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  • Neck circumference and blood pressure among children: a systematic review and meta-analysis
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-11-09
    Sajjad Moradi, Hamed Mohammadi, Abed Ghavami, Mohammad Hossein Rouhani

    Emerging evidence suggested that large neck circumference (NC) in children and adolescents may be an indicator of increased blood pressure. We sought to conduct a systematic review and meta-analysis regarding the association between NC and blood pressure in children. Pertinent studies were identified by searching PubMed and Scopus databases, up to January 2018. Studies which reported the correlation coefficient between NC, systolic blood pressure and diastolic blood pressure in children (aged <18 years) were selected. Fifteen studies met eligibility criteria for the quantitative synthesis. Overall, NC was significantly correlated with systolic blood pressure (effect size (z) = 0.39; 95% confidence interval [CI] = 0.29–0.49; P < .001; meta r = 0.371; r2 = 0.13) and diastolic blood pressure (effect size (z) = 0.25; 95% CI = 0.19–0.32; P < .001; meta r = 0.0.245; r2 = 0.06). NC had a positive relationship with the risk of hypertension (odds ratio [OR] = 1.35; 95% CI: 1.05–1.75). Furthermore, studies conducted in Western regions (OR = 1.55; 95% CI: 1.12–2.14) reported higher risk of hypertension in association with NC than those conducted in the Eastern regions (OR = 1.14; 95% CI: 1.03–1.25).NC seems to be a novel anthropometric measurement in children and adolescents. It can be a good predictor of elevated blood pressure, especially in the Western population.

    更新日期:2019-11-18
  • A risk score for carotid plaque as an assessment risk of cardiovascular risk among patients with hypertension
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-11-12
    Hui-Juan Zuo, Xian-Tao Song, Jin-Wen Wang, Li-Qun Deng

    This study aimed to describe the status of carotid plaques and develop a simple scoring system to predict the risk of carotid lesions in patients with hypertension. Basic testing for carotid plaques was carried out and used for risk score development (the training dataset, n = 2665) and validation (the test dataset, n = 1333). Independent predictors of carotid plaques from the multivariate model were assigned integer weights based on their coefficients and incorporated into a risk score. The discriminant ability of the score was tested by receiver operating characteristic analysis using the test dataset. A total of 1346 of 2665 patients were examined for carotid plaques, which were more frequent in men than in women, and increased with age. The final model included eight significant variables, and these variables were then used to develop a risk score for the prediction of carotid plaques. Receiver operating characteristic analysis demonstrated good discriminant power with a C-statistic of 0.732 (95% confidence interval: 0.713–0.751) and good calibration across quantiles of observed predicted risk (74.6%). We developed a simple risk score for the prediction of carotid plaques based on eight variables. The prediction model showed good discriminant power and calibration.

    更新日期:2019-11-18
  • Actigraphy-based sleep characteristics and aortic stiffness: the Multi-Ethnic Study of Atherosclerosis
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-09-29
    Jeongok G. Logan, Hyojung Kang, Jennifer Mason Lobo, Min-Woong Sohn, Gen-Min Lin, Joao A.C. Lima, Naresh M. Punjabi, Susan Redline, Younghoon Kwon

    The study aimed to examine the association between objective estimates of sleep duration and quality and aortic stiffness while accounting for the potential confounding effect of sleep-disordered breathing. Participants were part of the Multi-Ethnic Study of Atherosclerosis Sleep study. Sleep duration and quality were assessed by 7-day wrist actigraphy, sleep-disordered breathing by home polysomnography, and aortic stiffness by magnetic resonance imaging–based aortic pulse wave velocity (aPWV), ascending and descending aorta distensibility. Aortic stiffness of participants with “normal” sleep duration (6-8 hours) were compared with those of “short” (<6 hours) and “long” sleep duration (>8 hours) adjusting for common cardiovascular risk factors and apnea-hypopnea index. The sample consisted of 908 participants (mean age 68.4 ± 9.1 years, 55.3% female). There was a significant linear trend of increased aPWV across short (n = 252), normal (n = 552), and long sleep durations (n = 104) (P for trend = .008). Multivariable analysis showed that people with short sleep duration had 0.94 m/s lower aPWV (95% CI: −1.54, −0.35), compared with those with normal sleep duration. In this ethnically diverse community cohort, habitual short sleep duration as estimated by actigraphy was associated with lower aortic stiffness.

    更新日期:2019-11-18
  • Clinical impact of dipping and nocturnal blood pressure patterns in newly diagnosed, never-treated patients with essential hypertension
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-08-27
    Eugenia Gkaliagkousi, Panagiota Anyfanti, Antonios Lazaridis, Areti Triantafyllou, Anastasios Vamvakis, Nikolaos Koletsos, Panagiotis Dolgyras, Stella Douma

    The significance of nondipping and increased nighttime systolic blood pressure (SBP) in established hypertension is well defined. We investigated whether these factors alone or combined correlate with vascular damage in early-stage hypertension. Newly diagnosed, untreated hypertensives were classified as dippers and nondippers according to ambulatory blood pressure (BP). Twenty-four–hour urinary albumin excretion and markers of arterial stiffness (pulse wave velocity, augmentation index, central and peripheral pulse pressure, central BP) and atherosclerosis (carotid intima-media thickness) were assessed. Serum asymmetric dimethylarginine, an index of endothelial dysfunction, was measured in a study subgroup; 10-year cardiovascular risk was calculated. Among 222 hypertensives, only urinary albumin excretion was increased in nondippers, compared to dippers (P = .026). When dippers were further stratified according to nighttime SBP (<120 or ≥120 mm Hg), the first group demonstrated the lowest levels of office, aortic, 24-hour, daytime and nighttime BP, compared to dippers with elevated nighttime SBP and nondippers. Although vascular measurements and asymmetric dimethylarginine were comparable between these groups, dippers with normal nighttime SBP exhibited the lowest cardiovascular risk score (P = .050). In early-stage hypertension, nondipping was accompanied by microvascular, yet not macrovascular and endothelial dysfunction. Dippers with elevated nighttime SBP appear as a distinct group with increased hemodynamic pressure load and cardiovascular risk.

    更新日期:2019-11-18
  • National trends in the emergency department management of adult patients with elevated blood pressure from 2005 to 2015
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-10-14
    Elizabeth M. Goldberg, Sarah J. Marks, Roland C. Merchant

    Emergency department (ED)-based screening and referral of patients with elevated blood pressure (BP) are recommended by 2006 and 2013 American College of Emergency Physicians guidelines; however, it is unknown if these recommendations or disparities in care impact clinical practice. The objectives of the study were to assess temporal trends in antihypertensive prescriptions, outpatient follow-up referrals, and diagnosis of hypertension (HTN)/elevated BP and to identify potential disparities by patient characteristics. Using the 2005–2015 National Hospital Ambulatory Medical Care Survey, we examined the frequency and trends over time of antihypertensive prescriptions, outpatient follow-up referrals, and BP diagnoses for US ED visits by adult patients with an elevated triage BP and identified potential disparities in management by patient demography and socioeconomic status. Of the 594 million eligible ED visits by patients from 2005 to 2015, 1.2% (1.0%–1.4%) received antihypertensive prescriptions at discharge, 82.3% (80.0%–83.6%) outpatient follow-up referrals, and 2.1% (1.9%–2.4%) an HTN/elevated BP diagnosis. There were small annual increases over time in the odds of antihypertensive prescriptions at discharge (adjusted odds ratio [aOR] 1.05 [1.00–1.10]), follow-up referrals (aOR 1.04 [1.01–1.07]), and HTN/elevated BP diagnosis (aOR 1.05 [1.02–1.08]). For BPs ≥160/100 mm Hg, prescriptions were more common for Blacks (aOR 2.36 [1.93, 2.88]) and uninsured patients (aOR 1.81 [1.38, 2.38]), and diagnoses were more common for Blacks (aOR 1.95 [1.70, 2.24]) and uninsured patients (aOR 1.30 [1.09, 1.55]). These data suggest little change in and the need for improvement in the management of ED patients with elevated BP, despite the American College of Emergency Physicians guidelines, and raise concern about patient care disparities.

    更新日期:2019-11-18
  • A dose-response association of night sleep duration with hypertension in a Chinese rural population: the Henan Rural Cohort Study
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-10-24
    Haiqing Zhang, Yuqian Li, Zhenxing Mao, Min Liu, Wenqian Huo, Ruihua Liu, Xiaotian Liu, Runqi Tu, Kaili Yang, Xinling Qian, Jingjing Jiang, Xia Zhang, Zhongyan Tian, Ronghai Bie, Chongjian Wang

    The purpose of the study was to determine if there was a relationship between night sleep duration and hypertension, and to evaluate as to whether blood lipid levels played a role in this relationship. A total of 37,317 participants aged 18–79 years were included in this study. Night sleep duration was classified as <5, 5-, 6-, 7-, 8-, 9-, and ≥10 hours. Logistic regression and restricted cubic spline analysis was carried out to evaluate the association of sleep duration with hypertension. Compared with reference sleep duration (7 hours), in males, the multivariate odds ratios (ORs) (95% confidence interval [95% CI]) of the groups with longest sleep duration (≥10 hours) and shortest sleep duration (<5 hours) for hypertension was 1.52 (1.25–1.84) and 1.07 (0.80–1.44), respectively. Similarly, the longest sleep duration was associated with diagnosed hypertension (1.21, 1.00–1.45) in females. The OR for an indirect effect of sleep duration through low-density lipoprotein cholesterol (LDL-C) on hypertension was 1.085 (95% CI 1.038–1.137). Overall, a 3.5% possibility of hypertension being associated with sleep duration was attributable to LDL-C. In summary, a relationship between sleep duration and hypertension was observed in this rural population. LDL-C appeared to partially mediate the effect of sleep duration on hypertension in males.

    更新日期:2019-11-18
  • Postexercise hypotension as a clinical tool: a “single brick” in the wall
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-10-24
    Leandro C. Brito, Rafael Y. Fecchio, Tiago Peçanha, Aluisio Andrade-Lima, John R. Halliwill, Claudia L.M. Forjaz

    After an exercise session, a reduction of blood pressure (BP) is expected, a phenomenon called postexercise hypotension (PEH). PEH as a predictor of chronic training responses for BP has been broadly explored. It suggests that when PEH occurs after each exercise sessions, its benefits may summate over time, contributing to the chronic adaptation. Thus, PEH is an important clinical tool, acting as a “single brick” in the wall, and building the chronic effect of decreasing BP. However, there is large variation in the literature regarding methodology and results, creating barriers for understanding comparisons among PEH studies. Thus, the differences among subjects' and exercise protocols’ characteristics observed in the studies investigating PEH must be considered when readers interpret the results. Furthermore, understanding of these factors of influence might be useful for avoiding misinterpretations in future comparisons and how the subjacent mechanisms contribute to the BP reduction after exercise.

    更新日期:2019-11-18
  • Effects of exercise training on endothelial function in individuals with hypertension: a systematic review with meta-analysis
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-09-26
    Marinei L. Pedralli, Bruna Eibel, Gustavo Waclawovsky, Maximiliano I. Schaun, Walter Nisa-Castro-Neto, Daniel Umpierre, Linda S. Pescatello, Hirofumi Tanaka, Alexandre Machado Lehnen

    A slight increase (1%) in endothelial function is associated with reduction of cardiovascular risks by 13% in individuals with cardiovascular disease risk, including those with hypertension. Thus, we conducted a systematic review and meta-analysis to assess the efficacy of exercise training on endothelial function in individuals with hypertension.We included randomized clinical trials (RCTs) with adult participants diagnosed with hypertension undergoing exercise training (≥4 weeks), and the primary outcome was endothelial function, measured by flow-mediated dilatation (FMD). Five studies comprising a total of 362 participants (252 exercise and 110 controls; 59.3 years old, ranged from 52.0 to 67.2 years) were included in the meta-analysis. The pooled mean estimate indicated increased FMD after exercise training of 1.45 (P = .001), and 95% confidence interval −0.11 to 3.00 compared with control comparators. The studies were characterized by significant heterogeneity (χ2 = 23.34, P < .001, I2 = 70%). The present results are consistent with the notion that aerobic exercise training elicits favorable adaptations in endothelial function in individuals with hypertension. However, more studies are needed to make more definitive conclusions.

    更新日期:2019-11-18
  • Renal sonographic changes in heterogeneity index and echogenicity in children with hypertension: a novel assessment
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-11-15
    Christine B. Sethna, Dustin Kee, Pablo Casado, Megan Murphy, Lane S. Palmer, Sleiman R. Ghorayeb, Bradley Morganstern

    The kidneys are thought to contribute to the pathogenesis of primary hypertension, but hypertension is also known to cause target organ damage in the kidney. Noninvasive methods to capture possible changes in the kidney related to hypertension are limited. A new program that has been used to quantify the heterogeneity and percent echogenicity in renal ultrasound images was implemented to assess patients with hypertension. Children and adolescents <21 years with primary hypertension diagnosed by ambulatory blood pressure monitoring were compared with normotensive age- and sex-matched controls. Renal ultrasound images were evaluated by a technique that measured pixels of gray-scale images and transformed them into a binary map, which was converted to a heterogeneity index (HI) and percent echogenicity score. This study included 99 children with hypertension and 99 control subjects. Body mass index (BMI) was greater in the hypertension group. Average HI for hypertension was significantly higher than in controls (1.37 ± 0.19 vs. 1.2 ± 0.23, P = .001), while echogenicity scores were not different (26.6 ± 8.9 vs. 25.9 ± 10, P = .8). In regression analysis adjusting for BMI z-score and race, hypertension was associated with greater HI compared with controls (β = 0.11, 95% confidence interval 0.03–0.18, P = .005). In a model adjusted for age, sex, and BMI z-score in the hypertension group only, no ambulatory blood pressure monitoring measures were associated with HI or echogenicity scores (P > .05).HI was significantly greater in the hypertension group compared with normotensive controls. HI may be a novel method to detect changes in the kidney related to hypertension.

    更新日期:2019-11-18
  • Systolic and diastolic blood pressure percentiles by age and gender in Northeastern Iran
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-11-22
    Maryam Tayefi, Niloofar Shabani, Maryam Saberi-Karimian, Mohammadreza Oladi, Mohsen Mouhebati, Zahra Farjami, Zeinab Sadat Hoseini, Maryam Mohammadi-Bajgyran, Ali Asghar Mahmoudi, Marzieh Eidi Doustabad, Gordon A. Ferns, Habibollah Esmaily, Majid Ghayour-Mobarhan

    Hypertension (HTN) is a major risk factor for coronary artery disease. Its frequency is increasing globally. The aim of our study was to evaluate the reference range of blood pressure (BP) in the Iranian population stratified for age and gender. A total of 1449 subjects without diabetes, CVD, dyslipidemia, HTN history and with a normal BMI (18.5 ≤ BMI<25) were recruited in the present study. Participants were enrolled from the Mashhad stroke and heart atherosclerotic disorder study. Anthropometric indices and demographic data were collected by two health care specialists. A quantile regression model was used to estimate the expected systolic BP (SBP) and diastolic BP (DBP) at specific ages. A P-value of <.05 was considered significant for all analyses. All statistical analyses were performed using R (version 3.4.1) and SPSS software. The population included more men than women (51.6% vs. 48.4%). The mean and standard deviation of age in men (47.5 ± 8.4) was 2 years higher than women (45.63 ± 7.9; P < .001). SBP and DBP were higher in men than women (P < .001). By using a quantile regression model, we concluded that the 5th to 90th percentile of SBP in men, aged 30–69 years, ranged from 95 to 148.08 mm Hg and in women ranged from 86.66 to 140 mm Hg. The 5th to 90th percentile of DBP in men, aged 30–69 years, ranged from 60 to 91.66 mm Hg and in women ranged from 60 to 91.22 mm Hg. We have, for the first time, established the BP percentiles (1st, 5th, 10th, 50th, 90th, 95th, 99th) in an Iranian population stratified by age and gender. These data suggest that a local program for health promotion is necessary for the early identification of HTN in adults aged ≥30 years.

    更新日期:2019-11-18
  • Association between resting heart rate and hypertension in Chinese with different waist-to-height ratio: a population-based cross-sectional study
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-09-05
    Yali Yan, Ye Zhang, Qian Yang, Kaiyan Dong, Fujiao Duan, Shuying Liang, Nan Ma, Wei Nie, Chunhua Song, Kaijuan Wang

    Elevated resting heart rate (RHR) and obesity are important risk factors for hypertension. However, studies are rare on the combined impact of RHR and obesity on prehypertension and hypertension. This study aimed to investigate the association between RHR and hypertension with different waist-to-height ratio (WHtR) in Chinese. The population-based cross-sectional study was conducted during 2013-2015 in Henan province, China, and 15,536 participants aged ≥15 years were included. RHR was classified according to sex-specific quartiles. The cutoff value of WHtR was 0.5 in both sexes. Multilinear and multilogistic regression models were used to evaluate the association of RHR and WHtR with prehypertension and hypertension. In both sexes, higher RHR was associated with higher blood pressure and lower pulse pressure. Compared with the lowest RHR quartile, participants in the highest RHR quartile had an increased risk of prehypertension (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.18–1.65; OR: 1.27, 95% CI: 1.09–1.48) and hypertension (OR: 1.75, 95% CI: 1.43–2.15; OR: 1.36, 95% CI: 1.13–1.63) for male and female, respectively, after fully adjusting the data. In addition, adjusted ORs for prehypertension and hypertension of participants with high WHtR and high RHR were 2.91 (95% CI: 2.38–3.55) and 6.28 (4.96–7.97) for male and 2.45 (2.05–2.93) and 4.63 (3.66–5.85) for female, respectively, compared with the normal WHtR and normal RHR. In conclusion, elevated RHR was significantly associated with the risk of prehypertension and hypertension in Chinese and WHtR as a measure of abdominal obesity further increased this association.

    更新日期:2019-11-18
  • The variance of hypertension prevalence detected by epidemiological survey against clinical practice: data from a rural population in South China
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-11-22
    Min Lai, Huiyu Tong, Yirong Wan, Wenying Wang, Hai Su

    The present study intended to evaluate the variation of the hypertensive prevalence detected on a single-day blood pressure (BP) value against that on an average of 3-day BP values. This study included 1185 residents (age 21–94, 62.6 ± 14.0 years, 491 males) for BP measurements over three separate visits within a 7-day period. The newly diagnosed hypertension on the first day BP value was recorded as hypertension by epidemiological method, whereas that on the average of 3-day BP values as hypertension by clinical method. True positive rate (TPR) was the ratio of the newly diagnosed hypertensives by clinical method to those by epidemiological method. The overestimation ratio was calculated based on the following formula: (epidemiological prevalence–clinical prevalence)/epidemiological prevalence. Our results showed that of the 367 newly diagnosed hypertensives by epidemiological method, 308 were confirmed by clinical method, and with a TPR of 83.9%. The epidemiological prevalence of hypertension was higher than the clinical prevalence (41.1% vs. 36.1%) with an overestimation ratio of 12.2%. In addition, the participants aged <65 years had a lower TPR (77.9% vs. 87.8%, P = .012) against the participants aged ≥65 years. Furthermore, participants with systolic BP values of <160 mm Hg (78.2% vs. 100%, P < .001) or diastolic BP values of <100 mm Hg also had a lower TPR (70.1% vs. 100%, P = .006) compared with those having a systolic BP of 140–159 mm Hg or diastolic BP 90–99 mm Hg. It is concluded that in this population, the hypertension prevalence by epidemiological method is overestimated by 12.2% against clinical hypertension prevalence.

    更新日期:2019-11-18
  • BRD4 expression in patients with essential hypertension and its effect on blood pressure in spontaneously hypertensive rats
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-11-22
    Yan-Min Yang, Rong-Hua Shi, Chuan-Xiang Xu, Lei Li

    The objective of this study was to investigate BRD4 expression in patients with essential hypertension (EH) and its effects on the blood pressure in spontaneously hypertensive (SHR) rats. BRD4 expression was detected by quantitative real-time polymerase chain reaction and western blot in 163 patients with EH and its relation to systolic blood pressure and diastolic blood pressure were analyzed accordingly. In vivo, rats were divided into WKY (Wistar-Kyoto rats), SHR (spontaneously hypertensive rats), SHR + JQ1 (BRD4 inhibitor), and SHR + Vehicle control. Rats' blood pressure was measured by the tail-cuff method. The protein expressions related to inflammation and oxidative stress of rats were determined. BRD4 was higher in patients with EH than healthy controls, which was positively correlated to systolic blood pressure and diastolic blood pressure of enrolled subjects including patients with EH and healthy controls. Rats in the SHR group showed reduced food-intake, decreased body weight, and gradually increased blood pressure compared with WKY group. Besides, SHR rats were upregulated in plasma levels of Ang II, ET-1, MDA, IL-6, and TNF-α, and substantially downregulated in NO, NOS, and SOD levels. Moreover, eNOS activity in aortic tissues of SHR rats declined obviously, whereas the content of nitrite and O2−, the activity of NADPH oxidase and NADH oxidase, and the expression of p-NF-κB p65 went up statistically, which could be partially reversed by JQ1. BRD4 was highly expressed in patients with EH, and inhibiting BRD4 could reduce oxidative stress and inflammatory response, alleviate endothelial cell damage, ameliorate aortic injury, and lower blood pressure, supporting the hypothesis that BRD4 inhibition could be a potential target for the clinical treatment of patients with EH.

    更新日期:2019-11-18
  • Cumulative dose of bevacizumab associates with albuminuria rather than podocyturia in cancer patients
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-06-18
    Stephanie Lankhorst, Hans J. Baelde, Jose A.M.C. Verstijnen, Albert J. ten Tije, Marc H.M. Thelen, A.H. Jan Danser, Anton H. van den Meiracker, Mariëtte H.W. Kappers

    Angiogenesis inhibition with bevacizumab, a monoclonal antibody against vascular endothelial growth factor A (VEGF-A), is an anticancer treatment associated with hypertension and renal glomerular toxicity referred to as a preeclampsia-like syndrome. In preeclampsia, podocyturia predates proteinuria and clinical features of preeclampsia, and is regarded as a biomarker of ongoing glomerular injury. Using a quantitative polymerase chain reaction of the podocyte-specific molecules nephrin, podocin, and VEGF-A in the urine, we examined whether podocyturia is present in bevacizumab-treated cancer patients, and whether it relates to proteinuria and the cumulative dose of bevacizumab. Urine samples were cross-sectionally collected from 43 bevacizumab-treated patients, 21 chemotherapy-treated patients, and 7 healthy controls. Urinary protein-to-creatinine ratio (mean and range) was 32.0 mg/mmol (5.2–284.4) in the bevacizumab group, compared with 11.4 mg/mmol (1.1–21.0) in the chemotherapy group and 7.4 mg/mmol (3.9–16.5) (P < .05) in healthy controls, whereas urinary albumin-to-creatinine ratio values in the three groups were, respectively, 18.9 mg/mmol (0.1–227.7), 1.5 mg/mmol (0.2–3.5), and 0.2 mg/mmol (0.1–0.4) (P < .05). The cumulative dose of bevacizumab ranged from 550 to 93,628 mg. Urinary podocin mRNA expression was undetectable in 59% of participants, urinary nephrin mRNA expression per mmol creatinine ranged from 0.0 to 5.3 and urinary VEGF-A mRNA expression from 0.0 to 2.7. Urinary nephrin mRNA expression did not correlate to the albumin-to-creatinine ratio or the cumulative dose of bevacizumab, whereas the latter correlated with the albumin-to-creatinine ratio (r = 0.77; P < .001). Our results demonstrate that the cumulative dose of bevacizumab is closely correlated with albuminuria but not with podocyturia as measured with the quantitative polymerase chain reaction technique, challenging the feasibility of this measurement to monitor ongoing glomerular injury in patients chronically treated with bevacizumab.

    更新日期:2018-11-29
  • Impact of intradialytic blood pressure changes on cardiovascular outcomes is independent of the volume status of maintenance hemodialysis patients
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-06-28
    Jungho Shin, Seongyup Yeo, Jun Young Hong, Jin Ho Hwang, Su Hyun Kim

    Intradialytic systolic blood pressure (SBP) changes are related to the volume status; however, whether SBP change impacts on adverse outcomes depends on the volume status remains uncertain. We retrospectively investigated the relationship among intradialytic changes in SBP, cardiovascular outcomes, and volume status in maintenance hemodialysis patients. We determined SBP changes (ΔSBP) as postdialysis SBP minus predialysis SBP and volume status as the ratio of extracellular water to total body water (ECW/TBW) using bioelectrical impedance analysis. There were 82 (60.3%) with ΔSBP −20 to 10 mm Hg, 21 (15.4%) with ΔSBP ≤ −20 mm Hg, and 33 (24.3%) with ΔSBP ≥ 10 mm Hg, and they were followed up for a median of 34 months. Cardiovascular events more frequently occurred in the patients with ΔSBP ≤ −20 mm Hg and ≥ 10 mm Hg (hazard ratio: 2.3 and 3.0; P = .062 and .006); these associations persisted even after adjusting for postdialysis ECW/TBW (P = .056 and .028). Moreover, ΔSBP ≥ 10 mm Hg was associated with increased cardiovascular mortalities independent of postdialysis ECW/TBW (P = .043). There was an independent association of volume status between considerable SBP decrease or increase during hemodialysis and adverse cardiovascular outcomes. Besides appropriate volume control, other factors related to BP changes during hemodialysis must be investigated.

    更新日期:2018-11-29
  • Cardiovascular safety of mirabegron: analysis of an integrated clinical trial database of patients with overactive bladder syndrome
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-08-10
    William B. White, Emad Siddiqui, Tri Tat, Billy Franks, Carol R. Schermer

    Mirabegron is a β3-adrenoreceptor agonist used for the treatment of overactive bladder syndrome. We evaluated the cardiovascular (CV) safety of mirabegron using pooled data from 13 studies. The analysis included 13,396 patients who received ≥1 dose of mirabegron (25 mg/50 mg) or comparator antimuscarinics (solifenacin 2.5 mg/5 mg/10 mg or tolterodine extended release 4 mg) as monotherapies, or placebo. We focused on changes in blood pressure and CV adverse events. Baseline CV risk factors had an imbalanced effect on subsequent CV adverse events. The frequency of these adverse events was comparable for overactive bladder treatments (0.4%–1.5%) and placebo (0.9%). Changes from baseline in blood pressure were similar for the overactive bladder treatments and placebo, and did not confer increased risk of CV adverse events. Multivariate analyses demonstrated that baseline CV risk factors (history of arrhythmia, history of coronary artery disease, and history of stroke/transient ischemic attack) were significantly associated with subsequent CV adverse events in the trials, whereas overactive bladder therapies were not. In conclusion, using an analytical approach to carefully control for CV characteristics of patients in these trials demonstrated no evidence of increased CV risk for mirabegron or antimuscarinics over placebo in the treatment of overactive bladder syndrome.

    更新日期:2018-11-29
  • Normal-range albuminuria in healthy subjects increases over time in association with hypertension and metabolic outcomes
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-08-23
    Ayelet Grupper, Doron Schwartz, Shlomo Berliner, Moshe Shashar, Avishay Grupper, Roni Baruch, Idit F. Schwartz, Talia Weinstein, Orit Kliuk Ben-Bassat, Ori Rogowski, David Zeltser, Itzhak Shapira, Shani Shenhar-Tsarfaty

    Albuminuria is a prognostic factor for mortality and cardiovascular events, even at low levels. Changes in albumin excretion are associated with end-stage renal disease and hypertension (HTN) in cohorts including high-risk participants. We aimed to investigate the evolvement of albumin excretion in healthy individuals with normal kidney function and normoalbuminuria, and possible associations with HTN and metabolic outcomes. The study cohort consisted of 1967 healthy adults with normal kidney function (estimated glomerular filtration rate ≥ 90 mL/min/1.73 m2; urine albumin to creatinine ratio [ACR] < 30 mg/g). Delta ACR slope was calculated as ACR difference between two consecutive visits divided by the time interval. During a mean follow-up period of 93.8 months, mean delta ACR slope was 0.27 ± 3.29 mg/g/year and was higher in participants with age >40 years, obesity, a high waist circumference, higher baseline ACR, HTN, prediabetes, and metabolic syndrome. Delta ACR slopes in the upper quartile predicted diabetes (OR = 1.31, P = .027) and albuminuria (4.34, P < .001). Upper quartile of ACR slopes correlated with a higher risk for new-onset HTN (1.249, P = .031). Delta systolic and diastolic blood pressures were associated with ACR slopes in addition to age, body mass index, and baseline ACR. In conclusion, accelerated change in ACR correlates with HTN and diabetes in healthy individuals with normal kidney function and normoalbuminuria.

    更新日期:2018-11-29
  • Determinants of hypertension among adults in Bangladesh as per the JNC7 and 2017 ACC/AHA hypertension guidelines
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-10-22
    Gulam Muhammed Al Kibria, Krystal Swasey, Md. Zabir Hasan, Allysha Choudhury, Rajat Das Gupta, Samuel A. Abariga, Atia Sharmeen, Vanessa Burrowes

    We investigated determinants of hypertension in Bangladesh using both Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Hypertension Association (2017 ACC/AHA) guidelines. After reporting background characteristics, odds ratios (ORs) were obtained by multilevel logistic regression. Among 7,839 respondents aged ≥35 years, 25.7% (n=2016) and 48.0% (n=3,767) respondents had hypertension as per the JNC7 and 2017 ACC/AHA guidelines, respectively. The following factors were significant according to the 2017 ACC/AHA guideline: ≥65 (adjusted OR [AOR]: 2.4, 95% confidence interval [CI]: 2.2-3.0), 55-64 (AOR: 1.6, 95% CI: 1.4-1.9) and 45-54 years (AOR: 1.4, 95% CI: 1.3-1.6) age groups, females (AOR: 2.0, 95% CI: 1.7-2.2), overweight/obesity (AOR: 2.4, 95% CI: 2.0-2.8), diabetes (AOR: 1.4, 95% CI: 1.2-1.6), secondary (AOR: 1.2, 95% CI: 1.1-1.4), or college education level (AOR: 1.8, 95% CI: 1.4-2.3), middle (AOR: 1.3, 95% CI: 1.1-1.6), richer (AOR: 1.5, 95% CI: 1.2-1.8) or richest (AOR: 2.0, 95% CI: 1.6-2.4) wealth quintiles, residence in Khulna (AOR: 1.5, 95% CI: 1.2-1.9), and Rangpur (AOR: 1.7, 95% CI: 1.3-2.2) divisions. All factors were significant as per the JNC7 guideline too. Both guidelines found similar determinants. Prevention and control programs should prioritize increasing awareness among people with higher likelihood of hypertension.

    更新日期:2018-10-23
  • Pediatric Reference Values For Arterial Stiffness Parameters Cardio-Ankle Vascular Index (Cavi) And Cavi0
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-10-22
    Tomas Jurko, Michal Mestanik, Alexander Jurko, Bart Spronck, Alberto Avolio, Andrea Mestanikova, Nikola Sekaninova, Ingrid Tonhajzerova

    The process of arteriosclerosis begins early in life and cardiovascular risk factors identified in childhood tend to persist into adulthood. Cardio-ankle vascular index (CAVI), a recent parameter of arterial stiffness, is considered an independent predictor of cardiovascular risk. However, there are no studies reporting sex- and age-specific physiological values of CAVI in childhood. We aimed to establish reference values for CAVI and its blood pressure-corrected variant (CAVI0) in 500 healthy children and adolescents aged 7 to 19 years and to study potential relationships with anthropometric indices. Sex- and age-specific distributions of CAVI and CAVI0 values in healthy children and adolescents are presented. Boys aged 15–19 years had lower CAVI than girls, which could result from CAVI’s slight blood pressure dependence. CAVI0 did not show such sex difference. Body roundness index — a novel parameter to quantify abdominal fat — was a strong anthropometric predictor of both CAVI and CAVI0. This is the first study providing pediatric age- and sex-specific reference values for arterial stiffness parameters CAVI and CAVI0. The presented data can contribute to the understanding of the evolution of these indices during childhood and adolescence. Under specific conditions, CAVI0 may offer more robust information about arterial stiffness than standard CAVI.

    更新日期:2018-10-22
  • Supplemental Nutrition Assistance Program Size and Timing And Hypertension-Related Emergency Department Claims Among Medicaid Enrollees
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-10-12
    C.O. Ojinnaka, C. Heflin

    Background The Supplemental Nutrition Assistance Program (SNAP) is a public policy program that aims to reduce food insecurity- a social determinant of health that has been associated with suboptimal blood pressure control in the United States. Objective To explore the association between SNAP benefit timing and size, and probability of hypertension-related Emergency Department (ED) claims. Methods This study used the SNAP data from the Missouri’s Department of Social Services for January 2010 to December 2013 linked to Medicaid ED claims data. The dependent variable was probability of hypertension-related and hypertensive emergency ED claims. The independent variables of interest were week of calendar and SNAP benefit months and SNAP benefit amount. Probit regression analyses were conducted. Average marginal effects are reported. Results In a sample of 6,013,951 Medicaid insured SNAP beneficiaries, 11,709 hypertension-related claims were submitted for every 100,000 claims. The average marginal effect of SNAP benefit amount on hypertension-related ED claims was -0.0000638 (P<0.001); thus a $100 increase in SNAP benefits will reduce hypertension-related claims by 638 claims per 100,000 claim. The reduction in ED claims was higher for lower SNAP benefit amounts than at higher SNAP benefit amounts. There was no statistically significant association between week of calendar month in which SNAP benefit was received and probability of hypertension-related ED claims. Conclusion Higher SNAP benefit amount was associated with a decreased probability of hypertension-related ED claims. The impact of an additional dollar of SNAP benefits was larger at lower SNAP benefit amounts.

    更新日期:2018-10-12
  • A Comparison Of Blood Pressure Reductions Following 12-Weeks Of Isometric Exercise Training Either In The Laboratory Or At Home
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-09-22
    B.D.H. Gordon, E. Vinoski Thomas, J. Warren-Findlow, J.S. Marino, J.M. Bennett, A.M. Reitzel, L.J. Leamy, I. Swaine, R. Howden

    Purpose Isometric exercise training (IET) induced reductions in resting blood pressure (RBP) have been achieved in laboratory environments, but data in support of IET outside the lab is scarce. The aim of this study was to compare 12-weeks of home-based (HOM) IET with laboratory-based, face-to-face (LAB) IET in hypertensive adults. Methods 22 hypertensive participants (24-60 years) were randomized to three conditions; HOM, LAB or control (CON). IET involved isometric handgrip training (4 x 2-minutes at 30% maximum voluntary contraction, 3 days per week). RBP was measured every 6-weeks (0, 6 and 12 weeks) during training and 6-weeks post-training (18 weeks). Results Clinically meaningful, but not statistically significant reductions RBP were observed following 12 weeks of LAB IET (SBP -9.1±4.1; DBP -2.8±2.1 P>0.05), which was sustained for 6 weeks of detraining (SBP -8.2±2.9; DBP -4±2.9, P>0.05). RBP was reduced in the HOM group after 12 weeks of training (SBP -9.7±3.4; DBP -2.2±2.0 P>0.05) which was sustained for an additional 6 weeks of detraining (SBP -5.5±3.4; DBP -4.6±1.8, P>0.05). Conclusions Unsupervised home-based IET programs present an exciting opportunity for community-based strategies to combat hypertension but additional work is needed if IET is to be employed routinely outside the laboratory.

    更新日期:2018-09-25
  • Fear of Adverse Events Should Not Prevent the Use of Appropriate Antihypertensive Drug Therapy
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-09-20
    William J. Kostis, Javier Cabrera

    A recent publication reported that Systolic Blood Pressure Intervention Trial (SPRINT) participants with 10-year cardiovascular disease risk less than 11.5% derived more harm than benefit from intensive treatment. The authors consider that serious adverse events (SAE) are of equal importance to that of either all-cause death or the primary composite outcome (myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes). Under this premise, one death would correspond to 2.7 SAE and a primary outcome to 1.8 SAE overall, and to be between 6 and 18 times as important as a SAE in the intensive treatment group. In our opinion, patient utility should be considered when clinical decisions are made for the treatment of hypertension.

    更新日期:2018-09-21
  • Effect of Sleeve Gastrectomy on Hypertension
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-09-19
    Rohan Samson, Gregory Milligan, Eliza Lewine, Fareed Sindi, Joseph Garagliano, Camilo Fernanadez, Rachel Moore, Christopher Ducoin, Suzanne Oparil, Thierry H. Le Jemtel

    Objective To determine the effect of laparoscopic sleeve gastrectomy (LSG) on blood pressure in private practice settings. Methods A retrospective review of 870 consecutive adult patients > 18 years of age who underwent LSG over a period of 12 months in a private bariatric surgery center. Data were collected from the preoperative and postoperative follow up visits at 1, 3, 6 and 12 months. Results The study population consists of 694 hypertensive and 176 normotensive patients. From baseline to 12 months after LSG: 1) Mean body weight/body mass index decreased from 123 kg/44 kg/m2 to 94 kg/34 kg/m2 (p<0.001). 2) Mean systolic/diastolic blood pressure in hypertensive patients decreased from 131.9/79.9 to 127.6/77.1 mm Hg (p<0.001). 3) Only mean systolic blood pressure decreased in normotensive patients from 117.5 to 114.0 mm Hg (p<0.001). One month after LSG: mean systolic blood pressure had decreased from 131.9 to 126.2 mm Hg (p<0. 001) and average number of anti-hypertensive medications per patient declined from 1.5 at baseline to 0.6 (p<0.001). Over the following 11 months blood pressure remained stable despite reduced anti-hypertensive therapy. Patients requiring >2 antihypertensive agents fell from 49% at baseline to 22% at 12- months. HTN resolved in 34% of patients. Linear regression analysis showed no association between change in body weight and change in SBP. Conclusions Within one month of LSG, hypertensive patients experienced a significant decline in SBP and anti-hypertensive therapy that remains unchanged at 12 months in the face of major reductions in anti-hypertensive medications. Weight loss and BP reduction may not be directly related.

    更新日期:2018-09-20
  • Association of hypertension with parity and with the interaction between parity and body mass index in rural Chinese women
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-09-19
    Dechen Liu, Ming Zhang, Yu Liu, Xizhuo Sun, Zhaoxia Yin, Honghui Li, Xinping Luo, Linlin Li, Lu Zhang, Bingyuan Wang, Yongcheng Ren, Yang Zhao, Cheng Cheng, Leilei Liu, Xu Chen, Ruiyuan Zhang, Feiyan Liu, Qionggui Zhou, Dongsheng Hu

    A cross-sectional study was conducted; information for 9247 women living in rural China was collected by questionnaire interview and anthropometric and laboratory measurements during July to August 2013 and July to October 2014. Multiple logistic regression analysis was used to examine the association between parity and hypertension, estimating odds ratios (ORs) and 95% confidence intervals (CIs). The biological interaction between parity and BMI was estimated by the relative excess risk due to interaction (RERI), attributable proportion due to the interaction (AP), and synergy index (SI). In our study, the prevalence of multi-parity and hypertension was 93.10% and 22.90% in premenopausal women and 98.04% and 51.06% in postmenopausal women. For premenopausal women, parity hypertension was not associated with hypertension. And for postmenopausal women, as compared with para 0-1 status, para 2, 3, 4 and ≥5 were positively associated with hypertension: adjusted ORs (95% CI) was 2.04 (1.24-3.38), 2.25 (1.32-3.82), 2.41 (1.34-4.36) and 2.10 (1.04-4.22), respectively. The interaction effect between multi-parity and overweight/obesity on hypertension was additive (RERI [95% CI]: 1.59, 0.19-3.00; AP [95% CI]: 0.34, 0.02-0.67) only in postmenopausal women. Parity was independently related to hypertension, and the interaction effect between multi-parity and overweight/obesity on hypertension was additive in rural postmenopausal women.

    更新日期:2018-09-20
  • Independent Urban Effect On Hypertension Of Older Indians: Identification Of A Knowledge Gap From Study On Global Ageing And Health
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-09-19
    Dutta Ambarish, A.K. Kavitha, Samal Sudipta, Pati Sanghamitra, Swain Shubhashisa, Nanda Lipika, Panigrahi Pinaki

    Among older Indians,more cardiovascular diseases and risk factors are observed in the city-dwellers than in the rural population. Clustering of socio-economic privileges and consequent obesity in the Indian cities are known to underlie this phenomenon.But, it is unclear whether an independent urban effect exists on age-related ailments, unexplained by concentration of privileges and excess weight in the Indian cities.Hence, we aimed to estimate the independent urban effect on hypertension among older Indians after controlling for these factors. Nationally-representative data of 50 years+ Indians (n=7273) were collected by Study on Global AGEing and Health. Hypertension was defined as systolic and/or diastolic blood pressure >139 and>89 mm Hg respectively and/or someone receiving anti-hypertensive medications. Permanent place of residence (urban/rural) during interview was recorded. Socio-economic determinants included caste, occupation, assets and education. Body mass index, abdominal circumference,smoking, alcohol and physical activity were also controlled. The age-sex-adjusted Odds Ratio of hypertension for urban residents was 1.64(146-1.83), which partially attenuated to 1.22(1.07-1.38) after controlling for all the co-variates. This study highlights 22% excess odds of hypertension among the older Indian city-dwellers, unexplained by the greater urban concentration of socio-economic privileges and obesity. Future research should explore the constituents of this urban effect.

    更新日期:2018-09-20
  • Predicting the Risk of Apparent Treatment Resistant Hypertension: a Longitudinal, Cohort Study in an Urban Hypertension Referral Clinic
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-09-20
    M.G. Buhnerkempe, A. Botchway, C.E. Nolasco Morales, V. Prakash, L. Hedquist, J.M. Flack

    Background Apparent treatment resistant hypertension (aTRH) is associated with higher prevalence of secondary hypertension, greater risk for adverse pressure-related clinical outcomes, and influences diagnostic and therapeutic decision-making. We previously showed that cross-sectional prevalence estimates of aTRH are lower than its true prevalence as patients with uncontrolled hypertension undergoing intensification/optimization of therapy will, over time, increasingly satisfy diagnostic criteria for aTRH. Methods: aTRH was assessed in an urban referral hypertension clinic using a 140/90 mm Hg goal blood pressure target in 745 patients with uncontrolled blood pressure who were predominately African-American (86%) and female (65%). Analyses were stratified according to existing prescription of diuretic at initial visit. Risk for aTRH was estimated using logistic regression with patient characteristics at index visit as predictors. Results Amongst those prescribed diuretics, 84/363 developed aTRH; the risk score discriminated well (AUC = 0.77, bootstrapped 95% CI [0.71, 0.81]). In patients not prescribed a diuretic, 44/382 developed aTRH, and the risk score showed a significantly better discriminative ability (AUC = 0.82 [0.76, 0.87]; p < 0.001). In the diuretic and non-diuretic cohorts, 145/363 and 290/382 of patients had estimated risks for development of aTRH < 15%. Of these low-risk patients, 139/145 and 278/290 did not develop aTRH (negative predictive value, diuretics – 0.94 [0.91, 0.98], no diuretics – 0.95 [0.93, 0.97]). Conclusions We created a novel clinical score that discriminates well between those who will and will not develop aTRH, especially amongst those without existing diuretic prescriptions. Irrespective of baseline diuretic treatment status, a low risk score had very high negative predictive value.

    更新日期:2018-09-20
  • Association between Subjective Sleep Duration on Workdays or Non-workdays and Uncontrolled Blood Pressure in Southern China
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-08-03
    Lihua Hu, Yihua Zhou, Xiao Huang, Qian Liang, Chunjiao You, Wei Zhou, Juxiang Li, Ping Li, Yanqing Wu, Qinghua Wu, Zengwu Wang, Runlin Gao, Huihui Bao, Xiaoshu Cheng

    Objectives To examine the association between sleep duration on workdays or non-workdays and unsatisfactory blood pressure (BP) control in southern China. Methods We analyzed 4,370 hypertensive patients, including their self-reported sleep duration on workdays or non-workdays and their BP. Unsatisfactory BP control was defined as systolic BP (SBP) of ≥ 140 mmHg or diastolic BP (DBP) of ≥ 90 mmHg. Multivariate logistic regression analyses were performed to evaluate the association between sleep duration and unsatisfactory BP control. Results Overall, the multivariable-adjusted ORs of unsatisfactory BP control risk were 1.59 (95% CI, 1.14-2.22) for 9-10 h of sleep on workdays and 1.47 (95% CI, 1.07-2.03) for ≥ 10 h of sleep on non-workdays compared with a sleep duration of 5-9 h. No association between a short sleep duration and unsatisfactory BP control was noted. The association between a longer sleep duration (≥ 10 h) and unsatisfactory BP control was more pronounced among women aged 65-70 years, with a BMI ≥ 24 kg/m2. Conclusion People with hypertension who slept 9-10 h on workdays and ≥ 10 h on non-workdays were more likely to have unsatisfactory BP control compared to those with a sleep duration of 5-9 h; these associations tended to vary by age, sex and BMI. These findings indicate a longer sleep duration might be a way to predict uncontrolled BP in hypertensive adults.

    更新日期:2018-08-03
  • A concise prediction nomogram for renal artery stenosis in selective patients undergoing coronary angiography
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-07-25
    Haojian Dong, Zhiqiang Nie, Wenhui Huang, Yuan Liu, Guang Li, Yanqiu Ou, Yingling Zhou, Jianfang Luo

    As reported scoring systems of renal artery stenosis (RAS) screening were not easily validated, we further proposed a simple method to predict or rule out RAS in selective patients undergoing coronary angiography (CAG). After preliminary inclusive criterion (severe hypertension or atherosclerosis, flash pulmonary edema, or unexplained renal dysfunction), 503 and 158 consecutive patients undergoing renal arteriography at the timing of CAG were separately enrolled between 2012 and 2015, and 2016 and 2017 as the development and validation cohort. A nomogram was derived from the multivariable logistic regression model and its accuracy was assessed by the area under the receiver operating characteristic (AUC). Hypertension (OR 17.92), estimated glomerular filtration rate ≤72.66 ml/min·1.73m2 (OR 2.75), early to late transmitral flow velocity ratio ≤1.02 (OR 2.58) and low-density lipoprotein C ≤3.17mmol/L (OR 1.85) were identified as independent predictors for RAS. The AUC of the nomogram in the development and validation cohort were 0.754 (0.704,0.804) and 0.772 (0.700,0.844). The negative predictive value of hypertension (88.9%) was much higher than the other three predictors. The concise predictive nomogram can effectively estimate the probability of significant RAS during CAG. Along with normotensive, findings reported could easily evaluate RAS screening necessity based on clinical data.

    更新日期:2018-07-25
  • Arginine Impairs Endothelial And Executive Function In Older Subjects With Cardiovasculr Risk
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-07-10
    Joshua A. BECKMAN, Shelley HURWITZ, Naomi D.L. FISHER

    Background Neurovascular coupling, the relationship between cerebral blood flow and neuronal activity, is attenuated in patients with impaired executive function. We tested the hypothesis that peripheral vascular function may associate with executive function in older subjects with cardiovascular risk factors, and that treatment with the antioxidant L-arginine would improve both vascular and executive function. Methods Nineteen subjects with type 2 diabetes mellitus and/or controlled hypertension were enrolled. Subjects were treated with L-arginine or placebo for 4 days in a randomized, double-blinded cross-over study. Brachial artery vascular function, peripheral artery tonometry, and Trail Making Test Part B (TMTB) testing were performed on day 1 and day 4 during each condition. Results L-arginine signficiantly reduced the digital reactive hyperemia index, and the comparison of changes against placebo was significant (p=0.01). With executive function testing, we observed a significant interaction between treatment and order. Restricting the analysis to the first treatment period, subjects treated with placebo decreased their TMTB times by 57.3 ± 52.5 seconds from day 1 to day while those treated with arginine had no significant change (6.4 ± 18.4 seconds worse, p = 0.37). In addition, L-arginine was associated with increased mean arterial pressure from 88 ± 9 mm Hg to 92 ± 11 mm Hg, which trended toward significance. Conclusions L-arginine treatment worsened digital microvascular and executive function in older subjects with cardiovascular risk factors. These data further support a link between vascular and executive function.

    更新日期:2018-07-12
  • Physical activity and sedentary behavior thresholds for identifying childhood hypertension and its phenotypes: The Healthy Growth Study
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-07-10
    Kalliopi Karatzi, George Moschonis, Sofia Botelli, Odysseas Androutsos, George P. Chrousos, Christos Lionis, Yannis Manios

    Background Hypertension phenotypes may represent differential pathophysiologic mechanisms and clinical impact, yet they have been poorly investigated. The study aimed to examine the associations of physical activity and sedentary behavior with hypertension phenotypes in a large group of Greek children and to identify thresholds regarding risk of hypertension. Methods A cross-sectional study with a regionally representative sample of 2473 schoolchildren 9-13 years old, with full data on physical activity and sedentary behaviour indices, as well as arterial blood pressure measurements, physical examination and anthropometry. Results Hypertensive children of both sexes had lower levels of physical activity (steps/day). Hypertensive girls had lower moderate to vigorous physical activity (MVPA), while hypertensive boys with isolated systolic hypertension (ISH) had more screen time than their normotensive counterparts. Increased levels of physical activity was associated with 33-54% lower risk of all hypertension phenotypes in both sexes, while increased MVPA was associated with 41-65% lower risk of all phenotypes in girls and with ISH and systolic and diastolic hypertension (SDH) in boys. In boys, higher sedentary time was associated with 11-13% higher risk for SDH and ISH. Cut-off points of 12378 steps/day, 47.3 minutes/day of MVPA and 2.9 hours/day sedentary behavior were determined for identifying children at increased risk of hypertension. Conclusions Physical activity is inversely associated with all hypertension phenotypes, while sedentary behavior is positively associated with ISH and SDH in boys. More studies should confirm the hypertension-specific cut-off values identified in order to be used in future prevention programs for childhood hypertension.

    更新日期:2018-07-12
  • Bidirectional association between non-alcoholic fatty liver disease and hypertension from Dongfeng-Tongji cohort study
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-07-03
    Peiyi Liu, Yuhan Tang, Xiaoping Guo, Xinhong Zhu, Meian He, Jing Yuan, Youjie Wang, Sheng Wei, Weihong Chen, Xiaomin Zhang, Xiaoping Miao, Ping Yao

    The relation between non-alcoholic fatty liver disease (NAFLD) and hypertension is not fully understood. To examine the effect of the change in NAFLD status on the risk of incident hypertension, and vice versa, 6,704 eligible hypertension-free subjects and 9,328 NAFLD-free subjects from Dongfeng-Tongji (DFTJ) cohort study at baseline were enrolled in the study. Among the hypertension-free subjects, development NAFLD and persistent NAFLD patients was associated with an increased OR for incident hypertension (OR: 1.49, 95% CI: 1.26-1.76, P < 0.0001; OR: 1.50, 95% CI: 1.27-1.78, P < 0.0001). However, the resolution of NAFLD was not a risk factor for incident hypertension. Among the NAFLD-free subjects, the risk of new-emerging NAFLD was robust for hypertension status both in no-yes (OR: 1.45, CI: 1.23-1.71) and yes-yes (OR: 1.61, CI: 1.35-1.92). Moreover, stratified analysis by diabetes and overweight/obese for the risk of incident NAFLD showed that incident hypertension (no-yes) and persistent hypertension (yes-yes) were associated with risk of incident NAFLD in subjects without diabetes or overweight/obese. In the overweight/obese participants, persistent hypertension (yes-yes) was a risk factor for incident NAFLD (OR: 1.29, 95%CI: 1.01-1.64, P=0.0387). Conclusively, incidence and persistence of NAFLD are associated with increased risk of hypertension, and vice versa.

    更新日期:2018-07-03
  • Simple dietary advice reduces 24-hour urinary sodium excretion, blood pressure and drug consumption in hypertensive patients
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-06-30
    Natale Musso, Beatrice Carloni, Maria C. Chiusano, Massimo Giusti
    更新日期:2018-07-01
  • Aldosterone, Inactive Matrix Gla-protein, and Large Artery Stiffness in Hypertension
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-06-30
    Julio A. Chirinos, Mayank Sardana, Amer Ahmed Syed, Maheshwara R. Koppula, Swapna Varakantam, Izzah Vasim, Harold G. Oldland, Timothy S. Phan, Nadja EA. Drummen, Cees Vermeer, Raymond R. Townsend, Scott R. Akers, Wen Wei, Edward G. Lakatta, Olga V. Fedorova

    Background Vascular calcification leads to increased large artery stiffness. Matrix Gla-protein (MGP) is a vitamin K-dependent protein that inhibits arterial calcification. Aldosterone promotes vascular calcification and stiffness, but the relationships between aldosterone, MGP and arterial stiffness are unknown. Methods We studied 199 adults (predominantly older men) with hypertension. We assessed the relationship between levels of dp-ucMGP, aldosterone and carotid-femoral pulse wave velocity (CF-PWV) using standard regression and mediation analyses. Plasma aldosterone was measured in a subgroup of subjects (n=106). Results Aldosterone was strongly associated with dp-ucMGP (Standardized β=0.50, P<0.001), which was independent of potential confounders (β=0.37, P<0.001). Levels of dp-ucMGP were significantly associated with CF-PWV (β=0.30; P<0.001), which persisted after adjustment for potential confounders (β=0.25; P=0.004). Plasma aldosterone was also significantly associated with CF-PWV (Standardized β=0.21; P=0.035). However, in a model that included aldosterone and dp-ucMGP, only the latter was associated with CF-PWV. Mediation analyses demonstrated a significant dp-ucMGP-mediated effect of aldosterone on CF-PWV, without a significant direct (dp-ucMGP-independent) effect. Conclusions our study demonstrates a novel independent association between high aldosterone levels and dp-ucMGP, suggesting that aldosterone may influence the MGP pathway. This relationship appears to underlie the previously documented relationship between aldosterone and increased arterial stiffness.

    更新日期:2018-07-01
  • Measurement Of Pulse Wave Velocity, Augmentation Index and Central Pulse Pressure In Atrial Fibrillation: A Proof Of Concept Study
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-06-30
    Rogier Caluwé, An S. De Vriese, Bruno Van Vlem, Francis Verbeke

    Background Individualized weighing of the risk-benefit of anticoagulation is recommended in patients with atrial fibrillation (AF) that have low established risk scores or, conversely, are at increased risk for bleeding. Parameters of arterial stiffness and wave reflection could improve risk stratification, but their use has not been evaluated in arrhythmia. Methods We measured carotid-femoral pulse wave velocity (PWV), central augmentation index (AI) and central pulse pressure (CPP) using the SphygmoCor system in 34 patients (53 to 85 years; 25 males) with AF before and after elective electrical cardioversion. Agreement was assessed using the intraclass correlation coefficient (ICC) and the coefficient of variation, completed with Bland-Altman plots. Results Following cardioversion, mean arterial blood pressure (MAP) and heart rate (HR) decreased significantly by 8 mmHg and 18 bpm respectively. PWV decreased from 11.8 m/s to 10.7 m/s, AI increased from 24% to 29%, and CPP rose from 38 mmHg to 43 mmHg. The decrease in PWV was related to the decrease in MAP (beta=0.57; R2=0.33; P<0.001) whereas changes in AI and CPP were related to the decrease in HR (AI: beta=-0.59; R2=0.35; P<0.001, CPP: beta=-0.55; R2=0.28; P=0.001). After adjustment for changes in MAP and HR, reliability analysis showed an excellent agreement for PWV (ICC=0.89; 95%CI: 0.79-0.95) but moderate agreement for AI (ICC=0.59; 95%CI: 0.17-0.80). Excellent agreement was also found for CPP (ICC=0.89; 95%CI: 0.72-0.95). Conclusion Measurement of PWV and CPP is reliable in patients with AF, as they appear unaffected by the presence of arrhythmia.

    更新日期:2018-07-01
  • Facebook recruitment of Chinese-speaking participants for hypertension education
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-06-30
    Phillip H. Dunn, Benjamin K.P. Woo

    Background Effective dissemination of health information to a desired population can be a challenging and expensive process, particularly to Chinese-Americans. Print and radio advertisements are limited by geographic, language, cost, and demographic barriers. The expense and efforts necessary to overcome these challenges can delay the distribution of knowledge and make it more expensive than necessary. The advent of web-based advertisements through media platforms such as Facebook offer a new method of reaching target audiences that can be both cost-effective and specific. Methods A Facebook advertisement was displayed for 48 hours and consisted of a 26-character Chinese text body. The advertisement linked to an external informational video on hypertension prevention. Demographic information including age and gender were recorded. Descriptive statistics were used to compare reach and number of ad clicks between age groups. Results The 48 hour campaign reached a total of 508 people. Of those reached, 289 participants(56.9%) were between the ages of 55-64, and 170 participants(33.5%) were 65 years or older. The campaign also generated 52 link clicks. Conclusions The results show that Facebook is a promising method of engaging Chinese-Americans. It is particularly effective in reaching the older female population and is a cost-effective alternative to print-based advertisements.

    更新日期:2018-07-01
  • Comparison of Ankle-Brachial Index and Upstroke Time in Association with Target Organ Damage: The Northern Shanghai Study
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-06-30
    Shikai Yu, Yuyan Lu, Jing Xiong, Jiadela Teliewubai, Chen Chi, Hongwei Ji, Yiwu Zhou, Ximin Fan, Jun Zhang, Jacques Blacher, Jue Li, Yi Zhang, Yawei Xu

    A recent study indicated that upstroke time per cardiac cycle (UTCC) in lower extremities is equivalent to ankle-brachial index (ABI) in diagnosing peripheral arterial disease (PAD) and in predicting cardiovascular mortality. In this study, we aimed to compare ABI and UTCC in relation to target organ damage (TOD). A cohort of 1841 elderly participants from the Northern Shanghai Study were studied. ABI and UTCC were measured using VP-1000 device. TOD including left ventricular hypertrophy and diastolic dysfunction, carotid intima-media thickness and plaque, carotid-femoral pulse wave velocity (CF-PWV) and renal damage, were evaluated by standardized methods. In correlation analysis, ABI and UTCC both significantly correlated with CF-PWV, carotid plaque and eGFR, but not with cardiac damage. Compared with ABI, UTCC showed stronger correlation with CF-PWV. When ABI and UTCC separately put into fully-adjusted multivariate logistic regression models, both ABI (OR:2.27; 95%CI:1.63-3.17) and UTCC (OR:1.63; 95%CI: 1.18-2.24) significantly associated with carotid plaque, but only UTCC significantly associated with increased CF-PWV (OR:1.66; 95%CI:1.15-2.42) and renal damage (OR:1.63; 95%CI:1.07-2.47). When ABI and UTCC both put into multivariate stepwise logistic regression models together with covariates, consistent results were observed. In ROC curve analysis, after adjusted for cofounding factors, UTCC showed slightly greater area under curve (AUC) than ABI in detecting increased CF-PWV (AUC: 0.79 vs. 0.78; P=0.008); however, no difference was observed between UTCC and ABI in discriminating renal damage and carotid plaque. In conclusion, compared with ABI, UTCC showed significantly stronger association with vascular and renal damage in this elderly Chinese cohort.

    更新日期:2018-07-01
  • Misclassification of blood pressure of Vietnamese adults when only a single measurement is used
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-06-30
    Nga T.T. Tran, Christopher L. Blizzard, Khue N. Luong, Ngoc L.V. Truong, Bao Q. Tran, Panagiota Veloudi, Petr Otahal, Mark Nelson, Costan Magnussen, Seana Gall, Tan V. Bui, Velandai Srikanth, Thuy B. Au, Son T. Ha, Hai N. Phung, Mai H. Tran, Michele Callisaya, James Sharman

    Background Using a single clinic measurement of blood pressure (BP) may be common in low- and middle-income countries because of limited medical resources. This study aimed to examine the potential misclassification error when only one BP measurement is used. Methods Participants (n = 14706, 53.5 % females) aged 25–64 years were selected by multi-stage stratified cluster sampling from eight provinces each representing one of the eight geographical regions of Vietnam. Measurements were made using the World Health Organization STEPS protocols. Data were analysed using complex survey methods. Results For systolic BP, 62.7% had a higher first reading whilst 30.0% had a lower first reading, and 27.3% had a reduction of at least 5mmHg whilst 9.6% had an increase of at least 5mmHg. Irrespective of direction of change, increased variability in BP was associated with greater age, urban living, greater body size and fatness, reduced physical activity levels, elevated glucose, and raised total cholesterol. Conclusion A consequence of these measurement variations is that it would lead to misclassification in diagnosis of hypertension based on a single reading because almost 20% of subjects would receive a different diagnosis based on the mean of two readings.

    更新日期:2018-07-01
  • A Proposed Mechanism for the Berecek Phenomenon with Implications for Cardiovascular Reprogramming
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-06-20
    Richard N. Re

    Berecek and colleagues reported in the 1990s that when SHR mating pairs were treated with captopril and the resulting pups were continued on the drug for two months followed by drug discontinuation, the pups did not develop full blown hypertension and the cardiovascular structural changes associated with hypertension in SHR were mitigated. The offspring of the pups also displayed diminished hypertension and structural changes, suggesting that the drug therapy produced a heritable amelioration of the SHR phenotype. This observation is reviewed. The link between cellular renin angiotensin systems (RASs) and epigenetic histone modification is explored and a mechanism responsible for the observation is proposed. In any case, the observations of Berecek are sufficiently intriguing and biologically important to merit re-exploration and definitive explanation. Equally important is determining the role of RASs in epigenetic modification.

    更新日期:2018-06-22
  • Social capital and depression among migrant hypertensive patients in primary care
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-06-18
    Wu Zhu, Haitao Li, Xuejun Wang, Chen Mao

    Purposes This study was to investigate prevalence of depression among migrant hypertensive patients in primary care, and to examine hypertensive patients’ social capital and its relationship with the prevalence of depression. Methods An on-site based cross-sectional study was performed in Shenzhen, China. A total of 830 migrant hypertensive patients completed the survey by employing systematic sampling design. A questionnaire including information of depressive symptoms and social capital was administered by face-to-face interview surveys. Results We found that the prevalence of depression was 11.0% among migrant hypertensive patients in primary care. Social ties(OR=1.197, 95%CI: 1.034,1.387) and trust (OR=2.061, 95%CI: 1.342,3.165)were statistically significant associated with the prevalence of depression. Conclusions Our study shows that the prevalence of depression is high among migrant hypertensive patients in primary care. It also suggests an inverse association between social capital and depression among migrant hypertensive patients. Although causal pathways between social capital and depression cannot be established by the current study, it is plausible to design and implement social interventions to improve mental health of migrant hypertensive patients in primary care.

    更新日期:2018-06-19
  • The association between Antidepressant use and Orthostatic Hypotension in older people: a matched cohort study
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-06-14
    R. Briggs, D. Carey, T. McNicholas, P. Claffey, H. Nolan, S.P. Kennelly, R.A. Kenny

    Background Orthostatic hypotension (OH) is often reported as a significant potential adverse effect of antidepressant use but the association between phasic blood pressure (BP) and antidepressants has not yet been investigated. Method This cross-sectional study compares continuously measured phasic BP and prevalence of OH in a cohort of antidepressant users ≥50 years compared to an age and sex matched cohort not taking antidepressants. OH was defined as a drop in systolic BP ≥20 mmHg or in diastolic BP ≥10 mmHg at 30 seconds post standing, measured using continuous beat-to-beat finometry. Results Multilevel time x group interactions revealed significantly greater systolic and diastolic BP drop in antidepressant users than non-users at 30 seconds post-stand. The prevalence of OH amongst antidepressant users was 31% (63/206), compared to 17% in non-users (X2=9.7; p =0.002). Unadjusted logistic regression models demonstrated that Selective Serotonin Reuptake Inhibitor (SSRI) use was associated with OH at an odds ratio of 2.11 (95% CI: 1.25 – 3.57); p=0.005, and this association was not attenuated when covariates including cardiac disease and depressive symptom burden were added. There was no statistically significant association between Serotonin Noradrenaline Reuptake Inhibitor or Tricyclic Antidepressant use and OH in unadjusted models though the study was not powered to detect changes within these subgroups. Conclusions Older people taking antidepressants have a two-fold higher prevalence of OH than non-users, highlighting the importance of screening the older antidepressant user for OH and dizziness and rationalising medications in order to reduce the risk of falls within this vulnerable cohort.

    更新日期:2018-06-14
  • Short–term exposure to Dexamethasone promotes autonomic imbalance to the heart before hypertension.
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-06-13
    Francine Duchatsch, Paula, B. Constantino, Naiara, A. Herrera, Mayara, F. Fabrício, Lidieli, P. Tardelli, Aline, M. Martuscelli, Thiago, J. Dionísio, Carlos, F. Santos, Sandra, L. Amaral

    Hypertension is one of the chronic side–effects of dexamethasone (DEX) treatment, however almost nothing is known about its acute effects. Therefore, the aim of this study was to investigate the possible mechanisms involved in blood pressure control after acute or short–term DEX–treatment in adult animals. Eighty Wistar rats were divided into four groups: C1 and C5, for rats treated with saline for 1 or 5 days, respectively; D1 and D5, for rats treated with DEX for 1 or 5 days, respectively (decadron, 1 mg / kg, ip). Heart rate was increased in DEX treatment, but arterial pressure and cardiac muscle mass were not altered. Only few and isolated changes on gene expression and protein level of RAS components were observed. Five days of DEX treatment, but not one day, determined an increase in sympathetic component of spectral analysis (+75.93%, p<0.05) and a significant reduction of parasympathetic component (–18.02%, p<0.05), which contributed to the autonomic imbalance to the heart (LF/HF, +863.69%). The results of this present study demonstrated, for the first time, that short–term exposure to DEX treatment impairs the autonomic balance to the heart before hypertension, which was independent of RAS.

    更新日期:2018-06-13
  • Secondary Hypertension Due To A Juxtaglomerular Cell Tumor
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-06-07
    Igor Nunes, Tiago Santos, Joana Tavares, Lurdes Correia, João Coutinho, J.M. Braz Nogueira, Leonor Carvalho, J. L. Ducla Soares

    Juxtaglomerular cell tumors are rare, generally benign and they are one of the secondary surgically treatable causes of arterial hypertension. There are about 100 reported cases on literature and the diagnosis is usually made based on a high clinic suspicion index, mostly in patients with hypokaliemia and arterial hypertension. The diagnosis involves blood tests and imaging studies, but it is only definite with histopathological exam after surgical treatment. We present a case of a 22-year-old woman with resistant arterial hypertension and renal and cardiovascular target-organ lesions. High plasmatic renin and a nodular renal mass on MRI were present. A tumorectomy was performed and the histological exam confirmed a reninoma. After surgery, blood pressure and serum renin values returned to normal without medication. This work focuses on the need to exclude rare secondary causes of hypertension in young patients with resistant forms of this disease.

    更新日期:2018-06-07
  • Digital Health Intervention as an Adjunct to a Workplace Health Program in Hypertension
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-05-30
    Conor Senecal, R. Jay Widmer, Matthew P. Johnson, Lilach O. Lerman, Amir Lerman

    Background Hypertension is a common and difficult to treat condition, digital health tools may serve as adjuncts to traditional pharmaceutical and lifestyle-based interventions. Using a retrospective observational study we sought to evaluate the effect of a desktop and mobile digital health intervention (DHI) as an adjunct to a workplace health program in those previously diagnosed with hypertension. Methods As part of a workplace health program 3,330 patients were identified previously diagnosed with hypertension. A DHI was made available to participants providing motivational and educational materials assisting in the management of hypertension. We evaluated changes in blood pressure, weight, and body mass index (BMI) between users and non-users based on login frequency to the DHI using multivariate regression through the five visits over the course of one year. Results 1,622 (49%) participants logged into the application at least once. DHI users had significant greater improvements in systolic blood pressure (SBP; -2.79mmHg), diastolic blood pressure (DBP; -2.12mmHg) and BMI (-.23 m2/kg) at one year. Increased login frequency was significantly correlated with reductions in SBP, DBP, weight, and BMI (P ≤ 0.014). Discussion This large, observational study provides evidence that a DHI as an adjunct to a workplace health program is associated with greater improvement in blood pressure and BMI at one year. This study adds to the growing body of evidence that DHIs may be useful in augmenting the treatment of hypertension in addition to traditional management with pharmaceuticals and lifestyle changes.

    更新日期:2018-05-31
  • Chronic Kidney Disease as a Cardiovascular Risk Factor: Lessons From Kidney Donors : Lessons from living kidney donors
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-05-09
    Anna M. Price, Nicola C. Edwards, Manvir K. Hayer, William E. Moody, Richard P. Steeds, Charles J. Ferro, Jonathan N. Townend

    Chronic kidney disease is a major risk factor for cardiovascular disease but is often associated with other risks such as diabetes and hypertension and can be both a cause and an effect of cardiovascular disease. While epidemiological data of an independent association of reduced glomerular filtration rate with cardiovascular risk are strong, causative mechanisms are unclear. Living kidney donors provide a useful model for assessing the “pure” effects of reduced kidney function on the cardiovascular system. Following nephrectomy the glomerular filtration rate ultimately falls by about one third so many can be classified as having chronic kidney disease stages 2 or 3. This prompts concern based on the data showing an elevated cardiovascular risk with these stages of chronic kidney disease. Although initial data suggested no increase in adverse cardiovascular effects compared to control populations. Recent reports have shown a possible late increase in cardiovascular event rates and an early increase in left ventricular mass and markers of risk such as urate and albuminuria. The long term significance of these small changes is unknown. More detailed and long term research is needed to determine the natural history of these changes and their clinical significance.

    更新日期:2018-05-10
  • Renovascular hypertension in small children – is it Takayasu arteritis or fibromuscular dysplasia?
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-05-09
    Kjell Tullus, Derek Roebuck

    Renovascular hypertension in children is a rare but very severe condition with systolic blood pressures often reaching 200 mm Hg or higher. There are two major non-syndromic causes to this; Takayasu arteritis (TA) and fibromuscular dysplasia (FMD). These two diagnoses are used with different frequency in North America and Europe compared to Asia and South Africa. This most likely reflects real differences in prevalence of the two conditions but also different diagnostic traditions. TA is defined as an angiographic abnormality not caused by FMD or a similar disease while FMD is a non-atherosclerotic and non-inflammatory arterial disease. No clear difference in the distribution of the vascular lesions of TA and FMD have been described in children. The differential diagnoses between the two conditions can thus be very difficult. We will here provide guidance on how to reach the most accurate diagnosis and treatment of children severe renal artery stenosis.

    更新日期:2018-05-09
  • Effect of vitamin D supplementation on blood pressure parameters in patients with vitamin D deficiency: a systematic review and meta-analysis
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-05-09
    Liqin Shu, Kun Huang

    Objective Evidence suggests that supplementation of vitamin D can not decrease blood pressure in normal populations. However, in randomized controlled trials (RCTs) with vitamin D deficient participants (defined as baseline serum 25(OH) D levels < 30ng/ml or 50nmol/L), this effect is inconsistent and under debate. Thus, We performed this systematic review and meta-analysis to evaluate whether vitamin D supplementation could affect blood pressure parameters in vitamin D deficient subjects. Methods The PubMed, Web of Science, Science Direct, and Cochrane library databases were searched. Extracted data were pooled as weighted mean differences (WMDs) with 95% confidence intervals (CIs) to evaluate the effects. Subgroup analysis was further conducted according to the characteristics of included studies. Results Seven RCTs contained 560 participants were included in our meta-analysis. The pooled WMD of peripheral diastolic blood pressure was -1.65 mm Hg (95%CI: -3.05 to -0.25, I2=30.3%). No significant effect of vitamin D supplementation was found on other parameters. Subgroup analysis showed a significant decrease in peripheral SBP and DBP in Asia, 8 weeks of intervention and more than 5000IU of daily vitamin D supplementation subgroups. Conclusion For vitamin D deficient patients, there is a small but significant fall in peripheral blood pressure but no significant in other blood pressure parameters with vitamin D supplementation. Further RCTs with large numbers of participants is still warranted to confirm these effects.

    更新日期:2018-05-09
  • Ambulatory Hypertension in a Pediatric Cohort of Sickle Cell Disease
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-05-05
    Divya G. Moodalbail, Bonita Falkner, Scott W. Keith, Robert S. Mathias, Carlos E. Araya, Joshua J. Zaritsky, Marie J. Stuart

    Background Hypertension is an established risk factor for subsequent cardiovascular and renal disease in children as well as adults. Sickle Cell Disease (SCD) is a genetic disorder associated with chronic hemolytic anemia with the major manifestation of vaso-occlusive crises. While this disease entity involves most organ systems causing vascular and pulmonary injury, little is known about blood pressure (BP) levels or prevalence of hypertension in children with SCD. Methods A cross-sectional study was conducted on 56 children with SCD (54 with Hemoglobin SS disease; 2 with Hemoglobin Sβ0 thalassemia; 29 females). Study participants underwent 24-hour ambulatory BP monitoring (ABPM). Serum creatinine and cystatin C were obtained to assess estimated glomerular filtration rate (eGFR) with age-based formulas. A random urine sample was obtained to estimate urine osmolality and urine albumin to creatinine ratio. Results Mean age range was 11.9(±4.5) years. Seventeen participants (30%) met criteria for hypertension based on ABPM. Of the 17 participants classified with hypertension, three had office hypertension with ambulatory hypertension; and 14 had masked hypertension detected on ABPM. Another 28 participants (50%) had some abnormal ABPM parameters in the form of either pre-hypertension and/ or lack of normal nocturnal dipping status. Conclusion The prevalence of confirmed hypertension, largely manifest by masked hypertension, is high in children, as young as 6 years of age with SCD. Early identification of hypertension in SCD children can confer benefit as it is an important modifiable risk factor for progression of cardiovascular and renal disease.

    更新日期:2018-05-05
  • Diastolic blood pressure and risk profile in renal and cardiovascular diseases. Results from the sprint trial
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-05-05
    Rita Del Pinto, Davide Pietropaoli, Claudio Ferri

    Objective The SPRINT trial demonstrated the efficacy and safety of targeting a systolic blood pressure of <120 mmHg compared to <140 mmHg in selected hypertensive patients. Some evidence, however, suggests a J-curve for; diastolic blood pressure (DBP) particularly in subjects with cardiovascular and chronic kidney disease. We evaluated the risk of events in SPRINT with focus on these subgroups according to DBP. Methods Mean DBP (±SD) throughout follow-up time was calculated for each patient. Patients were then categorized into 5 groups according to mean DBP (<60 mmHg, 60–69 mmHg, 70–79 mmHg [reference], 80–89 mmHg, ≥90 mmHg); hazard ratio for outcomes was assessed overall and in the predefined subgroups. Results A higher risk for cardiovascular events was observed in the lower DBP range overall (HR 1.46, C.I.95% 1.1–1.95, p<0.001), but not in the absence of pre-existing cardiovascular or renal disease. Indeed, such risk significantly increased above 80 mmHg in patients with cardiovascular disease and below 70 mmHg in those with chronic kidney disease for selected outcomes. DBP<70 mmHg particularly affected renal outcomes irrespective of renal status. Conclusions Different risk profiles according to DBP appear to be related to specific clinical characteristics in SPRINT. These findings require further testing in dedicated trials with appropriate follow-up.

    更新日期:2018-05-05
  • The Cardiovascular Health Score And The Volume of Carotid Body In Computed Tomography Angiography In Patients With Arterial Hypertension
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-05-03
    Przemysław Jaźwiec, Paweł Gać, Małgorzata Poręba, Małgorzata Sobieszczańska, Grzegorz Mazur, Rafał Poręba

    Introduction The Cardiovascular Health (CVH) Score constitutes a reliable and measurable indicator of cardiovascular health proposed by the American Heart Association (AHA) calculated based on seven fundamental parameters, i.e. smoking, body mass index, physical activity, healthy diet score, blood pressure, blood cholesterol and fasting plasma glucose. The size and activity of carotid body (CB) play a important role in the pathogenesis of the cardiovascular system. Objective The objective of this study was to define the relationship between the AHA CVH Score and the volume of carotid body (VrCB+lCB) estimated based on computed tomography angiography (CTA) in patients with arterial hypertension. Material and methods Studies were conducted on a group of 57 patients with arterial hypertension (70.74±8.21 years old). The Cardiovascular Health Score was calculated and CTA of carotid arteries was carried out for all patients. The CB analysis was performed based on delayed phase imaging obtained from CTA of carotid arteries. Based on the CVH Score value, cardiovascular health was determined as optimal (CVH Score between 10-14 points), average (5-9 points) or inadequate (0-4 points). Results CVH Score in the studied group of patients was 6.53±1.81, VrCB+lCB - 38.58±18.43 mm3. Patients with an inadequate CVH Score (0-4 points) have statistically significantly higher VrCB+lCB and they are fraught with VrCB+lCB ≥ median much more often than patients with an optimal CVH Score (10-14 points). The ROC curve indicated a CVH Score value of 6 as an optimal cut-off point to predict VrCB+lCB ≥ median. The CVH Score ≤6 criterion indicates VrCB+lCB ≥ median with sensitivity of 58.6% and specificity of 71.4%. In the regression analysis, it was indicated that lower partial scores for physical activity, healthy diet score and blood pressure in the AHA CVH evaluation constitute independent risk factors for higher VrCB+lCB. Conclusions In the studied group of patients with arterial hypertension, an inversely proportional dependence between the Cardiovascular Health Score and the size of carotid body is observed in CTA of carotid arteries.

    更新日期:2018-05-04
  • Balloon Angioplasty of Renal Artery Stenosis Due to Takayasu Arteritis in a 2-Year-Old Child
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-04-25
    Alimujiang Abudoureyimu, Xingwei he, Jiangtao yan, Chang xu, Liru Qiu, Hesong Zeng

    The aim of this report is to demonstrate a 2-year-2-month-old child who presented with a history of malignant hypertension. He was made the diagnosis of Takayasu arteritis by laboratory tests and angiography; We initiated a treatment with sequential balloon pre-dilation. The patient's blood pressure improved dramatically, and patency of renal artery was demonstrated with renal arteriography over 8 months after the balloon pre-dilation.

    更新日期:2018-04-26
  • Ethanol withdrawal increases blood pressure and vascular oxidative stress: a role for angiotensin type 1 receptors
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-04-04
    Natália A. Gonzaga, Gabriel T. do Vale, Juliana M. Parente, Rodrigo Yokota, Bruno S. De Martinis, Dulce E. Casarini, Michele M. Castro, Carlos R. Tirapelli

    We evaluated the possible mechanisms underlying the oxidative stress induced by ethanol withdrawal. With this purpose, we verified the role of AT1 receptors in such response. Male Wistar rats were treated with ethanol 3-9% (vol./vol.) for 21 days. Ethanol withdrawal was induced by abrupt discontinuation of the treatment. Experiments were performed 48 h after ethanol discontinuation. Increased plasma levels of angiotensin II were detect after ethanol withdrawal. Losartan (10 mg/kg; p.o. gavage), a selective AT1 receptor antagonist impeded the increase in blood pressure induced by ethanol withdrawal. Increased lipoperoxidation and superoxide anion (O2-) levels were detected in aortas after ethanol withdrawal and losartan prevented these responses. Decreased hydrogen peroxide (H2O2) and nitrate/nitrite (NOx) concentration were detected in aortas after ethanol withdrawal and losartan prevented these effects. Nitrotyrosine immunostaining in the rat aorta was increased after ethanol withdrawal and AT1 blockade impeded this response. Increased expression of PKCδ and p47phox was detected after ethanol withdrawal and treatment with losartan prevented these responses. Our study provides novel evidence that ethanol withdrawal increases vascular oxidative stress and hypertension through AT1-dependent mechanisms. These findings highlight the importance of angiotensin II in ethanol withdrawal-induced increase in blood pressure and vascular oxidative damage.

    更新日期:2018-04-04
  • Stroke and (or) myocardial infarction attributable to modifiable risk factors in Henan, China
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-04-03
    Kaiyan Dong, Qian Yang, Fujiao Duan, Shuying Liang, Nan Ma, Wei Nie, Yali Yan, Ye Zhang, Rui Peng, Shuaibing Wang, Chunhua Song, Kaijuan Wang

    Estimating population attributable risks (PARs) of potential modifiable risk factors for stroke and (or) myocardial infarction (MI) may be useful for planning cardiovascular disease (CVD) preventive strategies. A population of 17292 adults aged 18 years and older from a cross-sectional survey were included in the study. The binary logistic regression was used to evaluate the association between risk factors with disease events, then population attributable fraction (PAF) according to prevalence and odds ratios were calculated to identify and compare the effects at different subpopulations. We found that the main risk factor for CVD events was hypertension with about 50% of PAF; prehypertension (22.24%) only act at rural older females; the efficiency of low and moderate level physical activity were higher in males (over 20%) than females (under 20%); ever smoked contributed to CVDs in rural older populations (males, 19.25%; females, 5.57%) and urban younger males (54.52%); while as for high BMI, overweight (12.59%) only made contribution to rural males past sixty. In conclusion, hypertension control in the whole population, physical activity increasing in males and older females, smoking prevention in rural elders and urban younger males, and slimming in rural elder males might be effective to reduce the burden of CVDs in Henan.

    更新日期:2018-04-04
  • Significant Interaction of Hypertension and Homocysteine on Neurological Severity in First-ever Ischemic Stroke Patients
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-04-03
    Ying-Li Fan, Rui Zhan, Yi-Fei Dong, Lei Huang, Xi-Xin Ji, Peng Lu, Jian Liu, Ping Li, Xiao-Shu Cheng

    Background It is not known whether combination of hypertension and high homocysteine (HHcy) impacts on stroke-related neurological severity. Our aim was to determine whether there is an interaction of hypertension and HHcy on neurological severity in first-ever ischemic stroke patients. Methods and Results We analyzed neurological severity among 189 consecutive first-ever ischemic stroke patients with or without hypertension or HHcy. Hypertension [odds ratio (OR): 8.086, 95% confidence interval (CI): 3.596 to 18.181, P < 0.001] and total homocysteine (tHcy) (OR: 1.403, 95% CI: 1.247 to 1.579, P < 0.001) were independently associated with neurological severity. In receiver-operating characteristic analysis, tHcy was a significant predictor of neurological severity (area under curve 0.794; P < 0.001). A multiplicative interaction of hypertension and HHcy on more severe neurological severity was revealed by binary logistic regression (OR: 13.154, 95% CI: 5.293 to 32.691, P < 0.001). Analysis further identified a more than multiplicative interaction of hypertension and HHcy on neurological severity compared with patients without each condition (OR: 50.600, 95% CI: 14.775 to 173.285, P < 0.001). Interaction effect measured on an additive scale showed that 76.4% patients with moderate/severe neurological severity were attributed to interaction of hypertension and HHcy. Conclusions Significant interaction of hypertension and HHcy on neurological severity was found on multiplicative and additive scale in first-ever Chinese ischemic stroke patients.

    更新日期:2018-04-04
  • Dose-response relationship between visceral fat index and untreated hypertension in Chinese rural population: the RuralDiab study
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-03-29
    Zhongyan Tian, Yuqian Li, Linlin Li, Xiaotian Liu, Yuanyuan Shi, Kaili Yang, Ruihua Liu, Honglei Zhang, Xinling Qian, Lei Yin, Jingzhi Zhao, Chongjian Wang

    The study aimed to explore the association of visceral fat index (VFI) with untreated hypertension in different genders, and evaluate the practicability of VFI as a marker for discriminating untreated hypertension in Chinese rural population. A total of 12536 eligible participants aged 35 years and over were derived from the RuralDiab study in China. VFI was assessed with bioelectrical impendence methods, and divided into sex-specific quartiles. Logistic regression and restricted cubic spline regression were performed. Receiver Operating Characteristic (ROC) curve was applied to analyze the discriminating performance of VFI. Meanwhile, a meta-analysis was conducted to validate the result of this study. Compared with the lowest VFI quartile, the adjusted odds ratios(ORs) and 95% confidence interval(95% CI) in the highest VFI quartile were 3.68(2.91-4.66) in male and 2.63(2.12-3.25) in female (Ptrend < 0.01). Nonlinear increasing trends about the risk of untreated hypertension were observed with the continuously increasing VFI in both genders (Plinearity < 0. 01). The sensitivity and specificity in the optimal cut-off values for VFI were 58.37%, 62.26% in male and 49.09%, 66.67% in female. The AUCs(95% CI) were 0.64(0.63-0.66) in male and 0.61(0.60-0.62) in female. Meta-analysis results displayed the pooled ORs(95% CI) were 2.65(1.79-3.93) in male and 2.27(1.74-2.95) in female.VFI was significantly positively correlated with the risk of untreated hypertension, and dose-response relationships were observed in both genders in Chinese rural population. However, VFI as a marker had limited potential for discriminating untreated hypertension.

    更新日期:2018-03-30
  • Comparison of three formulas to estimate 24-hour urinary sodium and potassium excretion in patients hospitalized in a hypertension unit
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-03-28
    Piotr Jędrusik, Bartosz Symonides, Zbigniew Gaciong

    Background Measurements of 24-hour urinary sodium (24hrUNa) and potassium (24hrUK) excretion are useful in hypertensives but 24-hour urine collection may be difficult or unreliable. We compared three formulas (Tanaka, Kawasaki, PAHO) proposed to estimate 24hrUNa and 24hrUK based on spot urine measurements. Methods We studied 382 patients admitted to a hypertension unit. Sodium, potassium, and creatinine levels were measured using standard laboratory methods in a morning urine sample, followed by 24-hour urinary collection. Agreement between estimated and measured 24hrUNa and 24hrUK was evaluated using the Pearson correlation and Bland-Altman plots. Results Measured 24hrUNa was 158±75 mmol/d and 24hrUK was 54±24 mmol/d. The correlation coefficient was r=0.53 for estimated vs. measured 24hrUNa, r=0.69-0.73 for estimated vs. measured 24hrUK (all P<0.001). The mean bias for 24hrUNa was significantly smaller for Tanaka (10.5 mmol/d) and PAHO (11.5 mmol/d) compared to Kawasaki formula (-29.9 mmol/d). The mean bias for 24hrUK was significantly smaller for Kawasaki (7.3 mmol/d) and PAHO (8.3 mmol/d) compared to Tanaka formula (16.5 mmol/d). Conclusion Using a single morning urine sample, we found the PAHO formula to be the best for predicting mean 24hrUK and 24hrUNa in hospitalized hypertensive patients. However, precision and accuracy of all the evaluated formulas was inadequate.

    更新日期:2018-03-29
  • Acute blood pressure effects of Programmable Hypertension Control (PHC) Therapy: rationale and evidence for the development of a durable treatment for hypertension
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-03-21
    Bing Yang, Yue Wang, Fengxiang Zhang, Weizhu Ju, Hongwu Chen, Yuval Mika, Ricardo Aviv, Steven J. Evans, Daniel Burkhoff, Jie Wang, Minglong Chen

    Objective We assessed the feasibility of achieving acute, sustained blood pressure reductions through the use of cardiac pacing algorithms delivered via standard dual-chamber pacing based on short atrio-ventricular (AV) delay (SAVD). Methods A total of 18 hypertensive subjects (57.3±9.8 years old; 10 male and 8 female) with average initial systolic and diastolic blood pressures of 151.2±17.6/92.2±12.7 mmHg and already scheduled to undergo an invasive electrophysiology procedure were included in this study. Pacing sequences were applied for ∼1-minute intervals with AV delays of 80, 40, 20 and 2 ms, while making high fidelity blood pressure measurements. Results Average reductions of 19.6±7.7 mmHg in systolic pressure and 4.3±3.8 mmHg in diastolic pressure (p<0.001 for each) were demonstrated with 2ms AV delay pacing. Initial SBP reductions were followed by rebound effects which diminished the SBP reducing effects of SAVD pacing, an effect attributed to baroceptor activation. However, the time course of SBP changes following initiation and termination of SAVD pacing suggested that baroreflex responses could be modulated by using pacing sequences consisting of alternating short and longer AV delay pacing. This was confirmed by direct measurements. Conclusions SBP can be reduced by SAVD pacing and secondary effects on baroreflex activation can be modulated by using a sequence of alternating short and longer AV delay pacing. If shown to be safe and effective over long periods of time, this approach could provide an important new therapeutic option for patients with persistent hypertension despite prescription of multi-drug regimens.

    更新日期:2018-03-22
  • Age and gender dependent associations of blood pressure and serum sodium and potassium-renal and extrarenal regulations
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-03-21
    Hongbing Sun, Michael Sun

    Association analyses between blood pressure (BP) and serum sodium and potassium for 14657 men and 16977 women between ages 12 and 85 show that responses of BP to serum sodium and potassium are age and gender dependent. The data were from the National Health and Nutrition Examination Survey between 2003 and 2014. Associations between serum sodium and BP are positive only for advanced age groups and for serum sodium level above 139∼140 mmol/l in less advanced groups. These positive associations can be explained by traditional renal-centered mechanism. Inverse associations between systolic BP and serum sodium exist when sodium is below 139 mmol/ in less advanced age groups (<60 for men and <70 for women). These inverse associations can partially be explained by the extrarenal regulatory mechanism in which sodium storage in negatively charged glycosaminoglycans in the interstitium may be involved. Associations of high serum potassium and low BP are consistent and exist in most age groups. Effect of potassium on systolic BP and diastolic BP are more prominent in less advanced age groups. Age dependent associations between sodium and BP support the theory that sodium homeostasis in the body may not be regulated by renal-centered responses alone. There might be regulation of an extrarenal system in which sodium attraction by negatively charged glycosaminoglycans plays a role.

    更新日期:2018-03-22
  • Integrated flow-mediated vasodilation response predicts cardiovascular events in elderly patients with cardiovascular risk factors: the Japan Morning Surge Home Blood Pressure Study
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-03-21
    Tomoyuki Kabutoya, Satoshi Hoshide, Kazuomi Kario

    The integrated flow-mediated vasodilation (FMD) response has been associated with cardiovascular risk factors, but the association between the integrated FMD response and subsequent cardiovascular events has been unclear. We enrolled 555 patients who had at least one cardiovascular risk factor (hypertension, dyslipidemia, diabetes or smoking). We measured the peak percentage change in diameter (ΔFMD), and integrated FMD response calculated as the area under the dilation curve over a 120-second dilation period (FMD-AUC120). Elderly patients (age≥65 years, N=270) in the lowest tertile of FMD-AUC120 (FMD-AUC120<5.6) had a higher rate of cardiovascular events compared with those in the two higher tertiles (FMD-AUC120 ≥5.6) (log rank 4.15, p=0.041). The association remained significant after adjusting for covariates age, gender and office systolic blood pressure (hazard ratio 3.84, p=0.007). In the 285 middle-aged patients (age<65 years, N=285), the cardiovascular event rates were similar between patients in the lowest tertile and those in the two higher tertiles of FMD-AUC120 (log rank 0.39, p=0.53). The cardiovascular event rates were similar between patients in the lowest tertile and those in the two higher tertiles of ΔFMD in elderly and middle-aged patient groups. In conclusion, integrated flow-mediated vasodilation response, but not ΔFMD, predicted cardiovascular events in elderly patients with cardiovascular risk factors.

    更新日期:2018-03-22
  • 更新日期:2018-03-22
  • Epidemiologic observations guiding clinical application of a urinary peptidomic marker of diastolic left ventricular dysfunction
    J. Am. Soc. Hypertens. (IF 2.268) Pub Date : 2018-03-21
    Zhen-Yu Zhang, Esther Nkuipou-Kenfack, Wen-Yi Yang, Fang-Fei Wei, Nicholas Cauwenberghs, Lutgarde Thijs, Qi-Fang Huang, Ying-Mei Feng, Joost P. Schanstra, Tatiana Kuznetsova, Jens-Uwe Voigt, Peter Verhamme, Harald Mischak, Jan A. Staessen

    Hypertension, obesity and older age are major risk factors for left ventricular (LV) diastolic dysfunction (LVDD), but easily applicable screening tools in people at risk are lacking. We investigated whether HF1, a urinary biomarker consisting of 85 peptides, can predict over a 5-year time span mildly impaired diastolic LV function as assessed by echocardiography. In 645 White Flemish (50.5% women; 50.9 years [mean]), we measured HF1 by capillary electrophoresis coupled with mass spectrometry in 2005–2010. We measured early (E) and late (A) peak velocities of the transmitral blood flow and early (e’) and late (a’) mitral annular peak velocities and their ratios in 2009–2013. In multivariable-adjusted analyses, per 1-SD increment in HF1, e’ was -0.193 cm/s lower (95% confidence interval [CI]: -0.352 to -0.033; P = .018) and E/e’ 0.174 units higher (0.005 to 0.342; P = .043). Of 645 participants, 179 (27.8%) had LVDD at follow-up, based on impaired relaxation in 69 patients (38.5%) or an elevated filling pressure in the presence of a normal (74 [43.8%]) or low (36 [20.1%]) age-specific E/A ratio. For a 1-SD increment in HF1, the adjusted odds ratio was 1.37 (CI, 1.07 to 1.76; P = .013). The integrated discrimination (+1.14%) and net reclassification (+31.7%) improvement of the optimized HF1 threshold (-0.350) in discriminating normal from abnormal diastolic LV function at follow-up over and beyond other risk factors was significant (P ≤ .024). In conclusion, HF1 may allow screening for LVDD over a 5-year horizon in asymptomatic people.

    更新日期:2018-03-22
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