 1.518–13.934, P = 0.007; OR = 4.942, 95% CI 1.851–13.198, P = 0.001, respectively). Conclusions High BPV within 4 days after PPCI and drug-eluting stent implantation in STEMI patients is a cardiovascular risk factor within 1 year after operation.

Patient activation, adherence to hypertension treatment plans and blood pressure control in Saudi Arabia: a cross-sectional study

ObjectivesTo explore the relationship between patient activation, adherence to hypertension treatment plans, blood pressure control and other important demographic factors.DesignA cross-sectional study.SettingPrimary healthcare centres in Riyadh province, Saudi Arabia.ParticipantsA total...

Cross-sectional associations between short and mid-term blood pressure variability, cognition, and vascular stiffness in older adults

High blood pressure variability (BPV), particularly in older age, appears to be an independent risk factor for incident dementia. The current study aimed to investigate the association between different BPV measures (short- and mid-term BPV including circadian patterns) and cognitive functioning as well as vascular stiffness measures to better understand the role that BPV plays in cognitive impairment. 70 older adults (60-80-year-olds) without dementia completed a cognitive test battery and had their blood pressure (BP) assessed via a 24-hour ambulatory BP monitor (divided into sleep and wake for short-term BPV) and 4-day morning and evening home-based BP monitor (for day-to-day BPV). Arterial stiffness was evaluated via pulse wave analysis and pulse wave velocity (PWV) and cerebrovascular pulsatility was assessed via transcranial doppler sonography of the middle cerebral arteries. High systolic as well as diastolic short- and mid-term BPV were associated with poorer cognitive functioning, independent of the mean BP. Higher short-term BPV was associated with poorer attention and psychomotor speed, whilst day-to-day BPV was negatively linked with executive functioning. Circadian BP patterns (dipping and morning BP surge) showed no significant relationships with cognition after adjusting for covariates. Higher systolic short-term BPV was associated with higher arterial stiffness (PWV) and higher diastolic day-to-day BPV was linked with lower arterial stiffness. No significant associations between BPV measures and cerebrovascular pulsatility were present. High BPV, independently of the mean BP, is associated with lower cognitive performance and increased arterial stiffness in older adults without clinically-relevant cognitive impairment. This highlights the role of systolic and diastolic BPV as a potential early clinical marker for cognitive impairment.

Odnos varijabilnosti arterijskog pritiska iz ambulatornog 24-časovnog monitoringa arterijskog pritiska sa ehokardiografskim parametrima u bolesnika pod antihipertenzivnom terapijom

Introduction: Variability of systolic daytime arterial pressure was until recently a controversial parameter but is now recognized as an independent prognostic risk factor for stroke in hypertensive patients. Blood pressure variability is a quantitative index of spontaneous daily and nocturnal variations in systolic and diastolic arterial blood pressure and has been proposed as a risk factor for inducing subclinical damage to target organs in arterial hypertension. Besides varying degrees of left ventricular myocardial hypertrophy (LVH), patients with hypertension also exhibit accompanying diastolic dysfunction of the left ventricle as an early sign of hypertensive damage, even when myocardial hypertrophy does not develop. The variability of pressure over 24 hours in Ambulatory Blood Pressure Monitoring (ABPM) has not been sufficiently studied in terms of correlation with echocardiographic parameters in controlled hypertension. Methods: A total of 196 adequately treated patients with stage 2 hypertension, with a target of achieving normotension less than 140/90, were examined. The total of 196 patients, 109 males and 87 females, with a mean age of 49.3 ± 8.4 years, untreated or inadequately treated patients with stage 2 hypertension (mean BP before treatment 167/106 mmHg) were divided into three groups according to blood pressure variability parameters. Alongside standard methods: medical history, clinical examination, and electrocardiogram (ECG), 24-hour ambulatory arterial pressure monitoring (ABPM, so-called blood pressure holter) was performed with 24-hour, daytime, and nighttime variability of systolic and diastolic blood pressure as well as Color and Tissue Doppler echocardiography after adequate treatment. Results: Elevated blood pressure variability was observed in 66/196 patients (34%) in group V despite good pressure regulation, while 130/169 (66%) had normal variability - group C (control). A subgroup ExtV was particularly highlighted within group V with extreme variability of daytime systolic BP (SD>20 mmHg) - 15/66 patients (8%). Evaluation of left ventricular myocardial mass index (LVMI) showed no difference in the degree of LVH between groups C and V. In the subgroup ExtV (from group V with extreme blood pressure variability), comprising 15/66 patients (8%), a significant difference in the degree of left ventricular myocardial hypertrophy was found between groups C and V regarding extreme variability (p<0.01). There was no difference concerning gender and age structure. Statistical analysis of investigated 24-hour blood pressure parameters and echocardiographic parameters did not show significant correlation through calculation of the linear correlation coefficient between mean arterial pressure measured by 24-hour ambulatory pressure monitoring and standard deviations of daytime and nighttime pressure and the degree of left ventricular myocardial hypertrophy (linear correlation coefficients r <0.20), as expected. However, there is a moderate but significant correlation between the best echocardiographic parameter of diastolic function, E/E' ratio, and variability of daytime systolic pressure: r= 0.41. Only the subgroup with extreme variability ExtV in terms of daytime systolic pressure has a statistically significant correlation with the degree of LVMI myocardial hypertrophy, r=0.51. Conclusion: One-third of the examined patients, 66/196 patients (34%) in group V, had elevated blood pressure variability despite good pressure regulation. There was no significant difference in the degree of left ventricular myocardial hypertrophy between the investigated parameters of 24-hour blood pressure and echocardiographic indices, except in extreme variability ExtV (P<0.01). However, there is a moderate but significant correlation between the best echocardiographic parameter of diastolic function, E/E' ratio, and variability of daytime systolic pressure: r= 0.41. Only the subgroup with extreme variability ExtV in terms of daytime systolic pressure has a statistically significant correlation with the degree of LVMI myocardial hypertrophy, r=0.51.

PS-P04-4: BLOOD PRESSURE VARIABILITY IN PRESCHOOL CHILDREN

Objective: To investigate the blood pressure variability (BPV) and its relevant factors in preschool children. Design and method: A total of 497 preschool children from two public kindergartens in Shanghai were enrolled. Blood pressure (BP) was standardized measured three times consecutively in a sitting position. Demographic information was collected. The measures used for BPV were the difference between the third and the first systolic blood pressure (SBP) (Delta-SBP), the difference between the third and the first diastolic blood pressure (DBP) (Delta-DBP), standard deviation of SBP (SBPSD) and DBP (DBPSD), and coefficient of variation of SBP (SBPCV) and DBP (DBPCV). Statistical analysis was performed by SAS9.4. Results: The subjects were on average 4.5 ± 0.8 years and 49.7% male. Mean blood pressure was 96/56mmHg. BPV was not significantly different between sex, however, it was significantly different among different SBP grade groups. According to the quartile of the first SBP, the subjects were divided into four groups. SBPSD and SBPCV were greater with the increase in SBP level. DBPSD and DBPCV were not significantly different among groups. Multiple linear regression showed that Delta-SBP was negatively correlated with the first SBP (Fig. 1), that was, the higher the first SBP, the magnitude of decrease from the third SBP to the first SBP was greater. After adjustment for sex, age, height, and weight, the first SBP was positively correlated with SBPCV. Conclusions: This study revealed that the higher the first SBP in preschool children, the greater the blood pressure variability may be.

PS-C09-8: FEATURES OF DAILY BLOOD PRESSURE PROFILE IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY

Purpose of the study: To study the daily profile of blood pressure in patients with arterial hypertension (AH) with obesity. Materials and methods of the study: The study included 71 patients with AH I-III degree (ESH, 2018) who received inpatient treatment. Obesity was defined according to the WHO classification (1997). The daily blood pressure profile was assessed using the Medicom-Combi device (Russia). Blood pressure was measured at intervals: day - 30 minutes, night - 60 minutes. Results of the study: Patients were divided into 3 groups depending on the degree of obesity: group 1 BMI 30–34.9 kg/m2 (43 patients), group 2 BMI 35–39.9 kg/m2 (19 patients) and group 3 BMI > 40 kg/m2 (9 patients). The compared groups had similar office SBP and DBP: 144.88 ± 21.84/88.14 ± 10.75 mm Hg. vs 143.42 ± 21.86/87.89 ± 9.76 mmHg vs 145.56 ± 17.40/87.78 ± 14.81 mmHg. Analysis of ambulatory blood pressure monitoring (ABPM) revealed that 3 grade obese patients with AH had significantly higher mean daily SBP values (124.98 ± 11.16 vs 120.00 ± 7.18 vs 132.22 ± 12.85 mm Hg, p < 0.018) and DBP (73.93 ± 8.86 vs 68.21 ± 4.71 vs 74.00 ± 7.68 mm Hg, p < 0.02), mean daily SBP (127.14 ± 10 .82 vs 120.95 ± 6.88 vs 134.11 ± 11.59 mmHg, p < 0.005), mean daily DBP (75.79 ± 9.41 vs 69.42 ± 4.98 vs 77.44 ± 7 .80 mm Hg, p < 0.012) compared with AH patients with 1–2 grade obesity. Variability in SBP and DBP did not differ significantly between the groups. The load index of SBP in the daytime was high in AH patients with 3rd grade obesity. Index of SBP daytime were 37.26 ± 29.31 (group 3 patients) vs 7.04 ± 9.78 (group 2) vs 16.35 ± 19.41% (group 1) p < 0.0009. A normal daily profile of SBP/DBP had 30.23%/37.21% of patients of the 1st group vs 21.05%/42.10% of patients of the 2nd group vs 33.33%/33.33% of patients of the 3rd group had, p < 0.145. The number of non-dippers in SBP was slightly higher in the group of patients with grade 1 obesity: night reduction speed (NRS) SBP/DBP 53.48%/ 46.51% in group 1 vs 52.63%/36.84% in group 2 vs 44.44%/ 33.33% in the third, p < 0.113. In the group of patients with grade 3 obesity, persons with daily SBP/DBP ‘night-picker’ profile significantly prevailed: 22.22%/22.22% vs 21.25%/21.05% vs 16.27% /13.95%, (in groups 3, 2, 1, respectively) p < 0.001. There were no patients with an excessive decrease in SBP and DBP at night. Conclusion: Patients with hypertension and obesity have more pronounced pronounced disturbances in the daily blood pressure profile, which contribute to an increased risk of developing complications of arterial hypertension.

Comparison of antihypertensive drugs amlodipine and perindopril on blood pressure variability after long-term treatment of hypertension induced by apatinib and bevacizumab.

The purpose of this study was to elucidate the therapeutic effect of different antihypertensive drugs (amlodipine and perindopril) on hypertension induced by apatinib and bevacizumab. Sixty patients with hypertension treated with apatinib or bevacizumab were selected and divided into two groups: one group was treated with amlodipine and the other group was treated with perindopril. Before and after treatment, the dynamic blood pressure (BP) measurement (systolic BP [SBP] and diastolic BP [DBP]), echocardiography (left ventricular end-diastolic diameter, interventricular septal thickness [IVST], left ventricular posterior wall thickness [LVPWT], and left atrial diameter [LAD]), and detection of nitric oxide (NO) content in venous blood were performed. In the amlodipine group, the 24hSBP, 24hSSD, 24hSCV, daytime mean SBP (dSBP), daytime mean SSD (dSSD), daytime mean SBP CV, night mean SBP (nSBP), night mean SSD, 24hDBP, 24hDSD, 24 h DBP CV, daytime mean DBP (dDBP), daytime mean DSD (dDSD), daytime mean DBP CV, night mean DBP (nDBP), LAD, and LAD index (LADi) after treatment were all lower than before treatment, while NO was higher than before treatment (all P < 0.05). In the perindopril group, the 24hSBP, dSBP, nSBP, 24hDBP, dDBP, nDBP, LAD, LADi, IVST, LVPWT, and left ventricular mass index (LVMI) after treatment were lower than before treatment, and NO level after treatment was higher than before treatment (all P < 0.05). After treatment, the 24hSBP, 24hSSD, dSBP, dSSD, nSBP, 24hDBP, 24hDSD, dDBP, dDSD, nDBP, night mean DSD, and NO were all lower while the LAD, LADi, IVST, LVPWT, and LVMI were higher in the amlodipine group than those in the perindopril group (all P < 0.05). Our study suggests that the SBP and DBP variability of amlodipine in the treatment of hypertension induced by apatinib and bevacizumab is slightly better than that of perindopril, but the effect of perindopril in improving endothelial function indices NO and echocardiographic data is better than that of amlodipine.

Urinary Sodium Excretion and Salt Intake Are Not Associated With Blood Pressure Variability in a White General Population.

Background Salt restriction may lower blood pressure variability (BPV), but previous studies have shown inconsistent results. Therefore, we investigated in an observational study and intervention trial whether urinary sodium excretion and salt intake are associated with 24-hour BPV. Methods and Results We used data from the cross-sectional population-based Maastricht Study (n=2652; 60±8 years; 52% men) and from a randomized crossover trial (n=40; 49±11 years; 33% men). In the observational study, we measured 24-hour urinary sodium excretion and 24-hour BPV and performed linear regression adjusted for age, sex, mean blood pressure, lifestyle, and cardiovascular risk factors. In the intervention study, participants adhered to a 7-day low- and high-salt diet (50 and 250 mmol NaCl/24 h) with a washout period of 14 days, 24-hour BPV was measured during each diet. We used linear mixed models adjusted for order of diet, mean blood pressure, and body mass index. In the observational study, 24-hour urinary sodium excretion was not associated with 24-hour systolic or diastolic BPV (β, per 1 g/24 h urinary sodium excretion: 0.05 mm Hg [95% CI, -0.02 to 0.11] and 0.04 mm Hg [95% CI, -0.01 to 0.09], respectively). In the intervention trial, mean difference in 24-hour systolic and diastolic BPV between the low- and high-salt diet was not statistically significantly different (0.62 mm Hg [95% CI, -0.10 to 1.35] and 0.04 mm Hg [95% CI, -0.54 to 0.63], respectively). Conclusions Urinary sodium excretion and salt intake are not independently associated with 24-hour BPV. These findings suggest that salt restriction is not an effective strategy to lower BPV in the White general population. Registration URL: https://clinicaltrials.gov/ct2/show/NCT02068781.

Comparative features of the immediate impact of manual therapy traction manipulations on the cardiorespiratory system of men and women

Purpose: the aim of this study was to determine the principal differences of changes in the cardiorespiratory system activity under the influence of traction manipulations in the thoracic spine of men and women. Material &amp; Methods: the 26 adults were involved in the study, including 18 women aged 39.6±12.1 years and 8 men aged 36.3±8.3 years. All patients were diagnosed with osteochondrosis of the thoracic spine, which was confirmed by radiographic examination. The study of the cardiorespiratory system was conducted in the first procedure of SMT before and after the use of traction manipulations directly in the physician office. The integrated method of studying the cardiorespiratory system defined as spiroarteriocardiorhythmography (SACR) was used. It simultaneously records the heart rate, rhythms of systolic and diastolic pressure at each heartbeat and respiratory rhythms, which provides significant time savings to determine the functional state of the heart, vessels and respiration, as well as to identify the important parameters of their interaction. Results: characterizing the changes in the cardiorespiratory system as a whole under the influence of traction manipulations on the thoracic spine, it should be noted that men and women had some significant unidirectional changes in HR (min–1), CO (dm3), CI (dm3/m2), IH (n. u.), which are determined primarily by the decrease in HR (min–1) under the influence of traction manipulations. As to the men, the significant effects were more related to the impact on the contractile function of the heart, which was confirmed by the improvement of the electrical systole of the ventricles (QTC, s), the increase in the activity of the effects of the parasympathetic branch of the ANS on the cardiac rhythm (HF, ms2) and a certain increase in the stroke index within the normative values (SI, cm3/m2), then to the women the significant effects were more related to the influence on the breathing pattern and vascular tone. Thus, characteristic and positive effects in women can be considered a decrease in the variability of diastolic blood pressure in the very-low-frequency range (VLFDBP, mmHg2), which is combined with a decrease in the total power of diastolic pressure variability (TPDBP, mmHg2) and an increase in the total peripheral vascular resistance (GPVR, dyn/s/cm−5). Conclusions: summarizing the results of the impact of traction manipulations in the thoracic spine on the cardiorespiratory system of men and women, it can be stated that their effect is different and has features associated with the use of different mechanisms. For men, the predominant effect is on the heart contractile function, and for women it is on the respiratory system and autonomous regulation of vascular tone.

Left atrial structure and function: association with blood pressure variability in pregnant women.

The aim of this study was to investigate the relationship between left atrial (LA) abnormalities and ambulatory blood pressure variability (BPV) in pregnant women and their relationship with hypertension-related clinical outcomes in pregnancy. This single-center, prospective study included 119 pregnant women. All participants underwent 24-h ambulatory blood pressure (BP) monitoring and echocardiographic examination before 20 weeks of gestation. BPV was evaluated using 24-h ambulatory BP monitoring. SD of the mean of SBP (SBP-SD) and DBP variability was calculated as 24-h, daytime and nighttime SBP and DBP. The patients were classified into two groups based on median 24-h SBP-SD (11.3 mmHg). LA features of the patients were compared according to the high and low BPV groups. One hundred and nineteen pregnant women (mean age, 28.6 ± 5.2 years) were included in the study. The mean office SBP and DBP were 108.7 ± 15.4 mmHg and 68.2 ± 10.2 mmHg, respectively. In pregnant women with high BPV, even though BP is normal, reservoir and conduit LA functions have decreased and LA stiffness has increased. Gestational hypertension and composite outcomes were more common in pregnant women with high BPV. Among the LA parameters, the most associated with composite outcome was conduit LA function. In pregnancy, higher BPV is associated with worse LA function. The LA conduit strain offers potential value in predicting hypertension-related clinical outcomes in pregnancy.

Posttraumatic stress disorder, diurnal cortisol, and ambulatory blood pressure in early and late pregnancy.

Posttraumatic stress disorder (PTSD) affects 1 in 20 reproductive-aged women and is associated with cardiovascular disease morbidity and mortality. The pathophysiology linking PTSD to cardiovascular disease in nonpregnant adults is proposed to include hypothalamic and autonomic dysregulation; however, the pathways explaining this association in pregnancy are unclear. We examined diurnal cortisol and ambulatory blood pressure (BP) among 254 pregnant women at approximately 12 and 32 gestational weeks. Participants were, on average, 31 years old (SD = 5), 24.4% reported their ethnicity as Hispanic, and 62.2% reported their race as White. PTSD symptoms were measured using the PTSD Checklist for DSM-5 (PCL-5). Hierarchical linear regression analyses were performed to examine associations pregnancy between PTSD and cortisol at awakening, 30 min after awakening, and bedtime in early and late pregnancy, as well as associations between PTSD symptoms and daytime and nighttime systolic (SBP) and diastolic BP (DBP) and BP variability. Logistic regression analyses were conducted to test associations between PTSD symptoms and BP dipping. The results showed a positive association between PTSD symptoms and nighttime BP and BP variability at 32 gestational weeks, ∆R2 = .036-.067. PTSD symptoms were negatively associated with awakening cortisol at 12 gestational weeks in unadjusted models. These findings contribute to understanding the associations between PTSD and adverse cardiovascular conditions in pregnancy. More research is needed to replicate these findings and examine whether PTSD interventions are effective at modifying pathways and decreasing the risk for cardiovascular complications in pregnancy.

Biomarkers of mitochondrial dysfunction and inflammaging in older adults and blood pressure variability.

Most physiopathological mechanisms underlying blood pressure variability (BPV) are implicated in aging. Vascular aging is associated with chronic low-grade inflammation occurring in late life, known as "inflammaging" and the hallmark "mitochondrial dysfunction" due to age-related stress. We aimed to determine whether plasma levels of the pleiotropic stress-related mitokine growth/differentiation factor 15 (GDF-15) and two inflammatory biomarkers, interleukin 6 (IL-6) and tumor necrosis factor receptor 1 (TNFR-1), are associated with visit-to-visit BPV in a population of community-dwelling older adults. The study population consisted of 1096 community-dwelling participants [median age 75 (72-78) years; 699 females, 63.7%] aged ≥ 70years from the MAPT study. Plasma blood sample was collected 12months after enrolment and BP was assessed up to seven times over a 4-year period. Systolic (SBPV) and diastolic BPV (DBPV) were determined through several indicators taking into account BP change over time, the order of measurements and formulas independent of mean BP levels. Higher values of GDF-15 were significantly associated with increased SBPV (all indicators) after adjustment for relevant covariates [adjusted 1-SD increase in GDF-15: β (SE) = 0.07 (0.04), p < 0.044, for coefficient of variation%]. GDF-15 levels were not associated with DBPV. No significant associations were found between IL-6 and BPV, whereas TNFR1 was only partially related to DBPV. Unlike inflammation biomarkers, higher GDF-15 levels were associated with greater SBPV. Our findings support the age-related process of mitochondrial dysfunction underlying BP instability, suggesting that BPV might be a potential marker of aging.

Intraoperative Blood Pressure Variability and Early Postoperative Stroke: A Case-Control Study.

This study aims to assess the association of postoperative stroke with intraoperative hemodynamic variability and transfusion management. In this case-control study, adult patients (≥ 18 years) who had a stroke within 72 hours of a surgical procedure were matched to 2 control patients according to age, sex, and procedure type. Primary risk factors assessed were intraoperative fluid administration, blood product transfusion, vasopressor use, and measures of variability in systolic and diastolic blood pressure and heart rate: maximum, minimum, range, SD, and average real variability. The variables were analyzed with conditional logistic regression, which accounted for the 1:2 matched case-control study design. Among 687581 procedures, we identified 64 postoperative strokes (incidence, 9.3 [95% CI, 7.2-11.9] strokes per 100000 procedures). These cases were matched with 128 controls. Stroke cases had higher Charlson cmorbidity index scores than did controls (P = .046). Blood pressure and heart rate variability measures were not associated with stroke. The risk of stroke was increased with red blood cell (RBC) transfusion (odds ratio [OR], 14.82; 95% CI, 3.40-64.66; P < .001), vasopressor use (OR, 3.91; 95% CI, 1.59-9.60; P = .003), and longer procedure duration (OR, 1.23/h; 95% CI, 1.01-1.51; P = .04). Multivariable analysis of procedure duration, RBC transfusion, and vasopressor use showed that only RBC transfusion was independently associated with an increased risk of stroke (OR, 10.10; 95% CI, 2.14-47.72; P = .004). Blood pressure variability was not associated with an increased risk of postoperative stroke; however, RBC transfusion was an independent risk factor.