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Made available in DSpace on 2022-04-28T19:49:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-02-01 Objective The present study aimed to analyze the association of 2-year changes in BMI and waist circumference with changes in blood pressure (BP) in a randomized sample of community-dwelling adults. Methods A sample of 331 middle-aged and older adults (mean age of 59.6±17.3years) was randomly selected. Measurements of SBP and DBP, BMI, and waist circumference were collected at baseline and after 2-year follow-up. Chronological age, sex, socioeconomic status, ethnicity, and self-reported medical diagnosis and use of medication for hypertension, diabetes, and high low-density lipoprotein-cholesterol were covariates. Multiple linear regression models were adopted for statistical analysis. Results SBP was positively associated with BMI (β=0.48, P=0.013) and waist circumference (β=0.21, P=0.005) at baseline and only with waist circumference at follow-up (β=0.20, P=0.007). DBP was positively associated with BMI (β=0.31, P=0.009) and waist circumference (β=0.12, P=0.006) values at baseline and at follow-up (BMI β=0.42, P=0.001; waist circumference β=0.18, P=0.001). Only the 2-year changes in waist circumference were associated to changes in SBP (β=0.33, P=0.013), regardless of confounding factors and BMI. Conclusion It is suggested that waist circumference is the main factor for control over the time in strategies focused on BP management in adult population. Movement Science Post-graduation Program Physical Education Department Universidade Estadual Paulista - Unesp Post-graduation Program in Rehabilitation Science Universidade Nove de Julho UNINOVE Post-Graduation Program in Physical Education Physical Education Department Universidade Federal de Santa Catarina - UFSC Centre for Research on Exercise Physical Activity and Health School of Human Movement and Nutrition Sciences The University of Queensland Research Center in Physical Activity health and Leisure (CIAFEL) Laboratory for Integrative and Translational Research in Population Health (ITR) Faculty of Sports - University of Porto (FADEUP) Movement Science Post-graduation Program Physical Education Department Universidade Estadual Paulista - Unesp

The present study aimed to investigate the associations between the trajectory of blood pressure (BP) change and the risk of subsequent dementia and to explore the differences in age, gender, and hypertension subgroups. We included 10,660 participants aged ≥ 60 years from 1998 to 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Latent growth mixture models were used to estimate BP trajectories. Cox-proportional hazard models were used to analyze the effects of BP trajectories on the risk of dementia. According to the results, stabilized systolic BP (SBP) was found to be associated with a higher risk of dementia compared with normal SBP [adjusted hazard ratio (aHR): 1.62; 95% confidence interval (CI): 1.27-2.07] and elevated SBP (aHR: 2.22; 95% CI: 1.51-3.28) in and only in the subgroups of the oldest-old, women, and subjects without hypertension at baseline. Similarly, stabilized pulse pressure (PP) was associated with a higher risk of dementia compared with normal PP (aHR: 1.52; 95% CI: 1.24-1.88) and elevated PP (aHR: 2.12; 95% CI: 1.48-3.04) in and only in the subgroups of the oldest-old, women, and subjects with hypertension at baseline. These findings suggest that stabilized SBP and PP have predictive significance for the occurrence of dementia in late life, and the factors of age, gender, and late-life hypertension should be considered when estimating the risk of BP decline on dementia.

Jinbo Yu,1– 3 Xiaohong Chen,1– 3 Yang Li,1– 3 Yaqiong Wang,1– 3 Zhonghua Liu,1– 3 Bo Shen,1– 3 Jie Teng,1– 3 Jianzhou Zou,1– 3 Xiaoqiang Ding1– 3 1Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China; 2Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People’s Republic of China; 3Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People’s Republic of ChinaCorrespondence: Xiaoqiang DingDivision of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, People’s Republic of ChinaTel +86-2164041990Email ding.xiaoqiang@zs-hospital.sh.cnBackground: A greater interdialytic weight gain (IDWG) implies a greater ultrafiltration rate, which might lead to hemodynamic instability and intradialytic blood pressure (BP) change in hemodialysis patients. However, current studies have not explicated the impact of IDWG on the association between intradialytic BP changes and prognosis, especially in patients without cardiac dysfunction and diabetes. In this study, we aimed to explore the relationship between absolute intradialytic BP changes and mortality with different IDWG levels.Methods: A total of 204 hemodialysis patients (without cardiac dysfunction and diabetes) were included in this prospective observation study, with a mean follow-up of 55.32± 20.99 months. Initially, we collected IDWG, IDWG% (percentages according to dry weight), and pre-/post-BPs of 36 consecutive dialysis sessions during three months enrollment. And the average value of them was defined as baseline value. Patients were divided into 3 cohorts according to IDWG% tertiles (< 3.3%, 3.3%– 4.6%, ≥ 4.6%). Comparisons between different tertiles were analyzed.Results: Compared to the low IDWG% group (tertile 1, T1), patients of high IDWG% group (tertile 3, T3) were younger, had higher ultrafiltration rate, less residual kidney function, lower BMI and dry weight, longer dialysis vintage and higher N terminal pro B type natriuretic peptide levels (P< 0.05). Correlations were found between IDWG% and intradialytic BP changes. Kaplan–Meier analysis and multivariate Cox regression model adjusted for demographic data, dialysis information and predialysis BPs indicated that greater absolute intradialytic BP changes were associated with worse prognosis in T1 group (P< 0.05). While in T3 group, less absolute intradialytic BP changes were associated with higher mortality (P< 0.05).Conclusion: There is a paradoxical association between absolute intradialytic BP changes and long-term mortality with different IDWG levels. Both BP stability and volume balance are crucial to patients’ prognosis.Keywords: all-cause mortality, hemodialysis, interdialytic weight gain, intradialytic blood pressure

A healthy diet reduces risk for high blood pressure. A small body size at birth increases risk for high blood pressure. Our aim was to study whether birth weight modifies the association between a healthy Nordic diet, characterized by high intake of Nordic vegetables, fruits, and berries, whole-grain rye, oat, and barley, and rapeseed oil, and blood pressure. Finnish men and women (n = 960) born in 1934–1944 attended clinical visits including clinical measurements, and questionnaires in 2001–2004 and 2011–2013. Linear regression was applied to investigate the interactions between birth weight and Nordic diet (measured by the Baltic sea diet score (BSDS)) on blood pressure change during the 10-year follow-up. Baseline Nordic diet and birth weight showed a significant interaction on systolic blood pressure (SBP) (p = 0.02), and pulse pressure (PP) (p

Objective This study aimed to understand how an increase in abdominal adiposity relative to overall adiposity is associated with blood pressure (BP) change. Methods A sex-stratified mixed linear model was used to examine the association (95% CI) between annual changes in waist circumference (WC) and systolic blood pressure and diastolic blood pressure, estimated from two to eight repeated measures across the 1993-2015 China Health and Nutrition Survey, among 5,742 men and 5,972 women (18-66 years) with no history of antihypertension medication use. Results The association between annual WC change and BP change remained statistically significant but was attenuated after controlling for annual BMI change, regardless of baseline abdominal obesity or overweight status. Each 10-cm annual WC gain in men and women was associated with a 0.98-mm Hg (95% CI: 0.61-1.35) and a 0.97-mm Hg (95% CI: 0.62-1.32) annual increase in systolic blood pressure and a 1.13-mm Hg (95% CI: 0.87-1.38) and a 0.74-mm Hg (95% CI: 0.51-0.97) annual increase in diastolic blood pressure, respectively, independent of annual BMI change. Conclusions WC gain may elevate BP even in the absence of BMI gain. BP management that addresses only BMI gain could overlook individuals at risk of elevated BP who have increased WC but not BMI.

Background Aortic stiffness is an independent predictor of cardiovascular events in patients with arterial hypertension. Resistant hypertension is often linked to hyperaldosteronism and associated with adverse outcomes. Spironolactone, a mineralocorticoid receptor antagonist, has been shown to reduce both the arterial blood pressure (BP) and aortic stiffness in resistant hypertension. However, the mechanism of aortic stiffness reduction by spironolactone is not well understood. We hypothesized that spironolactone reduces aortic stiffness in resistant hypertension independently of BP change. Methods and Results Patients with uncontrolled BP (≥140/90 mm Hg) despite use of ≥3 antihypertensive medications (including diuretics) were prospectively recruited. Participants were started on spironolactone at 25 mg/d, and increased to 50 mg/d at 4 weeks while other antihypertensive medications were withdrawn to maintain constant mean BP. Phase‐contrast cardiac magnetic resonance imaging of the ascending aorta was performed in 30 participants at baseline and after 6 months of spironolactone treatment to measure aortic pulsatility, distensibility, and pulse wave velocity. Pulse wave velocity decreased (6.3±2.3 m/s to 4.5±1.8 m/s, P P P Conclusions Our results suggest that spironolactone improves aortic properties in resistant hypertension independently of BP, which may support the hypothesis of an effect of aldosterone on the arterial wall. A larger prospective study is needed to confirm our findings.

Background The sodium (Na)/potassium (K) ratio was reported to be associated with blood pressure (BP). Recently, the Na/K ratio self-monitoring device using spot urine was established. We assessed whether the urinary Na/K ratio change measured using the Na/K device was positively associated with BP change in a health check-up setting. Methods We targeted 12,890 participants who attended the annually health check-up in Tome City, Miyagi Prefecture, Japan between 2017 and 2018. Tome city introduced urinary Na/K ratio measurement during health check-up since 2017. We assessed the relationship between change in urinary Na/K ratio and BP change using multiple regression analyses adjusted for age, sex, and change in body mass index (BMI) and alcohol intake. For each year, we compared the baseline characteristics according to the urinary Na/K ratio and BP level. Results The change in systolic BP and diastolic BP was positively associated with the change in urinary Na/K ratio. The average urinary Na/K ratio was significantly lower in 2018 than in 2017 (5.4±3.0 to 4.9±2.2, p Conclusions The positive association of change in urinary Na/K ratio with hypertension and change in systolic and diastolic BP can be explained by a change in alcohol intake, BMI, and urinary Na/K ratio. Key messages Measuring the urinary Na/K ratio in community settings is a potential population approach for counteracting hypertension.

We evaluated the clinical significance of the new non-invasive vascular indices to explore their potential utility using repeated cuff-oscillometric inflation. In 250 consecutive outpatients, we performed a cross-sectional, retrospective, single-center, observational study to investigate sequential differences in arterial stiffness using blood pressure, arterial velocity pulse index (AVI), and arterial pressure volume index (API) with repeated measurements. Males accounted for 62.7% of the patients, and the mean age was 68.1 ± 12.1 years. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the first reading in repeated measurements were 133.07 ± 21.20 mmHg and 73.94 ± 13.56 mmHg, respectively. The mean AVI and API were 23.83 ± 8.30 and 31.12 ± 7.86, respectively. In each measurement of these parameters, although DBP and AVI did not show significant changes throughout repeated measurements, SBP and API decreased significantly according to the measurement orders. Furthermore, changes in SBP and API were significantly correlated in several of the models. In this study, it was concluded that upper-arm SBP decline associated with repeated cuff-oscillometric inflation was significantly correlated with the arterial stiffness index. The findings of this study will allow clinicians to easily recognize the progression of atherosclerosis through regular, routine practice. In conclusion, this study suggests that changes in repeated SBP measurements may be predictive of arterial stiffness and atherosclerosis.

Introduction: Prior research on the association of anxiety with hypertension has yielded mixed results. Despite the high burden of both conditions in Hispanics/Latinos, little is known about their association in this population. This study examined the longitudinal relationship of trait anxiety with changes in BP and incidence of hypertension. Hypothesis: Higher trait anxiety at Visit 1 (V1) will be associated with greater increases in BP and incident hypertension over 6 years. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a multi-center prospective community-based study of 16,415 diverse Hispanics/Latinos ages 18-74 at V1 (2008-11). Data included 11,048 participants with complete information on BP, trait anxiety, and other variables at V1 and V2 (2014-17). Trait anxiety was measured at V1 using the 10-item Spielberger Trait Anxiety Scale, which was dichotomized into low and high using a cut-point of 20 points, the top quartile in the HCHS/SOL cohort. BP was measured using a standardized protocol and validated automated device. Hypertension was defined as systolic BP ≥ 140 or diastolic BP ≥ 90 mm Hg or self-reported antihypertensive medication use. Linear regressions were used to examine the association of anxiety with BP change; to account for medication use, 9 mmHg and 6 mmHg were added to systolic and diastolic BP of treated participants, respectively. The association of anxiety with incident hypertension at V2 was examined using Poisson regression among those without hypertension at V1 ( N = 7,878). Estimates were adjusted for complex survey design, sociodemographic factors, baseline BP, antidepressant/anxiolytic medication use, and health conditions. Results: Mean baseline age was 45.8 years and 60% were women. Mean change was 3.13 ( SE = 15.67) in systolic and 0.21 ( SE = 9.73) in diastolic BP. Individuals with high, compared to those with low, trait anxiety had greater increases in systolic ( B = 1.10, 95% CI = 0.28-1.93, p = 0.009) and diastolic BP ( B = 0.69, 95% CI = 0.11-1.27, p = 0.02) over 6 years, after adjusting for covariates. Individuals with high, relative to those with low, trait anxiety had an 18% higher risk of hypertension (RR = 1.18, 95% CI = 1.03-1.34, p = 0.012). Conclusions: Elevated trait anxiety is associated with small increases in BP over 6 years and an 18% higher risk of hypertension among diverse Hispanics/Latino adults. Research on the mechanisms underlying these relationships among Hispanics/Latinos is warranted to develop effective interventions to prevent and treat hypertension in this population.

Hypertension causes cerebrovascular and cardiovascular diseases. To help prevent this, early detection requires continuous monitoring of blood pressure in daily life, which must be measured without contact. We previously proposed a noncontact technique for measuring blood pressure in which we evaluated the relationship between the variation in blood pressure caused by the cardiac-dominant pattern and facial skin temperature distribution using independent component analysis and multiple regression analysis. The mechanism of blood pressure change is roughly classified into cardiac-dominant patterns and vascular-dominant patterns. An elucidation of the relationship between these patterns and facial skin temperature distribution is the objective of this study. Two tests resulting in cardiac-dominant and vascular-dominant patterns were conducted. These common and different features related to each mechanism of BP change in each subject were then evaluated. The results of the tests show that similar features were extracted from the nasal region and contrasting feature quantities were extracted from the other facial regions. Hence, individual models were constructed for estimating blood pressure using the common features related to both mechanisms. A high coefficient of determination was obtained from these models, suggesting that models for estimating blood pressure caused by both mechanisms can be constructed using the proposed approach.

Background: Extremes of both high and low systolic blood pressure (SBP) after mechanical thrombectomy (MT) in large artery occlusion stroke are known predictors of unfavorable outcome. However, the effect of SBP change (ΔSBP) during the first 24 hour on MT outcomes remains unclear. We aimed to investigate the association between ΔSBP at different time intervals and thrombectomy outcomes. Methods: We analyzed thrombectomy treated patients registered in the SITS International Stroke Thrombectomy Registry from 2014-01-01 to 2019-09-03. The primary outcome was 3-month unfavorable outcome (modified Rankin Scale [mRS] score 3-6). We defined ΔSBP as mean SBP of given time intervals after MT (0-2h, 2-4h, 4-12h, 12-24h) minus admission SBP. Multivariable mixed logistic regression models were used to adjust for known confounders and center as random effect. Subgroups analyses were included to contrast specific subpopulations. Restricted cubic splines were used to model the associations. Results: The study population consisted of 5835 patients (mean age 70 years, 51% male, median NIHSS 16). Mean ΔSBP was -12.3, -15.7, -17.2, and -16.9 for the time intervals 0-2h, 2-4h, 4-12h, 12-24h, respectively. Higher ΔSBP was associated with unfavorable outcome at all time intervals. Restricted cubic spline models suggested that increasing ΔSBP was associated with unfavorable outcomes, with higher values showing an even higher risk of unfavorable outcomes. (Figure 1). Successful reperfusion (mTICI ≥2b) retained an association between ΔSBP and outcomes, while unsuccessful reperfusion (mTICI Conclusion: Up to our knowledge, this is the first study to examine the relation between ΔSBP at different time intervals and the outcome of MT. BP increase after thrombectomy in large artery occlusion stroke is associated with poor functional outcome. The association between ΔSBP and poor outcome differed by reperfusion status.

A 53-year-old male undergoing emergency aortic valve replacement for infective endocarditis developed a hypertensive crisis early during the operation. Suspecting a pheochromocytoma, intravenous phentolamine was immediately administered, after which the procedure was completed as scheduled. Although quite rare, a pheochromocytoma can be encountered during emergency open heart surgery, thus early recognition of abnormal blood pressure change and appropriate management are important. Here, we present details of blood pressure control mainly by phentolamine use in this case to demonstrate effective management of a hypertensive crisis during emergency cardiac surgery because of a pheochromocytoma.

IntroductionBlood pressure variability, in addition to blood pressure itself, has been used as a predictor for mortality. This study examined the predictive power of baseline/latest/mean/median blood pressure and blood pressure variability measures for all-cause mortality and adverse cardiovascular outcomes.MethodsThe retrospective observational study analyzed patients who presented to family medicine clinics between 1st January, 2000 and 31st December, 2001. Blood pressure measurements were obtained over a five-year period. Standard deviation (SD), root mean square (RMS), coefficient of variation (CV) and a variability score (number of >=5 mmHg blood pressure change) were used as measures of blood pressure variability. The primary outcome was all-cause mortality and the secondary outcomes were heart failure, acute myocardial infarction, and transient ischemic attack (TIA)/stroke, with follow-up until 31 December 2019.ResultsThis study included 37540 patients (n=29597 patients with >=3 blood pressure measurements). A nonlinear inverse U-shaped relationship was observed between baseline/latest/maximum/minimum/mean/median/RMS measures of diastolic blood pressure and time-to-death for all-cause mortality (PConclusionNonlinear inverse U-shaped relationships were observed between blood pressure and its variability measures and all-cause mortality. Higher blood pressure variability was associated with increased risk of all-cause mortality, heart failure, acute myocardial infarction and TIA/stroke.

Background: The landmark Systolic Blood Pressure Intervention Trial (SPRINT) showed that more intensive systolic blood pressure treatment (SBP < 120 mm Hg) was associated with lower risk for cardiovascular events and mortality but higher risk for serious adverse events (SAEs). However, it is unclear if the magnitude and/or the direction of the BP change determines SAE risk. In this study, we aim to determine how the magnitude and direction of BP change impacts SAE risk. Methods: This is a secondary analysis of 7922 participants in SPRINT. Time-varying Cox proportional hazards models were used to explore the relationship between visit-to-visit BP change and SAE risk. BP change was categorized using five intervals: 1) decreases ≥30 mm Hg, 2) decreases 10-29 mm Hg, 3) increases or decreases Results: The hazard ratio (HR) for SAEs compared to the minimal BP change category was greatest for BP increases above 30 mm Hg (HR = 1.62, 95% confidence interval [1.30, 2.01]). However, the HR was similar for sharp BP decreases over 30 mm Hg (HR = 1.52 [1.23, 1.87]). Milder BP increases and decreases were associated with lower SAE risk (HR = 1.18 [1.06, 1.32] and HR = 1.10 [0.98, 1.22] for BP changes 10 to 30 mm Hg and -30 to -10 mm Hg, respectively). There were no significant interactions between BP change, intensive treatment, and baseline ASCVD risk. Conclusions: SAE risk was similar for similarly sized increases and decreases in BP between visits, with higher magnitude changes associated with higher SAE risk. When accounting for the magnitude of BP change, no significant effect of intensive treatment or baseline ASCVD risk was found.

Key points In this study, we focused on muscle sympathetic nerve activity (MSNA) burst size and occurrence separately as subcomponents of the sympathetic baroreflex in older adults, and we found that the distribution (variation) of burst size against burst occurrence was greater in women than men. Older women had greater carotid artery stiffness compared with older men, while blood pressure (BP) distribution (variation) was comparable between sexes. Sympathetic baroreflex sensitivity assessed with burst incidence was less sensitive as the carotid artery became stiffer in older men and women, while that assessed with burst area was more sensitive as the carotid artery became stiffer in older women but not in older men. These results help us understand the mechanisms underlying the compensation for the impaired response of MSNA burst occurrence in older women with greater carotid artery stiffness to regulate BP similar to that in older men. Abstract There are sex differences in arterial stiffness and neural control of blood pressure (BP) among older adults. We examined whether the sympathetic response to BP is greater in older women than men in burst size but not burst occurrence. Burst occurrence and size were assessed with burst interval and area of muscle sympathetic nerve activity, respectively, and the distributions of these indices were evaluated by range during supine rest in 61 healthy older subjects (30 men (69 ± 6 years) and 31 women (68 ± 6 years); means ± SD). Also, we analysed sympathetic baroreflex sensitivity (BRS) with burst occurrence and area simultaneously. Carotid β-stiffness was measured with B-mode ultrasonic image and carotid BP. The range of burst interval was smaller in older women than men (P = 0.002), while there was no difference in the range of burst area. Carotid β-stiffness was greater in older women than men (6.7 ± 2.7 vs. 5.1 ± 2.7, P = 0.027). Sympathetic BRS assessed with burst incidence was lower in older women than men (-2.3 ± 1.4 vs. -3.3 ± 1.4 bursts·100 beats-1 mmHg-1 , P = 0.007), while this sex difference was observed when assessed with burst area after adjusting for carotid β-stiffness (-116.1 ± 135.0 vs. -185.9 ± 148.2 a.u. burst-1 mmHg-1 , P = 0.040), but not before. Sympathetic BRS assessed with burst area was negatively (more sensitive) correlated with carotid β-stiffness in older women (r = -0.53, P = 0.002) but not men. These data suggest that the response of burst size within each burst is augmented for the baroreflex BP control despite the impaired response of burst occurrence in older women with greater carotid stiffness.

BACKGROUND: Cardiovascular disease is a leading economic and medical burden in the United States (US). As an important risk factor for cardiovascular disease, hypertension represents a critical point of intervention. Less is known about longitudinal effects of neighborhood deprivation on blood pressure outcomes, especially in light of new hypertension guidelines. METHODS: Longitudinal data from the Dallas Heart Study facilitated multilevel regression analysis of the relationship between neighborhood deprivation, blood pressure change, and incident hypertension over a 9-year period. Factor analysis explored neighborhood perception, which was controlled for in all analyses. Neighborhood deprivation was derived from US Census data and divided into tertiles for analysis. Hypertension status was compared using pre-2017 and 2017 hypertension guidelines. RESULTS: After adjusting for covariates, including moving status and residential self-selection, we observed significant associations between residing in the more deprived neighborhoods and 1) increasing blood pressure over time and 2) incident hypertension. In the fully adjusted model of continuous blood pressure change, significant relationships were seen for both medium (SBP: β=4.81, SE=1.39, p=0.0005; DBP: β=2.61, SE=0.71, p=0.0003) and high deprivation (SBP: β=7.64, SE=1.55, p

[Purpose]To investigate acute blood pressure change during aortic angiography in aortic dissection endovascular repair, and analyse the potential risk of this incident.[Method]24 patients with aortic dissection underwent endovascular repair in department of vascular surgery of Changhai hospital between May 2016 and July 2016 were enrolled in this research. Patients were divided into two groups: patients underwent general anesthesia and patients underwent lumbar anesthesia. Blood pressure was monitored by intro-artery catheter. Blood pressure readings were recorded every 10 seconds during the procedure of angiography. Outcome of these patients were observed in hospital. [Result] All patients received endovascular aortic repair, with 19 underwent lumbar anesthesia and 5 underwent general anesthesia. Patients underwent lumbar anesthesia presented temporary blood pressure decrease with average of -11.2±13.4mmHg, while patients underwent general anesthesia presented temporary blood pressure elevation with average of 4.2±6.3mmHg. The Maximum time interval were 26.7±12.7s vs25.8±15.8s, and difference in blood pressure between pre- and post-angiography were 1.53±4.4mmHg vs. 4.6±3.4mmHg, both without significance (P>0.05).[Conclusion] Angiography is an effective factor influencing blood pressure during TEVAR, it’s a potential “trigger” of intra-operative cardiovascular events. Blood pressure should be kept on proper level to avoid cardiovascular events induced by blood pressure variability with angiography. Angiography with General anesthesia has less influence on blood pressure than with lumbar anesthesia.

During the past 4 decades, the highest worldwide blood pressure (BP) levels have shifted from high-income countries to low- and middle-income countries. We investigated the association of intragenerational social mobility with changes in BP and also with the incidence of hypertension over a 4-year follow-up.Data for 6,529 baseline participants from ELSA-Brasil born between 1938 and 1975 were used. Based on a social mobility matrix, occupational social mobility was defined as the change in occupational social class between participants' first occupation and current occupation (stable high; upward; downward; stable low). Incident hypertension was defined as systolic blood pressure (SBP) ≥ 140 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg or use of antihypertensive medication. Hypertensive participants at baseline were excluded. Mixed effects regression models were used.Compared to the stable high group, the downwardly mobile group showed a higher increase over time in both SBP (β = 1.49, 95% CI 0.60; 2.37) and DBP (β = 0.96, 95% CI 0.32; 1.59) after adjustments for background characteristics and also proximal risk factors such as health-related behaviors and body mass index as time-dependent covariates, and diabetes. In contrast, upward mobility had no influence on BP changes (β = 0.67, 95% CI -0.07; 1.41 for SBP, and β = 0.47, 95% CI -0.05; 1.00 for DBP). Social mobility was not associated with the incidence of hypertension.We showed socioeconomic inequalities in BP progression over the life course. The longitudinal changes in BP varied by social mobility groups in the context of low- and middle-income countries, where high BP has become most prevalent.

OBJETIVO: Determinar si existen diferencias en el cambio de la presión arterial a lo largo del tiempo de acuerdo con la estatura en adultos mexicanos. MÉTODOS: Se analizaron las bases de datos de la Encuesta Nacional de Niveles de Vida de los Hogares en la que se siguieron a los miembros de los hogares entre el 2005 y 2009. Se seleccionaron a los participantes que tenían entre 20 y 40 años (n = 7,130). Se estimaron modelos multinivel con intercepto aleatorio para analizar diferencias en los cambios de la presión arterial de acuerdo con la estatura. Los modelos fueron ajustados por edad, tamaño de localidad, región geográfica, ingreso familiar per cápita, índice cintura-estatura, actividad física, consumo de alcohol, tabaquismo y uso de antihipertensivos. RESULTADOS: En ambos sexos, la presión arterial inicial tendió a ser menor conforme la estatura fuese menor. Las diferencias se mantuvieron tanto en los modelos crudos como en los modelos ajustados. En los varones los incrementos de la presión sistólica a lo largo del tiempo tendieron a ser mayores conforme la estatura era más alta. CONCLUSIONES: Contrario a lo observado en países de altos ingresos, en México la presión arterial se asoció positivamente con la estatura.

Background Selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) have been commonly prescribed for depression treatment. However, their effects on blood pressure are unclear. Materials and methods Effects on blood pressure of depressive patients in two groups (SSRIs versus placebo and SSRIs versus SNRIs) were evaluated. A search was conducted for double-blind, randomized controlled trials (RCTs) in PubMed, EMBASE, ISI Web of Science, PsycNET, CCRCT, and DARE (up to March 2017). The outcomes were systolic blood pressure (SBP) changes and diastolic blood pressure (DBP) changes from baseline to endpoint or to a certain period of treatment duration. Weighted mean differences (WMDs) and 95% CIs were calculated and pooled using random effects models. The χ2 test and I2 statistics were used to assess heterogeneity. Funnel plots, Begg's test, and Egger's test were used to estimate publication bias. Results A total of 23 RCTs involving 13,285 participants were included. Patients on SSRIs showed no significant differences in blood pressure changes compared with placebo. In the group of SSRIs versus SNRIs, overall SBP changes and DBP changes revealed statistical significances (WMD 1.5 mmHg, 95% CI -2.15, -0.84, Z=4.46, P

Background Home blood pressure is a more accurate prognosticator than office blood pressure and allows the observation of day‐to‐day blood pressure variability. Information on blood pressure change during the life course links the prediction of blood pressure elevation with age. We prospectively assessed age‐related trends in home blood pressure, home pulse rate, and their day‐to‐day variability evaluated as a coefficient of variation. Methods and Results We examined 1665 participants (men, 36.0%; mean age, 56.2 years) from the general population of Ohasama, Japan. A repeated‐measures mixed linear model was used to estimate the age‐related trends. In a mean of 15.9 years, we observed 5438 points of measurements including those at baseline. The home systolic blood pressure linearly increased with age and was higher in men than in women aged 40 years. However, an U‐shaped age‐related trend in day‐to‐day diastolic blood pressure variability with the nadir point at 65 to 69 years of age was observed. No significant sex differences in the day‐to‐day blood pressure variability were observed ( P ≥0.22). The average and day‐to‐day variability of home pulse rate decreased with age but were lower and higher, respectively, in men than in women. Conclusions The current descriptive data are needed to predict future home blood pressure and pulse rate. The data also provide information on the mechanism of day‐to‐day blood pressure and pulse rate variability.

Direct current (DC) cardioversion is used to convert persistent atrial fibrillation (AF) to sinus rhythm (SR), but there is limited knowledge about how blood pressure (BP) is affected by conversion to SR. We sought to evaluate how BP changed in AF patients who converted to SR, compared to patients still in AF. In this retrospective registry analysis, we included a total of 487 patients, treated with DC cardioversion for persistent AF. We obtained data regarding medical history, medication, BP, and electrocardiogram the day before and 7 days after cardioversion. Systolic BP increased by 9 (±16) mm Hg (P

Tomato is one of diets that is rich of nutrition. Moreover, tomato has an important role to keep body balance, tomato also can be used to cure hypertension. Tomato contains potassium, calcium, and other nutrition that can decrease blood pressure of menopause women. This study is aimed at knowing the influence of tomato juice towards blood pressure change of menopause women. The sample used in this study is 16 respondents. The design of the study is pre experimental with one group pre-test and post-test approach. The data analysis used in this study is Wilcoxon test. The result of the study shows that there is an influence of tomato juice towards the decreasing of systolic blood pressure of menopause women in campurejo-mojoroto-kediri. It is hoped that the result of this study will give a beneficial contribution to menopause women and other hypertension sufferers.Keyword: Hypertension, Tomato, Potassium, Calcium

BACKGROUND While changes in blood pressure (BP) are independently associated with cardiovascular events, less is known about the association between changes in BP and subsequent changes in renal function in adults with an estimated glomerular filtration rate (eGFR) of >60 ml/min/1.73 m2. METHODS The present study included 3,920 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) study who had ≥2 BP measurements during the first 5 years of MESA and had eGFR measurements at both year 5 and 10. Change in BP was estimated as the annualized slope of BP between year 0 and 5 based on linear mixed models (mean number of measurements = 4.0). Participants were then grouped into 1 of 3 categories based on the distribution of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) change (top 20%, middle 21–79%, bottom 20%). We calculated eGFR from cystatin C (ml/min/1.73 m2), estimated annual change in eGFR (ml/min/1.73 m2/year), and defined rapid kidney function decline as a >30% decrease in eGFR from year 5 to 10. We used multivariable logistic regression adjusting for year 0 demographic and clinical characteristics, including eGFR and BP, to determine associations of BP change with rapid kidney function decline. RESULTS Median age was 59 [interquartile range (IQR): 52, 67] and median eGFR at year 0 was 95.5 (IQR: 81.7, 105.9) ml/min/1.73 m2. Median SBP at year 0 was 111, 121, and 147 mm Hg for increasing, stable, and decreasing SBP change, respectively. Increasing SBP and widening PP change were each associated with higher odds of rapid kidney function decline compared with stable SBP and PP groups, respectively [odds ratio, OR 1.7 (95% confidence interval, CI 1.3, 2.4) for SBP; OR 1.4 (95% CI 1.1, 1.9) for PP]. Decreasing SBP was associated with rapid kidney function decline after adjusting for all covariates except for year 0 BP [OR 1.4 (95% CI 1.0, 1.8)], but this association was no longer statistically significant after adjustment for year 0 BP. There were no significant associations between DBP change and rapid decline in the fully adjusted models. Similar findings were seen with annual change in eGFR. CONCLUSIONS Increasing SBP and widening PP over time were associated with greater risk for accelerated kidney function decline even at BP levels below established hypertension thresholds.

The authors investigated whether a genetic risk score (GRS) constructed of 32 single nucleotide polymorphisms would predict incident hypertension and blood pressure (BP) change over time in a population cohort during an 11-year follow-up (n=5402 at baseline, 3266 at follow-up). In multivariable models, GRS was associated with higher systolic/diastolic BP values at baseline (β±standard error [SE], 1.04±0.14/1.11±0.13 mm Hg; P

Declining systolic blood pressure (SBP) is common in very old age and it is associated with adverse events, such as dementia. Knowledge of factors associated with SBP change could be used to formulate preventive strategies. This study investigated SBP change and associated factors in a representative sample of very old individuals followed–up after 5 years. The study was based on data from the Umeå85+/GERDA cohort study, containing cross-sectional and longitudinal data on participants aged 85, 90, and ≥95 years. Follow–up was 5 years. Main outcome was absolute SBP change. Factors associated with SBP change were assessed using multivariate linear regression models. Baseline SBP was measured in 1136 first–time participants. Within 5 years, 711 had died. Of the surviving participants, 297 were followed up with SBP measurement. Mean SBP change was -12 mm Hg ± standard deviation 25 mm Hg. Among survivors followed–up with SBP measurement, SBP change was independently associated with changing Barthel p–ADL score during follow–up, and inversely associated with investigation year, baseline SBP level, baseline antidepressant prescription, incident acute myocardial infarction during follow–up, and discontinued or new diuretic prescription during follow–up. In conclusion, SBP seems to be declining among very old individuals. The decline seems to depend on SBP level, investigation year, and health–related factors.

We evaluated the gender differences in the relation of baseline serum γ-glutamyltransferase (GGT) levels to blood pressure (BP) change during 4 yr. 4,025 normotensive subjects (1,945 men and 2,080 women) who aged 40-69 yr at baseline participated in the Ansung-Ansan cohort of the Korean Genome Epidemiology Study were included. The associations of GGT with baseline BP or 4-yr change of BP were evaluated. GGT levels were associated with systolic blood pressure (SBP) and diastolic blood pressure (DBP) at baseline after adjusting for age, body mass index (BMI), HDL-cholesterol, triglyceride, C-reactive protein (CRP), current smoking status and alcohol intake (SBP, β = 1.28, P < 0.001; DBP, β = 1.41, P < 0.001). GGT levels were also associated with 4-yr change in BP after adjusting for age, BMI, HDL-cholesterol, triglyceride, CRP, current smoking status, alcohol intake and SBP (SBP, β = 1.08, P = 0.001; DBP, β = 0.64, P = 0.003). This association was statistically significant in men (SBP, β = 1.82, P < 0.001; DBP, β = 1.05, P = 0.001), but not in women (SBP, β = 0.38, P = 0.466; DBP, β = -0.37, P = 0.304). Remarkably, this association between GGT and BP was significant in men at 40-49 yr of age. In summary, we found positive associations between GGT levels at baseline and the change of BP. The relation of GGT level and the change of BP was only significant in men, not in women, which warrants further studies to elucidate the biologic mechanisms.

Background One previous large cross-sectional study across four countries suggests that riboflavin intake may be inversely associated with blood pressure. Objective The aim of this analysis was to investigate a possible association between riboflavin intake and change in blood pressure over 5 years. Methods The study population comprised Chinese men and women who participated in the Jiangsu Nutrition Study. Quantitative data relating to riboflavin intake at baseline in 2002 and measurements of blood pressure at baseline and follow-up in 2007 were available for 1,227 individuals. Results Overall, 97.2% of the participants had inadequate riboflavin intake (below the Estimated Average Requirement). In multivariable analysis adjusted for sociodemographic and lifestyle factors and dietary patterns, a higher riboflavin intake was inversely associated with change in systolic blood pressure ( p = .036). In participants taking antihypertensive medication at baseline, the relationship between riboflavin intake and systolic blood pressure persisted; whereas, in those not taking antihypertensive medication, the diastolic blood pressure was less likely to increase with the increasing intake of riboflavin ( p = .031). There was a three-way interaction between antihypertensive medications, body mass index, and riboflavin intake. Among those who were obese and taking antihypertensive medication, a higher riboflavin intake was associated with a smaller increment in systolic blood pressure and pulse pressure. Conclusions There are complex interactions between riboflavin intake and blood pressure change that depend on prior antihypertensive use and the presence or absence of obesity.

The study aims to examine the blood pressure (BP) trajectory during pregnancy and its association with pre-gravid BP level. In a pre-conception cohort study, newly-married women in Liuyang, China underwent pre-gravid measurements and were followed throughout the pregnancy. BP was measured at pre-conception and again throughout pregnancy. The functional principal component analysis was used to examine the trajectory of BP changes during pregnancy. A total of 1282 women with a singleton pregnancy who had both pre-conception and gestational BP measurements performed were included in the final analysis. The results showed that BP decreased significantly in early pregnancy and increased thereafter, without BP drop around 20 weeks of gestation. Pre-gravid BP level was inversely associated with the BP drop in early pregnancy, such that women with higher pre-gravid BP had greater BP drop at the beginning, while women with the lowest pre-gravid BP level demonstrated no obvious BP drop throughout the entire pregnancy.

AIM: To evaluate blood pressure (BP) changes during phacoemulsification (PC) and femtosecond laser (FSL)-assisted cataract surgery. METHODS: A retrospective chart review was performed for all patients who received traditional phacoemulsification surgery (PC group) and FSL-assisted cataract surgery (FS group) from July 2013 to December 2014. Totally 206 eyes from 133 patients receiving the two types of procedures were included. Patient characteristics (age, gender, and hypertension history), pre- and post-operative BPs were collected. RESULTS: The pro-operative systolic and diastolic BPs (mm Hg) were 124.89±20.48 vs 126.98±16.85, and 71.88±9.81 vs 73.56±10.03, in PC and FS groups, respectively. While the post-operative systolic and diastolic BPs (mm Hg) were 130.13±22.59 vs 134.77±17.52, and 73.41±11.62 vs 78.89±12.2, in PC and FS groups, respectively. Paired-sample t-tests showed obvious systolic and diastolic BP elevations in FS group after surgery (P=0.001 and 0.007) and no reliability in PC group (P=0.094 and 0.359). A linear regression model revealed systolic and diastolic BP elevations, which were related to longer surgical times for FS group (P=0.008 and 0.021). Age, gender, and hypertension history were not correlated with blood pressure elevation in either group. CONCLUSION: BP increases but at a limited level after FSL-assisted cataract surgery compared to traditional phacoemulsificationKEYWORDS: cataract surgery; blood pressure; femtosecond-assisted cataract surgery; phacoemulsification

The purpose of this study was to investigate the clinical significance of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) defined stage 1 hypertension (systolic blood pressure (SBP) 130&ndash, 139 mmHg or diastolic blood pressure (DBP) 80&ndash, 89 mmHg), and increase in BP from previously normal BP in Korean adults. We conducted a retrospective analysis of 60,866 participants from a nationally representative claims database. Study subjects had normal BP (SBP &lt, 120 mmHg and DBP &lt, 80 mmHg), no history of anti-hypertensive medication, and cardiovascular disease (CVD) in the first period (2002&ndash, 2003). The BP change was defined according to the BP difference between the first and second period (2004&ndash, 2005). We used time-dependent Cox proportional hazards models in order to evaluate the effect of BP elevation on mortality and CVD with a mean follow-up of 7.8 years. Compared to those who maintained normal BP during the second period, participants with BP elevation from normal BP to stage 1 hypertension had a higher risk for CVD (adjusted hazard ratio (aHR) 1.23, 95% confidence interval (CI), 1.08&ndash, 1.40), and ischemic stroke (aHR 1.32, 95% CI, 1.06&ndash, 1.64). BP elevation to 2017 ACC/AHA defined elevated BP (SBP 120&ndash, 129 mmHg and DBP &lt, 80 mmHg) was associated with an increased risk of CVD (aHR 1.26, 1.50), but stage 1 isolated diastolic hypertension (SBP &lt, 130 and DBP 80&ndash, 89 mmHg) was not significantly related with CVD risk (aHR 1.12, 95% CI, 0.95&ndash, 1.31).

This editorial refers to ‘Midlife blood pressure change and left ventricular mass and remodelling in older age in the 1946 British Birth Cohort Study’, by A.K. Ghosh et al. on page doi:10.1093/eurheartj/ehu389 The 1946 Medical Research Council National Survey of Health and Development (MRC-NSHD) is the longest running birth cohort in the UK. Making use of this unique resource, Ghosh and colleagues have now demonstrated that left ventricular mass index (LVMI) and relative wall thickness at age 60–64 were associated with blood pressure (BP) or use of antihypertensive drugs from 36 years of age onwards, independent of current BP or treatment status.1 Moreover, the rate of BP increase over time rather than the absolute BP level at a given age determined the LVMI at 60–64 years.1 Ghosh and colleagues have to be congratulated for their meticulous analysis of longitudinal data spanning 28 years. Nevertheless, several issues cannot be disregarded in the interpretation of the results. First, as in all longitudinal studies, the attrition rate was high. Of 5362 initially enrolled participants, only 2856 were invited for echocardiography from 2006 until 2011. Invitations were not sent to those who had died ( n = 778), were living abroad ( n = 570), had previously withdrawn from the study ( n = 594), or had been lost to follow-up ( n = 564). Of those invited, 539 (18.9%) accepted to be visited at home, but only 1653 (57.8%) underwent echocardiography and 1480 (51.8%) had analysable images. The authors argued that participants who opted for a home visit had higher BP and were less healthy, …

Background and Objectives In a multi-center, single-arm, prospective study, we investigated the efficacy and safety of the fixed irbesartan/hydrochlorothiazide combination in Chinese patients with moderate to severe hypertension. Methods Eligible patients were aged 18–75 years, with a blood pressure of 160–199 mmHg systolic or 100–119 mmHg diastolic during a 1-week wash-out phase off antihypertensive medication. The enrolled patients started antihypertensive treatment with irbesartan/hydrochlorothiazide 150 mg/12.5 mg once daily, with the possible addition of irbesartan 150 mg once daily and up-titration to irbesartan/hydrochlorothiazide 300 mg/25 mg once daily at 4 and 8 weeks of follow-up, respectively. The primary efficacy variable was the goal blood pressure-attaining rate at 12 weeks of follow-up (

Although the head-up tilt (HUT) test and Valsalva maneuver (VM) have been widely used to identify sympathetic adrenergic impairment, the detailed relationship between the degree of orthostatic hypotension (OH) during the HUT test and the pattern of blood pressure (BP) change during the VM remains unknown. This study was performed to investigate the relationship between the degree of OH during the HUT test and the pattern of BP change during the VM. During a 4-year period, a total of 132 consecutive patients with neurogenic OH and 60 healthy controls were enrolled. The degree of OH was defined as mild (associated with a fall in systolic BP [SBP] ≥ 20 < 30 on tilting, n = 49), moderate (associated with a fall in SBP ≥ 30 < 40 on tilting, n = 43), and severe (associated with a fall in SBP ≥ 40 on tilting, n = 40). A standardized battery of autonomic tests, including the HUT test and VM using Finometer devices for recording beat-to-beat BP and heart rate response, and a quantitative sudomotor axon reflex test, was performed. Sympathetic indexes (SIs 1–6) were calculated from the VM. A composite autonomic severity score (CASS) was also obtained to evaluate the severity and distribution of autonomic dysfunction. The degree of OH was compared with the BP decline and recovery during the VM. All indexes exhibited overall significant differences among tested groups (P

A field measurements of the blood pressure change of elderly with the room air temperature change during the bathing were made in winter of Sapporo and Fukui. Average room air temperatures of the undressing room in Sapporo versus Fukui were 19.8 versus 12.6 degree-C. The temperature differences between the living and the undressing room in Sapporo versus Fukui were 2.7 versus 6.5 degree-C, respectively. It would appear that the insulation performance of houses in Sapporo is higher that in Fukui. Therefore, over the 5 degree of air temperature drop between the living and the undressing room brings about a terrible rise in their blood pressure at the probability of 80 percent or more.

Background : Hypertension is a long term condition in which blood pressure is higher than 140/90 mmHg. Antihypertensive drugs therapy took a long time and caused side effects so that further treatment is needed through non-pharmalogycal therapy such as the consumption of smoothies combination of various fruits and vegetables that contain high fiber and potassium. Objective : To determine the effectiveness of smoothies combination of various fruits and vegetables consumtion to changes in blood pressure change in adult women. Method : This research is a true experiment with Randomized Pre and Post Test Control Group Design. Sampling was done randomly to get 30 samples. Data collection were included by age, nutritional status, occupation, blood pressure data before and after treatment and fiber, sodium, potassium, calcium and magnesium intakes. Results : There was an effect of smoothies combination of various fruits and vegetables consumtion to decrease cytolic and diastolic blood pressure during the study with confounding variables of fiber, sodium, potassium and magnesium intake (p = 0.025 and p = 0.037). Conclusion : The average systolic and diastolic blood pressure in the treatment group were decreased after consumtion smoothies combination of various fruits and vegetables, while the control group tended to increased because they were not consume smoothies.