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Long and short sleep durations were reported as independently associated with hypertension, aortic stiffness, and cardiovascular disease. High-sensitivity C-reactive protein (hs-CRP) was shown to be associated with increased aortic stiffness. Here, we investigated the relationship between self-reported sleep duration and pulse wave velocity (PWV) in the elderly at high risk of cardiovascular disease. We also investigated whether hs-CRP moderates this relationship. Among 4310 patients with ≥1 cardiovascular risks recruited for the Japan Morning Surge-Home Blood Pressure Study, a questionnaire including items on daily sleep duration was completed. We measured the brachial-ankle PWV (baPWV) and hs-CRP levels in 2304 of these patients (mean age 64.7 years, 49.6% males). In accord with the patients' sleep duration (<6 hours, ≥6 to <8 hours, and ≥8 hours per night), significant associations between sleep duration and the PWV were observed (1594 vs. 1644 vs. 1763 cm/s, P < .0001). In the multiple regression analysis adjusted for age, body mass index, total cholesterol, HbA1c and clinic systolic blood pressure, long sleep duration (≥8 hours per night) ( P < .05), and log hs-CRP ( P < .05) were significantly positively associated with PWV when the patients with 6- to 8-hour sleep duration were defined as a reference group. Significant interactions of long sleep duration by age and that by antihypertensive medication for baPWV were observed. The effect of long sleep on PWV was greatest in the oldest age group. Long sleep duration and hs-CRP were significant indicators of increased baPWV in this elderly high-risk Japanese population. Age and antihypertensive medication use were significant modulators of the relationship between long sleep duration and arterial stiffness. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Recently, visit-to-visit blood pressure (BP) variability has been shown to be associated with vascular remodeling and cognitive dysfunction. However, there have been no studies that focused on the relationship between visit-to-visit BP variability and cognitive dysfunction in relation to vascular remodeling. In this study, we investigated the relationships among visit-to-visit BP measures, carotid artery remodeling and cognitive function in the elderly at high risk of cardiovascular disease. Methods: The cognitive function was evaluated using a Mini-Mental State Examination (MMSE) and global deterioration scale (GDS) in 201 elderly subjects at high risk of cardiovascular disease (79.9 ± 6.4 years old; female 75%). Based on 12 visits (once a month), visit-to-visit BP variability (expressed as the coefficient of variation [CV] and as delta [maximum − minimum] BP) were measured. Carotid ultrasound was performed to measure intima-media thickness (IMT) and the stiffness parameter β. Results: The patients having both high delta systolic BP (SBP) and high IMT had significantly higher prevalence of low MMSE score than those with both low delta SBP and low IMT (p < 0.05), and the patients having both high delta SBP and high stiffness parameter β also had significantly higher prevalence of low MMSE score than those with both low delta SBP and low stiffness parameter β (p < 0.01). In the logistic regression analysis adjusted for age, calcium channel blocker use, low density lipoprotein, average heart rate, and average SBP level, a significant interaction was found between delta SBP and stiffness parameter β for the low MMSE score (p < 0.05). Conclusions: In the high risk elderly, exaggerated visit-to-visit BP variability and advanced carotid artery remodeling have a synergetic association with cognitive dysfunction. [Copyright &y& Elsevier]

Abstract: Recently, visit-to-visit variability in systolic blood pressure (SBP) has been shown to be a predictor of stroke. In this study, we investigated the relationship of visit-to-visit blood pressure (BP) variations (based on 12 visits once a month) with intima-media thickness (IMT) and stiffness in common carotid artery among the 201 high-risk elderly (female 75%) at cardiovascular disease. Max-IMT was significantly positively correlated with age, smoking, renin-angiotensin system inhibitor use, coefficient of variation (CV), and delta (maximum-minimum) in SBP, and CV in diastolic BP (DBP) but was significantly negatively correlated with female, high-density lipoprotein (HDL), and minimum in SBP. Stiffness parameter β was significantly positively correlated with age, standard deviation (SD), CV, maximum, and delta in SBP, and SD, CV, and delta in DBP but was significantly negatively correlated with smoking, HDL, average, and minimum in DBP. In a multiple regression analysis, delta SBP (P < .001) was associated with max-IMT independently of average SBP. CV (P < .05) and delta (P < .05) in SBP, and CV (P < .001) and delta (P < .01) in DBP were associated with stiffness parameter β independently of average BP. In the high-risk elderly, exaggerated visit-to-visit BP fluctuations were significant indicators for carotid artery atherosclerosis and stiffness independently of average BP. [Copyright &y& Elsevier]

Abstract: The classical literature on neurocardiology has focused mainly on the subcortical regions of the central autonomic nervous system. However, recent studies have supported the notion that the cardiovascular system is regulated by cortical modulation. Modern neuroimaging data, including positron emission tomography and functional magnetic resonance imaging, have revealed that a network consisting of the insular cortex, anterior cingulate gyrus, and amygdala plays a crucial role in the regulation of central autonomic nervous system. Because the insular cortex is located in the region of the middle cerebral arteries, its structure tends to be exposed to a higher risk of cerebrovascular disease. The insular cortex damage has been associated with arrhythmia, diurnal blood pressure variation disruption (eg, a non-dipper or riser pattern), myocardial injury, and sleep disordered breathing, as well as higher plasma levels of brain natriuretic peptide, catecholamine, and glucose. This review article focuses on the role of the insular cortex as a mediator for the cardiovascular system and summarizes current knowledge on the relationships between cerebrovascular disease and cardiovascular system dysregulation. Finally, a hypothesis of the neural network involved in cortical cardiovascular modulation, including modulation of the insular cortex, is provided. [Copyright &y& Elsevier]

Keywords: Insular cortex; Hemorrhagic stroke; Autonomic nervous system; Laterality; Central autonomic network EN Insular cortex Hemorrhagic stroke Autonomic nervous system Laterality Central autonomic network N.PAG N.PAG 1 12/29/20 20210101 NES 210101 We read the interesting study by [5], who reported the autonomic and cardiovascular consequences resulting from an experimental intracerebral hemorrhage (ICH) stroke in the left or right intermediate insular cortex (Ic) in rats. The hypoactivity in the patient's left Ic due to the chronic left ICA occlusion might have led to a decrease in parasympathetic autonomic nervous activity, and to a shift in the sympathovagal balance toward a predominant SNS tone. [Extracted from the article]