Pub Date : 2020-01-02DOI: 10.1080/08037051.2019.1645586
A. Kiselev, A. Karavaev
Abstract Background: It is believed that the intensity of oscillations in the photoplethysmographic waveform variability reflects the activity of vascular regulatory mechanisms. However, the relationship of such fluctuations with the state of health is poorly understood. Purpose: The aim of our study was to assess the possibility of using spectral indices that reflect the intensity of oscillations of the photoplethysmographic waveform variability at frequencies 0.04-0.4 Hz as markers of hypertension and coronary artery disease. We did not study women to exclude the influence of menopause and sex hormones on the results. Materials and Methods: We compared synchronous 10-minute records of finger photoplethysmogram and respiration at rest in 30 healthy males (48.8 ± 4.5 years; data presented as Mean ± SD) versus 30 patients with hypertension (aged 49.0 ± 4.3 years) versus 30 patients with stable coronary artery disease (49.2 ± 4.8 years). Percentages of high-frequency and low-frequency ranges in the total power of photoplethysmographic waveform variability spectrum (HF% and LF%), and LF/HF ratio were assessed. Results: HF% are subject to by 2- to 5-fold increase in hypertensive patients (p < .001) and up to an 8-fold increase in patients with coronary artery disease (p < .001) when compared with healthy persons. On the contrary, LF% is reduced by 1.5-5 times in all patients when compared with healthy people (p < .001). We identified cut-off points for each photoplethysmographic index to distinguish patients with coronary artery disease or hypertension from healthy subjects. Multiple logistic regression models based on photoplethysmographic waveform variability indices had sufficient sensitivity and specificity for patients with hypertension or coronary artery disease. Conclusion: Frequency-domain indices of photoplethysmographic waveform variability (in particular, HF%, LF%, and LF/HF) are sufficiently sensitive and specific markers of hypertension and coronary artery disease in adult males.
{"title":"The intensity of oscillations of the photoplethysmographic waveform variability at frequencies 0.04–0.4 Hz is effective marker of hypertension and coronary artery disease in males","authors":"A. Kiselev, A. Karavaev","doi":"10.1080/08037051.2019.1645586","DOIUrl":"https://doi.org/10.1080/08037051.2019.1645586","url":null,"abstract":"Abstract Background: It is believed that the intensity of oscillations in the photoplethysmographic waveform variability reflects the activity of vascular regulatory mechanisms. However, the relationship of such fluctuations with the state of health is poorly understood. Purpose: The aim of our study was to assess the possibility of using spectral indices that reflect the intensity of oscillations of the photoplethysmographic waveform variability at frequencies 0.04-0.4 Hz as markers of hypertension and coronary artery disease. We did not study women to exclude the influence of menopause and sex hormones on the results. Materials and Methods: We compared synchronous 10-minute records of finger photoplethysmogram and respiration at rest in 30 healthy males (48.8 ± 4.5 years; data presented as Mean ± SD) versus 30 patients with hypertension (aged 49.0 ± 4.3 years) versus 30 patients with stable coronary artery disease (49.2 ± 4.8 years). Percentages of high-frequency and low-frequency ranges in the total power of photoplethysmographic waveform variability spectrum (HF% and LF%), and LF/HF ratio were assessed. Results: HF% are subject to by 2- to 5-fold increase in hypertensive patients (p < .001) and up to an 8-fold increase in patients with coronary artery disease (p < .001) when compared with healthy persons. On the contrary, LF% is reduced by 1.5-5 times in all patients when compared with healthy people (p < .001). We identified cut-off points for each photoplethysmographic index to distinguish patients with coronary artery disease or hypertension from healthy subjects. Multiple logistic regression models based on photoplethysmographic waveform variability indices had sufficient sensitivity and specificity for patients with hypertension or coronary artery disease. Conclusion: Frequency-domain indices of photoplethysmographic waveform variability (in particular, HF%, LF%, and LF/HF) are sufficiently sensitive and specific markers of hypertension and coronary artery disease in adult males.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"29 1","pages":"55 - 62"},"PeriodicalIF":1.8,"publicationDate":"2020-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2019.1645586","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43465670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-09DOI: 10.1080/08037051.2019.1697177
P. Midlöv, P. Nilsson, U. Bengtsson, M. Hoffmann, A. Wennersten, U. Andersson, U. Malmqvist, K. Steen Carlsson, A. Ranerup, K. Kjellgren
Abstract Purpose: For primary health care (PHC), hypertension is the number one diagnosis for planned health care visits. The treatment of high blood pressure (BP) and its consequences constitutes a substantial economic burden. In spite of efficient antihypertensive medications, a low percentage of patients reach a well-controlled BP. The PERson-centredness in Hypertension management using Information Technology (PERHIT) Study is a multicentre randomised controlled trial. PERHIT is designed to evaluate the effect of supporting self-management on systolic blood pressure by the use of information technology in Swedish primary health care. Materials and Methods: After inclusion, 900 patients from 36 PHC centres are randomised to two groups. In the intervention group, patients are provided with a self-management support system including a home-BP monitor and further requested to perform self-reports and measure BP every evening for eight consecutive weeks. In the control group, patients receive treatment as usual. Results: The primary outcome will be the change in systolic blood pressure in patients with hypertension. In addition, person-centredness, daily life activities, awareness of risk and health care costs will also be evaluated. Conclusion: The results of this randomised controlled trial with assessment of blood pressure and same-day self-reports will provide patients a tool to understand the interplay between blood pressure and lifestyle applicable to primary health care. The self-management support system may be of importance for improved adherence to treatment and persistence to treatment recommendations.
{"title":"PERson-centredness in hypertension management using information technology (PERHIT): a protocol for a randomised controlled trial in primary health care","authors":"P. Midlöv, P. Nilsson, U. Bengtsson, M. Hoffmann, A. Wennersten, U. Andersson, U. Malmqvist, K. Steen Carlsson, A. Ranerup, K. Kjellgren","doi":"10.1080/08037051.2019.1697177","DOIUrl":"https://doi.org/10.1080/08037051.2019.1697177","url":null,"abstract":"Abstract Purpose: For primary health care (PHC), hypertension is the number one diagnosis for planned health care visits. The treatment of high blood pressure (BP) and its consequences constitutes a substantial economic burden. In spite of efficient antihypertensive medications, a low percentage of patients reach a well-controlled BP. The PERson-centredness in Hypertension management using Information Technology (PERHIT) Study is a multicentre randomised controlled trial. PERHIT is designed to evaluate the effect of supporting self-management on systolic blood pressure by the use of information technology in Swedish primary health care. Materials and Methods: After inclusion, 900 patients from 36 PHC centres are randomised to two groups. In the intervention group, patients are provided with a self-management support system including a home-BP monitor and further requested to perform self-reports and measure BP every evening for eight consecutive weeks. In the control group, patients receive treatment as usual. Results: The primary outcome will be the change in systolic blood pressure in patients with hypertension. In addition, person-centredness, daily life activities, awareness of risk and health care costs will also be evaluated. Conclusion: The results of this randomised controlled trial with assessment of blood pressure and same-day self-reports will provide patients a tool to understand the interplay between blood pressure and lifestyle applicable to primary health care. The self-management support system may be of importance for improved adherence to treatment and persistence to treatment recommendations.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"29 1","pages":"149 - 156"},"PeriodicalIF":1.8,"publicationDate":"2019-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2019.1697177","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47013872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-02DOI: 10.1080/08037051.2019.1696180
L. Oinonen, Jenni Koskela, Arttu Eräranta, A. Tikkakoski, M. Kähönen, O. Niemelä, J. Mustonen, I. Pörsti
Abstract Purpose: The underlying causes of primary hypertension are not fully understood. Evidence on the relation of plasma calcium concentration with blood pressure (BP) is inconsistent and relies largely on studies utilizing office BP measurements in populations using cardiovascular drugs. In many studies adjustment for confounders was not optimal. In this cross-sectional study we examined the association of plasma total calcium concentration with the haemodynamic determinants of blood pressure. Subjects and methods: Supine haemodynamics were recorded using pulse wave analysis, whole-body impedance cardiography, and heart rate variability analysis in 618 normotensive or never-treated hypertensive subjects (aged 19–72 years) without diabetes, cardiovascular or renal disease, or cardiovascular medications. Linear regression analysis was used to investigate factors associated with haemodynamic variables. Results: Mean age was 45.0 years, body mass index 26.8 kg/m2, seated office BP 141/89 mmHg, and 307 subjects (49.7%) were male. Mean values of routine blood and plasma chemistry analyses were within the reference limits of the tests except for low-density lipoprotein cholesterol (3.05 mmol/l). In the laboratory, mean supine radial BP was 131/75 mmHg, and both systolic and diastolic BP correlated directly with plasma total calcium concentration (r = 0.25 and r = 0.22, respectively, p < 0.001 for both). In regression analysis plasma total calcium concentration was an independent explanatory variable for radial and aortic systolic and diastolic BP, and systemic vascular resistance, but not for cardiac output, pulse wave velocity, or any of the heart rate variability parameters. Conclusion: Plasma total calcium concentration was directly associated with systolic and diastolic BP and systemic vascular resistance in normotensive or never-treated hypertensive subjects without comorbidities and cardiovascular medications. Higher plasma calcium concentration potentially plays a role in primary hypertension via an effect on vascular resistance.
{"title":"Plasma total calcium concentration is associated with blood pressure and systemic vascular resistance in normotensive and never-treated hypertensive subjects","authors":"L. Oinonen, Jenni Koskela, Arttu Eräranta, A. Tikkakoski, M. Kähönen, O. Niemelä, J. Mustonen, I. Pörsti","doi":"10.1080/08037051.2019.1696180","DOIUrl":"https://doi.org/10.1080/08037051.2019.1696180","url":null,"abstract":"Abstract Purpose: The underlying causes of primary hypertension are not fully understood. Evidence on the relation of plasma calcium concentration with blood pressure (BP) is inconsistent and relies largely on studies utilizing office BP measurements in populations using cardiovascular drugs. In many studies adjustment for confounders was not optimal. In this cross-sectional study we examined the association of plasma total calcium concentration with the haemodynamic determinants of blood pressure. Subjects and methods: Supine haemodynamics were recorded using pulse wave analysis, whole-body impedance cardiography, and heart rate variability analysis in 618 normotensive or never-treated hypertensive subjects (aged 19–72 years) without diabetes, cardiovascular or renal disease, or cardiovascular medications. Linear regression analysis was used to investigate factors associated with haemodynamic variables. Results: Mean age was 45.0 years, body mass index 26.8 kg/m2, seated office BP 141/89 mmHg, and 307 subjects (49.7%) were male. Mean values of routine blood and plasma chemistry analyses were within the reference limits of the tests except for low-density lipoprotein cholesterol (3.05 mmol/l). In the laboratory, mean supine radial BP was 131/75 mmHg, and both systolic and diastolic BP correlated directly with plasma total calcium concentration (r = 0.25 and r = 0.22, respectively, p < 0.001 for both). In regression analysis plasma total calcium concentration was an independent explanatory variable for radial and aortic systolic and diastolic BP, and systemic vascular resistance, but not for cardiac output, pulse wave velocity, or any of the heart rate variability parameters. Conclusion: Plasma total calcium concentration was directly associated with systolic and diastolic BP and systemic vascular resistance in normotensive or never-treated hypertensive subjects without comorbidities and cardiovascular medications. Higher plasma calcium concentration potentially plays a role in primary hypertension via an effect on vascular resistance.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"29 1","pages":"137 - 148"},"PeriodicalIF":1.8,"publicationDate":"2019-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2019.1696180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44020538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-13DOI: 10.1080/08037051.2019.1684817
Kjersti B. Blom, K. Bergo, E. Espe, Vigdis Rosseland, O. Grøtta, G. Mjøen, A. Åsberg, S. Bergan, H. Sanner, T. K. Bergersen, R. Bjørnerheim, M. Skauby, I. Seljeflot, B. Waldum-Grevbo, D. O. Dahle, I. Sjaastad, J. Birkeland
Abstract Purpose: Until recently, it has been believed that donating a kidney not represents any risk for development of cardiovascular disease. However, a recent Norwegian epidemiological study suggests that kidney donors have an increased long-term risk of cardiovascular mortality. The pathophysiological mechanisms linking reduced kidney function to cardiovascular disease are not known. Living kidney donors are screened for cardiovascular morbidity before unilateral nephrectomy, and are left with mildly reduced glomerular filtration rate (GFR) after donation. Therefore, they represent an unique model for investigating the pathogenesis linking reduced GFR to cardiovascular disease and cardiovascular remodelling. We present the study design of Cardiovascular rEmodelling in living kidNey donorS with reduced glomerular filtration rate (CENS), which is an investigator-initiated prospective observational study on living kidney donors. The hypothesis is that living kidney donors develop cardiovascular remodelling due to a reduction of GFR. Materials and methods: 60 living kidney donors and 60 age and sex matched healthy controls will be recruited. The controls will be evaluated to fulfil the Norwegian transplantation protocol for living kidney donors. Investigations will be performed at baseline and after 1, 3, 6 and 10 years in both groups. The investigations include cardiac magnetic resonance imaging, echocardiography, bone density scan, flow mediated dilatation, laser Doppler flowmetry, nailfold capillaroscopy, office blood pressure, 24-h ambulatory blood pressure, heart rate variability and investigation of microbiota and biomarkers for inflammation, cardiovascular risk and the calcium-phosphate metabolism. Conclusions: The present study seeks to provide new insight in the pathophysiological mechanisms linking reduced kidney function to cardiovascular disease. In addition, we aim to enlighten predictors of adverse cardiovascular outcome in living kidney donors. The study is registered at Clinical-Trials.gov (identifier: NCT03729557).
{"title":"Cardiovascular rEmodelling in living kidNey donorS with reduced glomerular filtration rate: rationale and design of the CENS study","authors":"Kjersti B. Blom, K. Bergo, E. Espe, Vigdis Rosseland, O. Grøtta, G. Mjøen, A. Åsberg, S. Bergan, H. Sanner, T. K. Bergersen, R. Bjørnerheim, M. Skauby, I. Seljeflot, B. Waldum-Grevbo, D. O. Dahle, I. Sjaastad, J. Birkeland","doi":"10.1080/08037051.2019.1684817","DOIUrl":"https://doi.org/10.1080/08037051.2019.1684817","url":null,"abstract":"Abstract Purpose: Until recently, it has been believed that donating a kidney not represents any risk for development of cardiovascular disease. However, a recent Norwegian epidemiological study suggests that kidney donors have an increased long-term risk of cardiovascular mortality. The pathophysiological mechanisms linking reduced kidney function to cardiovascular disease are not known. Living kidney donors are screened for cardiovascular morbidity before unilateral nephrectomy, and are left with mildly reduced glomerular filtration rate (GFR) after donation. Therefore, they represent an unique model for investigating the pathogenesis linking reduced GFR to cardiovascular disease and cardiovascular remodelling. We present the study design of Cardiovascular rEmodelling in living kidNey donorS with reduced glomerular filtration rate (CENS), which is an investigator-initiated prospective observational study on living kidney donors. The hypothesis is that living kidney donors develop cardiovascular remodelling due to a reduction of GFR. Materials and methods: 60 living kidney donors and 60 age and sex matched healthy controls will be recruited. The controls will be evaluated to fulfil the Norwegian transplantation protocol for living kidney donors. Investigations will be performed at baseline and after 1, 3, 6 and 10 years in both groups. The investigations include cardiac magnetic resonance imaging, echocardiography, bone density scan, flow mediated dilatation, laser Doppler flowmetry, nailfold capillaroscopy, office blood pressure, 24-h ambulatory blood pressure, heart rate variability and investigation of microbiota and biomarkers for inflammation, cardiovascular risk and the calcium-phosphate metabolism. Conclusions: The present study seeks to provide new insight in the pathophysiological mechanisms linking reduced kidney function to cardiovascular disease. In addition, we aim to enlighten predictors of adverse cardiovascular outcome in living kidney donors. The study is registered at Clinical-Trials.gov (identifier: NCT03729557).","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"29 1","pages":"123 - 134"},"PeriodicalIF":1.8,"publicationDate":"2019-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2019.1684817","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46258513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-13DOI: 10.1080/08037051.2019.1689808
Min Min, Tingting Shi, Chenyu Sun, Mingming Liang, Yun Zhang, S. Tian, Yehuan Sun
Abstract Purposes: Many studies have indicated that orthostatic hypotension (OH) may be a risk factor for dementia and stroke, but the results have been inconsistent. To further ascertain the links between OH and cognition or stroke, a meta-analysis was performed. Methods: The Chinese Biomedical Database, PubMed, Web of Science, and the Cochrane Library database were searched (up to March 2019) to identify prospective cohort studies that examined the associations between OH and the risks of stroke and dementia among adult populations. Subgroup analyses and meta-regression analyses were conducted to identify sources of heterogeneity. We also performed Begg’s test and Egger’s test to assess publication bias. Results: A total of 3490 articles were identified, and 18 prospective observational cohort studies were ultimately included. Among these studies, eight prospective studies were about stroke, nine studies were about cognition and one study reported data about both stroke and dementia. Meta-analysis revealed an association between OH and worse cognition (hazard ratio (HR): 1.18, 95% confidence interval (CI): 1.03–1.35, I2 = 69.5%). For dementia, the pooled HR was 1.30, with 95% CI: 1.14–1.48, I2 = 31.0%. In addition, we found that OH was associated with a higher risk of stroke (HR: 1.36, 95% CI = 1.17–1.57, I2 = 67.3%). No publication bias was detected. Conclusion: This meta-analysis provides evidence that OH was associated with worse cognition. OH accounted for a 30% increase in the risk of dementia and a 36% increase in the risk of stroke.
{"title":"The association between orthostatic hypotension and cognition and stroke: a meta-analysis of prospective cohort studies","authors":"Min Min, Tingting Shi, Chenyu Sun, Mingming Liang, Yun Zhang, S. Tian, Yehuan Sun","doi":"10.1080/08037051.2019.1689808","DOIUrl":"https://doi.org/10.1080/08037051.2019.1689808","url":null,"abstract":"Abstract Purposes: Many studies have indicated that orthostatic hypotension (OH) may be a risk factor for dementia and stroke, but the results have been inconsistent. To further ascertain the links between OH and cognition or stroke, a meta-analysis was performed. Methods: The Chinese Biomedical Database, PubMed, Web of Science, and the Cochrane Library database were searched (up to March 2019) to identify prospective cohort studies that examined the associations between OH and the risks of stroke and dementia among adult populations. Subgroup analyses and meta-regression analyses were conducted to identify sources of heterogeneity. We also performed Begg’s test and Egger’s test to assess publication bias. Results: A total of 3490 articles were identified, and 18 prospective observational cohort studies were ultimately included. Among these studies, eight prospective studies were about stroke, nine studies were about cognition and one study reported data about both stroke and dementia. Meta-analysis revealed an association between OH and worse cognition (hazard ratio (HR): 1.18, 95% confidence interval (CI): 1.03–1.35, I2 = 69.5%). For dementia, the pooled HR was 1.30, with 95% CI: 1.14–1.48, I2 = 31.0%. In addition, we found that OH was associated with a higher risk of stroke (HR: 1.36, 95% CI = 1.17–1.57, I2 = 67.3%). No publication bias was detected. Conclusion: This meta-analysis provides evidence that OH was associated with worse cognition. OH accounted for a 30% increase in the risk of dementia and a 36% increase in the risk of stroke.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"29 1","pages":"12 - 3"},"PeriodicalIF":1.8,"publicationDate":"2019-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2019.1689808","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43083762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-12DOI: 10.1080/08037051.2019.1673149
G. J. Hassing, H. V. D. van der Wall, G. V. van Westen, M. Kemme, A. Adiyaman, A. Elvan, J. Burggraaf, P. Gal
Abstract Purpose: Elevated blood pressure induces electrocardiographic changes and is associated with an increase in cardiovascular disease later in life compared to normal blood pressure levels. The purpose of this study was to evaluate the association between normal to high normal blood pressure values (90–139/50–89 mmHg) and electrocardiographic parameters related to cardiac changes in hypertension in healthy young adults. Methods: Data from 1449 volunteers aged 18–30 years collected at our centre were analyzed. Only subjects considered healthy by a physician after review of collected data with systolic blood pressure values between 90 and 139 mmHg and diastolic blood pressure values between 50 and 89 mmHg were included. Subjects were divided into groups with 10 mmHg systolic blood pressure increment between groups for analysis of electrocardiographic differences. Backward multivariate regression analysis with systolic and diastolic blood pressure as a continuous variable was performed. Results: The mean age was 22.7 ± 3.0 years, 73.7% were male. P-wave area, ventricular activation time, QRS-duration, Sokolow–Lyon voltages, Cornell Product, J-point–T-peak duration corrected for heart rate and maximum T-wave duration were significantly different between systolic blood pressure groups. In the multivariate model with gender, body mass index and cholesterol, ventricular rate (standardized coefficient (SC): +0.182, p < .001), ventricular activation time in lead V6 (SC= +0.065, p = .048), Sokolow–Lyon voltage (SC= +0.135, p < .001), and Cornell product (SC= +0.137, p < .001) were independently associated with systolic blood pressure, while ventricular rate (SC= +0.179, p < .001), P-wave area in lead V1 (SC= +0.079, p = .020), and Cornell product (SC= +0.091, p = .006) were independently associated with diastolic blood pressure. Conclusion: Blood pressure-related electrocardiographic changes were observed incrementally in a healthy young population with blood pressure in the normal range. These changes were an increased ventricular rate, increased atrial surface area, ventricular activation time and increased ventricular hypertrophy indices on a standard 12 lead electrocardiogram.
{"title":"Blood pressure-related electrocardiographic findings in healthy young individuals","authors":"G. J. Hassing, H. V. D. van der Wall, G. V. van Westen, M. Kemme, A. Adiyaman, A. Elvan, J. Burggraaf, P. Gal","doi":"10.1080/08037051.2019.1673149","DOIUrl":"https://doi.org/10.1080/08037051.2019.1673149","url":null,"abstract":"Abstract Purpose: Elevated blood pressure induces electrocardiographic changes and is associated with an increase in cardiovascular disease later in life compared to normal blood pressure levels. The purpose of this study was to evaluate the association between normal to high normal blood pressure values (90–139/50–89 mmHg) and electrocardiographic parameters related to cardiac changes in hypertension in healthy young adults. Methods: Data from 1449 volunteers aged 18–30 years collected at our centre were analyzed. Only subjects considered healthy by a physician after review of collected data with systolic blood pressure values between 90 and 139 mmHg and diastolic blood pressure values between 50 and 89 mmHg were included. Subjects were divided into groups with 10 mmHg systolic blood pressure increment between groups for analysis of electrocardiographic differences. Backward multivariate regression analysis with systolic and diastolic blood pressure as a continuous variable was performed. Results: The mean age was 22.7 ± 3.0 years, 73.7% were male. P-wave area, ventricular activation time, QRS-duration, Sokolow–Lyon voltages, Cornell Product, J-point–T-peak duration corrected for heart rate and maximum T-wave duration were significantly different between systolic blood pressure groups. In the multivariate model with gender, body mass index and cholesterol, ventricular rate (standardized coefficient (SC): +0.182, p < .001), ventricular activation time in lead V6 (SC= +0.065, p = .048), Sokolow–Lyon voltage (SC= +0.135, p < .001), and Cornell product (SC= +0.137, p < .001) were independently associated with systolic blood pressure, while ventricular rate (SC= +0.179, p < .001), P-wave area in lead V1 (SC= +0.079, p = .020), and Cornell product (SC= +0.091, p = .006) were independently associated with diastolic blood pressure. Conclusion: Blood pressure-related electrocardiographic changes were observed incrementally in a healthy young population with blood pressure in the normal range. These changes were an increased ventricular rate, increased atrial surface area, ventricular activation time and increased ventricular hypertrophy indices on a standard 12 lead electrocardiogram.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"29 1","pages":"113 - 122"},"PeriodicalIF":1.8,"publicationDate":"2019-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2019.1673149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47074968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-07DOI: 10.1080/08037051.2019.1686343
Qi Chen, Yi-Bang Cheng, Meng Shen, Bin Yin, H. Yi, Jing Feng, Min Li, Qing-Yun Li, Yan Li, Ji-Guang Wang
Abstract Objective: In a randomised controlled trial, we investigated the blood pressure (BP) lowering effect of continuous positive airway pressure (CPAP) in patients with moderate-severe obstructive sleep apnoea syndrome (OSAS, an apnoea-hypopnoea index, AHI of 15 or higher) and nocturnal hypertension (night-time systolic/diastolic BP ≥120/70 mmHg). Methods: Sixty patients were randomly assigned to CPAP or sham CPAP, while maintaining their antihypertensive treatment. Ambulatory BP monitoring was performed at baseline (first run-in visit) and the end of follow-up. Clinic and home BP were measured at baseline and each of the monthly follow-up visits. Results: Of the 60 patients, 47 completed the 3-month study. CPAP (n = 26), compared with sham CPAP (n = 21), slightly and non-significantly reduced 24-h systolic/diastolic BP by −2.8/−2.5 mmHg (p ≥ 0.27), with a slightly greater between-group difference in the daytime (−4.0/−2.8 mmHg, p ≥ 0.29) than night-time (−0.2/−1.5 mmHg, p ≥ 0.50). The CPAP treatment did not significantly influence clinic or home BP during follow-up (p ≥ 0.27). Nonetheless, simple and partial correlation analyses showed that the ambulatory BP lowering effect was dependent on the daytime pulse rate at baseline (r ≥ 0.47, p ≤ 0.01). In patients with a daytime pulse rate greater than 85 beats/min, the mean changes in daytime systolic BP were significantly greater in the CPAP (n = 10) than sham CPAP group (n = 11), with a between-group mean difference of −10.1 mmHg (p = 0.048). Conclusions: The CPAP treatment did not show significant ambulatory BP lowering effect in patients with moderate-severe OSAS and nocturnal hypertension. However, it may be effective in lowering daytime BP in patients with a faster pulse rate.
{"title":"A randomized controlled trial on ambulatory blood pressure lowering effect of CPAP in patients with obstructive sleep apnea and nocturnal hypertension","authors":"Qi Chen, Yi-Bang Cheng, Meng Shen, Bin Yin, H. Yi, Jing Feng, Min Li, Qing-Yun Li, Yan Li, Ji-Guang Wang","doi":"10.1080/08037051.2019.1686343","DOIUrl":"https://doi.org/10.1080/08037051.2019.1686343","url":null,"abstract":"Abstract Objective: In a randomised controlled trial, we investigated the blood pressure (BP) lowering effect of continuous positive airway pressure (CPAP) in patients with moderate-severe obstructive sleep apnoea syndrome (OSAS, an apnoea-hypopnoea index, AHI of 15 or higher) and nocturnal hypertension (night-time systolic/diastolic BP ≥120/70 mmHg). Methods: Sixty patients were randomly assigned to CPAP or sham CPAP, while maintaining their antihypertensive treatment. Ambulatory BP monitoring was performed at baseline (first run-in visit) and the end of follow-up. Clinic and home BP were measured at baseline and each of the monthly follow-up visits. Results: Of the 60 patients, 47 completed the 3-month study. CPAP (n = 26), compared with sham CPAP (n = 21), slightly and non-significantly reduced 24-h systolic/diastolic BP by −2.8/−2.5 mmHg (p ≥ 0.27), with a slightly greater between-group difference in the daytime (−4.0/−2.8 mmHg, p ≥ 0.29) than night-time (−0.2/−1.5 mmHg, p ≥ 0.50). The CPAP treatment did not significantly influence clinic or home BP during follow-up (p ≥ 0.27). Nonetheless, simple and partial correlation analyses showed that the ambulatory BP lowering effect was dependent on the daytime pulse rate at baseline (r ≥ 0.47, p ≤ 0.01). In patients with a daytime pulse rate greater than 85 beats/min, the mean changes in daytime systolic BP were significantly greater in the CPAP (n = 10) than sham CPAP group (n = 11), with a between-group mean difference of −10.1 mmHg (p = 0.048). Conclusions: The CPAP treatment did not show significant ambulatory BP lowering effect in patients with moderate-severe OSAS and nocturnal hypertension. However, it may be effective in lowering daytime BP in patients with a faster pulse rate.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"82 1","pages":"21 - 30"},"PeriodicalIF":1.8,"publicationDate":"2019-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2019.1686343","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"59547552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-18DOI: 10.1080/08037051.2019.1678261
S. Kjeldsen, K. Narkiewicz, M. Burnier, S. Oparil
{"title":"Systolic blood pressure control prevents cognitive decline and slows development of white matter lesions in the brain: the SPRINT MIND study outcomes","authors":"S. Kjeldsen, K. Narkiewicz, M. Burnier, S. Oparil","doi":"10.1080/08037051.2019.1678261","DOIUrl":"https://doi.org/10.1080/08037051.2019.1678261","url":null,"abstract":"","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"28 1","pages":"356 - 357"},"PeriodicalIF":1.8,"publicationDate":"2019-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2019.1678261","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49591734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/08037051.2019.1664717
S. Kjeldsen, K. Narkiewicz, M. Burnier, S. Oparil
Novel angiotensin receptor antagonist/neprilysin inhibitors (ARNIs) seek to exploit the clinical benefits of combining renin-angiotensin-aldosterone-system (RAAS) antagonism and neutral endopeptida...
{"title":"The PARAGON-Heart failure trial – another disappointment for heart failure patients with hypertension and preserved ejection fraction","authors":"S. Kjeldsen, K. Narkiewicz, M. Burnier, S. Oparil","doi":"10.1080/08037051.2019.1664717","DOIUrl":"https://doi.org/10.1080/08037051.2019.1664717","url":null,"abstract":"Novel angiotensin receptor antagonist/neprilysin inhibitors (ARNIs) seek to exploit the clinical benefits of combining renin-angiotensin-aldosterone-system (RAAS) antagonism and neutral endopeptida...","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"28 1","pages":"276 - 278"},"PeriodicalIF":1.8,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2019.1664717","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43434899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-08DOI: 10.1080/08037051.2019.1644155
M. Burnier, Shan-yan Lin, L. Ruilope, G. Bader, S. Durg, P. Brunel
Abstract Objective: Angiotensin receptor blockers (ARB) are among the recommended first-line treatment options in patients with hypertension and chronic kidney disease (CKD). This meta-analysis evaluated the effect of ARB on blood pressure (BP) and renal function in patients with concomitant hypertension and CKD with or without diabetes. Methods: Literature search was performed in PubMed/MEDLINE, EMBASE and BIOSIS to identify parallel-group, randomized controlled trials (≥8 weeks) reporting the effects of ARB on office systolic/diastolic BP (SBP/DBP), estimated glomerular filtration rate (eGFR), serum creatinine (SCr), creatinine clearance (CrCl) or proteinuria in adults with hypertension and CKD. Mean difference (MD, generic inverse variance) with 95% confidence intervals (CIs) was used to report an outcome. Results: Among the 24 studies identified, 19 evaluated ARB as monotherapy, 4 evaluated ARB as combination therapy and one evaluated ARB both as monotherapy and combination therapy. Median (range) duration of the studies was 12 (1.84–54.0) months. ARB monotherapy significantly (p < 0.01) reduced BP (treatment ≥1 year: SBP [MD: −14.84 mmHg; 95% CI: −17.82 to −11.85]/DBP [−10.27 mmHg; −12.26 to −8.27]) and proteinuria (≥1 year [−0.90 g/L; −1.22 to −0.59]). Results were consistent for combination therapy. In these studies, non-significant changes were observed for eGFR, CrCl and SCr. The impact of SBP changes on eGFR was not significant; however, studies were of a relatively short duration. Conclusion: ARB had a favorable impact on BP and renal parameters such as proteinuria with monotherapy as well as with combination therapy, highlighting their potential benefits in patients with hypertension and CKD. During the short follow-up of these studies, no significant change in eGFR was observed.
{"title":"Effect of angiotensin receptor blockers on blood pressure and renal function in patients with concomitant hypertension and chronic kidney disease: a systematic review and meta-analysis","authors":"M. Burnier, Shan-yan Lin, L. Ruilope, G. Bader, S. Durg, P. Brunel","doi":"10.1080/08037051.2019.1644155","DOIUrl":"https://doi.org/10.1080/08037051.2019.1644155","url":null,"abstract":"Abstract Objective: Angiotensin receptor blockers (ARB) are among the recommended first-line treatment options in patients with hypertension and chronic kidney disease (CKD). This meta-analysis evaluated the effect of ARB on blood pressure (BP) and renal function in patients with concomitant hypertension and CKD with or without diabetes. Methods: Literature search was performed in PubMed/MEDLINE, EMBASE and BIOSIS to identify parallel-group, randomized controlled trials (≥8 weeks) reporting the effects of ARB on office systolic/diastolic BP (SBP/DBP), estimated glomerular filtration rate (eGFR), serum creatinine (SCr), creatinine clearance (CrCl) or proteinuria in adults with hypertension and CKD. Mean difference (MD, generic inverse variance) with 95% confidence intervals (CIs) was used to report an outcome. Results: Among the 24 studies identified, 19 evaluated ARB as monotherapy, 4 evaluated ARB as combination therapy and one evaluated ARB both as monotherapy and combination therapy. Median (range) duration of the studies was 12 (1.84–54.0) months. ARB monotherapy significantly (p < 0.01) reduced BP (treatment ≥1 year: SBP [MD: −14.84 mmHg; 95% CI: −17.82 to −11.85]/DBP [−10.27 mmHg; −12.26 to −8.27]) and proteinuria (≥1 year [−0.90 g/L; −1.22 to −0.59]). Results were consistent for combination therapy. In these studies, non-significant changes were observed for eGFR, CrCl and SCr. The impact of SBP changes on eGFR was not significant; however, studies were of a relatively short duration. Conclusion: ARB had a favorable impact on BP and renal parameters such as proteinuria with monotherapy as well as with combination therapy, highlighting their potential benefits in patients with hypertension and CKD. During the short follow-up of these studies, no significant change in eGFR was observed.","PeriodicalId":55591,"journal":{"name":"Blood Pressure","volume":"28 1","pages":"358 - 374"},"PeriodicalIF":1.8,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/08037051.2019.1644155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47355726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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