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... called diastole. Normal blood pressure is considered to be a systolic blood pressure of 115 millimeters of ... pressure reading of 140 over 90, he would be evaluated for having high blood pressure. If left ...
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Diastolic blood pressure; Systolic blood pressure; Blood pressure reading; Measuring blood pressure ... your health care provider will wrap the blood pressure cuff snugly around your upper arm. The lower ...
... page please turn Javascript on. Feature: High Blood Pressure Blood Pressure Quiz Past Issues / Fall 2011 Table of Contents ... About High Blood Pressure / Treatment: Types of Blood Pressure Medications / Blood Pressure Quiz Fall 2011 Issue: Volume 6 Number ...
Understanding Blood Pressure Readings
... Pressure Tools & Resources Stroke More Understanding Blood Pressure Readings Updated:Aug 17,2016 Blood pressure is typically ... Your doctor should evaluate unusually low blood pressure readings. How is high blood pressure diagnosed? Your healthcare ...
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Hypertension - infants ... and blood vessels The health of the kidneys High blood pressure in infants may be due to kidney or ... blood vessel of the kidney) In newborn babies, high blood pressure is often caused by a blood clot in ...
High Blood Pressure (Hypertension)
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Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart ... it pumps blood into the arteries. Your blood pressure is highest when your heart beats, pumping the ...
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... page from the NHLBI on Twitter. Description of High Blood Pressure Español High blood pressure is a common disease ... defines high blood pressure severity levels. Stages of High Blood Pressure in Adults Stages Systolic (top number) Diastolic (bottom ...
... the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. ...
High Blood Pressure in Pregnancy
... The Health Information Center High Blood Pressure in Pregnancy What Is High Blood Pressure? Blood pressure is ... Are the Effects of High Blood Pressure in Pregnancy? Although many pregnant women with high blood pressure ...
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Hypertension (High Blood Pressure)
... pressure to live. Without it, blood can't flow through our bodies and carry oxygen to our vital organs. But when blood pressure gets too high — a condition called hypertension — it can lead to ...
Hypertension (High Blood Pressure)
... blood pressure with the development of a practical method to measure it. Physicians began to note associations between hypertension and risk of heart failure, stroke, and kidney failure. Although scientists had yet to prove that lowering blood pressure ...
High Blood Pressure (Hypertension)
... For Consumers Consumer Information by Audience For Women High Blood Pressure (Hypertension) Share Tweet Linkedin Pin it More sharing options ... En Español Who is at risk? How is high blood pressure treated? Understanding your blood pressure: What do the ...
... High Blood Pressure Tools & Resources Stroke More Blood Pressure vs. Heart Rate Updated:Aug 30,2016 Blood ... last reviewed on 08/04/2014. High Blood Pressure • Home • About High Blood Pressure (HBP) Introduction What ...
Ehrenfeld, Jesse M.; Epstein, Richard H.; Bader, Stephen; Kheterpal, Sachin; Sandberg, Warren S.
Background Arterial blood pressure (BP) measurement at least every five minutes is part of the American Society of Anesthesiologists' (ASA) monitoring standard, but prolonged BP gaps in electronic anesthesia records have been noted. We undertook multicenter studies to determine the frequency of cases with at least one interval ≥ 10 minutes between successive BP measurements and then to ascertain if educational feedback via an electronic, near real-time notification system alerting providers to the presence of such gaps would reduce their incidence. Methods We evaluated 212,706 electronic anesthesia records from three large academic centers. We determined the fraction of cases with ≥ 10 minute BP monitoring gaps at baseline and did a root cause analysis to determine common causes for these lapses. We then designed and implemented automated systems at two of the hospitals to notify point-of-care providers immediately after such 10-minute gaps occurred and determined the subsequent impact of this feedback on BP gap incidence, compared to baseline. Results At Hospital A, the notification system reduced the incidence of cases with at least one BP gap (1.48% ± 0.19% SD vs 0.79% ± 0.36% SD, p<0.0001). At Hospital B, the gap incidence was not significantly altered when notification was provided after a 10-min gap had already occurred (2.72% ± 0.60% SD vs. 2.45% ± 0.48% SD, P=0.27), but the incidence was reduced when such notification was provided after 6 minutes without a BP reading (2.72% ± 0.60% SD vs 1.54% ± 0.19% SD, P<0.0001). At Hospital C, where notification was not implemented, the baseline rate of BP gaps was consistent across the preintervention and follow-up periods (7.03% ± 1.27% SD vs. 7.13% ± 0.11% SD, p=0.74). Although monitors disconnected during position change was the most common identifiable cause of BP gaps, reasons for the missing BPs were often not documented. During a week when the electronic charting system was temporarily inoperable, no
... more often referred to as a blood pressure cuff. The cuff is wrapped around your upper arm and inflated ... flow of blood in your artery. As the cuff is slowly deflated, your doctor uses a stethoscope ...
NASA Technical Reports Server (NTRS)
Engineering Development Laboratory developed a system for the cardiovascular study of weightless astronauts. This was designed to aid people with congestive heart failure and diabetes. While in space, astronauts' blood pressure rises, heart rate becomes unstable, and there are sometimes postflight lightheadedness or blackouts. The Baro-Cuff studies the resetting of blood pressure. When a silicone rubber chamber is strapped to the neck, the Baro-Cuff stimulates the carotid arteries by electronically controlled pressure application. Blood pressure controls in patients may be studied.
Volpe, Massimo; Rosei, Enrico Agabiti; Ambrosioni, Ettore; Cottone, Santina; Cuspidi, Cesare; Borghi, Claudio; De Luca, Nicola; Fallo, Francesco; Ferri, Claudio; Morganti, Alberto; Muiesan, Maria Lorenza; Sarzani, Riccardo; Sechi, Leonardo; Virdis, Agostino; Tocci, Giuliano; Trimarco, Bruno; Filippi, Alessandro; Mancia, Giuseppe
Observational clinical studies have demonstrated that only 30-40% of patients with arterial hypertension achieve the recommended blood pressure goals (below 140/90 mmHg). In contrast, interventional trials consistently showed that it is possible to achieve effective blood pressure targets in about 70% of treated hypertensive patients with different cardiovascular risk profiles, especially through the use of rational, effective and well tolerated combination therapies. In order to bridge the gap between current and desired blood pressure control and to achieve more effective prevention of cardiovascular diseases, the Italian Society of Hypertension (SIIA) has developed an interventional strategy aimed at reaching nearly 70% of treated controlled hypertensive patients by 2015. This ambitious goal can be realistically achieved by a more rational use of modern tools and supports, and also through the use of combination therapy in hypertension in daily clinical practice, especially if this approach can be simplified into a single pill (fixed combination therapy), which is a therapeutic option now also available in Italy. Since about 70-80% of treated hypertensive patients require a combination therapy based on at least two classes of drugs in order to achieve the recommended blood pressure goals, it is of key importance to implement this strategy in routine clinical practice. Amongst the various combination therapies currently available for hypertension treatment and control, the use of those strategies based on drugs that antagonize the renin-angiotensin system, such as angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) and ACE inhibitors, in combination with diuretics and/or calcium channel blockers, has been shown to significantly reduce the risk of major cardiovascular events and to improve patient compliance to treatment, resulting in a greater antihypertensive efficacy and better tolerability compared with monotherapy. The present document
NASA Technical Reports Server (NTRS)
An estimated 30 million people in the United States have high blood pressure, or hypertension. But a great many of them are unaware of it because hypertension, in its initial stages, displays no symptoms. Thus, the simply-operated blood pressure checking devices now widely located in public places are useful health aids. The one pictured above, called -Medimax 30, is a direct spinoff from NASA technology developed to monitor astronauts in space. For manned space flights, NASA wanted a compact, highly-reliable, extremely accurate method of checking astronauts' blood pressure without the need for a physician's interpretive skill. NASA's Johnson Space Center and Technology, Inc., a contractor, developed an electronic sound processor that automatically analyzes blood flow sounds to get both systolic (contracting arteries) and diastolic (expanding arteries) blood pressure measurements. NASA granted a patent license for this technology to Advanced Life Sciences, Inc., New York City, manufacturers of Medimax 30.
... Blood Pressure Tools & Resources Stroke More What is High Blood Pressure? Updated:Aug 26,2016 High blood pressure, also ... content was last reviewed on 08/04/2014. High Blood Pressure • Home • About High Blood Pressure (HBP) Introduction What ...
Diagnosis of High Blood Pressure
... the NHLBI on Twitter. Diagnosis of High Blood Pressure For most patients, health care providers diagnose high ... 140/90 mmHg or above. Confirming High Blood Pressure A blood pressure test is easy and painless ...
Prevention of High Blood Pressure
... page from the NHLBI on Twitter. Prevention of High Blood Pressure Healthy lifestyle habits, proper use of medicines, and ... prevent high blood pressure or its complications. Preventing High Blood Pressure Onset Healthy lifestyle habits can help prevent high ...
Blood pressure monitors for home
... type of blood pressure monitor for home use. DIGITAL BLOOD PRESSURE MONITORS A digital device will also have a cuff that wraps ... on its own. The screen will show a digital readout of your systolic and diastolic blood pressure. ...
Living with High Blood Pressure
... page from the NHLBI on Twitter. Living With High Blood Pressure If you have high blood pressure, the best thing to do is to talk ... help you track your blood pressure. Pregnancy Planning High blood pressure can cause problems for mother and baby. High ...
Stroke and High Blood Pressure
... Blood Pressure Tools & Resources Stroke More Stroke and High Blood Pressure Updated:Jan 6,2015 Stroke is a leading ... to heart disease and stroke. Start exploring today ! High Blood Pressure • Home • About High Blood Pressure (HBP) • Why HBP ...
What Causes High Blood Pressure?
... page from the NHLBI on Twitter. Causes of High Blood Pressure Changes, either from genes or the environment, in ... and blood vessel structure and function. Biology and High Blood Pressure Researchers continue to study how various changes in ...
Blood vessels, circulation and blood pressure.
Hendry, Charles; Farley, Alistair; McLafferty, Ella
This article, which forms part of the life sciences series, describes the vessels of the body's blood and lymphatic circulatory systems. Blood pressure and its regulatory systems are examined. The causes and management of hypertension are also explored. It is important that nurses and other healthcare professionals understand the various mechanisms involved in the regulation of blood pressure to prevent high blood pressure or ameliorate its damaging consequences.
NASA Technical Reports Server (NTRS)
Engineering Development Lab., Inc.'s E-2000 Neck Baro Reflex System was developed for cardiovascular studies of astronauts. It is regularly used on Space Shuttle Missions, and a parallel version has been developed as a research tool to facilitate studies of blood pressure reflex controls in patients with congestive heart failure, diabetes, etc. An advanced version, the PPC-1000, was developed in 1991, and the technology has been refined substantially. The PPC provides an accurate means of generating pressure for a broad array of laboratory applications. An improved version, the E2010 Barosystem, is anticipated.
High Blood Pressure in Pregnancy
... of the baby. Controlling your blood pressure during pregnancy and getting regular prenatal care are important for ... your baby. Treatments for high blood pressure in pregnancy may include close monitoring of the baby, lifestyle ...
High Blood Pressure Fact Sheet
... this? Submit What's this? Submit Button Related CDC Web Sites Heart Disease Stroke High Blood Pressure Salt ... Prevent and Control Chronic Diseases Million Hearts® WISEWOMAN Web Sites with More Information About High Blood Pressure ...
Risk Factors for High Blood Pressure
... the NHLBI on Twitter. Risk Factors for High Blood Pressure Anyone can develop high blood pressure; however, age, ... can increase your risk for developing high blood pressure. Age Blood pressure tends to rise with age. About 65 ...
Automated office blood pressure.
Myers, Martin G; Godwin, Marshall
Manual blood pressure (BP) is gradually disappearing from clinical practice with the mercury sphygmomanometer now considered to be an environmental hazard. Manual BP is also subject to measurement error on the part of the physician/nurse and patient-related anxiety which can result in poor quality BP measurements and office-induced (white coat) hypertension. Automated office (AO) BP with devices such as the BpTRU (BpTRU Medical Devices, Coquitlam, BC) has already replaced conventional manual BP in many primary care practices in Canada and has also attracted interest in other countries where research studies using AOBP have been undertaken. The basic principles of AOBP include multiple readings taken with a fully automated recorder with the patient resting alone in a quiet room. When these principles are followed, office-induced hypertension is eliminated and AOBP exhibits a much stronger correlation with the awake ambulatory BP as compared with routine manual BP measurements. Unlike routine manual BP, AOBP correlates as well with left ventricular mass as does the awake ambulatory BP. AOBP also simplifies the definition of hypertension in that the cut point for a normal AOBP (< 135/85 mm Hg) is the same as for the awake ambulatory BP and home BP. This article summarizes the currently available evidence supporting the use of AOBP in routine clinical practice and proposes an algorithm in which AOBP replaces manual BP for the diagnosis and management of hypertension. PMID:22265230
Serotonin and Blood Pressure Regulation
Morrison, Shaun F.; Davis, Robert Patrick; Barman, Susan M.
5-Hydroxytryptamine (5-HT; serotonin) was discovered more than 60 years ago as a substance isolated from blood. The neural effects of 5-HT have been well investigated and understood, thanks in part to the pharmacological tools available to dissect the serotonergic system and the development of the frequently prescribed selective serotonin-reuptake inhibitors. By contrast, our understanding of the role of 5-HT in the control and modification of blood pressure pales in comparison. Here we focus on the role of 5-HT in systemic blood pressure control. This review provides an in-depth study of the function and pharmacology of 5-HT in those tissues that can modify blood pressure (blood, vasculature, heart, adrenal gland, kidney, brain), with a focus on the autonomic nervous system that includes mechanisms of action and pharmacology of 5-HT within each system. We compare the change in blood pressure produced in different species by short- and long-term administration of 5-HT or selective serotonin receptor agonists. To further our understanding of the mechanisms through which 5-HT modifies blood pressure, we also describe the blood pressure effects of commonly used drugs that modify the actions of 5-HT. The pharmacology and physiological actions of 5-HT in modifying blood pressure are important, given its involvement in circulatory shock, orthostatic hypotension, serotonin syndrome and hypertension. PMID:22407614
Controlling your high blood pressure
Controlling hypertension ... when you wake up. For people with very high blood pressure, this is when they are most at risk ... 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed ...
Diabetes and blood pressure (image)
People with diabetes have a higher risk for heart attacks and strokes. Your doctor or nurse should check your blood pressure ... People with diabetes have a higher risk for heart attacks and strokes. Your doctor or nurse should check your blood pressure ...
Paediatric blood pressure and anaesthesia.
Mather, C M
One percent of children have appreciably and consistently raised arterial blood pressure. A 7-year-old girl admitted for routine tonsillectomy, had unrecognised hypertension which put her at increased risk. Should anaesthetic practice take more note of paediatric blood pressures? PMID:2035786
Dietary protein and blood pressure.
Bursztyn, P G; Vas Dias, F W
Vegetarians have lower blood pressures than omnivores. Dietary protein may be partly responsible. Human volunteers, whose normal diet contained little soya protein, were given soya based foods to replace some of the meat in their diet. During this period over 20% of the total protein intake was derived from soya, however blood pressures remained unchanged. Rabbits were given diets based on either soya, casein, or fish protein. The animals' diets were then changed to one of the other protein sources. During the subsequent 3 weeks, small increases in blood pressure were seen in the casein and soya groups. When rabbits were given fat enriched diets, blood pressures rose but the increase was independent of the type of protein in the diet. It is concluded that the type of protein consumed is unlikely to account for the blood pressure differences between vegetarians and omnivores. Arguments are presented suggesting that other dietary components, such as fat or fibre may be responsible.
Beat-to-Beat Blood Pressure Monitor
NASA Technical Reports Server (NTRS)
Lee, Yong Jin
This device provides non-invasive beat-to-beat blood pressure measurements and can be worn over the upper arm for prolonged durations. Phase and waveform analyses are performed on filtered proximal and distal photoplethysmographic (PPG) waveforms obtained from the brachial artery. The phase analysis is used primarily for the computation of the mean arterial pressure, while the waveform analysis is used primarily to obtain the pulse pressure. Real-time compliance estimate is used to refine both the mean arterial and pulse pressures to provide the beat-to-beat blood pressure measurement. This wearable physiological monitor can be used to continuously observe the beat-to-beat blood pressure (B3P). It can be used to monitor the effect of prolonged exposures to reduced gravitational environments and the effectiveness of various countermeasures. A number of researchers have used pulse wave velocity (PWV) of blood in the arteries to infer the beat-to-beat blood pressure. There has been documentation of relative success, but a device that is able to provide the required accuracy and repeatability has not yet been developed. It has been demonstrated that an accurate and repeatable blood pressure measurement can be obtained by measuring the phase change (e.g., phase velocity), amplitude change, and distortion of the PPG waveforms along the brachial artery. The approach is based on comparing the full PPG waveform between two points along the artery rather than measuring the time-of-flight. Minimizing the measurement separation and confining the measurement area to a single, well-defined artery allows the waveform to retain the general shape between the two measurement points. This allows signal processing of waveforms to determine the phase and amplitude changes. Photoplethysmography, which measures changes in arterial blood volume, is commonly used to obtain heart rate and blood oxygen saturation. The digitized PPG signals are used as inputs into the beat-to-beat blood
Diet, blood pressure, and multicollinearity.
Reed, D; McGee, D; Yano, K; Hankin, J
Recent reports of an inverse association between dietary calcium intake and hypertension stimulated this analysis of the relationship of blood pressure to more than 20 dietary factors among a group of 8000 Japanese men in Hawaii. Reported intakes of potassium, calcium, protein, and milk were all inversely associated with blood pressure levels when examined one at a time while controlling for other risk factors. Alcohol intake was directly associated with blood pressure, and was treated as a confounding variable in the analysis. The association of potassium intake with blood pressure was relatively stronger than the associations for other nutrients, but the intake of potassium was so highly correlated with intakes of calcium, milk, and protein that it was not statistically possible to identify the independent association of potassium and blood pressure. Calcium intake was strongly correlated with milk and potassium intakes, and only calcium from dairy sources was associated with blood pressure. These data thus indicate that several dietary factors are inversely related to blood pressure levels independently of other risk factors such as age, body mass, and alcohol intake. The high degree of intercorrelation (multicollinearity) among these dietary factors, however, indicates that the independent role of any specific nutrient cannot be conclusively separated from the possible effects of other nutrients in this type of study.
Potassium and High Blood Pressure
... in blood pressure to certain patterns of food consumption. For example, the D.A.S.H. (Dietary Approaches ... are good natural sources of potassium. Potassium-rich foods include: Sweet ... Levels Mean * ...
Medications for High Blood Pressure
... Consumers Home For Consumers Consumer Updates Medications for High Blood Pressure Share Tweet Linkedin Pin it More sharing options Linkedin Pin it Email Print Hypertension tends to worsen with age and you cannot ...
Types of Blood Pressure Medications
... inhibitors These medications reduce blood pressure by blocking neurotransmitters in the brain. This blocks the smooth muscles ... Monitoring of HBP • Prevention & Treatment of HBP Introduction Diet - Shaking the Salt Habit - Potassium - Alcohol Physical Activity ...
Genes That Influence Blood Pressure
... than 230 researchers across 6 continents scanned the genomes of over 200,000 European people to identify ... blood pressure. They followed up by analyzing the genomes of 70,000 people of East Indian, South ...
Indirect Blood Pressure Measuring Device
NASA Technical Reports Server (NTRS)
Hum, L.; Cole, C. E.
Design and performance of a blood pressure recording device for pediatric use are reported. A strain gage transducer with a copper-beryllium strip as force sensing element is used to monitor skin movements and to convert them into electrical signals proportional to those displacements. Experimental tests with this device in recording of force developed above the left femoral artery of a dog accurately produced a blood pressure curve.
How Is High Blood Pressure Treated?
... blood pressure and maintain normal blood pressure readings. Healthy Eating To help treat high blood pressure, health care ... Read more about the DASH eating plan. Heart-Healthy Eating Your health care provider also may recommend heart- ...
High Blood Pressure: Medicines to Help You
... For Consumers Consumer Information by Audience For Women High Blood Pressure--Medicines to Help You Share Tweet Linkedin Pin ... Click here for the Color Version (PDF 533KB) High blood pressure is a serious illness. High blood pressure is ...
Avoid the Consequences of High Blood Pressure
... Tools & Resources Stroke More Avoid the Consequences of High Blood Pressure Infographic Updated:Jun 19,2014 View a downloadable version of this infographic High Blood Pressure • Home • About High Blood Pressure (HBP) • Why HBP ...
Vegetarian diet and blood pressure.
Beilin, L J; Armstrong, B K; Margetts, B M; Rouse, I L; Vandongen, R
There is now convincing evidence from epidemiological studies and randomized controlled trials that adoption of an ovo-lacto vegetarian diet leads to blood pressure reduction in both normotensive and hypertensive subjects. This effect appears to be independent of both dietary sodium and weight loss but additive to effects of weight reduction. Long-term adherence to a vegetarian diet is associated with less of a rise of blood pressure with age and a decreased prevalence of hypertension. The nutrients responsible for these effects have not been clearly identified and the mechanisms involved are unknown. Resolution of these questions is needed to enable more widespread adoption of dietary changes which may reduce the prevalence of hypertension, reduce antihypertensive drug dependence and by effects on blood pressure and blood lipids ameliorate the natural history of hypertensive cardiovascular disease.
Beat-to-Beat Blood Pressure Monitor
NASA Technical Reports Server (NTRS)
Lee, Yong Jin
This device provides non-invasive beat-to-beat blood pressure measurements and can be worn over the upper arm for prolonged durations. Phase and waveform analyses are performed on filtered proximal and distal photoplethysmographic (PPG) waveforms obtained from the brachial artery. The phase analysis is used primarily for the computation of the mean arterial pressure, while the waveform analysis is used primarily to obtain the pulse pressure. Real-time compliance estimate is used to refine both the mean arterial and pulse pressures to provide the beat-to-beat blood pressure measurement. This wearable physiological monitor can be used to continuously observe the beat-to-beat blood pressure (B3P). It can be used to monitor the effect of prolonged exposures to reduced gravitational environments and the effectiveness of various countermeasures. A number of researchers have used pulse wave velocity (PWV) of blood in the arteries to infer the beat-to-beat blood pressure. There has been documentation of relative success, but a device that is able to provide the required accuracy and repeatability has not yet been developed. It has been demonstrated that an accurate and repeatable blood pressure measurement can be obtained by measuring the phase change (e.g., phase velocity), amplitude change, and distortion of the PPG waveforms along the brachial artery. The approach is based on comparing the full PPG waveform between two points along the artery rather than measuring the time-of-flight. Minimizing the measurement separation and confining the measurement area to a single, well-defined artery allows the waveform to retain the general shape between the two measurement points. This allows signal processing of waveforms to determine the phase and amplitude changes.
Blood Pressure. Learning Activity Package.
ERIC Educational Resources Information Center
Hime, Kirsten
This learning activity package on blood pressure is one of a series of 12 titles developed for use in health occupations education programs. Materials in the package include objectives, list of materials needed, a list of definitions, information sheets, reviews (self evaluations) of portions of the content, and answers to reviews. These topics…
Automatic blood pressure measuring system (M092)
NASA Technical Reports Server (NTRS)
Nolte, R. W.
The Blood Pressure Measuring System is described. It measures blood pressure by the noninvasive Korotkoff sound technique on a continual basis as physical stress is imposed during experiment M092, Lower Body Negative Pressure, and experiment M171, Metabolic Activity.
High Blood Pressure May Hike Dementia Risk
... medlineplus.gov/news/fullstory_161398.html High Blood Pressure May Hike Dementia Risk New statement from American ... MONDAY, Oct. 10, 2016 (HealthDay News) -- High blood pressure, particularly in middle age, might open the door ...
High Blood Pressure: Unique to Older Adults
... below to read more. High Blood Pressure and Edema : You may notice swelling in some parts of ... blood pressure. This buildup of fluids, called peripheral edema, usually occurs in your ankles, feet, lower legs, ...
High blood pressure and eye disease
... this page: //medlineplus.gov/ency/article/000999.htm High blood pressure and eye disease To use the sharing features ... Hypertensive retinopathy is damage to the retina from high blood pressure. The retina is the layer of tissue at ...
Taking your blood pressure at home (image)
... sure you are taking your blood pressure correctly. Compare your home machine with the one at your ... sure you are taking your blood pressure correctly. Compare your home machine with the one at your ...
[Blood pressure variability and cardiovascular morbimortality].
Robles, N R
Blood pressure is a changing parameter that is influenced by intrinsic body rhythms, physical and emotional environmental factors that act on the individual, and the differences produced by activity and rest periods of every subject. Blood pressure variability seems to be related with target organ damage due to high blood pressure. Its specific effect on left ventricular mass is likely, although it is not absolutely confirmed. Testing blood pressure variability should be a routine exploration in patients with a target organ lesion.
Cuff for Blood-Vessel Pressure Measurements
NASA Technical Reports Server (NTRS)
Shimizu, M.
Pressure within blood vessel is measured by new cufflike device without penetration of vessel. Device continuously monitors blood pressure for up to 6 months or longer without harming vessel. Is especially useful for vessels smaller than 4 or 5 millimeters in diameter. Invasive methods damage vessel wall, disturb blood flow, and cause clotting. They do not always give reliable pressure measurements over prolonged periods.
Ambulatory blood pressure monitoring: methodologic issues.
Prisant, L M; Bottini, P B; Carr, A A
Blood pressure, like heart rate, is a changing physiologic variable. Like ambulatory electrocardiography, ambulatory blood pressure can be recorded intermittently throughout the day. Ambulatory blood pressure is a dynamic variable influenced by multiple factors, and it correlates more strongly with target organ damage than do static office blood pressure measurements. Office (but not ambulatory) measurements are subject to the placebo and physician pressor effect. There is a great patient variability of blood pressure measurements in the office compared with ambulatory methods. Ambulatory blood pressure devices are portable rather than 'ambulatory'. The auscultatory (listens for Korotkoff sounds) and oscillometric (detects maximal arterial vibrations and calculates diastolic blood pressure) methods are used to detect blood pressure. Equipment is generally safe, although mild sleep derangements have been reported. The 24-h blood pressure and diurnal change are usually assessed. A 24-h ambulatory blood pressure mean of 140/90 mm Hg or above is clearly abnormal, though recent data suggest that the 95th centile is 134/84 mm Hg. Correlation of individual blood pressure readings with diary entries may be instructive. New American and British validation criteria have been published to assess the performance of each new device that becomes available. It should not be assumed that newer ambulatory devices have been tested (particularly by a third party) or are better. Test/retest 24-h ambulatory blood pressure shows less variability than office measurements; however, the percentage of patients with a mean difference greater than +/- 5 mm Hg on repeat 24-h blood pressure measurement after 1 week is still surprisingly high (49.3%, systolic; 52.1%, diastolic). European trials are in progress to assess the prognosis of hypertension assessed by ambulatory compared with office blood pressure. Ambulatory blood pressure monitoring has been restricted for use in several clinical
Central blood pressure and chronic kidney disease
Ohno, Yoichi; Kanno, Yoshihiko; Takenaka, Tsuneo
In this review, we focused on the relationship between central blood pressure and chronic kidney diseases (CKD). Wave reflection is a major mechanism that determines central blood pressure in patients with CKD. Recent medical technology advances have enabled non-invasive central blood pressure measurements. Clinical trials have demonstrated that compared with brachial blood pressure, central blood pressure is a stronger risk factor for cardiovascular (CV) and renal diseases. CKD is characterized by a diminished renal autoregulatory ability, an augmented direct transmission of systemic blood pressure to glomeruli, and an increase in proteinuria. Any elevation in central blood pressure accelerates CKD progression. In the kidney, interstitial inflammation induces oxidative stress to handle proteinuria. Oxidative stress facilitates atherogenesis, increases arterial stiffness and central blood pressure, and worsens the CV prognosis in patients with CKD. A vicious cycle exists between CKD and central blood pressure. To stop this cycle, vasodilator antihypertensive drugs and statins can reduce central blood pressure and oxidative stress. Even in early-stage CKD, mineral and bone disorders (MBD) may develop. MBD promotes oxidative stress, arteriosclerosis, and elevated central blood pressure in patients with CKD. Early intervention or prevention seems necessary to maintain vascular health in patients with CKD. PMID:26788468
Relation of blood volume and blood pressure in orthostatic intolerance
NASA Technical Reports Server (NTRS)
Jacob, G.; Biaggioni, I.; Mosqueda-Garcia, R.; Robertson, R. M.; Robertson, D.
A complex but crucial relationship exists between blood volume and blood pressure in human subjects; it has been recognized that in essential hypertension, renovascular hypertension, and pheochromocytoma, the relationship between plasma volume and diastolic blood pressure is an inverse one. This phenomenon has not been studied in individuals with low normal and reduced blood pressures. Orthostatic intolerance is a commonly encountered abnormality in blood pressure regulation often associated with tachycardia in the standing position. Most of these patients have varying degrees of reduced blood volume. We tested the hypothesis that the relationship previously found between plasma volume and diastolic blood pressure in pressor states would also hold in orthostatic intolerance. We studied 16 patients with a history of symptomatic orthostatic intolerance associated with an elevation in plasma norepinephrine in the upright posture and hypovolemia in 9 patients and normovolemia in 7 patients. Our studies demonstrate an inverse relationship between plasma volume and diastolic blood pressure in patients with orthostatic intolerance. This finding also holds for the change in diastolic blood pressure in response to upright posture. In this relationship, patients with orthostatic intolerance with high plasma norepinephrine resemble those with essential hypertension, renovascular hypertension, and pheochromocytoma. We conclude that in a variety of conditions at both ends of the blood pressure spectrum, the seemingly paradoxical association of hypovolemia and diastolic blood pressure is preserved.
Noninvasive continuous blood pressure monitoring
NASA Astrophysics Data System (ADS)
Poghosyan, Armen; Mouradian, Vahram; Hovhannisyan, Levon
We are presenting a novel photoplethysmographic (PPG) optical sensor and device with ambient optical, electrical and electromagnetic noises cancellation, thus allowing only the useful optical signals to be received by the health monitoring device. We are also presenting a new processing technique for canceling the ambient noises contributed by optical, electrical and electromagnetic artifacts in the measured PPG signals. Such a device and method allow the enhancement of the performance of the PPG sensors compared to conventional apparatus and methods. The presented sensor and methodology have been integrated into a prototype standalone device for noninvasive, continuous, wearable, remote and mobile monitoring of blood pressure and other human vital signs, such as heart rate, oxygen saturation, respiration rate, etc This small device allows the user to read, store, process and transmit all the measurements made using the PPG optical sensor and the electronic unit to a remote location.
Pierin, Angela M. G.; Ignez, Edna C.; Filho, Wilson Jacob; Barbato, Alfonso Júlio Guedes; Mion, Décio
OBJECTIVE To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement. METHODS A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed. RESULTS Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to "office measurement." CONCLUSION
Blood pressure control for diabetic retinopathy
Do, Diana V; Wang, Xue; Vedula, Satyanarayana S; Marrone, Michael; Sleilati, Gina; Hawkins, Barbara S; Frank, Robert N
Background Diabetic retinopathy is a common complication of diabetes and a leading cause of visual impairment and blindness. Research has established the importance of blood glucose control to prevent development and progression of the ocular complications of diabetes. Simultaneous blood pressure control has been advocated for the same purpose, but findings reported from individual studies have supported varying conclusions regarding the ocular benefit of interventions on blood pressure. Objectives The primary aim of this review was to summarize the existing evidence regarding the effect of interventions to control or reduce blood pressure levels among diabetics on incidence and progression of diabetic retinopathy, preservation of visual acuity, adverse events, quality of life, and costs. A secondary aim was to compare classes of anti-hypertensive medications with respect to the same outcomes. Search methods We searched a number of electronic databases including CENTRAL as well as ongoing trial registries. We last searched the electronic databases on 25 April 2014. We also reviewed reference lists of review articles and trial reports selected for inclusion. In addition, we contacted investigators of trials with potentially pertinent data. Selection criteria We included in this review randomized controlled trials (RCTs) in which either type 1 or type 2 diabetic participants, with or without hypertension, were assigned randomly to intense versus less intense blood pressure control, to blood pressure control versus usual care or no intervention on blood pressure, or to different classes of anti-hypertensive agents versus placebo. Data collection and analysis Pairs of review authors independently reviewed titles and abstracts from electronic and manual searches and the full text of any document that appeared to be relevant. We assessed included trials independently for risk of bias with respect to outcomes reported in this review. We extracted data regarding trial
Managing Blood Pressure with a Heart-Healthy Diet
... Blood Pressure Tools & Resources Stroke More Managing Blood Pressure with a Heart-Healthy Diet Updated:Apr 8, ... last reviewed on 08/04/2014. High Blood Pressure • Home • About High Blood Pressure (HBP) • Why HBP ...
Let's Talk about High Blood Pressure and Stroke
... Tools & Resources Stroke More Let's Talk About High Blood Pressure and Stroke Updated:Dec 9,2015 What is ... Blood Pressure? How Can I Reduce High Blood Pressure? High Blood Pressure and Stroke What Is Diabetes and How ...
Blood pressure and its significance in childhood.
Lauer, R. M.; Rames, L. K.; Clarke, W. R.
Hypertension is an important accelerator of the atherosclerotic process. Detection in childhood may be important although longitudinal data are lacking of the prognosis of blood pressure measurement in childhood through adult life. The blood pressure of children should be measured. In populations where salt intake is high, values for blood pressure increase with age. Populations who eat small quantities of salt are relatively free from hypertension. There is an epidemiological argument for limiting salt intake in children. There are few data to indicate the level of blood pressure in children which should be treated. Children's blood pressures are labile and elevated levels are sustained only in a small minority. In these secondary causes, advice should be sought. In subjects with extreme persistent hypertension drug therapy should be considered; in subjects with values of blood pressure not so extremely raised surveillance should be maintained to prevent the development of sustained hypertension. PMID:652686
Pressure natriuresis and the renal control of arterial blood pressure
Ivy, Jessica R; Bailey, Matthew A
The regulation of extracellular fluid volume by renal sodium excretion lies at the centre of blood pressure homeostasis. Renal perfusion pressure can directly regulate sodium reabsorption in the proximal tubule. This acute pressure natriuresis response is a uniquely powerful means of stabilizing long-term blood pressure around a set point. By logical extension, deviation from the set point can only be sustained if the pressure natriuresis mechanism is impaired, suggesting that hypertension is caused or sustained by a defect in the relationship between renal perfusion pressure and sodium excretion. Here we describe the role of pressure natriuresis in blood pressure control and outline the cascade of biophysical and paracrine events in the renal medulla that integrate the vascular and tubular response to altered perfusion pressure. Pressure natriuresis is impaired in hypertension and mechanistic insight into dysfunction comes from genetic analysis of blood pressure disorders. Transplantation studies in rats show that blood pressure is determined by the genotype of the kidney and Mendelian hypertension indicates that the distal nephron influences the overall natriuretic efficiency. These approaches and the outcomes of genome-wide-association studies broaden our view of blood pressure control, suggesting that renal sympathetic nerve activity and local inflammation can impair pressure natriuresis to cause hypertension. Understanding how these systems interact is necessary to tackle the global burden of hypertension. PMID:25107929
Effects of age on blood pressure (image)
... become less elastic with age. The "average" blood pressure increases from 120/70 to 150/90 and may persist slightly high even if treated. The blood vessels respond more slowly to a change in body ...
Blood Pressure Matters: Keep Hypertension in Check
... Early diagnosis and simple, healthy changes can keep high blood pressure from seriously damaging your health. Normal blood flow delivers nutrients and oxygen to all parts of your body, including important ...
Preeclampsia and High Blood Pressure During Pregnancy
... thrombophilia , or lupus • are obese •had in vitro fertilization What are the risks for my baby if ... blood cells. Hypertension: High blood pressure. In Vitro Fertilization: A procedure in which an egg is removed ...
Practical advice for home blood pressure measurement
McKay, Donald W; Godwin, Marshall; Chockalingam, Arun
Early diagnosis of hypertension is one benefit of home blood pressure monitoring. Home measurement may also be used for the detection of masked hypertension. Home blood pressure readings have a strong correlation with risk, and the method has many advantages over office measurement in the management of hypertension, especially in patients with chronic kidney disease or diabetes. The present article provides practical advice on incorporating home blood pressure monitoring into practice. Patient education and training are discussed, as are tips to aid in the selection of devices for blood pressure measurement at home. PMID:17534466
Blood pressure and blood lead concentration in bus drivers.
Sharp, D S; Osterloh, J; Becker, C E; Bernard, B; Smith, A H; Fisher, J M; Syme, S L; Holman, B L; Johnston, T
San Francisco bus drivers have an increased prevalence of hypertension. This study examined relationships between blood lead concentration and blood pressure in 342 drivers. The analysis reported in this study was limited to subjects not on treatment for hypertension (n = 288). Systolic and diastolic pressures varied from 102 to 173 mm Hg and from 61 to 105 mm Hg, respectively. The blood lead concentration varied from 2 to 15 micrograms/dL. The relationship between blood pressure and the logarithm of blood lead concentration was examined using multiple regression analysis. Covariates included age, body mass index, sex, race, and caffeine intake. The largest regression coefficient relating systolic blood pressure and blood lead concentration was 1.8 mm Hg/ln (micrograms/dL) [90% C. I., -1.6, 5.3]. The coefficient for diastolic blood pressure was 2.5 mm Hg/ln (micrograms/dL) [90% C. I., 0.1, 4.9]. These findings suggest effects of lead exposure at lower blood lead concentrations than those concentrations that have previously been linked with increases in blood pressure. PMID:3203632
Blood pressure and blood lead concentration in bus drivers
Sharp, D.S.; Osterloh, J.; Becker, C.E.; Bernard, B.; Smith, A.H.; Fisher, J.M.; Syme, S.L.; Holman, B.L.; Johnston, T.
San Francisco bus drivers have an increased prevalence of hypertension. This study examined relationships between blood lead concentration and blood pressure in 342 drivers. The analysis reported in this study was limited to subjects not on treatment for hypertension (n = 288). Systolic and diastolic pressure varied from 102 to 173 mm Hg and from 61 to 105 mm Hg, respectively. The blood lead concentration varied from 2 to 15 ..mu..g/dL. The relationship between blood pressure and the logarithm of blood lead concentration was examined using multiple regression analysis. Covariates included age, body mass index, sex, race, and caffeine intake. The largest regression coefficient relating systolic blood pressure and blood lead concentration was 1.8 mm Hg/ln (..mu..g/dL). The coefficient for diastolic blood pressure was 2.5 mm Hg/ln (..mu..g/dL). These findings suggest effects of lead exposure at lower blood lead concentrations than those concentrations that have previously been linked with increases in blood pressure.
Embedded programmable blood pressure monitoring system
NASA Astrophysics Data System (ADS)
Hasan, Md. Mahmud-Ul; Islam, Md. Kafiul; Shawon, Mehedi Azad; Nowrin, Tasnuva Faruk
A more efficient newer algorithm of detecting systolic and diastolic pressure of human body along with a complete package of an effective user-friendly embedded programmable blood pressure monitoring system has been proposed in this paper to reduce the overall workload of medical personals as well as to monitor patient's condition more conveniently and accurately. Available devices for measuring blood pressure have some problems and limitations in case of both analog and digital devices. The sphygmomanometer, being analog device, is still being used widely because of its reliability and accuracy over digital ones. But it requires a skilled person to measure the blood pressure and obviously not being automated as well as time consuming. Our proposed system being a microcontroller based embedded system has the advantages of the available digital blood pressure machines along with a much improved form and has higher accuracy at the same time. This system can also be interfaced with computer through serial port/USB to publish the measured blood pressure data on the LAN or internet. The device can be programmed to determine the patient's blood pressure after each certain interval of time in a graphical form. To sense the pressure of human body, a pressure to voltage transducer is used along with a cuff in our system. During the blood pressure measurement cycle, the output voltage of the transducer is taken by the built-in ADC of microcontroller after an amplifier stage. The recorded data are then processed and analyzed using the effective software routine to determine the blood pressure of the person under test. Our proposed system is thus expected to certainly enhance the existing blood pressure monitoring system by providing accuracy, time efficiency, user-friendliness and at last but not the least the 'better way of monitoring patient's blood pressure under critical care' all together at the same time.
The DASH diet and blood pressure.
Craddick, Shirley R; Elmer, Patricia J; Obarzanek, Eva; Vollmer, William M; Svetkey, Laura P; Swain, Martha C
High blood pressure (also called hypertension) is one of the most important and common risk factors for atherosclerotic cardiovascular disease (CVD) and other chronic diseases. National guidelines recommend that all individuals with blood pressure readings of 120/80 mm Hg or higher adopt healthy lifestyle habits, including the Dietary Approaches to Stop Hypertension (DASH) diet, to manage their blood pressure. The DASH diet, which is high in fruits, vegetables, and low-fat dairy products and reduced in fat, has been shown in large, randomized, controlled trials to reduce blood pressure significantly. The DASH diet also has been shown to reduce blood cholesterol and homocysteine levels and to enhance the benefits of antihypertensive drug therapy. The DASH diet should be promoted, along with maintaining healthy weight, reducing sodium intake, increasing regular physical activity, and limiting alcohol intake, for lowering blood pressure and reducing the risk of CVD.
Nutraceuticals for blood pressure control.
Sirtori, Cesare R; Arnoldi, Anna; Cicero, Arrigo F G
Significant effects on blood pressure (BP) have been reported from large nutritional interventions, particularly the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet. In more recent years, numerous studies have investigated the possible BP-lowering effect of different nutraceuticals; these range from specific foods to minerals, lipids, whole proteins, peptides, amino acids, probiotics, and vitamins. While a very large body of evidence supports the use of potassium, L-arginine, vitamins C and D, cocoa flavonoids, beetroot juice, some probiotics, coenzyme Q10, controlled-release melatonin, aged garlic extract, and coffee, the use of other nutraceuticals, such as green tea, flaxseed, and resveratrol, has not as yet been supported by adequate evidence. In some cases, e.g. proteins/peptides, the responsible component needs also to be fully uncovered. Finally, while for most of the products only short-term studies are available, with no specific end-points, an ongoing very large prospective study on chocolate flavanols will answer the question whether this may reduce cardiovascular risk. Thus, in addition to data on long-term safety, further clinical research is advisable in order to identify, among active nutraceuticals, those with the best cost-effectiveness and risk-benefit ratio for a wide use in the general population with a raised cardiovascular risk consequent to uncomplicated hypertension. PMID:26362125
24-h blood pressure monitoring in normal tension glaucoma: night-time blood pressure variability.
Plange, N; Kaup, M; Daneljan, L; Predel, H G; Remky, A; Arend, O
Systemic arterial hypotension, hypertension and altered ocular blood flow are known risk factors in glaucoma. In this study, 24-h ambulatory blood pressure monitoring was performed in patients with normal tension glaucoma (NTG) and controls to evaluate blood pressure variability. In all, 51 patients with NTG and 28 age-matched controls were included in this prospective study. A 24-h ambulatory blood pressure monitoring (SpaceLabs Medical Inc., Redmond, USA) was performed and systolic, diastolic and mean arterial blood pressures were measured every 30 min during daytime (0800-2000) and night time (0000-0600). To evaluate blood pressure variability a variability index was defined as the s.d. of blood pressure measurements. Night-time blood pressure depression ('dip') was calculated (in percent of the daytime blood pressures). Patients with NTG exhibited higher night-time diastolic (P = 0.01) and mean arterial blood pressure values (P = 0.02) compared to controls, whereas systolic blood pressure data were not significantly different. The variability indices of night-time systolic, diastolic and mean arterial blood pressure measurements were significantly increased in patients with NTG compared to controls (P < 0.05). The night-time blood pressure depression of systolic (P = 0.47), diastolic (P = 0.11) and mean arterial blood pressures (P = 0.28) was not significantly different between patients with NTG and controls. In conclusion, patients with NTG showed increased variability of night-time blood pressure measurements compared to controls. Increased fluctuation of blood pressure may lead to ocular perfusion pressure fluctuation and may cause ischaemic episodes at the optic nerve head. PMID:16239898
The importance of prompt blood pressure control.
Basile, Jan
Hypertension affects almost one-third of adults in the United States, but blood pressure is adequately controlled in only about 50% to 60% of persons with treated hypertension. Abundant clinical trial evidence has shown that antihypertensive therapy significantly reduces the risk of vascular events, and meta-analyses of observational and clinical trials have shown that greater reductions in blood pressure are associated with greater reductions in risk. Recent trials have also suggested that prompt control of blood pressure is beneficial in high-risk patients with hypertension. A post hoc analysis of a trial comparing an angiotensin II receptor blocker-based program with a calcium channel blocker-based treatment regimen found that the blood pressure response after 1 month (regardless of the drug used) predicted the risk of vascular events and survival. Therapy with > or =2 medications given separately or as a fixed combination is more likely than monotherapy to lower blood pressure to goal in part because drugs from different classes target different mechanisms that regulate blood pressure. Moreover, the likelihood of achieving blood pressure goals is greater if the time to achieve control is shortened, and prompt control of blood pressure is more likely with multiple-drug therapy than with monotherapy.
Dietary sodium intake and arterial blood pressure.
Dumler, Francis
We sought to summarize major recent studies in the field of dietary sodium intake and arterial blood pressure, and discuss the following trials. INTERSALT: Sodium intake correlates with the rise in blood pressure with age, but not with the prevalence of hypertension. The population study identified a minimal impact of sodium intake on blood pressure (0.9 mm Hg/10 mmol difference in salt intake). DASH: This diet induced significant reductions in blood pressure compared with the control diet. Further decreases were observed with DASH and a 50 mmol/day sodium intake. VANGUARD: Blood pressure was inversely related to urinary potassium, calcium and magnesium but not to sodium excretion. TONE: Cardiovascular events were highest in the usual care group (83%) and lowest in the sodium reduction-plus-weight loss group (56%). META-ANALYSIS: A systematic review of 11 long-term controlled randomized trials reported a small decrease (1.1 mm Hg) in median systolic but not diastolic blood pressure with a reduced dietary sodium intake. In conclusion, (1) sodium restriction in hypertensive patients reduces blood pressure, and (2) the long-term impact of reduced salt intake on blood pressure, mortality, and morbidity remains to be defined.
Education, lifestyle and arterial blood pressure.
Dressler, W W
Lower education is associated with higher blood pressure and mortality from cardiovascular disease. Reasons for this are explored in this paper. It is hypothesized that education is most important as a risk factor for high blood pressure to the extent that an individual's style of life is incongruent with his or her education. Style of life is defined here on the basis of the accumulation of consumer goods and exposure to mass media. It was found, in a study of blood pressure in an African-American community, that lifestyle incongruity, or the degree to which style of life exceeded education, was associated with higher systolic and diastolic blood pressure, adjusting for age, sex, Body Mass Index, income, chronic social stressors, and Type A behavior. It is argued that this incongruity leads to recurring frustrating social interactions, which in turn are related to higher blood pressure.
[Effect of alcohol on circadian blood pressure].
Stiffler, B; Suter, P M; Vetter, W
The effects of alcohol on blood pressure have been studied extensively. Abstention is recommended in high blood pressure as basic non pharmacological treatment. On the other hand short term lowering of blood pressure by alcohol is known. Blood pressure effects of alcohol vary according to chronicity and amount of intake. It is not known how alcohol affects the 24 hour profile of blood pressure, in particular day- and night-time differences. This explorative study investigates the effects of a single dose of alcohol in the evening on the 24 hour blood pressure profile. Nine individuals with essential hypertension (mean age 65.4 +/- 8.7 years) were compared to 10 normotensives (29.6 +/- 3.0 years). Blood pressure was followed on 2 consecutive days by means of a 24 hour ABPM. On one evening the test persons consumed 0.6 g/kg ethanol before bed time. Apart from the direct comparison of the two groups, effects of body weight and daily alcohol consumption were also considered. For analysis of the 24 hour recording the mean 24 hour values, the mean difference between day and night and loads (fraction of blood pressure > 140/90 mm Hg) as well as heart rate were used. Ethanol led to nocturnal drops of blood pressure in normotensives and hypertensives alike and thus to an increased day/night difference. The latter increased by 2 +/- 4 mm Hg for the systolic and 2 +/- 1 mm Hg for the diastole values in normotensives and by 6 +/- 2 mm Hg and 3 +/- 1 mm Hg, respectively, in hypertensives on the day of alcohol intake. This trend was more marked in individuals with smaller daily alcohol consumption as well as in obese hypertensives. The blood pressure differences were not significant in our test sample because of a large variance in the response. Two normotensives were found to be borderline hypertensives. They exhibited a marked increase of nocturnal blood pressure values above 140/90 mm Hg when compared to the control night. Our study indicates that alcohol consumption should
Health Behavior Change after Blood Pressure Feedback
Pu, Jia; Chewning, Betty A.; Johnson, Heather M.; Vanness, David J.; Young, Henry N.; Kreling, David H.
Better understanding is needed for antihypertensive medication initiation and lifestyle modification among younger populations with elevated blood pressure. This study aimed to assess health behavior change after receiving a report of elevated blood pressure among African Americans and Caucasians younger than 50 years old. We used the Coronary Artery Risk Development in Young Adults (CARDIA) repository dataset. By examination year twenty, 424 out of 2,478 Caucasian and 2,637 African American participants had received feedback from the CARDIA study due to elevated blood pressure readings. Blood pressure was measured by trained CARDIA researchers at the participant's home and was repeatedly recorded at seven examinations over twenty years. A feedback/referral letter was sent to participants with an elevated blood pressure reading. On average, participants first had an elevated blood pressure reading at the age of 34. After receiving the feedback letter, 44% of the previously undiagnosed participants received a formal diagnosis. In addition, 23% initiated the use of antihypertensive medication if they had not received medication treatment before. Among the participants with at-risk lifestyle behaviors, 40% reduced alcohol consumption, 14% increased exercise level, 11% stopped smoking, and 8% reached normal weight. While none of the studied patient factors were associated with lifestyle modification, age had a positive impact on antihypertensive medication initiation (p<0.05). We found no evidence of differences in health behavior change between African American and Caucasian participants after receiving the feedback letter. This research is one of the first to study what followed after receiving a feedback letter about elevated blood pressure outside of healthcare settings. Although additional referral care and behavior interventions are needed to facilitate medication initiation and lifestyle modification, our observations suggest that providing blood pressure
The Control of the Blood-pressure
Burn, J. H.
Present conceptions of the control of the general blood-pressure are based on the view that the sympathetic nerves are only constrictor in action and the circulating hormones, adrenaline and vasopressin, only pressor in effect. Surgical treatment of high blood-pressure and allied conditions has been directed accordingly to the removal of portions of the sympathetic system and to the removal of the suprarenal glands or tumours connected with them. Removal of portions of the sympathetic has been successful in relieving attacks of angina pectoris and removal of suprarenal tumours has relieved paroxysmal hypertension. Neither removal of portions of the sympathetic systems nor removal of the suprarenal glands has been successful in reducing continuous hypertension. It is suggested that our conceptions of the control of the blood-pressure need revision. The normal variation in blood-pressure is not sufficiently realized. It may be as low as 85 mm. or as high as 190 mm. About one in every 40 men has a blood-pressure higher than 160 mm. It is suggested that the diagnosis of essential hypertension should never be made unless it is known that the blood-pressure has been rising. A single observation of a high pressure is not enough for the diagnosis. Evidence is described that adrenaline and vasopressin may lower the blood-pressure as well as cause it to rise; similarly there is evidence that the sympathetic nerve supply to the skeletal muscles is dilator rather than constrictor in effect. Hence, all three mechanisms commonly thought of as pressor may also be depressor, and it seems more accurate to think of them as controlling the blood-pressure by raising or lowering it than simply as factors which raise it. PMID:19990013
Blood pressure and the perception of illusive pain.
Scheuren, Raymonde; Duschek, Stefan; Schulz, André; Sütterlin, Stefan; Anton, Fernand
Numerous studies have documented an inverse relationship between blood pressure and sensitivity to experimental nociceptive stimulation. The present study aimed to investigate possible associations between blood pressure and the occurrence and intensity of paradoxical pain induced by the thermal grill paradigm. Thirty-one healthy subjects were stimulated three times for 1 min with the nonnoxious temperatures of 15°C and 41°C set at the interlaced cold and warm bars of a water bath-driven thermal grill. Blood pressure and heart rate were recorded concomitantly. On account of previous observations of an association between the sensitivity of the cardiac baroreflex and pain perception, this parameter was additionally obtained. Numerical rating scales were used to quantify subjective pain intensity and pain unpleasantness; subjects were classified as responders and nonresponders to thermal grill stimulation based on pain intensity ratings. Responders exhibited lower systolic and diastolic blood pressure than nonresponders, and inverse linear associations arose between blood pressure and pain intensity and unpleasantness. Baroreflex sensitivity was unrelated to pain ratings. The findings confirmed the hypothesis of a blood pressure dependence of paradoxical pain and support the notion that the cardiovascular and pain regulatory systems interact not only in the processing of pain elicited by noxious input, but also in nonnoxiously generated illusive pain. While this finding is not consistent with the assumption of an involvement of the baroreflex system in mediating the observed interaction, psychological traits and neurochemical factors are alternatively considered. PMID:27079150
As part of the Pan American Hypertension Initiative (PAHI), the Pan American Health Organization and the National Heart, Lung, and Blood Institute of the National Institutes of Health of the United States of America conducted a working meeting to discuss blood pressure (BP) measurement methods used in various hypertension prevalence surveys and clinical trials, with the objective of developing a BP measurement protocol for use in hypertension prevalence surveys in the Americas. No such common protocol has existed in the Americas, so it has been difficult to compare hypertension prevention and intervention strategies. This piece describes a proposed standard method for measuring blood pressure for use in population surveys in the Region of the Americas. The piece covers: considerations for developing a common blood pressure measurement protocol, critical issues in measuring blood pressure in national surveys, minimum procedures for blood pressure measurement during surveillance, and quality assessment of blood pressure.
High Blood Pressure and Kidney Disease
... Information Center National Kidney Foundation Smokefree.gov MedlinePlus Kidney and Urologic Disease Organizations Many organizations provide support ... Alternate Language URL Español High Blood Pressure and Kidney Disease Page Content On this page: What is ...
Alcohol drinking and blood pressure among adolescents.
Jerez, S J; Coviello, A
The purpose of this study was to evaluate alcohol consumption among adolescents from Tucuman, Argentina, and to determine its possible relationship with increased levels of blood pressure. Three hundred fifty-six students aged 13-18 included in the study were asked to answer questionnaires anonymously. Two blood pressures measures were then taken. Differences between both sexes were found in quantity and frequency of alcohol consumption. Enjoyment was determined to be the main reason for drinking. There was an association between frequency and alcohol-related problems, and smoking habits. There were also differences in blood pressure among males and females. A weak, but significant, relationship between quantity/frequency index and diastolic blood pressure was found. A greater prevalence of hypertension in male heavy drinkers was noted as well. Because this addiction implies multiple social problems and it also accounts for a hypertension risk factor, the importance of aiming at developing prevention strategies for alcohol abuse among adolescents is stressed.
High Blood Pressure (Hypertension) (For Parents)
... KidsHealth in the Classroom What Other Parents Are Reading Upsetting News Reports? What to Say Vaccines: Which ... when the sounds disappear. When a blood pressure reading is taken, the higher number represents the systolic ...
Principles and techniques of blood pressure measurement
Ogedegbe, Gbenga; Pickering, Thomas
Although the mercury sphygmomanometer is widely regarded as the "gold standard" for office blood pressure measurement, the ban on use of mercury devices continues to diminish their role in office and hospital settings. To date, mercury devices have largely been phased out in US hospitals. This has led to the proliferation of non-mercury devices and has changed (probably for ever) the preferable modality of blood pressure measurement in clinic and hospital settings. In this article, the basic techniques of blood pressure measurement and the technical issues associated with measurements in clinical practice are discussed. The devices currently available for hospital and clinic measurements and their important sources of error are presented. Practical advice is given on how the different devices and measurement techniques should be used. Blood pressure measurements in different circumstances and in special populations such as infants, children, pregnant women, elderly persons, and obese subjects are discussed. PMID:20937442
Pragmatic Method Using Blood Pressure Diaries to Assess Blood Pressure Control
Sharman, James E.; Blizzard, Leigh; Kosmala, Wojciech; Nelson, Mark R.
PURPOSE Twenty-four–hour ambulatory blood pressure (ABP) is the reference standard of blood pressure control. Home blood pressure (HBP) is superior to clinic blood pressure for assessing control, but a barrier to its use is the need for physicians to calculate average blood pressure from patient diaries. We sought to develop a quick and pragmatic method to assess blood pressure control from patients' HBP diaries. METHODS Seven-day HBP and 24-hour ABP were measured in 286 patients with uncomplicated treated hypertension (aged 64 ± 8 years; 53% female). We determined the optimal ratio of home systolic blood pressure readings above threshold (≥135 mm Hg) for the last 10 recorded that would best predict elevated 24-hour ABP. Uncontrolled blood pressure was defined as 24-hour ABP systolic blood pressure ≥130 mm Hg or 24-hour ABP daytime systolic blood pressure ≥135 mm Hg. Validation by corroborative evidence was tested by association with markers of end-organ disease. RESULTS The best predictor of 24-hour ABP systolic blood pressure above treatment/target threshold was having 3 or more (≥30%) of the last 10 home systolic blood pressure readings ≥135 mm Hg (area under the receiver operating characteristic curve = 0.71). Importantly, patients meeting this criterion had evidence of target organ disease, with significantly higher aortic stiffness, left ventricular relative wall thickness, and left atrial area, and lower left ventricular ejection fraction, compared with those who did not meet this criterion. CONCLUSIONS To facilitate uptake of HBP monitoring, we propose that physicians can determine the percentage of the last 10 home systolic blood pressure values ≥135 mm Hg for a patient and tailor management accordingly. PMID:26755785
Cocoa, blood pressure, and cardiovascular health.
Ferri, Claudio; Desideri, Giovambattista; Ferri, Livia; Proietti, Ilenia; Di Agostino, Stefania; Martella, Letizia; Mai, Francesca; Di Giosia, Paolo; Grassi, Davide
High blood pressure is an important risk factor for cardiovascular disease and cardiovascular events worldwide. Clinical and epidemiological studies suggest that cocoa-rich products reduce the risk of cardiovascular disease. According to this, cocoa has a high content in polyphenols, especially flavanols. Flavanols have been described to exert favorable effects on endothelium-derived vasodilation via the stimulation of nitric oxide-synthase, the increased availability of l-arginine, and the decreased degradation of NO. Cocoa may also have a beneficial effect by protecting against oxidative stress alterations and via decreased platelet aggregation, decreased lipid oxidation, and insulin resistance. These effects are associated with a decrease of blood pressure and a favorable trend toward a reduction in cardiovascular events and strokes. Previous meta-analyses have shown that cocoa-rich foods may reduce blood pressure. Long-term trials investigating the effect of cocoa products are needed to determine whether or not blood pressure is reduced on a chronic basis by daily ingestion of cocoa. Furthermore, long-term trials investigating the effect of cocoa on clinical outcomes are also needed to assess whether cocoa has an effect on cardiovascular events. A 3 mmHg systolic blood pressure reduction has been estimated to decrease the risk of cardiovascular and all-cause mortality. This paper summarizes new findings concerning cocoa effects on blood pressure and cardiovascular health, focusing on putative mechanisms of action and "nutraceutical " viewpoints.
What about African Americans and High Blood Pressure?
ANSWERS by heart Lifestyle + Risk Reduction High Blood Pressure What About African Americans and High Blood Pressure? The prevalence of high blood pressure in African Americans is among the highest in ...
An underwater blood pressure measuring device.
Sieber, Arne; Kuch, Benjamin; L'abbate, Antonio; Wagner, Matthias; Dario, Paolo; Bedini, Remo
Measurement of arterial blood pressure is an important vital sign for monitoring the circulation. However, up to now no instrument has been available that enables the measurement of blood pressure underwater. The present paper details a novel, oscillometric, automatic digital blood pressure (BP) measurement device especially designed for this purpose. It consists mainly of analogue and digital electronics in a lexan housing that is rated to a depth of up to 200 metres' sea water, a cuff and a solenoid for inflation of the cuff with air supplied from a scuba tank. An integrated differential pressure sensor, exposed to the same ambient pressure as the cuff, allows accurate BP measurement. Calculation of systolic and diastolic pressures is based on the analysis of pressure oscillations recorded during the deflation. In hyperbaric chamber tests to pressures up to 405 kPa, BP measurements taken with the prototype were comparable to those obtained with established manual and automated methods. Swimming pool tests confirmed the correct functioning of the system underwater. The quality of the recorded pressure oscillations was very good even at 10 metres' fresh water, and allowed determination of diastolic and systolic pressure values. Based on these results we envisage that this device will lead to a better understanding of human cardiovascular physiology in underwater and hyperbaric environments.
Talk with Your Health Care Provider about High Blood Pressure
... mean? Blood pressure is measured by two numbers. systolic pressure 120 80 diastolic pressure Your provider will ... 120 over 80" The first (or top) number—"systolic"—is the pressure in your blood vessels when ...
Blood Pressure in Third Trimester of Pregnancy.
Sufrin, S; Nessa, A; Islam, M T; Khatun, A A; Husain, M F; Khatun, N; Wahed, F; Das, R K; Zannat, M R
Pregnancy is a great stressful physiological condition in women during their reproductive period. During pregnancy several hemodynamic, biochemical and hematological modifications occur as a part of the physiological adaptation of the body. Changes in blood pressure occur in third trimester of pregnancy, which may be associated with increased maternal and infant mortality and morbidity. This cross-sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, from July 2013 to June 2014. Study subjects were selected by following purposive sampling procedure and the protocol of this study was approved by Institutional Ethics Committee (IEC) of Mymensingh. This study enrolled 100 pregnant women of third trimester of pregnancy and 100 aged matched non-pregnant women from Mymensingh district. Mean systolic blood pressure in study group were 124.8±14.51 mm of Hg and in control group were 106.50±10.67 mm of Hg, which was statistically increased. Diastolic blood pressure in study group was 83.00±13.37 mm of Hg and in control group 71.05±7.12 mm of Hg, which was also statistically significant. The changes in blood pressure in third trimester of pregnancy is the major concern of developing the risk of pre-eclampsia & eclampsia, and increased prevalence of IUGR, pre-maturity and perinatal mortality. This study reveals significant changes of blood pressure during third trimester of pregnancy.
Lipids, blood pressure and kidney update 2015.
Banach, Maciej; Aronow, Wilbert S; Serban, Maria-Corina; Rysz, Jacek; Voroneanu, Luminita; Covic, Adrian
The most important studies and guidelines in the topics of lipid, blood pressure and kidney published in 2015 were reviewed. In lipid research, the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) trial revalidated the concept "lower is better" for low density lipoprotein (LDL)-cholesterol as a target for therapy, increasing the necessity of treatment the high-risk patients to achieve LDL-C goals. After these results, ezetimibe might become the preferred additional drug in the combination therapy of lipid disorders because of oral dosage form and lower acquisition cost. However, for the statin-intolerant patients and those patients requiring essential reductions in LDL-C to achieve their goals, new therapies, including PCSK9 inhibitors remain promising drugs. In blood pressure research, American Heart Association (AHA)/American College of Cardiology (ACC) 2015 guidelines recommended a target for blood pressure below 140/90 mmHg in stable or unstable coronary artery disease patients and below 150/90 mmHg in patients older than 80 years of age, however the recent results of the Systolic Blood Pressure Intervention Trial (SPRINT) trial have suggested that there might be significant benefits, taking into account cardiovascular risk, for hypertensive patients over 50 without diabetes and blood pressure levels <120/80. In kidney research, reducing the progression of chronic kidney disease and related complications such as anemia, metabolic acidosis, bone and mineral diseases, acute kidney injury and cardiovascular disease is still a goal for clinicians. PMID:26718096
Blood Pressure in Third Trimester of Pregnancy.
Sufrin, S; Nessa, A; Islam, M T; Khatun, A A; Husain, M F; Khatun, N; Wahed, F; Das, R K; Zannat, M R
Pregnancy is a great stressful physiological condition in women during their reproductive period. During pregnancy several hemodynamic, biochemical and hematological modifications occur as a part of the physiological adaptation of the body. Changes in blood pressure occur in third trimester of pregnancy, which may be associated with increased maternal and infant mortality and morbidity. This cross-sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, from July 2013 to June 2014. Study subjects were selected by following purposive sampling procedure and the protocol of this study was approved by Institutional Ethics Committee (IEC) of Mymensingh. This study enrolled 100 pregnant women of third trimester of pregnancy and 100 aged matched non-pregnant women from Mymensingh district. Mean systolic blood pressure in study group were 124.8±14.51 mm of Hg and in control group were 106.50±10.67 mm of Hg, which was statistically increased. Diastolic blood pressure in study group was 83.00±13.37 mm of Hg and in control group 71.05±7.12 mm of Hg, which was also statistically significant. The changes in blood pressure in third trimester of pregnancy is the major concern of developing the risk of pre-eclampsia & eclampsia, and increased prevalence of IUGR, pre-maturity and perinatal mortality. This study reveals significant changes of blood pressure during third trimester of pregnancy. PMID:26931243
`Sausage string' patterns in blood vessels at high blood pressures
NASA Astrophysics Data System (ADS)
Alstrøm, Preben; Eguíluz, Victor M.; Gustafsson, Finn; Holstein-Rathlou, Niels-Henrik
A new Rayleigh-type instability is proposed to explain the `sausage-string' pattern of alternating constrictions and dialtations formed in blood vessels at high blood pressure conditions. Our theory involves the nonlinear stress-strain characteristics of the vessel wall, and provides predictions for the conditions under which the normal cylindrical geometry of a blood vessel becomes unstable. The theory explains key features observed experimentally, e.g. the limited occurrence of the sausage-string pattern to small arteries and large arterioles, and only in those with small wall-to-lumen ratios.
Maternal Blood Pressure During Pregnancy and Early Childhood Blood Pressures in the Offspring
Lim, Wai-Yee; Lee, Yung-Seng; Yap, Fabian Kok-Peng; Aris, Izzudin Mohd; Ngee, Lek; Meaney, Michael; Gluckman, Peter D.; Godfrey, Keith M.; Kwek, Kenneth; Chong, Yap-Seng; Saw, Seang-Mei; Pan, An
Abstract Although epidemiological studies suggest that offspring of women with preeclampsia are at increased risk to higher blood pressures and cardiovascular disease, little is known about the nature of blood pressures between the mother and her offspring. As blood pressures comprise of both pulsatile (systolic blood pressure [SBP] and pulse pressure [PP]) and stable (diastolic blood pressure [DBP]) components, and they differ between central and peripheral sites, we sought to examine maternal peripheral and central blood pressure components in relation to offspring early childhood blood pressures. A prospective birth cohort of 567 Chinese, Malay, and Indian mother–offspring with complete blood pressure information were studied. Maternal brachial artery SBP, DBP, and PP were measured at 26 to 28 weeks gestation; and central SBP and PP were estimated from radial artery waveforms. Offspring brachial artery SBP, DBP, and PP were measured at 3 years of age. Associations between continuous variables of maternal blood pressures (peripheral SBP, DBP, PP, central SBP, and PP) and offspring blood pressures (peripheral SBP, DBP, and PP) were examined using multiple linear regression with adjustment for maternal characteristics (age, education level, parity, smoking status, alcohol consumption and physical activity during pregnancy, and pre-pregnancy BMI) and offspring characteristics (sex, ethnicity, BMI, and height at 3 years of age). In the multivariate models, offspring peripheral SBP increased by 0.08 (95% confidence interval 0.00–0.17, P = 0.06) mmHg with every 1-mmHg increase in maternal central SBP, and offspring peripheral PP increased by 0.10 (0.01–0.18, P = 0.03) mmHg for every 1-mmHg increase in maternal central PP. The relations of maternal-offspring peripheral blood pressures (SBP, DBP, and PP) were positive but not statistically significant, and the corresponding values were 0.05 (−0.03 to 0.13; P = 0.21), 0.03 (−0.04 to 0.10; P = 0
Estimation of central systolic blood pressure using an oscillometric blood pressure monitor.
Cheng, Hao-Min; Wang, Kang-Ling; Chen, Ying-Hwa; Lin, Shing-Jong; Chen, Lung-Ching; Sung, Shih-Hsien; Ding, Philip Yu-An; Yu, Wen-Chung; Chen, Jaw-Wen; Chen, Chen-Huan
Current noninvasive techniques for assessing central aortic pressure require the recording of an arterial pressure wave using a high-fidelity applanation tonometer. We therefore developed and validated a novel method to estimate the central aortic systolic pressure using an oscillometric blood pressure monitor alone. Invasive high-fidelity right brachial and central aortic pressure waves, and left-brachial pulse volume plethysmography from an oscillometric blood pressure monitor, were obtained at baseline and 3 min after administration of sublingual nitroglycerin in 100 patients during cardiac catheterization. In the initial 50 patients (Generation Group), Central systolic blood pressure was predicted by a multi-variate prediction model generated from the comprehensive analysis of the invasive brachial pressure wave, including brachial late-systolic shoulder pressure value and parameters related to wave reflection and arterial compliance. Another prediction model was similarly constructed from the noninvasively calibrated pulse volume plethysmography. Both models were validated in the subsequent 50 patients (Validation Group) with results: r=0.98 (P<0.001) and mean difference=0.5+/-4.5 (95% confidence interval -8.3 to 9.3) mm Hg for the invasive model, and r=0.93 (P<0.001) and mean difference=-0.1+/-7.6 (95% confidence interval -15.0 to 14.8) mm Hg for the noninvasive model. Thus, our results indicate that central aortic systolic blood pressure could be estimated by analysis of the noninvasive brachial pressure wave alone from an oscillometric blood pressure monitor.
[Blood pressure and polycystic ovary syndrome (PCOS)].
Kiałka, Marta; Milewicz, Tomasz; Klocek, Marek
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder occurring in women of childbearing age. The literature describes the relationship between PCOS and high blood pressure levels and increased risk of arterial hypertension development, which is an important and strong risk factor for adverse cardiovascular events in the future. Among the main causes of hypertension in PCOS women insulin resistance, hyperandrogenism, greater sympathetic nerve activity and concomitance of obesity are stressed. Because PCOS may contribute to earlier development of hypertension, as well as pre-hypertension, therefore it is advisable to monitor blood pressure systematically, to control known risk factors, and to initiate the treatment of hypertension when the disease occur.
Oscillometric blood pressure: a review for clinicians.
Alpert, Bruce S; Quinn, David; Gallick, David
Oscillometric devices for the non-invasive estimation of blood pressure (BP) have become the "clinical standard" because of training requirements for determination of BP by auscultation, cost, and the phasing-out/banning of mercury in many states and countries. Analysis of recent publications reveals a lack of understanding of the "meaning" of oscillometric blood pressure (OBP) measurements by authors, journal editors, and clinicians. We were invited to submit a review of OBP methodology written for clinicians. We hope that the material contained herein will clarify how clinicians should interpret OBP values for their patients. PMID:25492837
Blood pressure in head‐injured patients
Mitchell, Patrick; Gregson, Barbara A; Piper, Ian; Citerio, Giuseppe; Mendelow, A David; Chambers, Iain R
Objective To determine the statistical characteristics of blood pressure (BP) readings from a large number of head‐injured patients. Methods The BrainIT group has collected high time‐resolution physiological and clinical data from head‐injured patients who require intracranial pressure (ICP) monitoring. The statistical features of this dataset of BP measurements with time resolution of 1 min from 200 patients is examined. The distributions of BP measurements and their relationship with simultaneous ICP measurements are described. Results The distributions of mean, systolic and diastolic readings are close to normal with modest skewing towards higher values. There is a trend towards an increase in blood pressure with advancing age, but this is not significant. Simultaneous blood pressure and ICP values suggest a triphasic relationship with a BP rising at 0.28 mm Hg/mm Hg of ICP, for ICP up to 32 mm Hg, and 0.9 mm Hg/mm Hg of ICP for ICP from 33 to 55 mm Hg, and falling sharply with rising ICP for ICP >55 mm Hg. Conclusions Patients with head injury appear to have a near normal distribution of blood pressure readings that are skewed towards higher values. The relationship between BP and ICP may be triphasic. PMID:17138594
An implantable blood pressure and flow transmitter.
NASA Technical Reports Server (NTRS)
Rader, R. D.; Meehan, J. P.; Henriksen, J. K. C.
A miniature totally implantable FM/FM telemetry system has been developed to simultaneously measure blood pressure and blood flow, thus providing an appreciation of the hemodynamics of the circulation to the entire body or to a particular organ. Developed for work with animal subjects, the telemetry system's transmission time is controlled by an RF signal that permits an operating life of several months. Pressure is detected by a miniature intravascular transducer and flow is detected by an extravascular interferometric ultrasonic technique. Both pressure and flow are calibrated prior to implanting. The pressure calibration can be checked after the implanting by cannulation; flow calibration can be verified only at the end of the experiment by determining the voltage output from the implanted sensing system as a function of several measured flow rates. The utility of this device has been established by its use in investigating canine renal circulation during exercise, emotional encounters, administration of drugs, and application of accelerative forces.
21 CFR 870.2850 - Extravascular blood pressure transducer.
Code of Federal Regulations, 2014 CFR
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Extravascular blood pressure transducer. 870.2850... blood pressure transducer. (a) Identification. An extravascular blood pressure transducer is a device used to measure blood pressure by changes in the mechanical or electrical properties of the device....
21 CFR 870.2850 - Extravascular blood pressure transducer.
Code of Federal Regulations, 2012 CFR
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Extravascular blood pressure transducer. 870.2850... blood pressure transducer. (a) Identification. An extravascular blood pressure transducer is a device used to measure blood pressure by changes in the mechanical or electrical properties of the device....
21 CFR 870.2850 - Extravascular blood pressure transducer.
Code of Federal Regulations, 2011 CFR
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Extravascular blood pressure transducer. 870.2850... blood pressure transducer. (a) Identification. An extravascular blood pressure transducer is a device used to measure blood pressure by changes in the mechanical or electrical properties of the device....
21 CFR 870.2850 - Extravascular blood pressure transducer.
Code of Federal Regulations, 2013 CFR
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Extravascular blood pressure transducer. 870.2850... blood pressure transducer. (a) Identification. An extravascular blood pressure transducer is a device used to measure blood pressure by changes in the mechanical or electrical properties of the device....
Lead, blood pressure, and cardiovascular disease in men and women.
Schwartz, J
Lead has been shown to be associated with elevated blood pressure in males in the NHANES II survey and in numerous other studies. This study confirms the association in males aged 20 to 74 and documents a significant, although weaker, association in females as well. Prospective cardiovascular disease studies such as the Framingham study indicate that increases in blood pressure should be associated with increased risk of cardiovascular disease. Using electrocardiogram data from NHANES II, this study confirms the expected association of lead with left ventricular hypertrophy (p less than 0.01). Such an association with permanent cardiovascular changes adds weight to the blood pressure findings. The logistic risk coefficients from the Framingham study can be combined with the study's association between lead and blood pressure to examine its implication for more serious outcomes. The results suggest that a halving of the population mean blood lead level would reduce myocardial infarctions by approximately 24,000 events per year and incidence of all cardiovascular disease by over 100,000. These numbers suggest a small attributable risk compared to the vast incidence of cardiovascular disease in the U.S., but a large attributable risk compared to most environmental toxins. Several biological mechanisms have been identified, with different implications for the use of bone lead as an exposure measure. PMID:1828226
Neighborhood Disadvantage and Variations in Blood Pressure
ERIC Educational Resources Information Center
Cathorall, Michelle L.; Xin, Huaibo; Peachey, Andrew; Bibeau, Daniel L.; Schulz, Mark; Aronson, Robert
Purpose: To examine the extent to which neighborhood disadvantage accounts for variation in blood pressure. Methods: Demographic, biometric, and self-reported data from 19,261 health screenings were used. Addresses of participants were geocoded and located within census block groups (n = 14,510, 75.3%). Three hierarchical linear models were…
Ethnicity, education, and blood pressure in Cuba.
Ordunez, Pedro; Munoz, Jose Luis Bernal; Espinosa-Brito, Alfredo; Silva, Luis Carlos; Cooper, Richard S
The causes of variation in hypertension risk by ethnicity and educational level are not well understood. To gain further insight into this issue in a nonindustrialized country, a population-based sample of 1,667 persons aged 15-74 years was recruited in Cienfuegos, Cuba. In this 2001-2002 study, interviewers classified 29% of participants as Black or mulatto and 71% as White. Educational attainment was stratified at the median number of school years. Compared with White women, non-White women had higher blood pressures (3.0/1.7, systolic blood pressure/diastolic blood pressure) and a higher prevalence of hypertension (24%, 95% confidence interval: 20, 28 vs. 15%, 95% confidence interval: 12, 18). Among men, no differences in blood pressure were observed by ethnicity. Men with a lower level of education had a 14% lower risk of hypertension compared with men above the median. However, women with a lower level of education had a 24% increase in risk. The effect of education was equally strong among Whites alone and when occupation was used for stratification. No variation was observed for body mass index or self-reported health behaviors by ethnicity or education. The narrower ethnic gradient in hypertension prevalence than seen in North America and the gender-specific social status effect, in the context of relatively equal living conditions, suggest that the influence of psychosocial stressors may be specific to cultural contexts.
Alcohol drinking and blood pressure among adolescents.
Jerez, S J; Coviello, A
The purpose of this study was to evaluate alcohol consumption among adolescents from Tucuman, Argentina, and to determine its possible relationship with increased levels of blood pressure. Three hundred fifty-six students aged 13-18 included in the study were asked to answer questionnaires anonymously. Two blood pressures measures were then taken. Differences between both sexes were found in quantity and frequency of alcohol consumption. Enjoyment was determined to be the main reason for drinking. There was an association between frequency and alcohol-related problems, and smoking habits. There were also differences in blood pressure among males and females. A weak, but significant, relationship between quantity/frequency index and diastolic blood pressure was found. A greater prevalence of hypertension in male heavy drinkers was noted as well. Because this addiction implies multiple social problems and it also accounts for a hypertension risk factor, the importance of aiming at developing prevention strategies for alcohol abuse among adolescents is stressed. PMID:9650629
Vegetarian diet, blood pressure and cardiovascular risk.
Rouse, I L; Beilin, L J; Armstrong, B K; Vandongen, R
This paper reviews the association between a vegetarian diet and a number of risk factors for cardiovascular disease investigated in a series of epidemiological and experimental studies. Ninety-eight Seventh-day Adventist "vegetarians" were similar to 113 Mormon omnivores for strength of religious affiliation, consumption of alcohol, tea and coffee and use of tobacco, but were significantly less obese and had significantly lower blood pressures adjusted for age, height and weight. A random sample of forty-seven Adventist vegetarians had significantly lower home blood pressures, serum cholesterol levels and blood pressure responses to a cold-pressor test than Mormon omnivores carefully matched for age, sex and Quetelet's index. In a controlled dietary intervention study mean systolic and diastolic blood pressures and serum cholesterol fell significantly during feeding with a vegetarian diet--an effect unrelated to changes in other lifestyle factors. Dietary analysis indicated that a vegetarian diet provided more polyunsaturated fat, fibre, vitamin C, vitamin E, magnesium, calcium and potassium and significantly less total fat, saturated fat and cholesterol than an omnivore diet. There was no evidence for a difference between vegetarians and omnivores in levels of catecholamines, plasma renin activity, angiotensin II, cortisol or serum and urinary prostanoids.
Clinical Assessment of Central Blood Pressure
Miyashita, Hiroshi
Central aortic blood pressure (CBP) is increasingly considered a better cardiovascular prognostic marker than conventional cuff brachial blood pressure. Because CBP cannot be directly measured noninvasively, it has to be estimated from peripheral pressure pulses. To assess estimated CBP appropriately, the accuracy and features of the estimation method should be considered. The aim of this review is to provide basic knowledge and information useful for interpreting and assessing estimated CBP from a methodological point of view. Precise peripheral pressure pulse recording has been enabled by the introduction of arterial applanation tonometry, for which the radial artery may be the optimal site. An automated tonometry device utilizing a sensor array is preferable in terms of reproducibility and objectivity. Calibration of a peripheral pressure waveform has unresolved problems for any estimation method, due to imperfect brachial sphygmomanometry. However, if central and peripheral pressure calibrations are equivalent, two major methods to estimate CBP—those based on generalized pressure transfer function or radial late systolic pressure—may be comparable in their accuracy of CBP parameter estimation. PMID:22866025
Blood Pressure Modifies Retinal Susceptibility to Intraocular Pressure Elevation
He, Zheng; Nguyen, Christine T. O.; Armitage, James A.; Vingrys, Algis J.; Bui, Bang V.
Primary open angle glaucoma affects more than 67 million people. Elevated intraocular pressure (IOP) is a risk factor for glaucoma and may reduce nutrient availability by decreasing ocular perfusion pressure (OPP). An interaction between arterial blood pressure and IOP determines OPP; but the exact contribution that these factors have for retinal function is not fully understood. Here we sought to determine how acute modifications of arterial pressure will affect the susceptibility of neuronal function and blood flow to IOP challenge. Anaesthetized (ketamine:xylazine) Long-Evan rats with low (∼60 mmHg, sodium nitroprusside infusion), moderate (∼100 mmHg, saline), or high levels (∼160 mmHg, angiotensin II) of mean arterial pressure (MAP, n = 5–10 per group) were subjected to IOP challenge (10–120 mmHg, 5 mmHg steps every 3 minutes). Electroretinograms were measured at each IOP step to assess bipolar cell (b-wave) and inner retinal function (scotopic threshold response or STR). Ocular blood flow was measured using laser-Doppler flowmetry in groups with similar MAP level and the same IOP challenge protocol. Both b-wave and STR amplitudes decreased with IOP elevation. Retinal function was less susceptible to IOP challenge when MAP was high, whereas the converse was true for low MAP. Consistent with the effects on retinal function, higher IOP was needed to attenuated ocular blood flow in animals with higher MAP. The susceptibility of retinal function to IOP challenge can be ameliorated by acute high BP, and exacerbated by low BP. This is partially mediated by modifications in ocular blood flow. PMID:22359566
The Effect of Anthocyanins on Blood Pressure
Zhu, Yongjian; Bo, Yacong; Wang, Xi; Lu, Wenjie; Wang, Xule; Han, Zhanying; Qiu, Chunguang
Abstract The findings of clinical studies concerning the association between anthocyanins supplementation and blood pressure (BP) are inconsistent. In order to provide a more precise estimate of the overall effect of anthocyanins on systolic blood pressure (SBP) and diastolic blood pressure (DBP), we conducted a meta-analysis of clinical trials about anthocyanins supplementation and BP. PubMed, Web of Science, Wanfang Database, and China National Knowledge Infrastructure (CNKI) (until October 2015) were searched to identify potential studies with information on anthocyanins extract supplementation and arterial BP. The weighted mean difference (WMD) and 95% confidence interval (CI) were used as a summary statistic. Net changes in SBP and DBP between anthocyanins supplementation and placebo groups were calculated by subtracting the values at end of follow-up from those at baseline. Meta regression was used to explore the potential moderators of effect size. The publication bias was assessed using Begger's Funnel plots and Egger's tests; P < 0.05 was considered to be statistically significant. Finally, 6 clinical studies with 472 participants for the effect of anthocyanins consumption on BP were included in the present meta-analysis. There is no significant effect on either SBP (WMD: 1.15 mm Hg, 95% CI: −3.17 to 5.47, I2 = 56%) or DBP (WMD: 1.06 mm Hg, 95% CI: −0.71 to 2.83, I2 = 0%) following supplementation with anthocyanins. In summary, results from this meta-analysis do not favor any clinical efficacy of supplementation with anthocyanins in improving blood pressure. Further well-designed large randomized controlled trials (RCTs) with long follow-up period are needed to verify the association of anthocyanins supplementation and blood pressure. PMID:27082604
Alanine increases blood pressure during hypotension
NASA Technical Reports Server (NTRS)
Conlay, L. A.; Maher, T. J.; Wurtman, R. J.
The effect of L-alanine administration on blood pressure (BP) during haemorrhagic shock was investigated using anesthetized rats whose left carotid arteries were cannulated for BP measurement, blood removal, and drug administration. It was found that L-alanine, in doses of 10, 25, 50, 100, and 200 mg/kg, increased the systolic BP of hypotensive rats by 38 to 80 percent (while 100 mg/kg pyruvate increased BP by only 9.4 mmhg, not significantly different from saline). The results suggest that L-alanine might influence cardiovascular function.
21 CFR 870.1100 - Blood pressure alarm.
Code of Federal Regulations, 2011 CFR
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Blood pressure alarm. 870.1100 Section 870.1100...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1100 Blood pressure alarm. (a) Identification. A blood pressure alarm is a device that accepts the signal from a blood...
21 CFR 870.1100 - Blood pressure alarm.
Code of Federal Regulations, 2014 CFR
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Blood pressure alarm. 870.1100 Section 870.1100...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1100 Blood pressure alarm. (a) Identification. A blood pressure alarm is a device that accepts the signal from a blood...
21 CFR 870.1100 - Blood pressure alarm.
Code of Federal Regulations, 2012 CFR
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Blood pressure alarm. 870.1100 Section 870.1100...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1100 Blood pressure alarm. (a) Identification. A blood pressure alarm is a device that accepts the signal from a blood...
21 CFR 870.1100 - Blood pressure alarm.
Code of Federal Regulations, 2013 CFR
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Blood pressure alarm. 870.1100 Section 870.1100...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1100 Blood pressure alarm. (a) Identification. A blood pressure alarm is a device that accepts the signal from a blood...
21 CFR 870.1100 - Blood pressure alarm.
Code of Federal Regulations, 2010 CFR
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Blood pressure alarm. 870.1100 Section 870.1100...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1100 Blood pressure alarm. (a) Identification. A blood pressure alarm is a device that accepts the signal from a blood...
[Measurement of blood pressure variability and the clinical value].
Kékes, Ede; Kiss, István
Authors have collected and analyzed literature data on blood pressure variability. They present the methods of blood pressure variability measurement, clinical value and relationships with target organ damages and risk of presence of cardiovascular events. They collect data about the prognostic value of blood pressure variability and the effects of different antihypertensive drugs on blood pressure variability. They underline that in addition to reduction of blood pressure to target value, it is essential to influence blood pressure fluctuation and decrease blood pressure variability, because blood pressure fluctuation presents a major threat for the hypertensive subjects. Data from national studies are also presented. They welcome that measurement of blood pressure variability has been included in international guidelines.
Numerical simulation of noninvasive blood pressure measurement.
Hayashi, Satoru; Hayase, Toshiyuki; Shirai, Atsushi; Maruyama, Masaru
In this paper, a simulation model based on the partially pressurized collapsible tube model for reproducing noninvasive blood pressure measurement is presented. The model consists of a collapsible tube, which models the pressurized part of the artery, rigid pipes connected to the collapsible tube, which model proximal and distal region far from the pressurized part, and the Windkessel model, which represents the capacitance and the resistance of the distal part of the circulation. The blood flow is simplified to a one-dimensional system. Collapse and expansion of the tube is represented by the change in the cross-sectional area of the tube considering the force balance acting on the tube membrane in the direction normal to the tube axis. They are solved using the Runge-Kutta method. This simple model can easily reproduce the oscillation of inner fluid and corresponding tube collapse typical for the Korotkoff sounds generated by the cuff pressure. The numerical result is compared with the experiment and shows good agreement. PMID:16995754
Blood pressure control in acute cerebrovascular disease.
Owens, William B
Acute cerebrovascular diseases (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage) affect 780,000 Americans each year. Physicians who care for patients with these conditions must be able to recognize when acute hypertension requires treatment and should understand the principles of cerebral autoregulation and perfusion. Physicians should also be familiar with the various pharmacologic agents used in the treatment of cerebrovascular emergencies. Acute ischemic stroke frequently presents with hypertension, but the systemic blood pressure should not be treated unless the systolic pressure exceeds 220 mm Hg or the diastolic pressure exceeds 120 mm Hg. Overly aggressive treatment of hypertension can compromise collateral perfusion of the ischemic penumbra. Hypertension associated with intracerebral hemorrhage can be treated more aggressively to minimize hematoma expansion during the first 3 to 6 hours of illness. Subarachnoid hemorrhage is usually due to aneurysmal rupture; systolic blood pressure should be kept <150 mm Hg to prevent re-rupture of the aneurysm. Nicardipine and labetalol are recommended for rapidly treating hypertension during cerebrovascular emergencies. Sodium nitroprusside is not recommended due to its adverse effects on cerebral autoregulation and intracranial pressure. Hypoperfusion of the injured brain should be avoided at all costs.
Alfie, José
Postprandial hypotension, defined as a fall in systolic blood pressure (SBP) of 20 mmHg or greater within 2 hours after a meal, is a risk factor for stroke, coronary events and mortality. The clinical suspicion is typically raised by episodes of postprandial syncope or falls, whereas asymptomatic postprandial hypotension is mostly neglected. The magnitude of the postprandial fall in SBP, as detected by 24-hour recording in apparently healthy middle-aged to elderly subjects, was proportional to the severity of the silent cerebrovascular damage. Postprandial hypotension can also be detected by self-measured blood pressure before and within 2 hours after meals using automatic devices. The review highlights the value of home blood pressure monitoring (HBPM) as a screening test for asymptomatic postprandial hypotension in hypertensive patients. Using a HBPM protocol that included duplicated blood pressure measurements before and after three consecutive lunches, we detected unsuspected postprandial hypotension in 27.4% of the 230 hypertensive patients screened. The prevalence of postprandial hypotension was 13.2% in controlled and 42.2% in uncontrolled hypertensive patients (p < 0.001), raising the dilemma of further lowering blood pressure in the setting of postprandial hypotension. The inclusion of preprandial and postprandial measurements in the protocol of HBPM is useful to identify hypertensive patients with postprandial hypotension and may guide adjustments in antihypertensive treatment according to postprandial blood pressure.
Health Instruction Packages: How to Take a Blood Pressure.
ERIC Educational Resources Information Center
Lancaster, Carolyn; And Others
Text, illustrations, and exercises are utilized in these four learning modules to teach dental hygiene students, nursing students, and the general public how to measure blood pressure. The first module, "Can You Take a Blood Pressure?" by Carolyn Lancaster, defines blood pressure, distinguishes between systolic and diastolic pressure and lists the…
Ethanol and blood pressure in rats
Hatton, D.C.; Edgar, S.; McCarron, D.A. )
Epidemiologists have identified alcohol as a risk factor in hypertension. Attempts to increase blood pressure in rats with chronic alcohol ingestion have met with mixed results. Some investigators have reported increases in blood pressure while others have reported decreases. Most investigators have given alcohol in the drinking water which produced differences in food intake across groups. To control for food intake, Wister rats were simultaneously pair fed a liquid diet with either ethanol as 35% of calories or a control diet using ARF/Israel pair-feeding devices. At 5 weeks of age, animals on ethanol diets had lower systolic blood pressure than control animals (145 (n-19) vs. 121 (n-19) mmHg). There was no difference in weight between ethanol and control animals. The same pattern of results was apparent at 7 weeks (143 (n-13) vs. 119 (n-13) mmHg) and 9 weeks (147 (n-7) vs. 124 (n-7)). The data indicate that ethanol produces hypotension in rats when food intake is controlled.
Ambulatory Blood Pressure Monitoring in Clinical Practice: A Review
Viera, Anthony J.; Shimbo, Daichi
Ambulatory blood pressure monitoring offers the ability to collect blood pressure readings several times an hour across a 24-hour period. Ambulatory blood pressure monitoring facilitates the identification of white-coat hypertension, the phenomenon whereby certain individuals who are not on antihypertensive medication show elevated blood pressure in a clinical setting but show non-elevated blood pressure averages when assessed by ambulatory blood pressure monitoring. Additionally, readings can be segmented into time windows of particular interest, e.g., mean daytime and nighttime values. During sleep, blood pressure typically decreases, or dips, such that mean sleep blood pressure is lower than mean awake blood pressure. A non-dipping pattern and nocturnal hypertension are strongly associated with increased cardiovascular morbidity and mortality. Approximately 70% of individuals dip ≥10% at night, while 30% have non-dipping patterns, when blood pressure remains similar to daytime average, or occasionally rises above daytime average. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure since they increase accuracy for diagnosis and the prediction of cardiovascular risk. PMID:25107387
High blood pressure and visual sensitivity
NASA Astrophysics Data System (ADS)
Eisner, Alvin; Samples, John R.
The study had two main purposes: (1) to determine whether the foveal visual sensitivities of people treated for high blood pressure (vascular hypertension) differ from the sensitivities of people who have not been diagnosed with high blood pressure and (2) to understand how visual adaptation is related to standard measures of systemic cardiovascular function. Two groups of middle-aged subjects-hypertensive and normotensive-were examined with a series of test/background stimulus combinations. All subjects met rigorous inclusion criteria for excellent ocular health. Although the visual sensitivities of the two subject groups overlapped extensively, the age-related rate of sensitivity loss was, for some measures, greater for the hypertensive subjects, possibly because of adaptation differences between the two groups. Overall, the degree of steady-state sensitivity loss resulting from an increase of background illuminance (for 580-nm backgrounds) was slightly less for the hypertensive subjects. Among normotensive subjects, the ability of a bright (3.8-log-td), long-wavelength (640-nm) adapting background to selectively suppress the flicker response of long-wavelength-sensitive (LWS) cones was related inversely to the ratio of mean arterial blood pressure to heart rate. The degree of selective suppression was also related to heart rate alone, and there was evidence that short-term changes of cardiovascular response were important. The results suggest that (1) vascular hypertension, or possibly its treatment, subtly affects visual function even in the absence of eye disease and (2) changes in blood flow affect retinal light-adaptation processes involved in the selective suppression of the flicker response from LWS cones caused by bright, long-wavelength backgrounds.
Blood pressure, hypertension, and ambulatory blood pressure monitoring in children and adolescents.
Morgenstern, Bruce
Fixed essential hypertension in children is uncommon. Confusion surrounding the definitions and tools used in measuring blood pressure (BP), and the variable capacity to apply the definitions despite the device used explains this in part. In children, hypertension is defined statistically, based on a large normative population that is ethnically diverse. The standards were developed from the first BP measurement obtained in large studies, and the measurements were obtained using standard auscultatory sphygmomanometry. Technologic advances have seen the widespread introduction of oscillometric devices, which determine BP in a different fashion from auscultation, and the two values are not identical. In fact, as oscillometric devices use proprietary algorithms to calculate the BP, results are not readily interchangeable. Ambulatory BP devices have been added to this mix and offer unique opportunities for accurate diagnosis, and more effective therapies. Most ambulatory BP devices have neither been validated for use in children, nor have passed the validation process. A consensus document may be needed to optimize use and interpretation of data from ambulatory BP monitoring. PMID:11866234
Are Some Blood Pressure Meds Linked to Depression, Bipolar Risk?
... gov/news/fullstory_161421.html Are Some Blood Pressure Meds Linked to Depression, Bipolar Risk? Researchers add ... TUESDAY, Oct. 11, 2016 (HealthDay News) -- Some blood pressure drugs may boost the risk that patients will ...
1 in 4 Medicare Patients Uses Blood Pressure Meds Incorrectly
... html 1 in 4 Medicare Patients Uses Blood Pressure Meds Incorrectly The lifesaving drugs 'only work if ... prescription drug enrollees aren't taking their blood pressure medication as directed, increasing their risk of heart ...
Snapshot: Blood Pressure in the U.S.
... visit this page: About CDC.gov . Home Blood Pressure: Make Control Your Goal Infographic Recommend on Facebook ... Copy the code below to use the Blood Pressure Infographic on your web page or social media ...
Orthostatic Hypotension (Low Blood Pressure) and Parkinson's Disease
... Order Free Materials Today Orthostatic Hypotension (Low Blood Pressure) Callers to the Parkinson's Disease Foundation (PDF) National ... known as orthostatic hypotension (OH), or low blood pressure. If you have experienced it, you may already ...
High Blood Pressure Might Affect Some Kids' Thinking Ability
... Services, or federal policy. More Health News on: Child Development High Blood Pressure Recent Health News Related MedlinePlus Health Topics Child Development High Blood Pressure About MedlinePlus Site Map FAQs ...
Non-invasive blood pressure measurement in mice.
Feng, Minjie; DiPetrillo, Keith
Hypertension is a leading cause of heart attack, stroke, and kidney failure and represents a serious medical issue worldwide. The genetic basis of hypertension is well-established, but few causal genes have been identified thus far. Non-invasive blood pressure measurements are a critical component of high-throughput genetic studies to identify genes controlling blood pressure. Whereas this technique is fairly routine for blood pressure measurements in rats, non-invasive blood pressure measurement in mice has proven to be more challenging. This chapter describes an experimental protocol measuring blood pressure in mice using a CODA non-invasive blood pressure monitoring system. This method enables accurate blood pressure phenotyping in mice for linkage or mutagenesis studies, as well as for other experiments requiring high-throughput blood pressure measurement.
High blood pressure - what to ask your doctor
What to ask your doctor about high blood pressure; Hypertension - what to ask your doctor ... problems? What medicines am I taking to treat high blood pressure? Do they have any side effects? What should ...
[An integrated system of blood pressure measurement with bluetooth communication].
Wang, Wei; Wang, Jing; Sun, Hongyang; Xu, Zuyang; Chai, Xinyu
The development of the integrated blood pressure system with bluetooth communication function is introduced. Experimental results show that the system can complete blood pressure measurement and data transmission wireless effectively, which can be used in m-Health in future.
Even Poorer Nations Not Immune to High Blood Pressure
... Even Poorer Nations Not Immune to High Blood Pressure Researchers cite aging populations, diet, inactivity and lack ... News) -- For the first time ever, high blood pressure rates are higher in low- and middle-income ...
Blood Pressure Problems During Pregnancy, Heart Trouble Later?
... https://medlineplus.gov/news/fullstory_159580.html Blood Pressure Problems During Pregnancy, Heart Trouble Later? Spotting risk ... 2016 (HealthDay News) -- Pregnant women who have blood pressure in the high-normal range may have an ...
A Nutritional Strategy for the Treatment of High Blood Pressure.
ERIC Educational Resources Information Center
Podell, Richard N.
Some physicians wonder if high blood pressure can be controlled without the use of drugs and their potential side effects. Current findings concerning nutrition and high blood pressure are presented. (RM)
Blood pressure, edema and proteinuria in pregnancy. 4. Blood pressure relationships.
Friedman, E A
The significance of these and related data will be discussed in greater detail during the subsequent course of this workshop. For now, we can sum up our findings with the following general statements concerning this analysis: 1. Blood pressure elevation occuring alone during the course of pregnancy, in the absence of edema and/or proteinuria, affects perinatal survival adversely. 2. This relationship is most marked among nulliparas in the age range 20-34 years and is less pronounced, but still evident, in young nulliparas and in multiparas of comparable age. 3. The effect is greater among black patients than among white patients in the median-aged nulliparas and multiparas, but this difference is not mirrored in the young nulliparas studied. 4. Blood pressure elevations during weeks 20-28 of pregnancy result in much higher subsequent perinatal losses in white nulliparas (both median and young age groups) than comparable elevations earlier or later in pregnancy. 5. Among black nulliparas of median age, maximal blood pressure effect on outcome is encountered at the sixteenth week (the earliest available data), with continuing significant increases until the twenty-eighth week, and there is another increment at term. In younger black patients, the results from 20 through 28 weeks parallel those seen in white patients, but with an additional peak at term. 6. among multiparas, maximal effect occurs at 24-28 weeks in both black and white groups. 7. The critical blood pressure levels are significantly lower in early pregnancy than in late pregnancy. 8. Critical levels of blood pressure with advancing pregnancy appear to parallel the trend in mean blood pressures determined to exist for this series. 9. Utilizing blood pressure distribution data to set limits statistically, we find very meaningful increments in perinatal mortality rates for nulliparas presenting blood pressure elevations beyond the 95 percentile point. This holds also for diastolic or systolic levels when
Methods of Blood Pressure Measurement in the ICU
Lehman, Li-wei H.; Saeed, Mohammed; Talmor, Daniel; Mark, Roger; Malhotra, Atul
Objective Minimal clinical research has investigated the significance of different blood pressure monitoring techniques in the ICU and whether systolic vs. mean blood pressures should be targeted in therapeutic protocols and in defining clinical study cohorts. The objectives of this study are to compare real-world invasive arterial blood pressure with noninvasive blood pressure, and to determine if differences between the two techniques have clinical implications. Design We conducted a retrospective study comparing invasive arterial blood pressure and noninvasive blood pressure measurements using a large ICU database. We performed pairwise comparison between concurrent measures of invasive arterial blood pressure and noninvasive blood pressure. We studied the association of systolic and mean invasive arterial blood pressure and noninvasive blood pressure with acute kidney injury, and with ICU mortality. Setting Adult intensive care units at a tertiary care hospital. Patients Adult patients admitted to intensive care units between 2001 and 2007. Interventions None. Measurements and Main Results Pairwise analysis of 27,022 simultaneously measured invasive arterial blood pressure/noninvasive blood pressure pairs indicated that noninvasive blood pressure overestimated systolic invasive arterial blood pressure during hypotension. Analysis of acute kidney injury and ICU mortality involved 1,633 and 4,957 patients, respectively. Our results indicated that hypotensive systolic noninvasive blood pressure readings were associated with a higher acute kidney injury prevalence (p = 0.008) and ICU mortality (p < 0.001) than systolic invasive arterial blood pressure in the same range (≤70 mm Hg). Noninvasive blood pressure and invasive arterial blood pressure mean arterial pressures showed better agreement; acute kidney injury prevalence (p = 0.28) and ICU mortality (p = 0.76) associated with hypotensive mean arterial pressure readings (≤60 mm Hg) were independent of
Lipid, blood pressure and kidney update 2013.
Banach, Maciej; Serban, Corina; Aronow, Wilbert S; Rysz, Jacek; Dragan, Simona; Lerma, Edgar V; Apetrii, Mugurel; Covic, Adrian
The year 2013 proved to be very exciting as far as landmark trials and new guidelines in the field of lipid disorders, blood pressure and kidney diseases. Among these are the International Atherosclerosis Society Global Recommendations for the Management of Dyslipidemia, European Society of Cardiology (ESC)/European Society of Hypertension Guidelines for the Management of Arterial Hypertension, American Diabetes Association Clinical Practice Recommendations, the Kidney Disease: Improving Global Outcomes Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease (CKD) Patients, the American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, the Joint National Committee Expert Panel (JNC 8) Evidence-Based Guideline for the Management of High Blood Pressure in Adults, the American Society of Hypertension/International Society of Hypertension Clinical Practice Guidelines for the Management of Hypertension in the Community, the American College of Physicians Clinical Practice Guideline on Screening, Monitoring, and Treatment of Stage 1-3 CKD and many important trials presented among others during the ESC Annual Congress in Amsterdam and the American Society of Nephrology Annual Meeting--Kidney Week in Atlanta, GA. The paper is an attempt to summarize the most important events and reports in the mentioned areas in the passing year. PMID:24573394
21 CFR 870.1120 - Blood pressure cuff.
Code of Federal Regulations, 2014 CFR
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...
21 CFR 870.1110 - Blood pressure computer.
Code of Federal Regulations, 2012 CFR
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Blood pressure computer. 870.1110 Section 870.1110...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1110 Blood pressure computer. (a) Identification. A blood pressure computer is a device that accepts the electrical signal...
21 CFR 870.1120 - Blood pressure cuff.
Code of Federal Regulations, 2011 CFR
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...
21 CFR 870.1110 - Blood pressure computer.
Code of Federal Regulations, 2011 CFR
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Blood pressure computer. 870.1110 Section 870.1110...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1110 Blood pressure computer. (a) Identification. A blood pressure computer is a device that accepts the electrical signal...
21 CFR 870.1120 - Blood pressure cuff.
Code of Federal Regulations, 2012 CFR
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...
21 CFR 870.1110 - Blood pressure computer.
Code of Federal Regulations, 2014 CFR
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Blood pressure computer. 870.1110 Section 870.1110...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1110 Blood pressure computer. (a) Identification. A blood pressure computer is a device that accepts the electrical signal...
21 CFR 870.1120 - Blood pressure cuff.
Code of Federal Regulations, 2010 CFR
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...
21 CFR 870.1120 - Blood pressure cuff.
Code of Federal Regulations, 2013 CFR
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...
21 CFR 870.1140 - Venous blood pressure manometer.
Code of Federal Regulations, 2013 CFR
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Venous blood pressure manometer. 870.1140 Section... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a...
21 CFR 870.1130 - Noninvasive blood pressure measurement system.
Code of Federal Regulations, 2013 CFR
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Noninvasive blood pressure measurement system. 870... SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1130 Noninvasive blood pressure measurement system. (a) Identification. A noninvasive blood pressure...
Heart and Artery Damage and High Blood Pressure
... Resources Stroke More Heart and Artery Damage and High Blood Pressure Updated:Oct 22,2015 There are several harmful ... content was last reviewed on 08/04/2014. High Blood Pressure • Home • About High Blood Pressure (HBP) • Why HBP ...
21 CFR 870.1130 - Noninvasive blood pressure measurement system.
Code of Federal Regulations, 2010 CFR
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Noninvasive blood pressure measurement system. 870.1130 Section 870.1130 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Noninvasive blood pressure measurement system. (a) Identification. A noninvasive blood pressure...
21 CFR 870.1130 - Noninvasive blood pressure measurement system.
Code of Federal Regulations, 2014 CFR
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Noninvasive blood pressure measurement system. 870.1130 Section 870.1130 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Noninvasive blood pressure measurement system. (a) Identification. A noninvasive blood pressure...
21 CFR 870.1130 - Noninvasive blood pressure measurement system.
Code of Federal Regulations, 2012 CFR
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Noninvasive blood pressure measurement system. 870.1130 Section 870.1130 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Noninvasive blood pressure measurement system. (a) Identification. A noninvasive blood pressure...
21 CFR 870.1130 - Noninvasive blood pressure measurement system.
Code of Federal Regulations, 2011 CFR
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Noninvasive blood pressure measurement system. 870.1130 Section 870.1130 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Noninvasive blood pressure measurement system. (a) Identification. A noninvasive blood pressure...
Serum- and glucocorticoid-regulated kinase (SGK1) gene and blood pressure.
Busjahn, Andreas; Aydin, Atakan; Uhlmann, Regina; Krasko, Christine; Bähring, Sylvia; Szelestei, Tamas; Feng, Yuxi; Dahm, Stephan; Sharma, Arya M; Luft, Friedrich C; Lang, Florian
The serum- and glucose-regulated kinase (SGK1) gene has recently been identified as an important aldosterone-induced protein kinase that mediates trafficking of the renal epithelial Na(+) channel (ENaC) to the cell membrane. Thus, SGK1 is an appealing candidate for blood pressure regulation and possibly essential hypertension. To test this hypothesis, we recruited monozygotic (126 pairs) and dizygotic (70 pairs) normotensive twin subjects and parents of dizygotic twins. Blood pressure was measured in a controlled fashion: recumbent, sitting, and upright. We documented genetic variance on blood pressure in all positions. We then relied on microsatellite markers at the SGK1 gene locus (D6S472, D6S1038, and D6S270) and 2 single nucleotide polymorphisms within the SGK1 gene. We found significant linkage of the SGK1 gene locus to diastolic blood pressure (P<0.0002) and suggestive evidence for linkage for systolic blood pressure (P<0.04), documenting the locus as a quantitative trait locus for blood pressure. We next performed association, using all dizygotic twins and a monozygotic member from each pair. We found significant associations between both single nucleotide polymorphism variants and blood pressure, as well as a significant interaction between the single nucleotide polymorphisms enhancing the effect. This combined effect of the polymorphisms was confirmed in an independent sample of 260 young normotensive men. We conclude that the SGK1 gene is relevant to blood pressure regulation and probably to hypertension in man. PMID:12215463
Modern approaches to blood pressure measurement
Staessen, J.; O'Brien, E.; Thijs, L.; Fagard, R.
BACKGROUND—Blood pressure (BP) is usually measured by conventional sphygmomanometry. Although apparently simple, this procedure is fraught with many potential sources of error. This review focuses on two alternative techniques of BP measurement: ambulatory monitoring and self measurement. REVIEW—BP values obtained by ambulatory monitoring or self measurement are characterised by high reproducibility, are not subject to digit preference or observer bias, and minimise the transient rise of the blood pressure in response to the surroundings of the clinic or the presence of the observer, the so called white coat effect. For ambulatory monitoring, the upper limits of systolic/diastolic normotension in adults include 130/80 mm Hg for the 24 hour BP and 135/85 and 120/70 mm Hg for the daytime BP and night time BP, respectively. For the the self measured BP these thresholds include 135/85 mm Hg. Automated BP measurement is most useful to identify patients with white coat hypertension. Whether or not white coat hypertension predisposes to sustained hypertension remains debated. However, outcome is better correlated with the ambulatory BP than with the conventional BP. In patients with white coat hypertension, antihypertensive drugs lower the BP in the clinic, but not the ambulatory BP, and also do not improve prognosis. Ambulatory BP monitoring is also better than conventional BP measurement in assessing the effects of treatment. Ambulatory BP monitoring is necessary to diagnose nocturnal hypertension and is especially indicated in patients with borderline hypertension, elderly patients, pregnant women, patients with treatment resistant hypertension, and also in patients with symptoms suggestive of hypotension. CONCLUSIONS—The newer techniques of BP measurement are now well established in clinical research, for diagnosis in clinical practice, and will increasingly make their appearance in occupational and environmental medicine. Keywords: ambulatory blood
Clinical aspects of blood pressure autorhythmometry
NASA Technical Reports Server (NTRS)
Levine, H.; Halberg, F.
Self-measurements made by a 55-year-old physician with mild to moderate hypertension of ten years' duration are considered. The physician had been in excellent health until age 45 when sustained elevation of blood pressure up to 180/100 mmHg and a slight aortic diastolic murmur were noted. On the basis of the investigation it is suggested that physical and mental performance measures provide an objective basis for assessing the desirability of a given physiological change. Such studies will have to be complemented by a search for long-term effects.
Cerebral blood flow in normal pressure hydrocephalus
Mamo, H.L.; Meric, P.C.; Ponsin, J.C.; Rey, A.C.; Luft, A.G.; Seylaz, J.A.
A xenon-133 method was used to measure cerebral blood flow (CBF) before and after cerebrospinal fluid (CSF) removal in patients with normal pressure hydrocephalus (NPH). Preliminary results suggested that shunting should be performed on patients whose CBF increased after CSF removal. There was a significant increase in CBF in patients with NPH, which was confirmed by the favorable outcome of 88% of patients shunted. The majority of patients with senile and presenile dementia showed a decrease or no change in CBF after CSF removal. It is suggested that although changes in CBF and clinical symptoms of NPH may have the same cause, i.e., changes in the cerebral intraparenchymal pressure, there is no simple direct relation between these two events. The mechanism underlying the loss of autoregulation observed in NPH is also discussed.
Automatic Blood Pressure Measurements During Exercise
NASA Technical Reports Server (NTRS)
Weaver, Charles S.
Microprocessor circuits and a computer algorithm for automatically measuring blood pressure during ambulatory monitoring and exercise stress testing have been under development at SRI International. A system that records ECG, Korotkov sound, and arm cuff pressure for off-line calculation of blood pressure has been delivered to NASA, and an LSLE physiological monitoring system that performs the algorithm calculations in real-time is being constructed. The algorithm measures the time between the R-wave peaks and the corresponding Korotkov sound on-set (RK-interval). Since the curve of RK-interval versus cuff pressure during deflation is predictable and slowly varying, windows can be set around the curve to eliminate false Korotkov sound detections that result from noise. The slope of this curve, which will generally decrease during exercise, is the inverse of the systolic slope of the brachial artery pulse. In measurements taken during treadmill stress testing, the changes in slopes of subjects with coronary artery disease were markedly different from the changes in slopes of healthy subjects. Measurements of slope and O2 consumption were also made before and after ten days of bed rest during NASA/Ames Research Center bed rest studies. Typically, the maximum rate of O2 consumption during the post-bed rest test is less than the maximum rate during the pre-bed rest test. The post-bed rest slope changes differ from the pre-bed rest slope changes, and the differences are highly correlated with the drop in the maximum rate of O2 consumption. We speculate that the differences between pre- and post-bed rest slopes are due to a drop in heart contractility.
Relationship of blood lead to blood pressure in a longitudinal study of working men
Weiss, S.T.; Munoz, A.; Stein, A.; Sparrow, D.; Speizer, F.E.
The relationship of lead exposure to blood pressure has been examined in a longitudinal study of a cohort of 89 Boston, Massachusetts, policemen. At the baseline examination, subjects had a blood lead determination and three consecutive blood pressure measurements. Triplicate blood pressure measurements were also taken at years 3, 4, and 5. Multivariate analysis revealed that, after correction for previous systolic blood pressure, body mass index, age, and smoking, a high level of blood lead was a significant predictor of subsequent elevation of systolic pressure. Bootstrap simulations of these models provided supporting evidence for the observed associations. These data suggest that lead exposure can significantly affect systolic pressure.
21 CFR 870.1140 - Venous blood pressure manometer.
Code of Federal Regulations, 2014 CFR
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Venous blood pressure manometer. 870.1140 Section... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class...
21 CFR 870.1140 - Venous blood pressure manometer.
Code of Federal Regulations, 2011 CFR
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Venous blood pressure manometer. 870.1140 Section... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class...
21 CFR 870.1140 - Venous blood pressure manometer.
Code of Federal Regulations, 2012 CFR
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Venous blood pressure manometer. 870.1140 Section... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class...
Central aortic blood pressure assessment and cardiovascular risk.
Ram, C Venkata S
Peripheral brachial blood pressure measurements may not provide an accurate representation of degenerative changes that characterize cardiovascular disease. Evidence is mounting that antihypertensive treatment strategies with apparently similar effects on brachial blood pressure may have different effects on central aortic pressure, which in turn may lead to overestimation or underestimation of therapeutic efficacy. The relative importance of central and brachial blood pressure for predicting cardiovascular risk and clinical outcomes has been examined in several clinical studies. These studies have reported that a large proportion of individuals considered to have normal blood pressure values based on brachial systolic pressures had high-normal blood pressure based on central aortic pressure measurements. As additional evidence suggesting the superiority of central aortic pressure over peripheral assessments becomes more abundant, measurement of central aortic pressure may be the next important advancement in the management of hypertension.
Previous blood pressure measurement and associated factors in student adolescents
Magalhães, Marina Gabriella Pereira de Andrada; Farah, Breno Quintella; de Barros, Mauro Virgilio Gomes; Ritti-Dias, Raphael Mendes
Objective To identify prevalence of previous blood pressure measurement and analyze some associated factors in adolescents. Methods This cross-sectional study included 6,077 adolescents aged 14 to 19 years. Demographic characteristics included (sex, age, period of study, region of residence, work, skin color, and economic) status, history of blood pressure measurement within last 12 months, local of blood pressure measurement, and reading obtained. To assess associations between previous blood pressure measurement with demographic characteristics and high blood pressure we used descriptive statistics and logistic regression analysis. Results Out of the adolescents, 56.8% reported no blood pressure measurement within the last 12 months. The health centers and the physician's office were most mentioned places for blood pressure measurement (28.3% and 36.9%, respectively). Boys (odds ratio of 1.64 95%CI: 1.46-1.84) aged 14 to 16 years (odds ratio of 1.12; 95%CI: 1.01-1.25), whose economic status was unfavorable (odds ratio of 1.48; 95%CI: 1.32-1.67) were significantly associated with no blood pressure measurement. Working was a protective factor for was not blood pressure measurement (odds ratio of 0.84; 95%CI: 0.73-0.97). Conclusion Most of adolescents did not have their blood pressure measured within the last 12 months. Boys aged 14 to 16 years and those with unfavorable economic status had higher chance of not having their blood pressure measured. PMID:26466061
Diurnal blood pressure variation in kidney-pancreas transplant recipients.
Marx, M A; Gardner, S F; Ketel, B L
Blood pressure normally follows a characteristic pattern throughout the 24 h cycle with daytime pressures higher than nighttime pressures. Patients lacking a nocturnal decrease in pressure have a higher incidence of end organ damage. This investigation was designed to characterize the diurnal pattern of blood pressure and to evaluate blood pressure load in patients who have received a combined kidney-pancreas (KP) transplant. Ten patients (mean 10 months posttransplant) underwent 48 h of noninvasive ambulatory blood pressure monitoring using a commercially available device (SpaceLabs 90202 or 90207). Blood pressure was measured every 15 min from 6 AM to 9 PM and every 30 min from 9 PM to 6 AM. Ambulatory monitoring revealed a markedly increased nocturnal blood pressure (up to 25% greater than daytime pressures). These patients were found to have a higher nocturnal blood pressure load than during the day. No relationship was demonstrated between diurnal blood pressure variation and immunosuppression regimen, elapsed time after transplantation, or antihypertensive treatment. These results indicate that close attention must be given to the nocturnal blood pressure of KP recipients and suggest that standard antihypertensive medication regimens do not adequately treat the nocturnal hypertension in these patients. This may predispose these patients to further cardiovascular or cerebrovascular complications.
[Riva-Rocci and blood pressure].
van Gijn, Jan; Gijselhart, Joost P
Scipione Riva-Rocci (1863-1937) was educated in Turin as a physician and later as a doctor of internal medicine. In 1896 and 1897 he published a series of four articles (in Italian) on a new method for measuring blood pressure. Previous non-invasive methods were all based on compression of the radial pulse, in keeping with centuries of medical tradition, but they were cumbersome and unreliable. Riva-Rocci's innovation consisted in compressing the brachial artery instead, at the level of the upper arm. For this purpose he devised an inflatable rubber tube, which was rigid on the outside. Disappearance of the radial pulse on palpation indicated the systolic arterial pressure, as Riva-Rocci confirmed by calibration experiments in animals and with human cadavers. His instrument was introduced world-wide after a chance visit by the American neurosurgeon Harvey Cushing (1869-1939). The Russian surgeon Nikolai Korotkoff (1874-1920) was the first to apply auscultation of the artery below the cuff (in 1905), a method that allowed determination of diastolic arterial pressure. Riva-Rocci was Chief of Medicine at the municipal hospital in Varese from 1900 to 1928, where he developed a special interest in paediatrics. PMID:23328024
Relationship of blood lead to systolic blood pressure in a longitudinal study of policemen
Weiss, S.T.; Munoz, A.; Stein, A.; Sparrow, D.; Speizer, F.E.
We examined the relationship of blood lead level to systolic and diastolic blood pressure in a longitudinal study of 89 Boston, MA, policemen. At the second examination blood lead level and blood pressure were measured in triplicate. Blood pressure measurements were taken in a similar fashion in years 3, 4, and 5. Multivariate analysis using a first-order autoregressive model revealed that after adjusting for previous systolic blood pressure, body mass index, age, and cigarette smoking, an elevated blood lead level was a significant predictor of subsequent systolic blood pressure. Bootstrap simulations of these models provided supporting evidence for the observed association. These data suggest that blood lead level can influence systolic blood pressure even within the normal range.
The epidemiology of blood pressure and its worldwide management.
Rahimi, Kazem; Emdin, Connor A; MacMahon, Stephen
Despite the vast amount of evidence on the benefits of blood pressure lowering accumulated to date, elevated blood pressure is still the leading risk factor for disease and disability worldwide. The purpose of this review is to summarize the epidemiological evidence underpinning the association between blood pressure and a range of conditions. This review focuses on the association between systolic and diastolic blood pressures and the risk of cardiovascular and renal disease. Evidence for and against the existence of a J-shaped curve association between blood pressure and cardiovascular risk, and differences in the predictive power of systolic, diastolic, and pulse pressure, are described. In addition, global and regional trends in blood pressure levels and management of hypertension are reviewed.
Sodium intake and blood pressure in children.
Hanevold, Coral D
Elevation of blood pressure (BP) and the risk for progression to hypertension (HTN) is of increasing concern in children and adolescents. Indeed, it is increasingly recognized that target organ injury may begin with even low levels of BP elevation. Sodium intake has long been recognized as a modifiable risk factor for HTN. While it seems clear that sodium impacts BP in children, its effects may be enhanced by other factors including obesity and increasing age. Evidence from animal and human studies indicates that sodium may have adverse consequences on the cardiovascular system independent of HTN. Thus, moderation of sodium intake over a lifetime may reduce risk for cardiovascular morbidity in adulthood. An appetite for salt is acquired, and intake beyond our need is almost universal. Considering that eating habits in childhood have been shown to track into adulthood, modest sodium intake should be advocated as part of a healthy lifestyle.
A comparison of two methods of blood pressure measurement.
Jones, Soraya; Simpson, Heidi; Ahmed, Hafez
In current practice, a two-stage approach to measuring blood pressure (BP) has been widely accepted as the most accurate and reliable method. However, by changing the local haemodynamics, this procedure might alter the blood pressure. In a study of 39 subjects, blood pressure was measured using two indirect methods (two-stage and one-stage approaches). Results showed no statistically significant difference in values for systolic blood pressure obtained from the two methods. Statistically significant lower diastolic blood pressure values were obtained using the two-stage compared to the one-stage approach. It is proposed that initial inflation of the cuff to estimate systolic blood pressure in the two-stage approach might lead to reactive hyperaemia and, therefore, a lower diastolic value. This two-stage approach might not provide the accurate readings it claims, and in addition it requires more time and subjects the patient to longer periods of stress.
A novel SCFA receptor, the microbiota, and blood pressure regulation
Pluznick, Jennifer
The maintenance of blood pressure homeostasis is a complex process which is carefully regulated by a variety of inputs. We recently identified two sensory receptors (Olfactory receptor 78 and G protein couple receptor 41) as novel regulators of blood pressure. Both Olfr78 and Gpr41 are receptors for short chain fatty acids (SCFAs), and we showed that propionate (a SCFA) modifies blood pressure in a manner which is differentially modulated by the absence of either Olfr78 or Gpr41. In addition, propionate modifies renin release in an Olfr78-dependent manner. Our study also demonstrated that antibiotic treatment modulates blood pressure in Olfr78 null mice, indicating that SCFAs produced by the gut microbiota likely influence blood pressure regulation. In this addendum, we summarize the findings of our recent study and provide a perspective on the implications of the interactions between the gut microbiota and blood pressure control. PMID:24429443
Dietary sodium and blood pressure: interactions with other nutrients.
Kotchen, T A; Kotchen, J M
This paper reviews the evidence that salt sensitivity of blood pressure is related both to the anion ingested with sodium as well as to other components of the diet. In several experimental models of salt-sensitive hypertension and in humans, blood pressure is not increased by a high sodium intake provided with anions other than chloride. Salt-induced increase of blood pressure depends on the concomitant ingestion of both sodium and chloride. Both epidemiologic and clinical evidence suggest that sodium chloride-induced increases of blood pressure are augmented by diets deficient in potassium or calcium. In experimental animals, a high intake of simple carbohydrates also augments sodium chloride sensitivity of blood pressure. These observations indicate that the effect of dietary sodium on blood pressure is modulated by other components of the diet.
Vegetarian diet, lifestyle and blood pressure in two religious populations.
Rouse, I L; Armstrong, B K; Beilin, L J
1. The association between vegetarianism and blood pressure was studied in relation to obesity, sex and aspects of lifestyle in 180 Seventh-day Adventists and 113 Mormons aged 25-44 y. 2. Volunteers completed a questionnaire, a 1-day diet record and submitted to standardized measurements of blood pressure, heart rate and body size. 3. Ninety-eight Adventist "vegetarians' were comparable to the 113 Mormon omnivores for strength of religious affiliation, consumption of alcohol, tea and coffee and use of tobacco, but were significantly less obese. 4. Obesity correlated positively with blood pressures in males and females of both diet classes. Age showed a positive correlation with blood pressure in females only. 5. Adjustment of blood pressures for age and Quetelet Index indicated that there is an additional blood pressure reducing effect associated with a vegetarian diet.
Ambulatory blood pressure monitoring during exercise and physical activity.
White, W B
Ambulatory blood pressure recorders have two potential advantages over standard casual blood pressure measurements; they are able to take multiple recordings automatically throughout the day and night and also during the activities of normal daily living. At present, the general recommendations for validation of blood pressure recorders do not include assessment during motion. In order to obtain accurate information on an ambulatory blood pressure recorder's capabilities during exercise or physical activity, the blood pressure standard must use direct (intra-arterial) measurements. Data from some of the existing ambulatory blood pressure recorders suggest that many are accurate during resting measurements but lose their precision when the subjects are walking or during exercise. If ambulatory recorders are to be used in ambulant conditions with a moving arm, the device should be validated for accuracy and reliability during motion, using simultaneous direct measurements for comparison. PMID:1795196
Influence of age, systemic blood pressure, smoking, and blood viscosity on orbital blood velocities.
Williamson, T H; Lowe, G D; Baxter, G M
The influence of multiple systemic factors upon the blood velocities obtained from the orbital circulations was investigated. The velocities obtained by colour Doppler imaging from the ophthalmic artery, central retinal artery, and vein from 95 ophthalmologically healthy volunteers were analyzed. The effects of age, systemic blood pressure, and smoking habit were examined. In 24 volunteers blood viscosity was also measured and its relation with blood velocity assessed. Age was weakly negatively correlated with the blood velocities in the ophthalmic artery and weakly positively correlated with resistance to flow in the retinal circulation. Systolic blood pressure showed a positive correlation with the peak systolic velocities in the arteries while cigarette smoking was associated with lower ophthalmic artery velocities. Increased haematocrit and viscosity were positively correlated with resistance to flow proximal to the ophthalmic artery and red cell rigidity negatively correlated with the pulsatility of flow in the retinal vein. These results help to identify the roles of systemic conditions in the ocular circulation. The influence of blood viscosity on retinal venous flow may be relevant to the pathogenetic mechanisms of conditions such as central retinal vein occlusion. Images PMID:7880783
Iijima, Katsuya
In the clinical settings, it has frequently seen that the elderly have rapid blood pressure (BP) elevation and decline, leading to such as orthostatic disorders and post-urination syncope. Excessive blood pressure variability (BPV) according to aging leads to aggravation of hypertensive target organ damage due to both disturbed baroreflex function and arterial stiffening. We developed continuous BP monitoring sensor using newly developing device 'wearable BP sensor', as our advantageous approach of without a cuff-stress. The new mobile device could reflect continuous beat-to-beat systolic BP, heart rate(HR), these very close changes and double product(sBPX HR) as a major indicator of cardiac lead, in consistent with cuff-based BP value. Our new challenge using this device might approach to the potential to achieve the quality-up of treatment strategy with consideration for very short-term BPV.
Home blood pressure measurement with oscillometric upper-arm devices.
Braam, R L; Thien, Th
The market for automated blood pressure measuring devices is growing rapidly. Many patients want to buy a device for blood pressure measurement at home and ask their physician for advice about which one to choose. In this article an overview is given of the different devices available for blood pressure measurement and possible pitfalls in the interpretation of measurements taken at home are pointed out. A second article will specifically address those devices that are used to take blood pressure measurements at the wrist.
Electrocardiogram-assisted blood pressure estimation.
Ahmad, Saif; Chen, Silu; Soueidan, Karen; Batkin, Izmail; Bolic, Miodrag; Dajani, Hilmi; Groza, Voicu
Accurate automatic noninvasive assessment of blood pressure (BP) presents a challenge due to conditions like arrhythmias, obesity, and postural changes that tend to obfuscate arterial amplitude pulsations sensed by the cuff. Researchers tried to overcome this challenge by analyzing oscillometric pulses with the aid of a higher fidelity signal-the electrocardiogram (ECG). Moreover, pulse transit time (PTT) was employed to provide an additional method for BP estimation. However, these methods were not fully developed, suitably integrated, or tested. To address these issues, we present a novel method whereby ECG-assisted oscillometric and PTT (measured between ECG R-peaks and maximum slope of arterial pulse peaks) analyses are seamlessly integrated into the oscillometric BP measurement paradigm. The method bolsters oscillometric analysis (amplitude modulation) with more reliable ECG R-peaks provides a complementary measure with PTT analysis (temporal modulation) and fuses this information for robust BP estimation. We have integrated this technology into a prototype that comprises a BP cuff with an embedded conductive fabric ECG electrode, associated hardware, and algorithms. A pilot study has been undertaken on ten healthy subjects (150 recordings) to validate the performance of our prototype against United States Food and Drug Administration approved Omron oscillometric monitor (HEM-790IT). Our prototype achieves mean absolute difference of less than 5 mmHg and grade A as per the British Hypertension Society protocol for estimating BP, with the reference Omron monitor.
[Management of blood pressure for stroke prevention].
Tanahashi, Norio
Hypertension is a major risk factor for both cerebral infarction and intracerebral hemorrhage. The relationship between blood pressure (BP) and stroke risk is strong and continuous. Throughout the usual range of BPs, including the nonhypertensive range, the higher the BP is, the greater the risk of stroke. Regular BP screening and appropriate treatment of patients with hypertension, including life style modification and pharmacotherapy, are recommended. Patients who have hypertension should be treated with antihypertensive drugs to a target BP of < 140/90 mmHg. Successful reduction of BP is more important in reducing stroke risk than the choice of a specific agent, and treatment should be individualized on the basis of other patient characteristics and medication tolerance. In hypertensive patients with stroke, subjects to be treated with antihypertensive drugs and the target level of BP control are determined on the basis of clinical disease type, interval after onset, severity, age, and the use of antithrombotic. drugs. According to the guideline of the Japanese Society of Hypertension (JSH 2014), in the chronic phase of cerebral infarction, cerebral hemorrhage and subarachnoid hemorrhage, target BP should be < 140/ 90 mmHg. In patients with lacunar infarction, those taking antithrombotic drugs, cerebral hemorrhage and subarachnoid hemorrhage, a lower level, < 130/80 mmHg should be targeted if possible. Oral antihypertensive drugs such as Ca channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and diuretics are recommended for patients with stroke. PMID:27333760
Predicting Increased Blood Pressure Using Machine Learning
Golino, Hudson Fernandes; Amaral, Liliany Souza de Brito; Duarte, Stenio Fernando Pimentel; Soares, Telma de Jesus; dos Reis, Luciana Araujo
The present study investigates the prediction of increased blood pressure by body mass index (BMI), waist (WC) and hip circumference (HC), and waist hip ratio (WHR) using a machine learning technique named classification tree. Data were collected from 400 college students (56.3% women) from 16 to 63 years old. Fifteen trees were calculated in the training group for each sex, using different numbers and combinations of predictors. The result shows that for women BMI, WC, and WHR are the combination that produces the best prediction, since it has the lowest deviance (87.42), misclassification (.19), and the higher pseudo R2 (.43). This model presented a sensitivity of 80.86% and specificity of 81.22% in the training set and, respectively, 45.65% and 65.15% in the test sample. For men BMI, WC, HC, and WHC showed the best prediction with the lowest deviance (57.25), misclassification (.16), and the higher pseudo R2 (.46). This model had a sensitivity of 72% and specificity of 86.25% in the training set and, respectively, 58.38% and 69.70% in the test set. Finally, the result from the classification tree analysis was compared with traditional logistic regression, indicating that the former outperformed the latter in terms of predictive power. PMID:24669313
20-HETE and Blood Pressure Regulation
Wu, Cheng-Chia; Gupta, Tanush; Garcia, Victor; Ding, Yan; Schwartzman, Michal L.
20-Hydroxy-5, 8, 11, 14-eicosatetraenoic acid (20-HETE) is a cytochrome P450 (CYP)–derived omega-hydroxylation metabolite of arachidonic acid. 20-HETE has been shown to play a complex role in blood pressure regulation. In the kidney tubules, 20-HETE inhibits sodium reabsorption and promotes natriuresis, thus, contributing to antihypertensive mechanisms. In contrast, in the microvasculature, 20-HETE has been shown to play a pressor role by sensitizing smooth muscle cells to constrictor stimuli and increasing myogenic tone, and by acting on the endothelium to further promote endothelial dysfunction and endothelial activation. In addition, 20-HETE induces endothelial angiotensin-converting enzyme, thus, setting forth a potential feed forward prohypertensive mechanism by stimulating the renin–angiotensin–aldosterone system. With the advancement of gene sequencing technology, numerous polymorphisms in the regulatory coding and noncoding regions of 20-HETE–producing enzymes, CYP4A11 and CYP4F2, have been associated with hypertension. This in-depth review article discusses the biosynthesis and function of 20-HETE in the cardiovascular system, the pharmacological agents that affect 20-HETE action, and polymorphisms of CYP enzymes that produce 20-HETE and are associated with systemic hypertension in humans. PMID:23584425
Neurohumoral blood pressure regulation in lead exposure
Boscolo, P.; Carmignani, M.
Previous human studies demonstrated that lead exposure may modify the metabolism of catecholamines and of hormones controlled by the hypothalamo-pituitary axis and may affect the kallikrein-kinin system. This paper reports unpublished data on the plasma renin activity of lead-exposed workers; these results are in agreement with those of previous human and experimental studies suggesting that the synthesis or release of renin is increased after short and moderate exposure to inorganic lead and reduced whenever the exposure is prolonged. Previous experimental investigations demonstrated that lead may act on the cardiovascular system, with effects on the renin-angiotensin system, on the reactivity to stimulation of peripheral catecholaminergic receptors, on sympathetic and vagal tone, and on reactivity to the stimulation of baroreceptors. This paper reports the results of a study on male Sprague-Dawley rats that received 0, 15, 30, and 60 ..mu..g/mL of lead in drinking water for 18 months. Blood pressure was increased in the rats receiving 30 and 60 ppm of lead; cardiac inotropism was augmented only in those receiving the higher dose of the metal, and heart rate was not modified. Cardiovascular responses to agonists indicated that lead exposure affects the renin-angiotensin system and induces sympathetic hyperactivity be acting on central and peripheral sympathetic junctions increasing the responsiveness to stimulation of ..cap alpha../sub 2/-adrenoreceptors and by increasing the reactivity to stimulation of cardiac and vascular ..beta..-adrenergic and dopaminergic receptors.
Managing hypertension with ambulatory blood pressure monitoring.
White, William B; Gulati, Vinay
There has been a dramatic shift in the manner in which blood pressure (BP) is measured to provide far more comprehensive clinical information than that provided by a single set of office BP readings. Extensive clinical and epidemiological research shows an important role of ambulatory BP monitoring (ABPM) in the management of hypertensive patients. A 24-h BP profile helps to determine the absence of nocturnal dipping status and evaluate BP control in patients on antihypertensive therapy. The ability to detect white-coat or masked hypertension is enhanced by ambulatory BP monitoring. In 2001, the Center for Medicare and Medicaid Services approved ABPM for reimbursement for the identification of patients with white-coat hypertension. In 2011, the National Institute for Health and Clinical Excellence (NICE) in the UK published guidelines that recommended the routine use of ABPM in all patients suspected of having hypertension. The European Society of Hypertension (ESH) 2013 guidelines also support greater use of ABPM in clinical practice. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to its cost, the complexity of data evaluation, as well as patient inconvenience. In this review, we evaluate the clinical importance of ABPM, highlighting its role in the current management of hypertension.
Blood Pressure Management in Intracerebral Hemorrhage.
Mohammad, Yousef; Qureshi, Adnan
Intracerebral hemorrhage (ICH) is associated with devastating outcomes. Admission to the intensive care unit has been the only proven course to improve outcomes. All other treatment modalities have failed so far. The majority of patients presenting with ICH have an elevated blood pressure (BP). Initial data on the safety and efficacy of BP treatment in acute ICH have been conflicting. This has led to large prospective and randomized clinical trials to assess the safety and efficacy of early BP lowering in acute ICH. These trials showed safety and a tendency toward improved functional outcomes. In fact, the results of three subsequent meta-analyses also showed safety and possible efficacy of early lowering of BP in ICH. Based on the results of the published clinical trials and meta-analyses, the American Heart Association and the European Stroke Association concluded that early intensive treatment of BP in acute ICH is safe and might improve functional outcome. The authors advocate that-pending additional data from ongoing trials-health care professionals should maintain the SBp < 140 mm Hg in patients presenting with acute ICH. PMID:27214702
Challenges in blood pressure self-measurement.
Wagner, Stefan; Toftegaard, Thomas Skjødeberg; Bertelsen, Olav W
Blood pressure self-measurement (BPSM) requires patients to follow a range of recommendations in order to be considered reliable for diagnostic use. We investigated currently used BPSM interventions at four medical clinics combined with an online questionnaire targeting BPSM users. We found that the participating healthcare personnel perceived BPSM as a relevant and useful intervention method providing that the recommendations are followed. A total of six challenges were identified: (1) existing devices do not guarantee that the recommendations are followed, (2) healthcare providers cannot verify whether self-monitoring patients follow the recommendations, (3) patients are not aware of all recommendations and the need to follow them, (4) risk of patient induced reporting bias, (5) risk of healthcare provider induced data-transfer bias, and (6) risk of data being registered as belonging to the wrong patient. We conclude that existing BPSM interventions could be significantly affected by user-induced bias resulting in an indeterminable quality of the measurement data. Therefore, we suggest applying context-aware technological support tools to better detect and quantify user errors. This may allow us to develop solutions that could overcome or compensate for such errors in the future.
Comparison of blood pressure between Indiana AMA and NMA members.
Baker, F. M.
OBJECTIVE: 1) To determine whether African-American physicians, compared to caucasian physicians, were at increased risk to develop hypertension; and 2) to determine whether physicians' knowledge of cardiovascular risk factors influenced their pattern of exercise. DESIGN: A mailed survey of members of the American Medical Association (AMA) and the National Medical Association (NMA) was completed to assess health status and plans for retirement. RESULTS: High-normal blood pressure was defined as systolic blood pressure of 85-89 mmHg. Mild (stage-1) hypertension was defined as systolic blood pressure of 140-159 mmHg and diastolic blood pressure of 90-99 mmHg. Gender (male), age, and body mass index (BMI) were significantly correlated with elevated levels of selected blood pressure measures. Using regression analysis to control for gender, age, and BMI, ethnicity was identified as a fourth factor accounting for elevated blood pressure. NMA physicians had 3.25 times the risk of having systolic blood pressure in the mild (stage-1) hypertension range, 5.78 times the risk for blood pressure in the high-normal diastolic hypertension range, and 5.19 times the risk for blood pressure in the mild (stage-1) diastolic hypertension range. Medical specialty and type of psychological support were not significant predictors of elevated blood pressure. CONCLUSION: These data suggest that African-American physicians may be at an increased risk to develop abnormal blood pressure, compared to caucasian physicians, potentially affecting the number of physicians available to minority communities. PMID:14651369
Assessing cerebral blood flow control from variability in blood pressure and arterial CO2 levels.
Nikolić, Dragana; Birch, Anthony A; Panerai, Ronney B; Simpson, David M
Blood flow to the brain is controlled by a number of physiological mechanisms that respond to changes in arterial blood pressure, arterial CO2 levels and many other factors. Assessing the integrity of this control system is a major challenge. We report on repeatability of measures based on single and multiple input models during spontaneous and enhanced fluctuations in blood pressure.
Development of a cuffless blood pressure measurement system.
Shyu, Liang-Yu; Kao, Yao-Lin; Tsai, Wen-Ya; Hu, Weichih
This study constructs a novel blood pressure measurement device without the air cuff to overcome the problem of discomfort and portability. The proposed device measures the blood pressure through a mechanism that is made of silicon rubber and pressure transducer. The system uses a microcontroller to control the measurement procedure and to perform the necessary computation. To verify the feasibility of the constructed device, ten young volunteers were recruited. Ten blood pressure readings were obtained using the new system and were compared with ten blood pressure readings from bedside monitor (Spacelabs Medical, model 90367). The results indicated that, when all the readings were included, the mean pressure, systolic pressure and diastolic pressure from the new system were all higher than those from bedside monitor. The correlation coefficients between these two were 0.15, 0.18 and 0.29, for mean, systolic and diastolic pressures, respectively. After excluding irregular apparatus utilization, the correlation coefficient increased to 0.71, 0.60 and 0.41 for diastolic pressure, mean pressure and systolic pressure, respectively. We can conclude from these results that the accuracy can be improved effectively by defining the user regulation more precisely. The above mentioned irregular apparatus utilization factors can be identified and eliminated by the microprocessor to provide a reliable blood pressure measurement in practical applications in the future. PMID:23366320
Multiphasic effects of blood pressure on survival in hemodialysis patients.
Hannedouche, Thierry; Roth, Hubert; Krummel, Thierry; London, Gérard M; Jean, Guillaume; Bouchet, Jean-Louis; Drüeke, Tilman B; Fouque, Denis
Dialysis patients exhibit an inverse, L- or U-shaped association between blood pressure and mortality risk, in contrast to the linear association in the general population. We prospectively studied 9333 hemodialysis patients in France, aiming to analyze associations between predialysis systolic, diastolic, and pulse pressure with all-cause mortality, cardiovascular mortality, and nonfatal cardiovascular endpoints for a median follow-up of 548 days. Blood pressure components were tested against outcomes in time-varying covariate linear and fractional polynomial Cox models. Changes throughout follow-up were analyzed with a joint model including both the time-varying covariate of sequential blood pressure and its slope over time. A U-shaped association of systolic blood pressure was found with all-cause mortality and of both systolic and diastolic blood pressure with cardiovascular mortality. There was an L-shaped association of diastolic blood pressure with all-cause mortality. The lowest hazard ratio of all-cause mortality was observed for a systolic blood pressure of 165 mm Hg, and of cardiovascular mortality for systolic/diastolic pressures of 157/90 mm Hg, substantially higher than currently recommended values for the general population. The 95% lower confidence interval was approximately 135/70 mm Hg. We found no significant correlation for either systolic, diastolic, or pulse pressure with myocardial infarction or nontraumatic amputations, but there were significant positive associations between systolic and pulse pressure with stroke (per 10-mm Hg increase: hazard ratios 1.15, 95% confidence interval 1.07 and 1.23; and 1.20, 1.11 and 1.31, respectively). Thus, whereas high pre-dialysis blood pressure is associated with stroke risk, low pre-dialysis blood pressure may be both harmful and a proxy for comorbid conditions leading to premature death. PMID:27521114
Multiphasic effects of blood pressure on survival in hemodialysis patients.
Hannedouche, Thierry; Roth, Hubert; Krummel, Thierry; London, Gérard M; Jean, Guillaume; Bouchet, Jean-Louis; Drüeke, Tilman B; Fouque, Denis
Dialysis patients exhibit an inverse, L- or U-shaped association between blood pressure and mortality risk, in contrast to the linear association in the general population. We prospectively studied 9333 hemodialysis patients in France, aiming to analyze associations between predialysis systolic, diastolic, and pulse pressure with all-cause mortality, cardiovascular mortality, and nonfatal cardiovascular endpoints for a median follow-up of 548 days. Blood pressure components were tested against outcomes in time-varying covariate linear and fractional polynomial Cox models. Changes throughout follow-up were analyzed with a joint model including both the time-varying covariate of sequential blood pressure and its slope over time. A U-shaped association of systolic blood pressure was found with all-cause mortality and of both systolic and diastolic blood pressure with cardiovascular mortality. There was an L-shaped association of diastolic blood pressure with all-cause mortality. The lowest hazard ratio of all-cause mortality was observed for a systolic blood pressure of 165 mm Hg, and of cardiovascular mortality for systolic/diastolic pressures of 157/90 mm Hg, substantially higher than currently recommended values for the general population. The 95% lower confidence interval was approximately 135/70 mm Hg. We found no significant correlation for either systolic, diastolic, or pulse pressure with myocardial infarction or nontraumatic amputations, but there were significant positive associations between systolic and pulse pressure with stroke (per 10-mm Hg increase: hazard ratios 1.15, 95% confidence interval 1.07 and 1.23; and 1.20, 1.11 and 1.31, respectively). Thus, whereas high pre-dialysis blood pressure is associated with stroke risk, low pre-dialysis blood pressure may be both harmful and a proxy for comorbid conditions leading to premature death.
A dramatic drop in blood pressure following prehospital GTN administration.
Boyle, Malcolm J
A male in his sixties with no history of cardiac chest pain awoke with chest pain following an afternoon sleep. The patient did not self medicate. The patient's observations were within normal limits, he was administered oxygen via a face mask and glyceryl trinitrate (GTN). Several minutes after the GTN the patient experienced a sudden drop in blood pressure and heart rate, this was rectified by atropine sulphate and a fluid challenge. There was no further deterioration in the patient's condition during transport to hospital. There are very few documented case like this in the prehospital scientific literature. The cause appears to be the Bezold-Jarish reflex, stimulation of the ventricular walls which in turn decreases sympathetic outflow from the vasomotor centre. Prehospital care providers who are managing any patient with a syncopal episode that fails to recover within a reasonable time frame should consider the Bezold-Jarisch reflex as the cause and manage the patient accordingly.
Twenty four hour blood pressure monitoring in normal tension glaucoma.
Meyer, J H; Brandi-Dohrn, J; Funk, J
BACKGROUND: The few investigations that used continuous 24 hour blood pressure monitoring to investigate whether blood pressure in patients with normal tension glaucoma is lower than in normal subjects yielded conflicting results. Therefore, a prospective controlled trial was carried out. METHODS: Systemic blood pressure was recorded continuously over a 24 hour period in 20 patients with normal tension glaucoma (IOP < or = 21 mm Hg). Eight of them showed a localised loss of the neuroretinal rim area and, in addition, optic disc haemorrhages-that is, focal ischaemic signs. Twenty healthy patients without glaucoma, who were hospitalised for cataract or retinal surgery, served as controls. Blood pressure was automatically measured every 20 minutes during the day and every 40 minutes at night. RESULTS: Both groups showed a significant (physiological) blood pressure drop at night, which was significantly (p < 0.001, ANOVA) more pronounced in the group with normal tension glaucoma than in the control group. There was a weak trend towards lower blood pressure values in the normal tension glaucoma group. Minima, maxima, and mean values of the systolic, diastolic, and mean arterial pressures did not differ significantly between the group with normal tension glaucoma and the control group. The greatest differences occurred with nocturnal systolic and diurnal diastolic values. There were no significant differences between the subgroup with focal lesions and the other patients with normal tension glaucoma. CONCLUSIONS: Patients with normal tension glaucoma tend to have lower blood pressure values (p > 0.05, ANOVA) than normals; this difference is probably much smaller than formerly assumed. Patients with normal tension glaucoma, however, have significantly greater nocturnal blood pressure drops (p < 0.001, ANOVA) than normal controls. Nocturnal blood pressure drops (relative day-night differences) may play a more important role in the pathogenesis of normal tension glaucoma
Normalization effect of sports training on blood pressure in hypertensives.
Chen, Yi-Liang; Liu, Yuh-Feng; Huang, Chih-Yang; Lee, Shin-Da; Chan, Yi-Sheng; Chen, Chiu-Chou; Harris, Brennan; Kuo, Chia-Hua
Exercise is recommended as a lifestyle intervention in preventing hypertension based on epidemiological findings. However, previous intervention studies have presented mixed results. This discrepancy could be associated with shortcomings related to sample sizes or the inclusion of normotensive participants. The aim of this prospective cohort study (N = 463) was to compare the chronic effect of increasing sports training time on resting blood pressure for normotensives and hypertensives. We assessed systolic blood pressure, diastolic blood pressure, body mass index (BMI), and homeostasis model assessment for insulin resistance (HOMA-IR) for 69 untreated hypertensive patients (age 20.6 +/- 0.1 years, systolic blood pressure >140 mmHg) and 394 normotensive controls (age 20.6 +/- 0.1 years) before training and at follow-up visits at 12 months. All participants enrolled in various sports training lessons for 8 hours a week. The baseline BMI and HOMA-IR in the hypertensive group were significantly higher than those in the control group. For the normotensive control group, no significant changes in systolic and diastolic blood pressure were observed after training. However, for the hypertensives, systolic and diastolic blood pressure were significantly reduced after training by approximately 15 mmHg and approximately 4 mmHg, respectively, and HOMA-IR was reduced by approximately 25%. In conclusion, the effect of sports training to lower blood pressure was confined to the group of hypertensives, which may account for the overall minimal reduction in blood pressure observed in previous intervention studies.
21 CFR 870.1110 - Blood pressure computer.
Code of Federal Regulations, 2013 CFR
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Blood pressure computer. 870.1110 Section 870.1110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... computer. (a) Identification. A blood pressure computer is a device that accepts the electrical signal...
21 CFR 870.1110 - Blood pressure computer.
Code of Federal Regulations, 2010 CFR
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Blood pressure computer. 870.1110 Section 870.1110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... computer. (a) Identification. A blood pressure computer is a device that accepts the electrical signal...
Social Support, Assimilation and Biological Effective Blood Pressure Levels.
ERIC Educational Resources Information Center
Walsh, Anthony; Walsh, Patricia Ann
The twin processes of migration and assimilation are highly stressful. This stress can be manifested in elevated blood pressure. According to this study, immigrants receiving high levels of social support had significantly lower blood pressure levels than those receiving less social support. (VM)
High Blood Pressure in Pregnancy - Multiple Languages: MedlinePlus
... الدم أثناء الحمل - العربية Bilingual PDF Health Information Translations Bosnian (Bosanski) High Blood Pressure in Pregnancy Visok ... u trudnoći - Bosanski (Bosnian) Bilingual PDF Health Information Translations Chinese - Simplified (简体中文) High Blood Pressure in Pregnancy ...
High Blood Pressure - Multiple Languages: MedlinePlus
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Association of blood pressure and PCB level in Yusho patients
Akagi, K.; Okumura, M.
Correlations of blood polychlorinated biphenyl (PCB) levels or PCB patterns and blood pressures were studied in 59 patients with Yusho (PCB poisoning) above 40 years old. In spite of the passage of 13 years from the onset, 52.5% of these patients still have PCB levels higher than the range found in the general population. The frequency of hypertension in the patients was 16.9%, a value similar to that expected on the basis of the rate for a population of the same age and sex compositions. As an independent variable, the blood pressure of patients was not associated with blood PCB levels and PCB patterns. No PCB blood pressure association was confirmed in 20 patients with PCB levels persistently higher than 5 ppb for 9 years. On the other hand, age, obesity and habitual alcohol intake, known influencing factors for hypertension, tended to be positively associated with elevated blood pressure in these Yusho patients.
Blood pressure regulation by CCR genes.
Mettimano, Marco; Specchia, Maria Lucia; La Torre, Giuseppe; Bruno, Antonio; Ricciardi, Gualtiero; Savi, Luigi; Romano-Spica, Vincenzo
New genetic evidence strongly supports a role for the immune system in the pathogenesis of essential hypertension (EH) through chemokines and their receptors (CCR) involvement. The aim of the present study was to evaluate the possible relation between CCR2 and CCR5 alleles and blood pressure (BP) levels in hypertensive subjects. In all, 118 essential hypertensive outpatients (male 90, female 28; stage I and II; age 27-54 years; not previously treated with antihypertensive drugs) were selected for the study. All of the subjects underwent office BP measurement. Subsequently, 24-h ambulatory BP monitoring (ABPM) was performed with a Spacelabs 90207 monitor during a regular working day. CCR264I and CCR5Delta32 polymorphisms were determined by polymerase chain reaction (PCR), following the standard molecular biology protocols. Allelic frequencies were the following: CCR5Delta32= 0.097, CCR264I=0.101. Logistic regression analysis showed an association between the CCR5Delta32 allele and the following: 24-h systolic BP (SBP >140 mmHg; p = 0.027), values over the 50th percentile of 24-h SBP (p = 0.032), and the values over the 50th percentile of nighttime SBP (p = 0.039). Office BP showed an association with the Delta32 allele in a range over the 75th percentile of SBP (p = 0.087) and the 75th percentile of DBP (p = 0.085). No significant association was observed for CCR264I and BP levels or between physiological nocturnal BP decline and genotype. The observed results not only support the role of the immune system in the development and maintenance of hypertension, but they also indicate an influence of CCR5Delta32 polymorphism on the establishment of BP levels. PMID:17060059
Nutrition, physical activity, and blood pressure in the elderly.
Ideno, K T; Kubena, K S
Forty noninstitutionalized elderly subjects, ages 65-86 years, were recruited for a study to determine relationships between nutritional status, physical activity, and blood pressure. A 24-hour recall of dietary intake and activities, health history, skinfolds, circumferences, height, weight, and blood pressure were obtained. Obesity was associated with hypertension in this group of elderly subjects. Truncal skinfolds (abdomen and subscapula) were positively correlated (P less than .05) with systolic blood pressure while body mass index, dietary magnesium and dietary calcium to magnesium ratio were directly related (P less than .05) to diastolic blood pressure. Physical activity and energy expenditure were not correlated (P greater than .05) with blood pressure in this study; however, the level of activity did not include strenuous exercise.
Severely elevated blood pressure: when is it an emergency?
Lawson, Lauren
High blood pressure is one of the most common chronic medical conditions in this country, occurring in about 1 of every 3 adults. It is not uncommon for nurses to see individuals in the emergency room, hospital, home, or other settings who have severely elevated blood pressure readings. Extremely elevated readings generally evoke considerable concern among healthcare staff. They are faced with deciding whether the individual requires immediate treatment and a higher level of care, such as transport to an emergency department. Severely elevated blood pressure can be a true medical emergency, may require urgent care, or may in fact be a nonemergency. The purpose of this article is to assist nurses in recognizing those situations in which severely elevated blood pressure requires immediate intervention. Current research and best evidence regarding severely elevated blood pressure are presented.
A Ubiquitous Blood Pressure Sensor Worn at the Ear
NASA Astrophysics Data System (ADS)
Koizumi, Hiroshi; Shimada, Junichi; Uenishi, Yuji; Tochikubo, Osamu
Blood pressure (BP) measurement and BP control are important for the prevention of lifestyle diseases, especially hypertension, which can lead to more serious conditions, such as cardiac infarction and cerebral apoplexy. The purpose of our study is to develop a ubiquitous blood pressure sensor that is more comfortable and less disruptive of users' daily activities than conventional blood pressure sensors. Our developed sensor is worn at an ear orifice and measures blood pressure at the tragus. This paper describes the concept, configuration, and the optical and electronic details of the developed ear-worn blood pressure sensor and presents preliminary evaluation results. The developed sensor causes almost no discomfort and produces signals whose quality is high enough for detecting BP at an ear, making it suitable for ubiquitous usage.
Dietary calcium. A method of lowering blood pressure.
Bierenbaum, M L; Wolf, E; Bisgeier, G; Maginnis, W P
Previous work in this laboratory has shown that supplemental dietary calcium using milk as the source can lower blood pressure and serum cholesterol levels. Attempting to circumvent lactose intolerance, a 6-month crossover study of blood pressure and serum lipids in 50 free-living volunteers was done comparing 1,150 mg/day of supplemental calcium via yogurt, cottage cheese, and milk to 32 oz/day of orange juice. Systolic blood pressure responded dramatically initially to calcium supplementation and continued lower than on orange juice at 6 months, 120 +/- 1.5 to 115 +/- 1.5 mm Hg, P less than 0.2, vs. 118 +/- 1.7 to 117 +/- 1.6 mm Hg. Diastolic blood pressure and serum lipid changes were not significant. Dietary calcium supplementation may prove beneficial in lowering systolic blood pressure in the long term.
Perinatal factors associated with blood pressure during childhood.
Bergel, E; Haelterman, E; Belizán, J; Villar, J; Carroli, G
This study aims to determine whether variables reflecting an adverse intrauterine environment are associated with childhood blood pressure. The authors conducted a secondary analysis of data from a prospective cohort of children born to healthy, nulliparous women enrolled in a randomized controlled trial. A total of 518 children were traced in 1995-1996 from 614 eligible children born in a clinic in Rosario, Argentina. The outcome was systolic blood pressure at 5-9 years. Hemoglobin during pregnancy was positively associated with children's pressure. Other maternal characteristics during pregnancy (blood pressure, smoking, weight gain, weight at 20 weeks' gestation, and glycemia) and size at birth (birth weight, ponderal index, head circumference/length ratio, and small for gestational age) were not associated with children's pressure. Among children in the upper quartile of body mass index, there was a weak inverse correlation between birth weight and systolic pressure, and systolic pressure was 14.8 mmHg (95 percent confidence interval: 3.3, 26.4) higher in low birth weight children than in others. The main predictors of childhood pressure were childhood body mass index and maternal pressure outside pregnancy. In this healthy population, the authors found weak support for an association between variables reflecting an adverse fetal environment and childhood blood pressure. Low birth weight was a risk factor for high blood pressure only in overweight children. PMID:10733041
Direct measurement of capillary blood pressure in the human lip
NASA Technical Reports Server (NTRS)
Parazynski, S. E.; Tucker, B. J.; Aratow, M.; Crenshaw, A.; Hargens, A. R.
In this study, we developed and tested a new procedure for measuring microcirculatory blood pressures above heart level in humans. Capillary and postcapillary venule blood pressures were measured directly in 13 human subjects by use of the servonulling micropressure technique adapted for micropuncture of lip capillaries. Pressure waveforms were recorded in 40 separate capillary vessels and 14 separate postcapillary venules over periods ranging from 5 to 64 s. Localization and determination of capillary and postcapillary vessels were ascertained anatomically before pressure measurements. Capillary pressure was 33.2 +/- 1.5 (SE) mm Hg in lips of subjects seated upright. Repeated micropunctures of the same vessel gave an average coefficient of variation of 0.072. Postcapillary venule pressure was 18.9 +/- 1.6 mm Hg. This procedure produces a direct and reproducible means of measuring microvascular blood pressures in a vascular bed above heart level in humans.
Harmonics tracking of intracranial and arterial blood pressure waves.
Shahsavari, Sima; McKelvey, Tomas
Considering cardiorespiratory interaction and heart rate variability, a new approach is proposed to decompose intracranial pressure and arterial blood pressure to their different harmonics. The method is based on tracking the amplitudes of the harmonics by a Kalman filter based tracking algorithm. The algorithm takes benefit of combined frequency estimation technique which uses both Fast Fourier Transform and RR-interval detection. The result would be of use in intracranial pressure and arterial blood pressure waveform analysis as well as other investigations which need to estimate contribution of specific harmonic in above mentioned signals such as Pressure-Volume Compensatory Reserve assessment.
Fauvel, J P; Mpio, I; Quelin, P; Rigaud, J P; Laville, M; Ducher, M L
High job strain has been reported to be associated with higher blood pressure. Job strain could lead to hypertension if individual perception of stress or cardiovascular reactivity to stress are high. We report the results of the first five-year follow up study, which aimed to assess the respective influences of perception of professional strain and cardiovascular reactivity to a mental stress test on BP. A cohort of 292 healthy subjects (mean +/- SEM, 38 +/- 1 years) was followed for progression to hypertension outcome which was defined as an increase in SBP or DBP higher than 7 mmHg or a DBP higher than 95 mmHg during the follow-up. The high strain (HS) group representing 20.9% of the subjects was compared with the remaining subjects (NHS). Similarly the 20.9% subjects with the highest BP stress reactivity (HR) were compared with the remaining subjects (NHR). The Kaplan-Meier survival estimates revealed that neither high job strain, nor high stress reactivity, increased incidence of progression to hypertension. Age, alcohol, salt diet, BMI, and occupation did not interfere with our results. In conclusion, high stress cardiovascular reactivity and high job strain do not appear to be major risk markers for future high BP in healthy young adults. Stress could be associated with high BP at a short term and could explain high blood pressure in a long run only in stress-sensible subjects.
[Neural control of the peripheral circulation and blood pressure].
Estañol, Bruno; Porras-Betancourt, Manuel; Sánchez-Torres, Gustavo; Martínez-Memije, Raúl; Infante, Oscar; Sentíes-Madrid, Horacio
In the XIX century Claude Bernard discovered the action of the nervous system on the peripheral circulation. In the first half of the XX century Ewald Hering discovered the baro-receptor and the reflex control of the heart rate and blood pressure. Cowley and Guyton demonstrated that sino-aortic denervation induces persistent changes in the blood pressure in the dog. The autonomic nervous system is mainly responsible for the regulation of the circulation and blood pressure in the short term on a beat to beat basis. It controls the vasomotor tone, the heart rate and the cardiac output. With the advent of non invasive methods that measure the blood pressure on a beat to beat basis (Finapres) and with the methods of measurement of the variability of the blood pressure in the frequency domain (spectral analysis) we can currently measure many variables including heart rate, blood pressure, stroke volume, peripheral resistances and the baroreceptor sensitivity and make some inferences about their control mechanisms. These variables can be measured at rest in the supine position, standing up, during rhythmic breathing and during the Valsalva maneuver. In this article we present a review of the neural control of the blood pressure and heart rate.
Utilizing ambulatory blood pressure recordings to evaluate antihypertensive drug therapy.
White, W B
Until recently, the efficacy and pharmacodynamics of antihypertensive agents were assessed by resting blood pressure measurements in the doctor's office or a research clinic. The limitations of the office or clinic blood pressure measurement include the lack of representation (from recording only 1 point of time in the dosing schedule), the effects of the doctor's office on the patient's blood pressure, and, perhaps more relevant, observer bias. Ambulatory monitoring of the blood pressure has gained worldwide acceptance as an alternative method to assess antihypertensive drug efficacy and the time-effect relation of a drug. The ambulatory monitoring devices have been refined and are smaller, more precise, and more reliable than earlier recording models. Although there are no reference standards for analysis of ambulatory blood pressure data, international consensus groups are presently addressing this problem. Key roles for ambulatory blood pressure recordings in clinical trials of antihypertensive agents now include determination of the entry criteria for patients, improving the assessment of peak/trough pharmacodynamics in the patient's own environment (including nocturnal/sleep readings), and evaluating efficacy through calculation of the hypertensive burden, or blood pressure load. PMID:1575177
Aerobic exercise reduces blood pressure in resistant hypertension.
Dimeo, Fernando; Pagonas, Nikolaos; Seibert, Felix; Arndt, Robert; Zidek, Walter; Westhoff, Timm H
Regular physical exercise is broadly recommended by current European and American hypertension guidelines. It remains elusive, however, whether exercise leads to a reduction of blood pressure in resistant hypertension as well. The present randomized controlled trial examines the cardiovascular effects of aerobic exercise on resistant hypertension. Resistant hypertension was defined as a blood pressure ≥140/90 mm Hg in spite of 3 antihypertensive agents or a blood pressure controlled by ≥4 antihypertensive agents. Fifty subjects with resistant hypertension were randomly assigned to participate or not to participate in an 8- to 12-week treadmill exercise program (target lactate, 2.0±0.5 mmol/L). Blood pressure was assessed by 24-hour monitoring. Arterial compliance and cardiac index were measured by pulse wave analysis. The training program was well tolerated by all of the patients. Exercise significantly decreased systolic and diastolic daytime ambulatory blood pressure by 6±12 and 3±7 mm Hg, respectively (P=0.03 each). Regular exercise reduced blood pressure on exertion and increased physical performance as assessed by maximal oxygen uptake and lactate curves. Arterial compliance and cardiac index remained unchanged. Physical exercise is able to decrease blood pressure even in subjects with low responsiveness to medical treatment. It should be included in the therapeutic approach to resistant hypertension.
Blood pressure survey on the Navajo Indian reservation.
DeStefano, F; Coulehan, J L; Wiant, M K
The authors conducted blood pressure screening on the Navajo Indian reservation in northeastern Arizona and northwestern New Mexico. Six hundred forty Navajos over 19 years of age were surveyed at various sites. The mean systolic and diastolic blood pressures in Navajo men and women did not show as great increases with age as those seen among white and black Americans. Navajos also had generally lower blood pressures and lower prevalence of hypertension than white and black Americans. The authors were unable to demonstrate any association between degree of acculturation and blood pressure, but they did find that obesity in both men and women and alcohol use in men were associated with a higher prevalence of elevated pressure in the Navajos. PMID:453170
Tobacco exposure, weight status, and elevated blood pressure in adolescents.
Huntington-Moskos, Luz; Turner-Henson, Anne; Rice, Marti
The pathogenesis of hypertension begins in youth. An estimated 4% of US adolescents have diagnosed hypertension and 17% have elevated blood pressures, predisposing them to hypertension and cardiovascular disease (CVD) later in life. There is limited research on the clustering of CVD risk factors such as tobacco exposure and weight status that may be associated with high blood pressure in adolescents. The aim of this exploratory study was to determine the relationships between total smoke exposure (TSE; cigarette smoking and secondhand smoke), waist circumference, and blood pressure in a sample of rural adolescents, ages 15-18. A convenience sample of 148 adolescents ages 15-18 was recruited from two rural high schools (88 female and 60 male, all Caucasian). Adolescents were assessed for tobacco exposure (self-report, salivary cotinine), weight status (body mass index, waist circumference), and blood pressure. Self-report measures of tobacco exposure included the Uptake Continuum and Peer and Family Smoking measure. Age, gender, waist circumference and salivary cotinine contributed to 35% of the variance in systolic blood pressure and 18% in diastolic blood pressure. One-fourth (25%) of adolescent males and 11% of adolescent females had elevated systolic blood pressures. Approximately one-fifth of the sample (22%) had elevated salivary cotinine levels indicative of tobacco use and secondhand smoke exposure. TSE and waist circumference were predictors of elevated blood pressure in adolescents. Public health measures need to address clusters of risk factors including blood pressure, tobacco exposure, and weight status among adolescents in order to reduce CVD.
The effect of fish oil supplements on blood pressure.
Lofgren, R P; Wilt, T J; Nichol, K L; Crespin, L; Pluhar, R; Eckfeldt, J
We conducted a double-blind, placebo-controlled crossover study to determine the effects of fish oil supplementation on blood pressure in middle-aged men. Subjects were randomly assigned to consume either 20 g of fish oil or safflower oil for 12 weeks and then consume the other oil for an additional 12 weeks after a 4-week washout period. We found no significant changes from the pretreatment value in systolic or diastolic blood pressure with the use of fish oil supplements. In addition, there were no significant differences in the posttreatment blood pressures comparing the fish and safflower oil phases of the study. PMID:8427339
Goat Meat Does Not Cause Increased Blood Pressure
Sunagawa, Katsunori; Kishi, Tetsuya; Nagai, Ayako; Matsumura, Yuka; Nagamine, Itsuki; Uechi, Shuntoku
While there are persistent rumors that the consumption of goat meat dishes increases blood pressure, there is no scientific evidence to support this. Two experiments were conducted to clarify whether or not blood pressure increases in conjunction with the consumption of goat meat dishes. In experiment 1, 24 Dahl/Iwai rats (15 weeks old, body weight 309.3±11.1 g) were evenly separated into 4 groups. The control group (CP) was fed a diet containing 20% chicken and 0.3% salt on a dry matter basis. The goat meat group (GM) was fed a diet containing 20% goat meat and 0.3% salt. The goat meat/salt group (GS) was fed a diet containing 20% goat meant and 3% to 4% salt. The Okinawan mugwort (Artemisia Princeps Pampan)/salt group (GY) was fed a diet containing 20% goat meat, 3% to 4% salt and 5% of freeze-dried mugwort powder. The experiment 1 ran for a period of 14 weeks during which time the blood pressure of the animals was recorded. The GS, and GY groups consumed significantly more water (p<0.01) than the CP and GM groups despite the fact that their diet consumption levels were similar. The body weight of animals in the CP, GM, and GS groups was similar while the animals in the GY group were significantly smaller (p<0.01). The blood pressure in the GM group was virtually the same as the CP group throughout the course of the experiment. In contrast, while the blood pressure of the animals in the GS and GY group from 15 to 19 weeks old was the same as the CP group, their blood pressures were significantly higher (p<0.01) after 20 weeks of age. The GY group tended to have lower blood pressure than the GS group. In experiment 2, in order to clarify whether or not the increase in blood pressure in the GS group and the GY group in experiment 1 was caused by an excessive intake of salt, the effects on blood pressure of a reduction of salt in diet were investigated. When amount of salt in the diet of the GS and GY group was reduced from 4% to 0.3%, the animal's blood pressure
Ion channels and the control of blood pressure
Baker, Emma H
Ion channels exist in all cells and are enormously varied in structure, function and regulation. Some progress has been made in understanding the role that ion channels play in the control of blood pressure, but the discipline is still in its infancy. Ion channels provide many different targets for intervention in disorders of blood pressure and exciting advances have been made in this field. It is possible that new drugs, as well as antisense nucleotide technology or gene therapy directed towards ion channels, may form a new class of treatments for high and low blood pressure in the future. PMID:10718773
24 hour blood pressure monitoring in healthy and hypertensive children.
Reusz, G S; Hóbor, M; Tulassay, T; Sallay, P; Miltényi, M
24 Hour ambulatory blood pressure monitoring (ABPM) was performed to provide data on the normal daily blood pressure of healthy schoolchildren and on patients with hypertension. The subjects studied were 123 healthy schoolchildren with a mean (SD) age of 12.5 (1.6) years (range 9.5-14.5 years), 24 children with borderline or mild hypertension, 17 with renal hypertension and normal renal function, 10 with chronic renal failure, and six with a renal allograft. In eight children with definite renal disease a second measurement was performed after treatment modification. The monitor used for ABPM was validated with a mercury column manometer. The mean (SD) of the signed differences of the blood pressure measured by the two methods was -0.19 (1.75) mmHg for the systolic and -0.21 (2.11) mmHg for the diastolic blood pressure (n = 60). Normal values for daytime and night time blood pressure were determined for those aged 10-14 years. The mean (SD) blood pressure of the 123 children was 109 (7)/66 (8) mmHg (systolic/diastolic) for the daytime and 96 (8)/52 (7) mmHg at night time. Of the 24 children with borderline or mild hypertension 14 had a raised blood pressure on ABPM. The circadian rhythm was disturbed in three children of this group. Even children with normal daytime blood pressure had significantly higher systolic blood pressure in the night when compared with the controls. The incidence of disturbed circadian rhythm was higher in the groups with renal hypertension (4/17 in the subgroup with normal renal function, 5/16 in the group with renal failure and/or transplantation). All children undergoing a second ABPM measurement had a lower average blood pressure after treatment adjustment. ABPM measurements were reproducible and accurate. The method provided new data on the physiological circadian variation of blood pressure in healthy children. It proved to be a helpful tool in the diagnosis of hypertension, particularly in the detection of cases of disturbance of the
State of the market for devices for blood pressure measurement.
O'Brien, E
There is a large market for blood pressure measuring devices, not only in clinical medicine, but also with the public where the demand for self-measurement of blood pressure is growing rapidly. For the consumer, whether medical or lay, device accuracy should be of prime importance in selecting a blood pressure measuring device. However, the majority of devices available have not been evaluated independently for accuracy. In this paper the published evidence for independent validation is reviewed and it is recommended that such reviews should be undertaken regularly by international bodies, such as the European Society of Hypertension. PMID:12055402
Moreau, T; Hannaert, P; Orssaud, G; Huel, G; Garay, R P; Claude, J R; Juguet, B; Festy, B; Lellouch, J
Five red blood cell cation transport systems (RBCTS), together with blood lead level and blood pressure, were measured in 129 male adult subjects who were not occupationally exposed to lead or subsequent to a course of treatment for hypertension. Blood lead was positively related with systolic blood pressure, and to a lesser degree with diastolic blood pressure. Blood lead was found significantly negatively related to one of the RBCTS, Na+,K+ cotransport, and in addition, Na+,K+ cotransport appeared negatively related to blood pressure. Final results showed that blood lead no longer accounts for an increase in systolic blood pressure when Na+,K+ cotransport was taken into account; the same trend was observed with diastolic blood pressure. These findings suggest that a blood lead-related Na+,K+ cotransport impairment could explain the blood pressure increase observed to parallel the blood lead increase. PMID:3203645
Orthostatic blood pressure regulation predicts classroom effort in children.
Carapetian, Stephanie; Siedlarz, Monika; Jackson, Sandra; Perlmuter, Lawrence C
The increase in orthostatic systolic blood pressure associated with the shift in posture from lying to standing requires several compensatory mechanisms to ensure adequate cerebral perfusion. Decreased efficiency in the various mechanisms controlling orthostatic blood pressure regulation can result in dizziness, lightheadedness, and syncope. The degree of effectiveness of orthostatic systolic blood pressure regulation (OBPR) serves as a marker for a variety of problems including fatigue, depression, anxiety, reduced attention, impulsive behavior and reduced volition. In normal children, an insufficient increase in systolic blood pressure in response to upright posture is predictive of mild cognitive and affective problems. The present study examined orthostatic systolic blood pressure regulation in relation to yearlong teachers' evaluations of academic grades and effort in 7-11 year old children. Poorer systolic blood pressure regulation in response to orthostasis was associated with reduced levels of classroom effort, while academic grades were spared. Converging evidence from clinical as well as experimental studies suggests that the linkage between (OBPR) and effort may be partially mediated by sympathetic dysfunction, altered release of neurotransmitters, or reduced cerebral blood flow. PMID:18280600
[Current clinical aspects of ambulatory blood pressure monitoring].
Sauza-Sosa, Julio César; Cuéllar-Álvarez, José; Villegas-Herrera, Karla Montserrat; Sierra-Galán, Lilia Mercedes
Systemic arterial hypertension is the prevalentest disease worldwide that significantly increases cardiovascular risk. An early diagnosis together to achieve goals decreases the risk of complications significatly. Recently have been updated the diagnostic criteria for hypertension and the introduction of ambulatory blood pressure monitoring. The introduction into clinical practice of ambulatory blood pressure monitoring was to assist the diagnosis of «white coat hypertension» and «masked hypertension». Today has also shown that ambulatory blood pressure monitoring is better than the traditional method of recording blood pressure in the office, to the diagnosis and to adequate control and adjustment of drug treatment. Also there have been introduced important new concepts such as isloted nocturnal hypertension, morning blood pressure elevation altered and altered patterns of nocturnal dip in blood pressure; which have been associated with increased cardiovascular risk. Several studies have shown significant prognostic value in some stocks. There are still other concepts on which further study is needed to properly establish their introduction to clinical practice as hypertensive load variability, pulse pressure and arterial stiffness. In addition to setting values according to further clinical studies in populations such as elderly and children. PMID:26794338
[Current clinical aspects of ambulatory blood pressure monitoring].
Sauza-Sosa, Julio César; Cuéllar-Álvarez, José; Villegas-Herrera, Karla Montserrat; Sierra-Galán, Lilia Mercedes
Systemic arterial hypertension is the prevalentest disease worldwide that significantly increases cardiovascular risk. An early diagnosis together to achieve goals decreases the risk of complications significatly. Recently have been updated the diagnostic criteria for hypertension and the introduction of ambulatory blood pressure monitoring. The introduction into clinical practice of ambulatory blood pressure monitoring was to assist the diagnosis of «white coat hypertension» and «masked hypertension». Today has also shown that ambulatory blood pressure monitoring is better than the traditional method of recording blood pressure in the office, to the diagnosis and to adequate control and adjustment of drug treatment. Also there have been introduced important new concepts such as isloted nocturnal hypertension, morning blood pressure elevation altered and altered patterns of nocturnal dip in blood pressure; which have been associated with increased cardiovascular risk. Several studies have shown significant prognostic value in some stocks. There are still other concepts on which further study is needed to properly establish their introduction to clinical practice as hypertensive load variability, pulse pressure and arterial stiffness. In addition to setting values according to further clinical studies in populations such as elderly and children.
The Role of Home Blood Pressure Telemonitoring for Blood Pressure Control
Lee, Chan Joo; Park, Sungha
Despite improvements in hypertension awareness and treatment, the blood pressure (BP) control rate still remains at around 50%. One of the major determinants of low BP control results from therapeutic inertia of the physician and suboptimal compliance of the patients. Home BP self-measurement and monitoring improves patients' awareness and helps the management of hypertension. Recent technological advances are allowing for accurate measurement and telemonitoring of home BP, with a number of randomized clinical trials demonstrating the efficacy of telemonitoring for BP control. Home BP telemonitoring combined with self-adjustment based on prespecified treatment algorithms has been shown to improve BP control. Additionally, telemonitoring with active intervention by medical professionals has been shown to improve drug compliance and increase the target BP achievement rate. Although nothing can replace the tried and tested doctor-patient relationship in the office, telemonitoring of home BP will be an important tool for treating hypertension in the future. PMID:27752479
Low-level lead exposure, blood pressure, and calcium metabolism
Morris, C.; McCarron, D.A.; Bennett, W.M. )
Previous research has shown an association of both blood lead and dietary calcium with blood pressure (BP) in populations. We examined the relationship between blood levels and BP, the effect of calcium supplementation on blood lead, and whether the reported antihypertensive effect of calcium supplementation was related to any observed change in blood lead. BP was measured on four occasions, 1 week apart in 251 subjects. During this period, blood lead and erythrocyte protoporphyrin (EPP) levels were measured, as well as markers of calcium metabolism. In an intervention period, 142 patients were assigned to receive 1 g of calcium per day as calcium carbonate for 12 weeks; at the end of this period, blood lead and EPP were remeasured. In males, blood lead levels were significantly, directly related to BP; a 0.48 mumol/dL (10 micrograms/dL) increase in blood lead concentration was associated with a 5 mm Hg increase in systolic pressure. There was no relationship of blood lead levels to BP in females. EPP was unrelated to BP. Similarly, there was no relationship of blood lead levels to markers of calcium metabolism. With calcium supplementation, blood lead and EPP levels did not change significantly. We conclude that it is unlikely that modification of lead status explains any effects of calcium supplementation on BP.
Kang, In Sook; Shin, Jinho; Ihm, Sang-Hyun; Kim, Ju Han; Park, Sungha; Kim, Kwang-Il; Kim, Woo-Shik; Kim, Soon Gil; Shin, Gil Ja
Background and Objectives Blood pressure variability (BPV) was recently shown to be a risk factor of stroke. White coat hypertension (WCH) used to be regarded as innocuous, but one long-term follow-up study reported that WCH increased stroke rate compared to normotension (NT). In this study, we aimed to evaluate the relationship between WCH and BPV. Subjects and Methods We analyzed 1398 subjects from the Korean Ambulatory Blood Pressure Registry, who were divided into NT (n=364), masked hypertension (n=122), white coat hypertension (n=254), and sustained hypertension (n=658) groups. Results Baseline characteristics were similar among groups. The average real variability (ARV), a highly sensitive BPV parameter, was highest in the WCH group, followed by the sustained hypertension, masked hypertension, and NT groups. The results persisted after being adjusted for covariates. The WCH vs. sustained hypertension results (adjusted mean±standard error) were as follows: 24-h systolic ARV, 22.9±0.8 vs. 19.4±0.6; 24-h diastolic ARV, 16.8±0.6 vs. 14.3±0.5; daytime systolic ARV, 21.8±0.8 vs. 16.8±0.6; and daytime diastolic ARV, 16.2±0.6 vs. 13.4±0.5 (p<0.001 for all comparisons). Conclusion From the registry data, we found that subjects with WCH or masked hypertension had higher BPV than NT. However, long-term follow-up data assessing the clinical influences of WCH on stroke are needed. PMID:27275173
Blood pressure, ethnic group, and salt intake in Belize.
Simmons, D
A total of 1316 individuals were studied in seven villages in Belize, Central America. This represented 92% of the area population aged over 18. Generally, they were members of three ethnic groups--Maya, Spanish, and Creole. The systolic and diastolic IV and V blood pressures were recorded using standardised procedure. Significant differences in blood pressure, weight, and obesity were found between ethnic groups in both sexes, Creoles having higher means than the other groups. Significant relationships with blood pressure were found with obesity, age, and number of children. An early morning urine specimen was obtained from a random 50% of the men, and only in Creoles was there an association between raised blood pressure and sodium/potassium urinary excretion ratio. PMID:6875443
Update on blood pressure goals in diabetes mellitus.
Laffin, Luke J; Bakris, George L
The most recent guideline statements by the 2014 Expert Panel of the National Institutes of Health as well as the American and International Societies of Hypertension recommend a blood pressure goal of <140/90 mmHg in patients with diabetes mellitus. This follows prior guidelines that recommended lower BP treatment goals of <130/80 mmHg in patients with diabetes. Reducing cardiovascular morbidity and mortality by trying to achieve recommended goals of risk factors like blood pressure, glucose, and cholesterol in patients with diabetes is paramount. Data from multiple trials demonstrates that early treatment of hypertension in people with diabetes clearly prevents both macrovascular and microvascular complications, but the goal blood pressure that should be achieved is now modified to a higher level. We address the evidence and evolution of how and why this blood pressure goal has changed in recent years.
Dietary Mineral Could Be One Key to Blood Pressure Control
... https://medlineplus.gov/news/fullstory_159836.html Dietary Mineral Could Be One Key to Blood Pressure Control ... 2016 (HealthDay News) -- Sufficient dietary levels of the mineral nutrient magnesium might be a boon to good ...
[Secondary prevention of stroke through arterial blood pressure reduction].
Mancia, G; Grassi, G
Large scale observational studies have conclusively demonstrated that systolic and diastolic blood pressure values are linearly related to the incidence of cerebrovascular diseases and that high blood pressure is an important risk factor for both primary and secondary development of stroke. Interventional studies have shown that blood pressure lowering by antihypertensive treatment reduces the incidence of stroke in hypertensive patients without a history of previous stroke. Whether this is the case also for the secondary prevention of cerebral ischemic attacks has not been unequivocally shown, however. The PROGRESS ("Perindopril Protection Against Recurrent Stroke Study") study has been designed and is under way to collect information on this important issue of the antihypertensive treatment, its purpose being to evaluate the blood pressure lowering effects with an ACE-inhibitor on recurrent stroke in an overall population of 6000 patients with a positive history of previous cerebral ischemic attacks or stroke. PMID:9340173
Racial differences in hypertension: implications for high blood pressure management.
Lackland, Daniel T
The racial disparity in hypertension and hypertension-related outcomes has been recognized for decades with African Americans with greater risks than Caucasians. Blood pressure levels have consistently been higher for African Americans with an earlier onset of hypertension. Although awareness and treatment levels of high blood pressure have been similar, racial differences in control rates are evident. The higher blood pressure levels for African Americans are associated with higher rates of stroke, end-stage renal disease and congestive heart failure. The reasons for the racial disparities in elevated blood pressure and hypertension-related outcomes risk remain unclear. However, the implications of the disparities of hypertension for prevention and clinical management are substantial, identifying African American men and women with excel hypertension risk and warranting interventions focused on these differences. In addition, focused research to identify the factors attributed to these disparities in risk burden is an essential need to address the evidence gaps.
New Approaches to Evaluating and Monitoring Blood Pressure.
Goldberg, Elizabeth M; Levy, Phillip D
Digital health innovations for hypertension include cuffless blood pressure sensors, wireless smartphone-enabled upper arm blood pressure monitors, mobile applications, and remote monitoring technologies. Wearable trackers have drawn interest from medical professionals and patients alike. They have the potential to improve hypertension control and medication adherence through easier logging of repeated blood pressure measurements, better connectivity with health-care providers, and medication reminder alerts. With increasing emphasis on home and ambulatory blood pressure monitoring to confirm hypertension prior to treatment, such devices also can help improve the diagnostic landscape. However, privacy, accuracy, and cost concerns have prevented widespread clinical uptake. To foster implementation, device designers and clinical researchers should collaborate on development of rigorous clinical trials that test cardiovascular outcomes associated with emerging technologies. We review the current literature on mobile health technologies and novel diagnostic and management protocols and make recommendations on how to incorporate these innovations into practice. PMID:27137524
Automated analysis of blood pressure measurements (Korotkov sound)
NASA Technical Reports Server (NTRS)
Golden, D. P.; Hoffler, G. W.; Wolthuis, R. A.
Automatic system for noninvasive measurements of arterial blood pressure is described. System uses Korotkov sound processor logic ratios to identify Korotkov sounds. Schematic diagram of system is provided to show components and method of operation.
Racial differences in hypertension: implications for high blood pressure management.
Lackland, Daniel T
The racial disparity in hypertension and hypertension-related outcomes has been recognized for decades with African Americans with greater risks than Caucasians. Blood pressure levels have consistently been higher for African Americans with an earlier onset of hypertension. Although awareness and treatment levels of high blood pressure have been similar, racial differences in control rates are evident. The higher blood pressure levels for African Americans are associated with higher rates of stroke, end-stage renal disease and congestive heart failure. The reasons for the racial disparities in elevated blood pressure and hypertension-related outcomes risk remain unclear. However, the implications of the disparities of hypertension for prevention and clinical management are substantial, identifying African American men and women with excel hypertension risk and warranting interventions focused on these differences. In addition, focused research to identify the factors attributed to these disparities in risk burden is an essential need to address the evidence gaps. PMID:24983758
Pediatric Blood Pressure and Adult Preclinical Markers of Cardiovascular Disease
Magnussen, Costan G.; Smith, Kylie J.
A high blood pressure level in adults is considered the single most important modifiable risk factor for global disease burden, especially those of cardiovascular (CV) origin such as stroke and ischemic heart disease. Because blood pressure levels have been shown to persist from childhood to adulthood, elevations in pediatric levels have been hypothesized to lead to increased CV burden in adulthood and, as such, might provide a window in the life course where primordial and primary prevention could be focused. In the absence of substantive data directly linking childhood blood pressure levels to overt adult CV disease, this review outlines the available literature that examines the association between pediatric blood pressure and adult preclinical markers of CV disease. PMID:27168729
Vegetarian diet and blood pressure levels: incidental or causal association?
Beilin, L J; Rouse, I L; Armstrong, B K; Margetts, B M; Vandongen, R
Evidence that nutrients other than the major cations may influence blood pressure levels stems from studies of acculturated vegetarians and from randomized controlled dietary trials. Earlier studies of vegetarians focused on religious groups and on vegans, making it difficult to know whether their lower blood pressures were due to diet per se or to other aspects of lifestyle. Seventh-day Adventist vegetarians showed significantly less hypertension and lower blood pressures compared with Mormon omnivores, effects which were independent of differences in obesity and not due to altered sodium intake. Subsequently, controlled dietary intervention studies in healthy normotensive omnivores provided more direct evidence for a blood pressure-lowering effect of a lactoovovegetarian diet with reversible changes of 5-6 mm Hg systolic and 2-3 mm Hg diastolic occurring over 6-wk periods. Similar dietary effects in mild hypertensive subjects provides impetus for identifying the responsible nutrients.
Unusual blood pressure response during standing therapy in tetraplegic man.
Ogata, Hisayoshi; Ogata, Toru; Hoshikawa, Shinya; Uematsu, Azusa; Ogawa, Tetsuya; Saitou, Sakiko; Kitamura, Taku; Nakazawa, Kimitaka
We report a case of an individual with cervical spinal cord injury who showed a unique blood pressure response during passive standing and passive walking-like leg movement, i.e., hypertension with standing and hypotension with leg movement.
Socioeconomic Status Modifies the Seasonal Effect on Blood Pressure
Cois, Annibale; Ehrlich, Rodney
Abstract Seasonal variations in blood pressure have been consistently reported. However, uncertainty remains about the size of the seasonal effect in different regions, and about factors that explain the differences observed across and within populations. Using data from a national panel study, we investigated seasonal variations in blood pressure in the South African adult population, and whether these variations differed across socioeconomic strata. We estimated age-specific seasonal effects on blood pressure using a multilevel structural equation model, with repeated measurements nested within subjects. Effect modification by socioeconomic status was assessed by repeating the analyses in the subpopulations defined by levels of education, household income per capita, and type of housing. In men and women, season had a statistically significant effect on blood pressure, with higher levels in winter and lower levels in summer. For systolic blood pressure, the magnitude of the seasonal effect was 4.25/4.21 mmHg (women/men) and was higher in the older age groups. For diastolic blood pressure, the effect size was 4.00/4.01 mmHg, with no evident age trend. Seasonal effects were higher among subjects in the lowest socioeconomic classes than in the highest, with differences between 2.4 and 7.7 mmHg, depending on gender, whether systolic or diastolic blood pressure, and socioeconomic status indicator. In the South African adult population, blood pressure shows seasonal variation modified by age and socioeconomic status. These variations have epidemiological, clinical, and public health implications, including the prospect of population level intervention to reduce elevated risk of cold weather cardiovascular morbidity. PMID:26334893
Gene Silencing and Haploinsufficiency of Csk Increase Blood Pressure
Kim, Sung-Moon; Ji, Su-Min; Park, So-Yon; Kim, Marina E.; Jigden, Baigalmaa; Lim, Ji Eun; Hwang, Sue-Yun; Lee, Young-Ho; Oh, Bermseok
Objective Recent genome-wide association studies have identified 33 human genetic loci that influence blood pressure. The 15q24 locus is one such locus that has been confirmed in Asians and Europeans. There are 21 genes in the locus within a 1-Mb boundary, but a functional link of these genes to blood pressure has not been reported. We aimed to identify a causative gene for blood pressure change in the 15q24 locus. Methods and Results CSK and ULK3 were selected as candidate genes based on eQTL analysis studies that showed the association between gene transcript levels and the lead SNP (rs1378942). Injection of siRNAs for mouse homologs Csk, Ulk3, and Cyp1a2 (negative control) showed reduced target gene mRNA levels in vivo. However, Csk siRNA only increased blood pressure while Ulk3 and Cyp1a2 siRNA did not change it. Further, blood pressure in Csk+/- heterozygotes was higher than in wild-type, consistent with what we observed in Csk siRNA-injected mice. We confirmed that haploinsufficiency of Csk increased the active form of Src in Csk+/- mice aorta. We also showed that inhibition of Src by PP2, a Src inhibitor decreased high blood pressure in Csk+/- mice and the active Src in Csk+/- mice aorta and in Csk knock-down vascular smooth muscle cells, suggesting blood pressure regulation by Csk through Src. Conclusions Our study demonstrates that Csk is a causative gene in the 15q24 locus and regulates blood pressure through Src, and these findings provide a novel therapeutic target for the treatment of hypertension. PMID:26751575
Early life stress and blood pressure levels in late adulthood.
Alastalo, H; Räikkönen, K; Pesonen, A-K; Osmond, C; Barker, D J P; Heinonen, K; Kajantie, E; Eriksson, J G
Severe stress experienced in early life may have long-term consequences on adult physiological functions. We studied the long-term effects of separation on blood pressure levels in non-obese subjects who were separated temporarily in childhood from their parents during World War II (WWII). The original clinical study cohort consists of people born during 1934-1944 in Helsinki, Finland. This substudy includes 1361 non-obese subjects (body mass index <30 kg m(-2)). Of these, 192 (14.1%) had been evacuated abroad during WWII. The remaining subjects served as controls. Blood pressure levels and use of blood pressure medication were studied. The separated subjects had significantly higher systolic blood pressure values than the non-separated (148.6+21.5 vs 142.2+19.6 mm Hg, P<0.0001) in adult life. Those subjects separated in early childhood had markedly higher systolic and diastolic blood pressure values in adult life compared with the non-separated (154.6 vs 142.5 mm Hg; 95% confidence interval (CI) 2.6-14.7; P<0.005 and 90.8 vs 87.7 mm Hg; 95% CI 1.0-7.3; P<0.02, respectively). Systolic blood pressure was also higher in the group separated for a duration of <1 year (151.7 vs 142.2 mm Hg; 95% CI 0.0-12.4; P<0.05) compared with the non-separated. Besides being separated, age at separation and duration of separation also influenced blood pressure levels in adult life. This could be due to early hormonal and metabolic programming, during plastic periods in early life, influencing blood pressure levels in adult life.
Short Term Effects of Cocoa Consumption on Blood Pressure
Alleyne, T; Alleyne, A; Arrindell, D; Balleram, N; Cozier, D; Haywood, R; Humphrey, C; Pran, L; Rampersad, K; Reyes, D; Bahall, S; Holder, R; Ignacio, D
Hypertension, defined as diastolic pressure ≥ 90 mmHg and systolic pressure ≥ 140 mmHg, is a major cause of morbidity and mortality among black populations globally. Several studies have shown that prolonged consumption of cocoa or cocoa containing products leads to decreased blood pressure (BP) in hypertensives. In this study, we investigated the flavonoid content of the top selling cocoa/cocoa based products in Trinidad and Tobago and attempted to determine if consumption of cocoa had any immediate impact on blood pressure levels. The flavonoid content of three 100% cocoa powder products and four cocoa-based formulas was measured using a modified Folin-Ciocalteu procedure. The brand with the highest flavonoid content, 372 gallic acid equivalents, was selected to evaluate the short-term impact of cocoa consumption on blood pressure. Thirty-six participants comprising nineteen hypertensives and seventeen persons with normal blood pressure had their blood pressure recorded on three separate days using ambulatory blood pressure monitors; the blood pressure was recorded every half hour for eight hours. On the first day, the participants received no intervention but on the second and third days, they received either the intervention (5 g cocoa in 125 ml water) or a placebo, in any order. Statistical analysis conducted using t-test statistic and a 95% confidence interval revealed that whether participants regularly took antihypertensive medication or not, a single intervention of cocoa induced decreases in both the diastolic and systolic BPs that were significant (p = 0.0001). Mean decreases of between 8 mmHg and 18 mmHg were observed. PMID:25429467
Potential benefits of exercise on blood pressure and vascular function.
Pal, Sebely; Radavelli-Bagatini, Simone; Ho, Suleen
Physical activity seems to enhance cardiovascular fitness during the course of the lifecycle, improve blood pressure, and is associated with decreased prevalence of hypertension and coronary heart disease. It may also delay or prevent age-related increases in arterial stiffness. It is unclear if specific exercise types (aerobic, resistance, or combination) have a better effect on blood pressure and vascular function. This review was written based on previous original articles, systematic reviews, and meta-analyses indexed on PubMed from years 1975 to 2012 to identify studies on different types of exercise and the associations or effects on blood pressure and vascular function. In summary, aerobic exercise (30 to 40 minutes of training at 60% to 85% of predicted maximal heart rate, most days of the week) appears to significantly improve blood pressure and reduce augmentation index. Resistance training (three to four sets of eight to 12 repetitions at 10 repetition maximum, 3 days a week) appears to significantly improve blood pressure, whereas combination exercise training (15 minutes of aerobic and 15 minutes of resistance, 5 days a week) is beneficial to vascular function, but at a lower scale. Aerobic exercise seems to better benefit blood pressure and vascular function.
Techniques for estimating blood pressure variation using video images.
Sugita, Norihiro; Obara, Kazuma; Yoshizawa, Makoto; Abe, Makoto; Tanaka, Akira; Homma, Noriyasu
It is important to know about a sudden blood pressure change that occurs in everyday life and may pose a danger to human health. However, monitoring the blood pressure variation in daily life is difficult because a bulky and expensive sensor is needed to measure the blood pressure continuously. In this study, a new non-contact method is proposed to estimate the blood pressure variation using video images. In this method, the pulse propagation time difference or instantaneous phase difference is calculated between two pulse waves obtained from different parts of a subject's body captured by a video camera. The forehead, left cheek, and right hand are selected as regions to obtain pulse waves. Both the pulse propagation time difference and instantaneous phase difference were calculated from the video images of 20 healthy subjects performing the Valsalva maneuver. These indices are considered to have a negative correlation with the blood pressure variation because they approximate the pulse transit time obtained from a photoplethysmograph. However, the experimental results showed that the correlation coefficients between the blood pressure and the proposed indices were approximately 0.6 for the pulse wave obtained from the right hand. This result is considered to be due to the difference in the transmission depth into the skin between the green and infrared light used as light sources for the video image and conventional photoplethysmogram, respectively. In addition, the difference in the innervation of the face and hand may be related to the results.
Race and blood pressure status influences cardiovascular responses to challenge.
Saab, P G; Tischenkel, N; Spitzer, S B; Gellman, M D; Pasin, R D; Schneiderman, N
The influence of race and blood pressure status on cardiovascular responses to three challenges (interview, video game and cold pressor) was investigated in 50 healthy normotensive and 30 unmedicated mild-to-moderate hypertensive black and white men, aged 25-44 years old. Group differences were obtained for two tasks. The interview evoked race and blood pressure status differences: higher heart rate responses were elicited from normotensives compared with hypertensives and larger diastolic blood pressure (DBP) responses were elicited from whites compared with blacks. For the video game, black hypertensives displayed larger DBP responses than white hypertensives and greater systolic blood pressure and DBP responses than black normotensives. The video game heart rate response of white normotensives exceeded that of black normotensives and white hypertensives. These findings suggest that cardiovascular responses to challenge are affected by race and blood pressure status. The blood pressure hyperresponsiveness of black hypertensives compared with black normotensives to a psychological challenge (video game) provides generality to previous research conducted only on whites. PMID:1851788
Poor Concordance Between Elevated Blood Pressures in the Preschool Years.
To, Wendy J; King, Tonya S; Sekhar, Deepa L
The 2013 US Preventive Services Task Force report found insufficient evidence for pediatric blood pressure screening. This retrospective study evaluated the reliability of successive annual blood pressure screening of children for hypertension at the 3-, 4-, and 5-year-old health maintenance visits (January 1, 2010 to June 18, 2014). Of 328 patients, 290 (88%) were normotensive at all 3 visits. All elevated blood pressures (≥95th percentile) were stage 1. No patient was hypertensive (3 elevated measures). The extended concordance correlation coefficient indicated poor agreement for systolic (0.19, 95% CI -0.49 to 0.72) and diastolic (0.11, 95% CI -0.39 to 0.56) measurements. Blood pressure at the 3-year (κ -0.008, 95% CI -0.11 to 0.09), 4-year (κ 0.09, 95% CI -0.06 to 0.24), or 5-year (κ 0.08, 95% CI -0.05 to 0.20) visit was not associated with elevated blood pressures at the other 2 time points. In the preschool years, stage 1 elevated blood pressures do not correlate with hypertension and may be better managed by watchful waiting and parental reassurance.
Calcium intake and blood pressure in blacks and whites.
Freudenheim, J L; Russell, M; Trevisan, M; Doemland, M
This study focuses on 1790 residents of Erie County, New York, over age 19, who participated in a study of blood pressure in 1986. Subjects were selected using a highly stratified sampling procedure to obtain a sample that included approximately equal numbers of blacks and whites in three educational strata (less than 12 years, 12 years, and more than 12 years of education). Calcium intake was estimated using questions regarding usual frequency of intake of foods high in calcium and of calcium-containing supplements and antacids. Calcium intake by normotensives tended to be higher than intake by hypertensives; differences were significant for females but not for males. Calcium intake was significantly inversely associated with systolic blood pressure for black females and diastolic blood pressure in black and white females after control for age, education, body mass index, smoking, and alcohol. For other sex-race groups, there was generally a trend (although not significant) toward decreased blood pressure with increased calcium intake. Diastolic blood pressure was inversely associated with calcium from milk and yogurt (but not cheese) for white females. A similar association (although not significant) was found for black females; no association was found for males. No differences were found between blacks and whites in response to calcium. This cross-sectional study provides some additional evidence of a protective effect of calcium intake on blood pressure in both black and white females.
Boltz, Agnes; Told, Reinhard; Napora, Katarzyna J.; Palkovits, Stefan; Werkmeister, René M.; Schmidl, Doreen; Popa-Cherecheanu, Alina; Garhöfer, Gerhard; Schmetterer, Leopold
Aim In the present study the response of optic nerve head blood flow to an increase in ocular perfusion pressure during isometric exercise was studied. Based on our previous studies we hypothesized that subjects with an abnormal blood flow response, defined as a decrease in blood flow of more than 10% during or after isometric exercise, could be identified. Methods A total of 40 healthy subjects were included in this study. Three periods of isometric exercise were scheduled, each consisting of 2 minutes of handgripping. Optic nerve head blood flow was measured continuously before, during and after handgripping using laser Doppler flowmetry. Blood pressure was measured non-invasively in one-minute intervals. Intraocular pressure was measured at the beginning and the end of the measurements and ocular perfusion pressure was calculated as 2/3*mean arterial pressure –intraocular pressure. Results Isometric exercise was associated with an increase in ocular perfusion pressure during all handgripping periods (p < 0.001). By contrast no change in optic nerve head blood flow was seen. However, in a subgroup of three subjects blood flow showed a consistent decrease of more than 10% during isometric exercise although their blood pressure values increased. In addition, three other subjects showed a consistent decline of blood flow of more than 10% during the recovery periods. Conclusion Our data confirm previous results indicating that optic nerve head blood flow is autoregulated during an increase in perfusion pressure. In addition, we observed a subgroup of 6 subjects (15%) that showed an abnormal response, which is in keeping with our previous data. The mechanisms underlying this abnormal response remain to be shown. PMID:24324774
Treatment: Types of Blood Pressure Medications | NIH MedlinePlus the Magazine
... page please turn Javascript on. Feature: High Blood Pressure Treatment: Types of Blood Pressure Medications Past Issues / Fall 2011 Table of Contents Treatment: Types of Blood Pressure Medications Here's a rundown on the main types ...
Quiz: Does Your Blood Pressure Pass the Test? | NIH MedlinePlus the Magazine
... please turn Javascript on. Special Section: Healthy Blood Pressure Quiz: Does Your Blood Pressure Pass the Test? Past Issues / Winter 2010 Table of Contents Blood pressure changes throughout the day. It is highest while ...
"Keep the Beat" Healthy Blood Pressure Helps Prevent Heart Disease | NIH MedlinePlus the Magazine
... Javascript on. Special Section: Healthy Blood Pressure "Keep the Beat": Healthy Blood Pressure Helps Prevent Heart Disease ... Contents Your blood pressure rises and falls during the day. But when it stays elevated over time, ...
Anger Expression and Blood Pressure in Adolescents
ERIC Educational Resources Information Center
Starner, Tamie M.; Peters, Rosalind M.
The clinical significance of childhood hypertension is important as elevated pressures during childhood are found to follow a progressively increasing track into adulthood. Little work has been done to examine the relationship of emotions and emotional behavioral factors to the development of hypertension in children. Using the Roy Adaptation…
21 CFR 870.1140 - Venous blood pressure manometer.
Code of Federal Regulations, 2010 CFR
... catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class II... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Venous blood pressure manometer. 870.1140 Section... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1140 Venous...
Jackson, James; Kohn-Parrott, Kate A; Parker, Cyndy; Levins, Neil; Dyer, Susan; Hedalen, Erika J; Frank, Elaine; Bramer, Susan; Brandt, Debra; Doyle, Joseph J
Worksite-based wellness programs can be a means to improve employee health awareness and potentially reduce health care costs. The "BP Success Zone: You Auto Know" program was a worksite-based intervention to reduce the incidence of hypertension among auto workers at Chrysler LLC. This 6-month program comprised an intervention consisting of education, awareness, and support intended to intensify the engagement of Chrysler employees at moderate-to-high cardiovascular risk who were not adequately controlling their blood pressure. The 539 participants had systolic blood pressure of ≥ 120 mmHg, diastolic blood pressure of ≥ 80 mmHg, or were told by a health care provider that they had hypertension. Questionnaires compared awareness and knowledge of hypertension and lifestyle choices before and at the end of the intervention. After the 6-month intervention, mean systolic blood pressure had decreased from a baseline value of 133 mmHg to 129 mmHg (P < 0.0001) and mean blood diastolic pressure had decreased from 85 mmHg to 82 mmHg (P < 0.0001). The proportion of participants with controlled blood pressure increased from 52% to 62% (P < 0.0001) over the course of the intervention. Eighty-six percent of the participants reported that the program helped them to better understand and control their blood pressure and 84% reported that they had a better understanding of their treatment options. In conclusion, a program of hypertension awareness, education, and lifestyle modification helped to improve blood pressure control among a group of Chrysler LLC employees.
Pressure and wall shear stress in blood hammer - Analytical theory.
Mei, Chiang C; Jing, Haixiao
We describe an analytical theory of blood hammer in a long and stiffened artery due to sudden blockage. Based on the model of a viscous fluid in laminar flow, we derive explicit expressions of oscillatory pressure and wall shear stress. To examine the effects on local plaque formation we also allow the blood vessel radius to be slightly nonuniform. Without resorting to discrete computation, the asymptotic method of multiple scales is utilized to deal with the sharp contrast of time scales. The effects of plaque and blocking time on blood pressure and wall shear stress are studied. The theory is validated by comparison with existing water hammer experiments. PMID:27474207
Pressure and wall shear stress in blood hammer - Analytical theory.
Mei, Chiang C; Jing, Haixiao
We describe an analytical theory of blood hammer in a long and stiffened artery due to sudden blockage. Based on the model of a viscous fluid in laminar flow, we derive explicit expressions of oscillatory pressure and wall shear stress. To examine the effects on local plaque formation we also allow the blood vessel radius to be slightly nonuniform. Without resorting to discrete computation, the asymptotic method of multiple scales is utilized to deal with the sharp contrast of time scales. The effects of plaque and blocking time on blood pressure and wall shear stress are studied. The theory is validated by comparison with existing water hammer experiments.
This document is a decision document regarding the scope of HEPA filter differential pressure interlock system installations at Tank Farm emission units. It is intended to provide supporting information for administration of Baseline Change Request.
Blood pressure and interpersonal discrimination: systematic review of epidemiologic studies.
Couto, Paulo Francisco; Goto, Janaina Brugnera; Bastos, João Luiz
The relationship between blood pressure and discrimination has been recently investigated, and there are conflicting debates in literature devoted to the topic. The objective of this study was to update previous literature reviews on discrimination and blood pressure. A bibliographic search was conducted in PubMed between January/2000 and December/2010, including epidemiological studies, assessing the relationship between interpersonal discrimination and blood pressure/hypertension. The 22 studies included originated from the United States; 96% of them used the cross-sectional design with convenience sample, comprising, in 59% of the studies, exclusively Black participants. The Everyday Discrimination Scale and the Perceived Racism Scale were the most frequently used instruments, emphasizing lifetime or chronic/everyday racial/ethnic discrimination. In the 22 studies assessed, the association between discrimination and blood pressure/hypertension was assessed 50 times. Twenty results (40%) showed no association between them, and only 15 (30%) revealed global positive associations, of which 67% were statistically significant. Eight negative associations were also observed, suggesting that higher exposure to discrimination would be associated with lower blood pressure/hypertension. The studies did not consistently support the hypothesis that discrimination is associated with higher blood pressure. These findings can be partially attributed to the limitations of the studies, especially those related to the measurement of discrimination and of factors that might modify its association with outcomes. To establish discrimination as an epidemiological risk factor, more rigorous methodological strategies should be used, and the theoretical frameworks that postulate causal relationships between discrimination and blood pressure should be reviewed.
Blood-Pressure Measuring System Gives Accurate Graphic Output
NASA Technical Reports Server (NTRS)
The problem: To develop an instrument that will provide an external (indirect) measurement of arterial blood pressure in the form of an easily interpreted graphic trace that can be correlated with standard clinical blood-pressure measurements. From sphygmograms produced by conventional sphygmographs, it is very difficult to differentiate the systolic and diastolic blood-pressure pulses and to correlate these indices with the standard clinical values. It is nearly impossible to determine these indices when the subject is under physical or emotional stress. The solution: An electronic blood-pressure system, basically similar to conventional ausculatory sphygmomanometers, employing a standard occluding cuff, a gas-pressure source, and a gas-pressure regulator and valve. An electrical output transducer senses cuff pressure, and a microphone positioned on the brachial artery under the occluding cuff monitors the Korotkoff sounds from this artery. The output signals present the conventional systolic and diastolic indices in a clear, graphical display. The complete system also includes an electronic timer and cycle-control circuit.
Calculated mean arterial blood pressure in critically ill neonates.
Gevers, M; Hack, W W; Ree, E F; Lafeber, H N; Westerhof, N
Mean arterial pressure (MAP) is the area under the pressure wave form averaged over the cardiac cycle. A widely used rule of thumb to estimate MAP of peripheral arterial pressure waves in adults is adding one-third of the pulse pressure (PP) to diastolic arterial pressure (DAP). However, radial artery pressure waves in newborns differ from those in adults and resemble proximal aortic pressure waves, so that the above-mentioned calculation of MAP may not be correct. The present study was set up to obtain an arithmetical approximation to derive MAP from blood pressure waves measured in the radial artery of the neonate. We accurately recorded about 300 invasively obtained blood pressure curves in the radial artery of 10 neonates admitted for intensive care. We found that MAP in the radial artery in these neonates can be well approximated by adding 46.6% PP to DAP (range 43.0-50.1%). We suggest that the rule of thumb to derive MAP from radial artery waves in the neonate to be approximately the average of systolic and diastolic pressure, as opposed to adding one-third of the pulse pressure to the diastolic value in the adult.
Ethnic Differences in Physical Fitness, Blood Pressure and Blood Chemistry in Women (AGES 20-63)
NASA Technical Reports Server (NTRS)
Ayers, G. W.; Wier, L. T.; Jackson, A. S.; Stuteville, J. E.; Keptra, Sean (Technical Monitor)
This study examined the role of ethnicity on the aerobic fitness, blood pressure, and selected blood chemistry values of women. One hundred twenty-four females (mean age 41.37 +/- 9.0) were medically Examined at the NASA/Johnson Space Center occupational health clinic. Ethnic groups consisted of 23 Black (B), 18 Hispanic (H) and 83 Non-minority (NM). Each woman had a maximum Bruce treadmill stress test (RER greater than or = 1.1) and a negative ECG. Indirect calorimetry, skinfolds, self-report physical activity (NASA activity scale), seated blood pressure, and blood chemistry panel determined VO2max, percent fat, level of physical activity, blood pressure and blood chemistry values. ANOVA revealed that the groups did not differ (p greater than 0.05) in age, VO2 max, weight, percent fat, level of physical activity, total cholesterol, or HDL-C. However, significant differences (p greater than 0.05) were noted in BMI, diastolic blood pressure, and blood chemistries. BMI was 3.17 higher in H than in NM; resting diastolic pressures were 5.69 and 8.05 mmHg. lower in NM and H than in B; triglycerides were 48.07 and 37.21 mg/dl higher in H than in B and NM; hemoglobin was .814 gm/dl higher in NM than B; fasting blood sugar was 15.41 mg/dl higher in H than NM; The results of this study showed that ethnic groups differed in blood pressure and blood chemistry values but not aerobic fitness or physical activity. There was an ethnic difference in BMI but not percent fat.
Midlife blood pressure predicts future diastolic dysfunction independently of blood pressure
Ghosh, Arjun Kumar; Hughes, Alun David; Francis, Darrel; Chaturvedi, Nishi; Pellerin, Denis; Deanfield, John; Kuh, Diana; Mayet, Jamil; Hardy, Rebecca
Objectives High blood pressure (BP) is associated with diastolic dysfunction, but the consequence of elevated BP over the adult life course on diastolic function is unknown. We hypothesised that high BP in earlier adulthood would be associated with impaired diastolic function independent of current BP. Methods Participants in the Medical Research Council National Survey of Health and Development birth cohort (n=1653) underwent investigations including echocardiography at age 60–64 years. The relationships between adult BP, antihypertensive treatment (HTT) and echocardiographic measures of diastolic function were assessed using adjusted regression models. Results Increased systolic BP (SBP) at ages 36, 43 and 53 years was predictive of increased E/e′ and increased left atrial volume. These effects were only partially explained by SBP at 60–64 years and increased left ventricular mass. HTT was also associated with poorer diastolic function after adjustment for SBP at 60–64 years. Faster rates of increase in SBP in midlife were also associated with increased poorer diastolic function. Conclusions High SBP in midlife is associated with poorer diastolic function at age 60–64 years. Early identification of individuals with high BP or rapid rises in BP may be important for prevention of impaired cardiac function in later life. PMID:27056972
Pressure Gradient Estimation Based on Ultrasonic Blood Flow Measurement
NASA Astrophysics Data System (ADS)
Nitta, Naotaka; Homma, Kazuhiro; Shiina, Tsuyoshi
Mechanical load to the blood vessel wall, such as shear stress and pressure, which occurs in blood flow dynamics, contribute greatly to plaque rupture in arteriosclerosis and to biochemical activation of endothelial cells. Therefore, noninvasive estimations of these mechanical loads are able to provide useful information for the prevention of vascular diseases. Although the pressure is the dominant component of mechanical load, for practical purposes, the pressure gradient is also often important. So far, we have investigated the estimation of the kinematic viscosity coefficient using a combination of the Navier-Stokes equations and ultrasonic velocity measurement. In this paper, a method for pressure gradient estimation using the estimated kinematic viscosity coefficient is proposed. The validity of the proposed method was investigated on the basis of the analysis with the data obtained by computer simulation and a flow phantom experiment. These results revealed that the proposed method can provide a valid estimation of the pressure gradient.
Low blood pressure in vegetarians: the possible role of potassium.
Ophir, O; Peer, G; Gilad, J; Blum, M; Aviram, A
Ninety-eight confirmed adult vegetarians were examined against a matched group of nonvegetarians living in the same urban environment in order to evaluate the prevalence of arterial hypertension. The average blood pressure was 126/77 for the vegetarians and 147/88 for the control group (p less than 0.05). Significantly lower blood pressure was found in every decade of age. Only 2% of the vegetarians had hypertension (higher than 160/95) as compared to 26% hypertensives in the nonvegetarians. These differences in blood pressure were maintained also when individuals with the same "relative weight" were compared. Family history of hypertension was similar in both groups. Analysis of factors such as coffee drinking and smoking did not favor reduced blood pressure among the vegetarian group. Sodium and potassium intake were evaluated from their ratios to creatinine in a single urine sample. It was evident that both groups excreted the same amounts of sodium, while potassium excretion was significantly higher in the vegetarians. In view of the increasing evidence that potassium plays an important role in the regulation of blood pressure it is concluded that the protective antihypertensive factor in the vegetarian diet is the presence of high amounts of potassium.
Ambulatory blood pressure monitoring: coming of age in nephrology.
Townsend, R R; Ford, V
The number of patients undergoing ambulatory blood pressure monitoring (ABPM) and the number of publications using this technique to evaluate the risks and effects of high blood pressure on target organs has been increasing, and dramatically so, in the last 5 years. Much of this growth has centered on the role of the blood pressure load (the percentage of systolic or diastolic readings above a preset value during a specific time period) and the changes in blood pressures levels that occur, with sleep. Although many studies are focused on the interaction between blood pressure (as assessed by ABPM) and the heart, interest is growing in the application of ABPM to the practice of nephrology. This paper discusses some of the technical aspects of ABPM, followed by a review of five areas of clinical research using ABPM, and which are relevant to renal medicine: microalbuminuria, renal function, renovascular hypertension, dialysis (hemodialysis and continuous ambulatory peritoneal dialysis), and transplantation. Despite a general lack of reimbursement for performance of the ABPM procedure, the growth in its usage and the willingness of clinicians to withhold or alter therapy on the basis of ABPM readings is testimony to its clinical value in the management of hypertension. PMID:8959618
[Blood pressure limits--the lower, the better?].
Leibundgut, Gregor
Arterial hypertension is a widespread risk factor for cardiovascular disease. The benefit of a consistent drug therapy is proportionally associated with the degree of blood pressure reduction. By extrapolating the data, the assumption arose "the lower the better" and was widely accepted. However, several studies found an increase in morbidity and mortality with an excessive reduction of blood pressure (J-curve). This seems to affect mainly cardiac risk, and only at lower blood pressures<60 mmHg also the cerebral risk. An important factor here is the diastolic blood pressure. Others found a linear correlation. Overall, a j-shaped connection remains controversial and is not considered equally for all organ systems. At the same time cardiovascular risk seems not to increase with additional reduction in blood pressure of <140 mm Hg to <120 mmHg. This has led to the latest guidelines of all societies recommending higher target values. Reasons for higher targets in drug therapy of arterial hypertension, are increased adverse drug reactions or increased healthcare costs with few additional benefit. The current recommendations of the ESH/ESC, AHA/ACC/ASH and the JNC 8 set a higher target value for some subgroups, but remain inconsistent among themselves. PMID:26098188
[Fruit and vegetable intake, and blood pressure. A population research].
Pienovi, Lucía; Lara, Macarena; Bustos, Patricia; Amigo, Hugo
Consuming fruits and vegetables is known to lower blood pressure. However, it is unclear how much should be consumed in order to achieve this effect. The aim of this study was to analyze the association between fruit and vegetable consumption and blood pressure. A cross-sectional study was conducted among a random sample of 777 adults between the ages of 32 and 38 from the Region of Valparaiso, Chile. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and a survey was carried out to quantify consumption trends over the past month. The fruit and vegetable intake was divided into three groups: less than 200 g, 200-400 g, and more than 400 g. In the analysis, multiple linear regression models were used and were adjusted for sex, BMI, physical activity, socioeconomic status, smoking, and sodium intake. It was observed that increasing intake of fruits and vegetables lowers the systolic blood pressure (β = -3.37 , 95% CI : -6.45 to -0.29; for consumption between 200 and 400 g ) (β = -4.02, 95% CI: -7.06 to -0.98; for consumption great than 400 g), while an effect on diastolic pressure is only seen in those who meet the WHO recommendation of consuming more than 400 g per day (β -2.87, CI = -5.17 to -0.57). In conclusion, consuming fruits and vegetables in amounts larger than 400 g per day, provides a protective effect against increases in both systolic and diastolic blood pressure.
Cuffless differential blood pressure estimation using smart phones.
Chandrasekaran, Vikram; Dantu, Ram; Jonnada, Srikanth; Thiyagaraja, Shanti; Subbu, Kalyan Pathapati
Smart phones today have become increasingly popular with the general public for their diverse functionalities such as navigation, social networking, and multimedia facilities. These phones are equipped with high-end processors, high-resolution cameras, and built-in sensors such as accelerometer, orientation-sensor, and light-sensor. According to comScore survey, 26.2% of U.S. adults use smart phones in their daily lives. Motivated by this statistic and the diverse capability of smart phones, we focus on utilizing them for biomedical applications. We present a new application of the smart phone with its built-in camera and microphone replacing the traditional stethoscope and cuff-based measurement technique, to quantify vital signs such as heart rate and blood pressure. We propose two differential blood pressure estimating techniques using the heartbeat and pulse data. The first method uses two smart phones whereas the second method replaces one of the phones with a customized external microphone. We estimate the systolic and diastolic pressure in the two techniques by computing the pulse pressure and the stroke volume from the data recorded. By comparing the estimated blood pressure values with those measured using a commercial blood pressure meter, we obtained encouraging results of 95-100% accuracy.
[Blood pressure: the lower the better? Maybe no].
Parretti, Damiano; Parretti, Luca; Medolla, Alessandra
Antihypertensive treatment is aimed at reducing as much as possible health outcomes in terms of morbidity and mortality. The main international guidelines and clinical trials showed different positions about blood pressure targets. At present, there is no common opinion about the benefits of an aggressive drug treatment; moreover it is not clear whether lower blood pressure values are related to increased morbidity and mortality. The recent randomized SPRINT trial has compared intensive vs standard drug therapy in a non-diabetic hypertensive population. The trial has shown benefits of intensive treatment in reducing important health outcomes, though results were not confirmed in several patient subsets. We examined the studies on hypertensive patients with comorbidities (i.e., chronic kidney disease, cardiovascular disease) to identify blood pressure targets recommended in these populations, but no strong evidence was found about the benefits of intensive treatment. In geriatric patients the "lower is better" paradigm cannot be entirely applied because of comorbidity, polypharmacy and frailty. PMID:27310906
Algorithmic Summaries of Perioperative Blood Pressure Fluctuations.
Toddenroth, Dennis; Ganslandt, Thomas; Drescher, Caroline; Weith, Thomas; Prokosch, Hans-Ulrich; Schuettler, Juergen; Muenster, Tino
Automated perioperative measurements such as cardiovascular monitoring data are commonly compared to established upper and lower thresholds, but could also allow for more complex interpretations. Analyzing such time series in extensive electronic medical records for research purposes may itself require customized automation, so we developed a set of algorithms for quantifying different aspects of temporal fluctuations. We implemented conventional measures of dispersion, summaries of absolute gradients between successive values, and Poincaré plots. We aggregated the severity and duration of hypotensive episodes by calculating the average area under different mean arterial pressure (MAP) thresholds. We applied these methods to 30,452 de-identified MAP series, and analyzed the similarity between alternative indices via hierarchical clustering. To explore the potential utility of these propositional metrics, we computed their statistical association with presumed complications due to cardiovascular instability. We observed that hierarchical clustering reliably segregated features that had been designed to quantify dissimilar aspects. Summaries of temporary hypotension turned out to be significantly increased among patient subgroups with subsequent signs of a complicated recovery. These associations were even stronger for measures that were specifically geared to capturing short-term MAP variability. These observations suggest the potential capability of our proposed algorithms for quantifying heterogeneous aspects of short-term MAP fluctuations. Future research might also target a wider selection of outcomes and other attributes that may be subject to intraoperative variability. PMID:27577440
Lee, Byung-Kook; Kim, Yangho
Introduction: We present data on the association of manganese (Mn) level with hypertension in a representative sample of the adult Korean population who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) 2008. Methods: This study was based on the data obtained by KNHANES 2008, which was conducted for three years (2007-2009) using a rolling sampling design involving a complex, stratified, multistage, probability-cluster survey of a representative sample of the noninstitutionalized civilian population of South Korea. Results: Multiple regression analysis after controlling for covariates, including gender, age, regional area, education level, smoking, drinking status, hemoglobin, and serum creatinine, showed that the beta coefficients of log blood Mn were 3.514, 1.878, and 2.517 for diastolic blood pressure, and 3.593, 2.449, and 2.440 for systolic blood pressure in female, male, and all participants, respectively. Multiple regression analysis including three other blood metals, lead, mercury, and cadmium, revealed no significant effects of the three metals on blood pressure and showed no effect on the association between blood Mn and blood pressure. In addition, doubling the blood Mn increased the risk of hypertension 1.828, 1.573, and 1.567 fold in women, men, and all participants, respectively, after adjustment for covariates. The addition of blood lead, mercury, and cadmium as covariates did not affect the association between blood Mn and the prevalence of hypertension. Conclusion: Blood Mn level was associated with an increased risk of hypertension in a representative sample of the Korean adult population. - Highlights: {yields} We showed the association of manganese with hypertension in Korean population. {yields} This study was based on the data obtained by KNHANES 2008. {yields} Blood manganese level was associated with an increased risk of hypertension.
Genetic and sociocultural components of high blood pressure.
Ward, R H
The cardiovascular diseases exert widely differing contributions to the total burden of mortality and morbidity in extant human populations. To a large extent these differences are a reflection of the variable distribution of specific antecedent risk factors. For one such risk factor, blood pressure, there is considerable variability in its distribution between different ethnic groups, especially between traditional and nontraditional societies. Intensive epidemiological studies in Western societies, together with a number of cross-cultural comparisons, suggest that the major determinants of high blood pressure are likely to be a constellation of sociocultural factors, with genetic determination being limited to the interaction between genotype and environment. Studies of populations in sociocultural transition offer an unique opportunity to identify the relative influence of specific sociocultural factors on the rate of change of blood pressure. In addition, when the study of such populations is placed in a quasi-experimental context, genetic-environmental interactions may also be detected. This strategy is illustrated by a study of the changing blood pressure distribution in Tokelauan migrants. Such an approach requires the initial definition of a response variable which measures change in blood pressure as a consequence of migration. The response variable, which identifies the relative influence of concomitants such as weight, age, and obesity, can then be subjected to genetic analysis. In the Tokelau case, blood pressure response tends to be positive in migrants but negative in nonmigrants. Further statistical analysis indicates that there is a small proportion of high responders in both populations and that these cluster in families in the migrant population. However, estimates of the transmission parameter suggest that sociocultural transmission, rather than Mendelian segregation, is responsible. To date there is little evidence that genetic
Child maltreatment and blood pressure in young adulthood.
Gooding, Holly C; Milliren, Carly; McLaughlin, Katie A; Richmond, Tracy K; Katz-Wise, Sabra L; Rich-Edwards, Janet; Austin, S Bryn
Adverse childhood experiences are associated with hypertension in older adults. This study assessed whether an association between child maltreatment and blood pressure is detectable in young adults and whether any association differs by sex or is modified by genetic polymorphisms known to be involved in stress sensitivity. We examined these patterns in a sample of 12,420 young adults ages 24-32 years who participated in Wave IV of the National Longitudinal Study of Adolescent Health. Participants retrospectively reported history of physical, emotional, or sexual abuse before age 18 years. Participants with a systolic blood pressure (SBP) ≥140 mmHg or a diastolic blood pressure (DBP) ≥90 mmHg were classified as hypertensive. We used sex-stratified linear and logistic regression models to assess associations between each type of childhood maltreatment and SBP, DBP, and hypertension. We created interaction terms to assess for effect modification of any relationship between maltreatment and blood pressure by sex or SLC64A genotype. Fifteen percent of females and 31.5% of males were hypertensive. Frequent physical abuse in childhood was reported by 5%, frequent emotional abuse by 12%, and any sexual abuse by 5%. No association was observed between abuse history and blood pressure in either males or females, nor was effect modification present by SLC64A genotype. Child maltreatment exposure was not associated with blood pressure or hypertension in young adults in this study. Future studies should investigate additional critical windows for the effect of child maltreatment on cardiovascular health. PMID:25245501
Egan, Brent M; Li, Jiexiang; Wagner, C Shaun
The Systolic Blood Pressure (SBP, mm Hg) Intervention Trial (SPRINT) showed that targeting SBP <120 mm Hg (intensive treatment, mean SBP: 121.5 mm Hg) versus <140 (standard treatment, mean SBP: 134.6 mm Hg) reduced cardiovascular events 25%. SPRINT has 2 implicit assumptions that could impact future US hypertension guidelines: (1) standard therapy controlled SBP similarly to that in adults with treated hypertension and (2) intensive therapy produced a lower mean SBP than in adults with treated hypertension and SBP <140 mm Hg. To examine these assumptions, US National Health and Nutrition Examination Survey 2009 to 2012 data were analyzed on 3 groups of adults with treated hypertension: group 1 consisted of SPRINT-like participants aged ≥50 years; group 2 consisted of participants all aged ≥18 years; and group 3 consisted of participants aged ≥18 years excluding group 1 but otherwise similar to SPRINT-like participants except high cardiovascular risk. Mean SBPs in groups 1, 2, and 3 were 133.0, 130.1, and 124.6, with 66.2%, 72.2%, and 81.9%, respectively, controlled to SBP <140; 68.3%, 74.8%, and 83.4% of the controlled subset had SBP <130. Mean SBPs in those controlled to <140 were 123.3, 120.9, and 118.9, respectively. Among US adults with treated hypertension, (1) the SPRINT-like group had higher mean SBP than comparison groups, yet lower than SPRINT standard treatment group and (2) among groups 1 to 3 with SBP <140, SBP values were within <3 mm Hg of SPRINT intensive treatment. SPRINT results suggest that treatment should be continued and not reduced when treated SBP is <130, especially for the SPRINT-like subset. Furthermore, increasing the percentage of treated adults with SBP <140 could approximate SPRINT intensive treatment SBP without lowering treatment goals.
Genome-wide linkage analysis for loci affecting pulse pressure: the Family Blood Pressure Program.
Bielinski, Suzette J; Lynch, Amy I; Miller, Michael B; Weder, Alan; Cooper, Richard; Oberman, Albert; Chen, Yii-Der Ida; Turner, Stephen T; Fornage, Myriam; Province, Michael; Arnett, Donna K
Pulse pressure, the difference between systolic and diastolic blood pressure, is an independent risk factor for cardiovascular disease. Increased pulse pressure reflects reduced compliance of arteries and is a marker of atherosclerosis. To locate genes that affect pulse pressure, a genome-wide linkage scan for quantitative trait loci influencing pulse pressure was performed using variance components methods as implemented in sequential oligogenic linkage analysis routines. The analysis sample included 10 798 participants in 3320 families who were recruited as part of the Family Blood Pressure Program and were phenotyped with an oscillometric blood pressure measurement device using a consistent protocol across centers. Pulse pressure was adjusted for the effects of sex, age, age2, age-by-sex interaction, age2-by-sex interaction, body mass index, and field center to remove sources of variation other than the genetic effects related to pulse pressure. Significant linkage was observed on chromosome 18 (logarithm of odds [LOD]=3.2) in a combined racial sample, chromosome 20 (LOD=4.4), and 17 (LOD=3.6) in Hispanics, chromosome 21 (LOD=4.3) in whites, chromosome 19 (LOD=3.1) in a combined sample of blacks and whites, and chromosome 7 (logarithm of odds [LOD]=3.1) in blacks from the GenNet Network. Our genome scan shows significant evidence for linkage for pulse pressure in multiple areas of the genome, supporting previous published linkage studies. The identification of these loci for pulse pressure and the apparent congruence with other blood pressure phenotypes provide increased support that these regions contain genes influencing blood pressure phenotypes.
Breaux-Shropshire, Tonya L; Judd, Eric; Vucovich, Lee A; Shropshire, Toneyell S; Singh, Sonal
Objective Our objective was to compare the clinical effectiveness of home blood pressure monitoring (HBPM) and 24-hour ambulatory blood pressure monitoring (ABPM) on blood pressure (BP) control and patient outcomes. Design A systematic review was conducted. We also appraised the methodological quality of studies. Data sources PubMed, Scopus, CINAHL, and the Cochrane Central Register of Control Trials (CENTRAL). Inclusion criteria Randomized control trials, prospective and retrospective cohort studies, observational studies, and case-control studies published in English from any year to present that describe HBPM and 24-hour ABPM and report on systolic and/or diastolic BP and/or heart attack, stroke, kidney failure and/or all-cause mortality for adult patients. Due to the nature of the question, studies with only untreated patients were not considered. Results Of 1,742 titles and abstractions independently reviewed by two reviewers, 137 studies met predetermined criteria for evaluation. Nineteen studies were identified as relevant and included in the paper. The common themes were that HBPM and ABPM correlated with cardiovascular events and mortality, and targeting HBPM or ABPM resulted in similar outcomes. Associations between BP measurement type and mortality differed by study population. Both the low sensitivity of office blood pressure monitoring (OBPM) to detect optimal BP control by ABPM and the added association of HBPM with cardiovascular mortality supported the routine use of HBPM in clinical practice. There was insufficient data to determine the benefit of using HBPM as a measurement standard for BP control. Conclusion HBPM encourages patient-centered care and improves BP control and patient outcomes. Given the limited number of studies with both HBPM and ABPM, these measurement types should be incorporated into the design of randomized clinical trials within hypertensive populations. PMID:26170715
Blood pressure rhythmicity and visceral fat in children with hypertension.
Niemirska, Anna; Litwin, Mieczysław; Feber, Janusz; Jurkiewicz, Elżbieta
Primary hypertension is associated with disturbed activity of the sympathetic nervous system and altered blood pressure rhythmicity. We analyzed changes in cardiovascular rhythmicity and its relation with target organ damage during 12 months of antihypertensive treatment in 50 boys with hypertension (median, 15.0 years). The following parameters were obtained before and after 12 months of antihypertensive treatment: 24-hour ambulatory blood pressure, left ventricular mass, carotid intima-media thickness, and MRI for visceral and subcutaneous adipose tissue. Amplitudes and acrophases of mean arterial pressure and heart rate rhythms were obtained for 24-, 12-, and 8-hour periods. After 1 year of treatment, 68% of patients were normotensive, and left ventricular mass and carotid intima-media thickness decreased in 60% and 62% of patients, respectively. Blood pressure and heart rate rhythmicity patterns did not change. Changes in blood pressure amplitude correlated with the decrease of waist circumference (P=0.035). Moreover, the decrease of visceral fat correlated with the decrease of 24-hour mean arterial pressure and heart rate acrophases (both P<0.05). There were no differences in changes of blood pressure and heart rate rhythms between patients who achieved or did not achieve normotension and regression of left ventricular mass and carotid intima-media thickness. It was concluded that abnormal cardiovascular rhythmicity persists in children with primary hypertension despite effective antihypertensive treatment, which suggests that it may be the primary abnormality. The correlation between changes in cardiovascular rhythmicity and visceral obesity may indicate that the visceral fat plays an important role in the sympathetic activity of adolescents with hypertension.
Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease
Appel, Lawrence J.; Wright, Jackson T.; Greene, Tom; Agodoa, Lawrence Y.; Astor, Brad C.; Bakris, George L.; Cleveland, William H.; Charleston, Jeanne; Contreras, Gabriel; Faulkner, Marquetta L.; Gabbai, Francis B.; Gassman, Jennifer J.; Hebert, Lee A.; Jamerson, Kenneth A.; Kopple, Joel D.; Kusek, John W.; Lash, James P.; Lea, Janice P.; Lewis, Julia B.; Lipkowitz, Michael S.; Massry, Shaul G.; Miller, Edgar R.; Norris, Keith; Phillips, Robert A.; Pogue, Velvie A.; Randall, Otelio S.; Rostand, Stephen G.; Smogorzewski, Miroslaw J.; Toto, Robert D.; Wang, Xuelei
BACKGROUND In observational studies, the relationship between blood pressure and end-stage renal disease (ESRD) is direct and progressive. The burden of hypertension-related chronic kidney disease and ESRD is especially high among black patients. Yet few trials have tested whether intensive blood-pressure control retards the progression of chronic kidney disease among black patients. METHODS We randomly assigned 1094 black patients with hypertensive chronic kidney disease to receive either intensive or standard blood-pressure control. After completing the trial phase, patients were invited to enroll in a cohort phase in which the blood-pressure target was less than 130/80 mm Hg. The primary clinical outcome in the cohort phase was the progression of chronic kidney disease, which was defined as a doubling of the serum creatinine level, a diagnosis of ESRD, or death. Follow-up ranged from 8.8 to 12.2 years. RESULTS During the trial phase, the mean blood pressure was 130/78 mm Hg in the intensive-control group and 141/86 mm Hg in the standard-control group. During the cohort phase, corresponding mean blood pressures were 131/78 mm Hg and 134/78 mm Hg. In both phases, there was no significant between-group difference in the risk of the primary outcome (hazard ratio in the intensive-control group, 0.91; P = 0.27). However, the effects differed according to the baseline level of proteinuria (P = 0.02 for interaction), with a potential benefit in patients with a protein-to-creatinine ratio of more than 0.22 (hazard ratio, 0.73; P = 0.01). CONCLUSIONS In overall analyses, intensive blood-pressure control had no effect on kidney disease progression. However, there may be differential effects of intensive blood-pressure control in patients with and those without baseline proteinuria. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Center on Minority Health and Health Disparities, and others.) PMID:20818902
Leal-Noval, S R; Muñoz, M; Asuero, M; Contreras, E; García-Erce, J A; Llau, J V; Moral, V; Páramo, J A; Quintana, M; Basora, M; Bautista-Paloma, F J; Bisbe, E; Bóveda, J L; Castillo-Muñoz, A; Colomina, M J; Fernández, C; Fernández-Mondéjar, E; Ferrándiz, C; García de Lorenzo, A; Gomar, C; Gómez-Luque, A; Izuel, M; Jiménez-Yuste, V; López-Briz, E; López-Fernández, M L; Martín-Conde, J A; Montoro-Ronsano, B; Paniagua, C; Romero-Garrido, J A; Ruiz, J C; Salinas-Argente, R; Sánchez, C; Torrabadella, P; Arellano, V; Candela, A; Fernández, J A; Fernández-Hinojosa, E; Puppo, A
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: « Does this particular AABT reduce the transfusion rate or not?» All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.
Leal-Noval, S R; Muñoz, M; Asuero, M; Contreras, E; García-Erce, J A; Llau, J V; Moral, V; Páramo, J A; Quintana, M; Basora, M; Bautista-Paloma, F J; Bisbe, E; Bóveda, J L; Castillo-Muñoz, A; Colomina, M J; Fernández, C; Fernández-Mondéjar, E; Ferrándiz, C; García de Lorenzo, A; Gomar, C; Gómez-Luque, A; Izuel, M; Jiménez-Yuste, V; López-Briz, E; López-Fernández, M L; Martín-Conde, J A; Montoro-Ronsano, B; Paniagua, C; Romero-Garrido, J A; Ruiz, J C; Salinas-Argente, R; Sánchez, C; Torrabadella, P; Arellano, V; Candela, A; Fernández, J A; Fernández-Hinojosa, E; Puppo, A
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: "Does this particular AABT reduce the transfusion rate or not?" All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology. PMID:23415109
Leal-Noval, S R; Muñoz, M; Asuero, M; Contreras, E; García-Erce, J A; Llau, J V; Moral, V; Páramo, J A; Quintana, M; Basora, M; Bautista-Paloma, F J; Bisbe, E; Bóveda, J L; Castillo-Muñoz, A; Colomina, M J; Fernández, C; Fernández-Mondéjar, E; Ferrándiz, C; García de Lorenzo, A; Gomar, C; Gómez-Luque, A; Izuel, M; Jiménez-Yuste, V; López-Briz, E; López-Fernández, M L; Martín-Conde, J A; Montoro-Ronsano, B; Paniagua, C; Romero-Garrido, J A; Ruiz, J C; Salinas-Argente, R; Sánchez, C; Torrabadella, P; Arellano, V; Candela, A; Fernández, J A; Fernández-Hinojosa, E; Puppo, A
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: « Does this particular AABT reduce the transfusion rate or not?» All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology. PMID:23507335
Blood pressure responses of wild giraffes studied by radio telemetry.
Van Citters, R L; Kemper, W S; Franklin, D L
Blood pressure was telemetered from transducers chronically implanted in the carotid arteries of two adult, wild, male giraffes captured and released near Kiboko, Kenya. Cerebral perfusion pressure ranged from 280/180 mm-Hg while the animal was lying with its head on the ground to 125/75 mm-Hg when it was standing erect; it varied between these levels during spontaneous activity such as walking, grazing, and running.
Burstyn, P G; Husbands, D R
Rabbits were fed diets containing 200 g.kg-1 coconut oil, palm oil, or safflower oil. Some of the diets also contained 200 g.kg-1 cellulose. The blood pressure was measured daily by a non-invasive technique for the 2 month duration of the experiment. Blood samples were drawn after an overnight fast at intervals during the experiment and analysed for lipids. Blood pressure was always increased by a fat-enriched diet. This effect was diminished and delayed by adding cellulose to the diets, though cellulose itself had no effect on the blood pressure in the absence of fat. There was a modest negative correlation between fasting serum triglyceride concentration and the blood pressure in animals fed fat enriched diets without added cellulose, but not in animals fed diets containing both fat and cellulose. These results coupled with those of Wright, Burstyn and Gibney may serve partly to explain the observation that vegetarians have lower blood pressures than omnivores, the latter consuming diets which are relatively richer in fats and poorer in fibre than the former. PMID:6253068
Burstyn, P G; Husbands, D R
Rabbits were fed diets containing 200 g.kg-1 coconut oil, palm oil, or safflower oil. Some of the diets also contained 200 g.kg-1 cellulose. The blood pressure was measured daily by a non-invasive technique for the 2 month duration of the experiment. Blood samples were drawn after an overnight fast at intervals during the experiment and analysed for lipids. Blood pressure was always increased by a fat-enriched diet. This effect was diminished and delayed by adding cellulose to the diets, though cellulose itself had no effect on the blood pressure in the absence of fat. There was a modest negative correlation between fasting serum triglyceride concentration and the blood pressure in animals fed fat enriched diets without added cellulose, but not in animals fed diets containing both fat and cellulose. These results coupled with those of Wright, Burstyn and Gibney may serve partly to explain the observation that vegetarians have lower blood pressures than omnivores, the latter consuming diets which are relatively richer in fats and poorer in fibre than the former.
Whyte, H M
Brief descriptions are given of the main methods of psychological intervention for controlling blood pressure and comments are made on their usefulness as gathered from recent reviews of the subject. Over-all assessment suggests that they are of value in the treatment of some patients with hypertension, mainly as adjuncts to pharmacological therapy, with relaxation, meditation and biofeedback techniques in order of decreasing effectiveness. Although the reduction in blood pressure produced is generally small, it is comparable with that produced by drugs, and was associated with a 30% reduction in the incidence of morbid events in the Australian therapeutic trial in mild hypertension. Further research integrating the behavioural, biological, and pharmacological aspects of blood pressure control is needed.
Shih, Y-T; Cheng, H-M; Sung, S-H; Hu, W-C; Chen, C-H
Central aortic systolic blood pressure (SBP-C) can be estimated from a cuff oscillometric waveform derived during the pulse volume plethysmography (PVP) by applying a device-specific aortic pressure-to-PVP waveform-generalized transfer function (A2P(GTF)). The present study compared the performance of an aortic-to-brachial pressure waveforms generalized transfer function (A2B(GTF)), which is independent of any PVP devices, with an A2P(GTF). Generalized transfer function of aortic-to-brachial (A2B(GTF)) and aortic-to-PVP (A2P(GTF)) were generated from the simultaneously obtained central aortic and brachial pressure waveforms recorded by a high-fidelity dual pressure sensor catheter, and the PVP waveform recorded by a customized noninvasive blood pressure monitor during cardiac catheterization in 40 patients, and were then applied in another 100 patients with simultaneously recorded invasive aortic pressure and noninvasively calibrated (using cuff SBP and diastolic blood pressures) PVP waveforms. The mean difference±s.d. between the noninvasively estimated and invasively recorded SBP-C was -2.1±7.7 mm Hg for A2B(GTF), which was not greater than that of -3.0±7.7 mm Hg for A2P(GTF) (P<0.01). In conclusion, SBP-C can be measured reliably using a noninvasive blood pressure monitor by applying either an A2P(GTF) or A2B(GTF) to a noninvasively calibrated PVP waveform. The performance of an A2B(GTF) is not inferior to that of an A2P(GTF).
Poor Long-Term Blood Pressure Control after Intracerebral Hemorrhage
Zahuranec, Darin B.; Wing, Jeffrey J.; Edwards, Dorothy F.; Menon, Ravi S.; Fernandez, Stephen J.; Burgess, Richard E.; Sobotka, Ian A.; German, Laura; Trouth, Anna J.; Shara, Nawar M.; Gibbons, M. Chris; Boden-Albala, Bernadette; Kidwell, Chelsea S.
Background and Purpose Hypertension is the most important risk factor associated with intracerebral hemorrhage (ICH). We explored racial differences in blood pressure (BP) control after ICH and assessed predictors of BP control at presentation, 30 days, and 1 year in a prospective cohort study. Methods Subjects with spontaneous ICH were identified from the DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) Project. Blood pressure was compared by race at each time point. Multivariable linear regression was used to determine predictors of presenting mean arterial pressure (MAP), and longitudinal linear regression was used to assess predictors of MAP at follow-up. Results A total of 162 patients were included (mean age 59, 53% male, 77% black). MAP at presentation was 9.6 mmHg higher in blacks than whites despite adjustment for confounders (p=0.065). Fewer than 20% of patients had normal blood pressure (<120/80 mmHg) at 30 days or 1 year. While there was no difference at 30 days (p=0.331), blacks were more likely than whites to have Stage I/II hypertension at one year (p=0.036). Factors associated with lower MAP at follow-up in multivariable analysis were being married at baseline (p=0.032) and living in a facility (versus personal residence) at the time of BP measurement (p=0.023). Conclusions Long-term blood pressure control is inadequate in patients following ICH, particularly in blacks. Further studies are needed to understand the role of social support and barriers to control to identify optimal approaches to improve blood pressure in this high-risk population. PMID:22903494
Insulin and blood pressure during weight loss in obese adolescents.
Rocchini, A P; Katch, V; Schork, A; Kelch, R P
The role of insulin in the regulation of blood pressure was evaluated in 50 obese adolescents before and after a 20-week weight loss program. When compared with 10 nonobese adolescents, the obese subjects had significantly higher systolic, diastolic, and mean arterial pressures (p = 0.005), an elevated 24-hour urinary sodium excretion (p = 0.002), an elevated fasting insulin concentration (p = 0.001), and an abnormal insulin response to an oral glucose tolerance test (sum of the insulins at 0, 1, and 2 hours post-oral glucose load; p = 0.001). We also observed a significant correlation between systolic and diastolic blood pressure (age and sex normalized) and body weight (r = 0.57, p less than 0.01 and r = 0.7, p less than 0.01), fasting insulin (r = 0.49, p less than 0.01 and r = 0.54, p less than 0.01), and sum of insulins (r = 0.42, p less than 0.01 and r = 0.46, p less than 0.01). To study the effect of weight loss on the relationship between blood pressure and insulin, the obese subjects were randomly assigned to three groups: 15 to a diet and behavior change group, 18 to a diet, behavior change, and exercise group, and 17 to an obese control group. Compared with the obese control group, the two weight loss groups each experienced a significant decrease in insulin (p less than 0.01), sum of the insulins (p less than 0.01), and blood pressure (p less than 0.01). The decrease in blood pressure during the weight loss program significantly correlated with the change in both insulin and body weight.(ABSTRACT TRUNCATED AT 250 WORDS)
Relations of blood pressure and head injury to regional cerebral blood flow.
Kisser, Jason E; Allen, Allyssa J; Katzel, Leslie I; Wendell, Carrington R; Siegel, Eliot L; Lefkowitz, David; Waldstein, Shari R
Hypertension confers increased risk for cognitive decline, dementia, and cerebrovascular disease. These associations have been attributed, in part, to cerebral hypoperfusion. Here we posit that relations of higher blood pressure to lower levels of cerebral perfusion may be potentiated by a prior head injury. Participants were 87 community-dwelling older adults - 69% men, 90% white, mean age=66.9years, 27.6% with a history of mild traumatic brain injury (mTBI) defined as a loss of consciousness ≤30min resulting from an injury to the head, and free of major medical (other than hypertension), neurological or psychiatric comorbidities. All engaged in clinical assessment of systolic and diastolic blood pressure (SBP, DBP) and single photon emission computed tomography (SPECT). Computerized coding of the SPECT images yielded relative ratios of blood flow in left and right cortical and select subcortical regions. Cerebellum served as the denominator. Sex-stratified multiple regression analyses, adjusted for age, education, race, alcohol consumption, smoking status, and depressive symptomatology, revealed significant interactions of blood pressure and head injury to cerebral blood flow in men only. Specifically, among men with a history of head injury, higher systolic blood pressure was associated with lower levels of perfusion in the left orbital (β=-3.21, p=0.024) and left dorsolateral (β=-2.61, p=0.042) prefrontal cortex, and left temporal cortex (β=-3.36, p=0.014); higher diastolic blood pressure was marginally associated with lower levels of perfusion in the left dorsolateral prefrontal cortex (β=-2.79, p=0.051). Results indicate that men with a history of head injury may be particularly vulnerable to the impact of higher blood pressure on cerebral perfusion in left anterior cortical regions, thus potentially enhancing risk for adverse brain and neurocognitive outcomes. PMID:27206865
Association of low-level blood lead and blood pressure in NHANES 1999-2006
Scinicariello, Franco; Abadin, Henry G.; Edward Murray, H.
This study investigated whether low blood-lead levels ({<=}10 {mu}g/dL) were associated with blood pressure (BP) outcomes. The authors analyzed data from National Health and Nutrition Examination Survey 1999-2006 and participants aged 20 years or older. Outcome variables were systolic and diastolic BP measurements, pulse pressure, and hypertension status. Multivariable linear and logistic regressions stratified by race/ethnicity and gender were performed. Blood lead levels (BLL) were significantly correlated with higher systolic BP among black men and women, but not white or Mexican-American participants. BLLs were significantly associated with higher diastolic BPs among white men and women and black men, whereas, a negative association was observed in Mexican-American men that had, also, a wider pulse pressure. Black men in the 90th percentile of blood lead distribution (BLL{>=}3.50 {mu}g/dL) compared to black men in the 10th percentile of blood lead distribution (BLL{<=}0.7 {mu}g/dL) had a significant increase of risk of having hypertension (adjusted POR=2.69; 95% CI: 1.08-6.72). In addition, blood cadmium was significantly associated with hypertension and systolic and diastolic blood. This study found that, despite the continuous decline in blood lead in the U.S. population, lead exposure disparities among race and gender still exist.
Gevers, M; Hack, W W; Ree, E F; Lafeber, H N; Westerhof, N
The aim of this study was to document arterial blood pressure wave forms at two sites along the arterial tree of the neonate: in the radial and posterior tibial arteries. Using a high-fidelity catheter tip-transducer system, peripheral arterial blood pressure wave forms in 26 critically newborn infants were studied. In 14 infants the radial artery and in 12 infants the posterior tibial artery was cannulated. Radial artery blood pressure waves resembled those of proximal aortic rather than those of the radial artery in adults. Quantitative analysis of the waves was performed to reassure this finding. Blood pressure waves obtained from posterior tibial artery resembled those of femoral artery rather than those of posterior tibial artery waves in adults. We conclude that radial and posterior tibial artery wave forms in neonates appear to have a central appearance. This phenomenon might be explained by the close proximity of the radial and posterior tibial artery to the central aorta and femoral artery respectively, due to the small and short limbs of the neonate. The finding allows an "easy central pressure look" at both ends of the neonatal aorta.
Study, Examinations, and Stress: Blood Pressure Assessments in College Students
ERIC Educational Resources Information Center
Hughes, Brian M.
The issue of stress associated with higher education and its impact on markers of student health is explored in three experiments looking at blood pressure levels in college students. All participants were full-time undergraduate students of psychology. In Experiment 1, academic fear of failure, assessed using psychometric testing, was found to be…
Health Promotion to Reduce Blood Pressure Level among Older Blacks.
ERIC Educational Resources Information Center
Haber, David
Low-income Black elders completed a 10-week health promotion program for the purpose of lowering or stabilizing blood pressure levels. Comparisons were made between classes that met weekly versus three times a week, and between yoga and aerobics formats. A peer-led program was developed that continued for 10 months after the professionally-led…
Time Spent on the Internet and Adolescent Blood Pressure
ERIC Educational Resources Information Center
Cassidy-Bushrow, Andrea E.; Johnson, Dayna A.; Peters, Rosalind M.; Burmeister, Charlotte; Joseph, Christine L. M.
Internet use is nearly ubiquitous among adolescents. Growing evidence suggests heavy Internet use negatively impacts health, yet the relationship between time spent on the Internet and adolescent blood pressure (BP) is unknown. We examined the association between Internet use and elevated BP in a racially diverse cross-sectional sample of 331…
Measures of blood pressure and cognition in dialysis patients
Technology Transfer Automated Retrieval System (TEKTRAN)
There are few reports on the relationship of blood pressure with cognitive function in maintenance dialysis patients. The Cognition and Dialysis Study is an ongoing investigation of cognitive function and its risk factors in six Boston area hemodialysis units. In this analysis, we evaluated the rela...
Dairy and blood pressure: a fresh look at the evidence.
Park, Keigan M; Cifelli, Christopher J
The Dietary Guidelines for Americans, 2010 indicated there is moderate evidence for an association between the consumption of dairy foods and lower blood pressure in adults; however, it also stated that more evidence was needed, especially in clinical trials, to fully delineate a causal relationship. The purpose of this review is to provide background by examining the historical literature and the evidence reviewed by the 2010 Dietary Guidelines Advisory Committee, to examine the gaps in knowledge indicated by that committee, and to determine if recently published evidence is sufficient to elucidate or dismiss an association between dairy foods and blood pressure maintenance. Examination of the newly published literature, together with evaluation of the evidence as a whole, shows that the preponderance of evidence indicates dairy foods are beneficially associated with blood pressure; however, additional research is necessary to identify the mechanism of action of dairy foods. New evidence should come from carefully designed clinical trials that examine not only blood pressure outcomes but also the ability of dairy foods to affect the vasculature.
Blood Pressure-Lowering Diet May Help Treat Gout
... blood pressure may also offer a non-drug treatment for gout -- a type of inflammatory arthritis, a new study ... risk for gout. A dietary approach to prevent gout should be considered first-line therapy," said study senior author Dr. Edgar Miller III. ...
21 CFR 870.2850 - Extravascular blood pressure transducer.
Code of Federal Regulations, 2010 CFR
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Extravascular blood pressure transducer. 870.2850 Section 870.2850 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Monitoring Devices § 870.2850...
A Nutrition Curriculum for Families with High Blood Pressure.
ERIC Educational Resources Information Center
Farris, Rosanne P.; And Others
A nutrition curriculum for elementary and secondary school students with high blood pressure was implemented as part of a Dietary/Exercise Alteration Program trial. Reduced sodium and energy intake and increased potassium intake were promoted. Materials and methods of the program are described. (Author/DF)
Measuring Arterial Blood Pressure. A Self-Contained Instructional Module.
ERIC Educational Resources Information Center
Schultz, Chris Ellen
This self-contained instructional module is designed to help adult caregivers learn how to measure arterial blood pressure in the home. The module includes the following parts: objectives; pretest (with answers); four sections of instructional material covering (1) equipment, (2) cuff placement and locating the brachial artery, (3) measuring blood…
Cardiac risk factors: new cholesterol and blood pressure management guidelines.
Anthony, David; George, Paul; Eaton, Charles B
The 2013 American College of Cardiology/American Heart Association cholesterol guidelines depart from low-density lipoprotein (LDL) treatment targets and recommend treating four specific patient groups with statins. Statins are the only cholesterol-lowering drugs with randomized trial evidence of benefit for preventing atherosclerotic cardiovascular disease (ASCVD). The groups are patients with clinical ASCVD; patients ages 40 to 75 years with diabetes and LDL of 70 to 189 mg/dL but no clinical ASCVD; patients 21 years or older with LDL levels of 190 mg/dL or higher; and patients ages 40 to 75 years with LDL of 70 to 189 mg/dL without clinical ASCVD or diabetes but with 10-year ASCVD risk of 7.5% or higher. Ten-year ASCVD risk may be calculated using the Pooled Cohort Equations. The Eighth Joint National Committee (JNC 8) guidelines for blood pressure management recommend a blood pressure goal of less than 140/90 mm Hg for all adults except those 60 years or older. For the latter group, the JNC 8 recommends a systolic blood pressure goal of less than 150 mm Hg. In another notable change from prior guidelines, the JNC 8 recommends relaxing the systolic blood pressure goal for patients with diabetes and chronic kidney disease to less than 140 mm Hg from less than 130 mm Hg. PMID:24936717
Health Instruction Packages: Consumer--Your Heart and Blood Pressure.
ERIC Educational Resources Information Center
Woods, James W.; And Others
Text, illustrations, and exercises are utilized in this set of learning modules to instruct the general public in the prevention and treatment of heart disease. The first module, by James W. Woods, presents a medical definition of high blood pressure, reviews its causes and effects, and discusses its treatment. A script to a slide version of this…
National High Blood Pressure 12-Month Kit. May 1988.
ERIC Educational Resources Information Center
National Heart and Lung Inst. (DHHS/NIH), Bethesda, MD. National High Blood Pressure Education Program.
Part I of this kit provides information for program planners and health professionals on ways to overcome barriers to health care among the medically underserved, promote high blood pressure control through the media and other community channels, and improve adherence to treatment among hypertensive patients. It lists additional resources for…
Blood Pressure Variability and Stress Management Training for Essential Hypertension
ERIC Educational Resources Information Center
Garcia-Vera, Maria Paz; Sanz, Jesus; Labrador, Francisco J.
The purpose of this study was to determine whether stress management training reduces blood pressure (BP) variability in hypertensive patients. Previous literature suggests that cardiovascular risk is not only a function of BP levels, but also of BP variability, and this partially depends on changes induced by the stress of everyday life. The…
Assessment of ambulatory blood pressure recorders: accuracy and clinical performance.
White, W B
There are now more than ten different manufacturers of non-invasive, portable blood pressure monitors in North America, Europe, and Japan. These ambulatory blood pressure recorders measure blood pressure by either auscultatory or oscillometric methodology. Technologic advances in the recorders have resulted in reduction in monitor size, reduction in or absence of motor noise during cuff inflation, ability to program the recorder without an external computer system, and enhanced precision. Recently, there has been concern that more structured validation protocols have not been implemented prior to the widespread marking of ambulatory blood pressure recorders. There is a need for proper assessment of recorders prior to use in clinical research or practice. Data on several existing recorders suggest that while most are reasonably accurate during resting measurements, many lose this accuracy during motion, and clinical performance may vary among the monitors. Validation studies of ambulatory recorders should include comparison with mercury column and intra-arterial determinations, resting and motion measurements, and assessment of clinical performance in hypertensive patients. PMID:1893652
The conundrum of arterial stiffness, elevated blood pressure, and aging.
AlGhatrif, Majd; Lakatta, Edward G
Isolated systolic hypertension is a major health burden that is expanding with the aging of our population. There is evidence that central arterial stiffness contributes to the rise in systolic blood pressure (SBP); at the same time, central arterial stiffening is accelerated in patients with increased SBP. This bidirectional relationship created a controversy in the field on whether arterial stiffness leads to hypertension or vice versa. Given the profound interdependency of arterial stiffness and blood pressure, this question seems intrinsically challenging, or probably naïve. The aorta's function of dampening the pulsatile flow generated by the left ventricle is optimal within a physiological range of distending pressure that secures the required distal flow, keeps the aorta in an optimal mechanical conformation, and minimizes cardiac work. This homeostasis is disturbed by age-associated, minute alterations in aortic hemodynamic and mechanical properties that induce short- and long-term alterations in each other. Hence, it is impossible to detect an "initial insult" at an epidemiological level. Earlier manifestations of these alterations are observed in young adulthood with a sharp decline in aortic strain and distensibility accompanied by an increase in diastolic blood pressure. Subsequently, aortic mechanical reserve is exhausted, and aortic remodeling with wall stiffening and dilatation ensue. These two phenomena affect pulse pressure in opposite directions and different magnitudes. With early remodeling, there is an increase in pulse pressure, due to the dominance of arterial wall stiffness, which in turn accelerates aortic wall stiffness and dilation. With advanced remodeling, which appears to be greater in men, the effect of diameter becomes more pronounced and partially offsets the effect of wall stiffness leading to plateauing in pulse pressure in men and slower increase in pulse pressure (PP) than that of wall stiffness in women. The complex nature of
Skin blood flow dynamics and its role in pressure ulcers
Liao, Fuyuan; Burns, Stephanie; Jan, Yih-Kuen
Pressure ulcers are a significant healthcare problem affecting the quality of life in wheelchair bounded or bed-ridden people and are a major cost to the healthcare system. Various assessment tools such as the Braden scale have been developed to quantify the risk level of pressure ulcers. These tools have provided an initial guideline on preventing pressure ulcers while additional assessments are needed to improve the outcomes of pressure ulcer prevention. Skin blood flow function that determines the ability of the skin in response to ischemic stress has been proposed to be a good indicator for identifying people at risk of pressure ulcers. Wavelet spectral and nonlinear complexity analyses have been performed to investigate the influences of the metabolic, neurogenic and myogenic activities on microvascular regulation in people with various pathological conditions. These findings have contributed to the understanding of the role of ischemia and viability on the development of pressure ulcers. The purpose of the present review is to provide an introduction of the basic concepts and approaches for the analysis of skin blood flow oscillations, and present an overview of the research results obtained so far. We hope this information may contribute to the development of better clinical guidelines for the prevention of pressure ulcers. PMID:23602509
Magnetic sensor for arterial distension and blood pressure monitoring.
Ruhhammer, Johannes; Herbstritt, Tamara; Ruh, Dominic; Foerster, Katharina; Heilmann, Claudia; Beyersdorf, Friedhelm; Goldschmidtboeing, Frank; Seifert, Andreas; Woias, Peter
A novel sensor for measuring arterial distension, pulse and pressure waveform is developed and evaluated. The system consists of a magnetic sensor which is applied and fixed to arterial vessels without any blood vessel constriction, hence avoiding stenosis. The measurement principle could be validated by in vitro experiments on silicone tubes, and by in vivo experiments in an animal model, thereby indicating the non-linear viscoelastic characteristics of real blood vessels. The sensor is capable to provide absolute measurements of the dynamically varying arterial diameter. By calibrating the sensor, a long-term monitoring system for continuously measuring blood pressure and other cardiovascular parameters could be developed based on the method described. This will improve diagnostics for high risk patients and enable a better, specific treatment.
Effect of hematocrit on blood pressure via hyperviscosity.
Cinar, Y; Demir, G; Paç, M; Cinar, A B
Increase in blood viscosity, defined as resistance to flow, is one factor in hypertension and atherosclerosis that contributes to the morbidity and mortality associated with tissue ischemia. In this research we evaluated the effect of hematocrit on increasing viscosity, and possible related changes in blood pressure, flow rate, and the equivalent physiologic compensation ratios. Blood samples were taken from 32 healthy individuals and centrifuged for 5 min at 3000 rpm to obtain 2.5 mL of erythrocyte mass from each. Then, at each step 0.5 mL of plasma was consecutively added in a total of 17 steps. The resultant hematocrit and viscosity changes were measured. Viscosity measurement was performed by capillary viscometer. The results were evaluated by the Student t test. It was observed that in the range of 60.16% and 25.32%, a 10.99% increase of hematocrit produced an increase of 1 unit relative viscosity, which means approximately a 20% increase in blood viscosity for a healthy individual. According to Poiseuille's equation, with a constant vessel length, if viscosity is increased by 20%, the decrease in blood flow rate will be 16.67% (100/120 = 83.33%; 100 - 83.33 = 16.67%). For the physiologic compensation of 20% increased viscosity, blood pressure increase will be 20% or vasodilation will be 4.66% in radius. Atherosclerotic and some healthy vessels with little vasodilatory capacities might benefit from treatment modalities to decrease the viscosity by hemodilution.
Blood Pressure and Lifestyle on Saba, Netherlands Antilles
Soloway, LE; Demerath, EW; Ochs, N; James, GD; Little, MA; Bindon, JR; Garruto, RM
During the 20th century, infectious disease morbidity and mortality generally waned while chronic degenerative diseases posed a growing burden at the global level. The population on Saba, Netherlands Antilles, has recently experienced such an epidemiologic transition, and hypertension was reported to be extraordinarily high, although no prevalences have been reported and relationships with lifestyle factors associated with rapid modernization have not been explored. In this study, a medical and demographic questionnaire, as well as body composition and blood pressure measures were collected from 278 Saban men and women aged 18-91 years. When age and sex adjusted, 48% of the population was hypertensive. Age, BMI and Afro-Caribbean descent were all associated with higher blood pressures. In a second phase, 124 individuals of the 278 were invited to receive a longer questionnaire on individual exposure to modernizing influences such as travel and education. Higher blood pressure was associated with having lived in fewer different places in the past; those who stayed only on Saba or Statia had higher blood pressures than those who had also lived in more modernized areas. However, this was no longer statistically significant after adjustment for age and BMI. Lifestyle incongruity was positively associated with higher blood pressure in that those with more discord between material wealth and income were more likely to be hypertensive, and this remained statistically significant after adjustment for age and adiposity. In summary, hypertension is highly prevalent on Saba, and tended to be associated with greater age, adiposity, Afro-Caribbean ancestry and lifestyle incongruity. PMID:19189411
Clitoral blood flow increases following vaginal pressure stimulation.
Lavoisier, P; Aloui, R; Schmidt, M H; Watrelot, A
The vascular responses of clitoral arteries to vaginal pressure stimulation in 10 volunteer women were evaluated by Doppler ultrasonography. Pressure stimulations (20-160 mm Hg) along the lower third of the vagina increased blood velocity and flow into clitoral arteries in 9 of the 10 women. The latency and duration of the Doppler responses ranged from 0.1 to 1.6 sec and from 3.2 to 9.5 sec, respectively, and the response was associated with a blood flow increase of 4 to 11 times the baseline prestimulation level. This response parallels that recorded in the cavernous arteries in men when a similar range of pressure stimulations are applied to the glans penis. Similar responses evoked in the male and female suggest a sexual synergy that may occur during intercourse in that such physiological responses and reflexes may be reciprocally reinforced.
Implantable blood pressure sensor for analyzing elasticity in arteries
NASA Astrophysics Data System (ADS)
Franco-Ayala, Marco; Martínez-Piñón, Fernando; Reyes-Barranca, Alfredo; Sánchez de la Peña, Salvador; Álvarez-Chavez, José A.
MEMS technology could be an option for the development of a pressure sensor which allows the monitoring of several electronic signals in humans. In this work, a comparison is made between the typical elasticity curves of several arteries in the human body and the elasticity obtained for MEMS silicon microstructures such as membranes and cantilevers employing Finite Element analysis tools. The purpose is to identify which types of microstructures are mechanically compatible with human arteries. The goal is to integrate a blood pressure sensor which can be implanted in proximity with an artery. The expected benefits for this type of sensor are mainly to reduce the problems associated with the use of bulk devices through the day and during several days. Such a sensor could give precise blood pressure readings in a continuous or periodic form, i.e. information that is especially important for some critical cases of hypertension patients.
Synchronization patterns in cerebral blood flow and peripheral blood pressure under minor stroke
NASA Astrophysics Data System (ADS)
Chen, Zhi; Ivanov, Plamen C.; Hu, Kun; Stanley, H. Eugene; Novak, Vera
Stroke is a leading cause of death and disability in the United States. The autoregulation of cerebral blood flow that adapts to changes in systemic blood pressure is impaired after stroke. We investigate blood flow velocities (BFV) from right and left middle cerebral arteries (MCA) and beat-to-beat blood pressure (BP) simultaneously measured from the finger, in 13 stroke and 11 healthy subjects using the mean value statistics and phase synchronization method. We find an increase in the vascular resistance and a much stronger cross-correlation with a time lag up to 20 seconds with the instantaneous phase increment of the BFV and BP signals for the subjects with stroke compared to healthy subjects.
Effect of hematocrit and systolic blood pressure on cerebral blood flow in newborn infants
Younkin, D.P.; Reivich, M.; Jaggi, J.L.; Obrist, W.D.; Delivoria-Papadopoulos, M.
The effects of hematocrit and systolic blood pressure on cerebral blood flow were measured in 15 stable, low birth weight babies. CBF was measured with a modification of the xenon-133 (/sup 133/Xe) clearance technique, which uses an intravenous bolus of /sup 133/Xe, an external chest detector to estimate arterial /sup 133/Xe concentration, eight external cranial detectors to measure cephalic /sup 133/Xe clearance curves, and a two-compartmental analysis of the cephalic /sup 133/Xe clearance curves to estimate CBF. There was a significant inverse correlation between hematocrit and CBF, presumably due to alterations in arterial oxygen content and blood viscosity. Newborn CBF varied independently of systolic blood pressure between 60 and 84 mm Hg, suggesting an intact cerebrovascular autoregulatory mechanism. These results indicate that at least two of the factors that affect newborn animal CBF are operational in human newborns and may have important clinical implications.
Background The effects of baseline and changes in blood pressure and low density lipoprotein (LDL) cholesterol on the carotid intima media thickness (IMT) have not been well documented. Methods A total of 2572 adults (mean age 53.8 years, 54.6% women) in a Taiwanese community undertook three blood pressure and LDL cholesterol examinations over 6 years. Latent growth curve modeling was used to investigate the effects of baseline and change in blood pressure and LDL cholesterol on IMT. Results Greater baseline LDL and blood pressure were associated with an increase in IMT (0.005 ± 0.002 mm per 1 mg/dL [p = 0.006] and 0.041 ± 0.004 mm mmHg [p <0.0001], respectively. Change in blood pressure was associated with a significant increase in IMT (0.047±0.016, P = 0.004), whilst the association between change in LDL and change in IMT was not statistically significant (0.008±0.006, P = 0.20). Conclusions Carotid IMT was associated with baseline blood pressure and LDL cholesterol, yet only changes of blood pressure, not LDL cholesterol, were related to carotid IMT during the 6-year observation. PMID:22900906
Immune cells control skin lymphatic electrolyte homeostasis and blood pressure.
Wiig, Helge; Schröder, Agnes; Neuhofer, Wolfgang; Jantsch, Jonathan; Kopp, Christoph; Karlsen, Tine V; Boschmann, Michael; Goss, Jennifer; Bry, Maija; Rakova, Natalia; Dahlmann, Anke; Brenner, Sven; Tenstad, Olav; Nurmi, Harri; Mervaala, Eero; Wagner, Hubertus; Beck, Franz-Xaver; Müller, Dominik N; Kerjaschki, Dontscho; Luft, Friedrich C; Harrison, David G; Alitalo, Kari; Titze, Jens
The skin interstitium sequesters excess Na+ and Cl- in salt-sensitive hypertension. Mononuclear phagocyte system (MPS) cells are recruited to the skin, sense the hypertonic electrolyte accumulation in skin, and activate the tonicity-responsive enhancer-binding protein (TONEBP, also known as NFAT5) to initiate expression and secretion of VEGFC, which enhances electrolyte clearance via cutaneous lymph vessels and increases eNOS expression in blood vessels. It is unclear whether this local MPS response to osmotic stress is important to systemic blood pressure control. Herein, we show that deletion of TonEBP in mouse MPS cells prevents the VEGFC response to a high-salt diet (HSD) and increases blood pressure. Additionally, an antibody that blocks the lymph-endothelial VEGFC receptor, VEGFR3, selectively inhibited MPS-driven increases in cutaneous lymphatic capillary density, led to skin Cl- accumulation, and induced salt-sensitive hypertension. Mice overexpressing soluble VEGFR3 in epidermal keratinocytes exhibited hypoplastic cutaneous lymph capillaries and increased Na+, Cl-, and water retention in skin and salt-sensitive hypertension. Further, we found that HSD elevated skin osmolality above plasma levels. These results suggest that the skin contains a hypertonic interstitial fluid compartment in which MPS cells exert homeostatic and blood pressure-regulatory control by local organization of interstitial electrolyte clearance via TONEBP and VEGFC/VEGFR3-mediated modification of cutaneous lymphatic capillary function. PMID:23722907
Wang, Anxin; Li, Zhifang; Yang, Yuling; Chen, Guojuan; Wang, Chunxue; Wu, Yuntao; Ruan, Chunyu; Liu, Yan; Wang, Yilong; Wu, Shouling
Background To investigate the relationship between baseline systolic blood pressure (SBP) and visit-to-visit blood pressure variability in a general population. Methods This is a prospective longitudinal cohort study on cardiovascular risk factors and cardiovascular or cerebrovascular events. Study participants attended a face-to-face interview every 2 years. Blood pressure variability was defined using the standard deviation and coefficient of variation of all SBP values at baseline and follow-up visits. The coefficient of variation is the ratio of the standard deviation to the mean SBP. We used multivariate linear regression models to test the relationships between SBP and standard deviation, and between SBP and coefficient of variation. Results Approximately 43,360 participants (mean age: 48.2±11.5 years) were selected. In multivariate analysis, after adjustment for potential confounders, baseline SBPs <120 mmHg were inversely related to standard deviation (P<0.001) and coefficient of variation (P<0.001). In contrast, baseline SBPs ≥140 mmHg were significantly positively associated with standard deviation (P<0.001) and coefficient of variation (P<0.001). Baseline SBPs of 120–140 mmHg were associated with the lowest standard deviation and coefficient of variation. The associations between baseline SBP and standard deviation, and between SBP and coefficient of variation during follow-ups showed a U curve. Conclusion Both lower and higher baseline SBPs were associated with increased blood pressure variability. To control blood pressure variability, a good target SBP range for a general population might be 120–139 mmHg. PMID:27536123
[Results and evaluation of long-term blood pressure monitoring].
Krönig, B
Using validated equipment for ABPM (by the indirect, intermittent, oscillometric and/or auscultatory method) reproducible results for day- and night-time blood-pressure, early morning readings, and blood-pressure variability may be obtained. The frequency of recordings should be about 15-min while awake and about 30-min during sleep-time, with at least 50 validated readings in 24-h to get an informative recording. Standardization could be achieved for the normotensive mean day-time value (upper limit 135/85 mmHg) and mean night-time recording (at least minus 10% compared to the day-time mean value). Using ABPM the diagnosis of arterial hypertension may be optimized, e.g. patients with white-coat hypertension could be discovered as well as those with diminished day-night rhythm ("non-dippers"); with the latter condition cerebral or myocardial damage might occur as consequence of primary hypertension; even more so, secondary hypertension may be discovered in patients with "non-dipper" constellation. In respect to therapy, a "profile-adjusted" medication may be obtained by ABPM; side-effects, which could be produced by "overtreatment", may be discovered. Since day- as well as night-time values, possibly even early morning pressures and the blood-pressure variability are positively correlated to cerebral and cardiovascular complications, ABPM becomes an important prognostic tool.
Daniels, J W; Molé, P A; Shaffrath, J D; Stebbins, C L
This study examined the acute effects of caffeine on the cardiovascular system during dynamic leg exercise. Ten trained, caffeine-naive cyclists (7 women and 3 men) were studied at rest and during bicycle ergometry before and after the ingestion of 6 mg/kg caffeine or 6 mg/kg fructose (placebo) with 250 ml of water. After consumption of caffeine or placebo, subjects either rested for 100 min (rest protocol) or rested for 45 min followed by 55 min of cycle ergometry at 65% of maximal oxygen consumption (exercise protocol). Measurement of mean arterial pressure (MAP), forearm blood flow (FBF), heart rate, skin temperature, and rectal temperature and calculation of forearm vascular conductance (FVC) were made at baseline and at 20-min intervals. Plasma ANG II was measured at baseline and at 60 min postingestion in the two exercise protocols. Before exercise, caffeine increased both systolic blood pressure (17%) and MAP (11%) without affecting FBF or FVC. During dynamic exercise, caffeine attenuated the increase in FBF (53%) and FVC (50%) and accentuated exercise-induced increases in ANG II (44%). Systolic blood pressure and MAP were also higher during exercise plus caffeine; however, these increases were secondary to the effects of caffeine on resting blood pressure. No significant differences were observed in heart rate, skin temperature, or rectal temperature. These findings indicate that caffeine can alter the cardiovascular response to dynamic exercise in a manner that may modify regional blood flow and conductance. PMID:9655769
[Pharmacological study on blood pressure in rats with bone disorders].
Shamoto, T
To evaluate the relationship between the elevation of blood pressure and altered bone metabolism, the changes of systolic blood pressure in six experimental models for bone disorders were investigated. Rats used were either parathyroidectomized, ovariectomized, fed with a calcium-deficient diet, fed with a vitamin D-deficient diet, treated with HEBP (1-Hydroxyethylidene-1, 1-bisphosphonate) or treated with streptozotocin. Hypertension developed in 5-week-old male rats fed with a calcium-deficient diet for 2 weeks, which evoked hypocalcemia and nutritional hyperparathyroidism. The blood pressure returned to normal when fed with a normal calcium diet. In parathyroidectomized rats receiving a normal calcium diet, the blood pressure did not rise, though the plasma calcium level decreased to an extent similar to the rats fed with the calcium-deficient diet. These findings seem to indicate that hyperparathyroidism, but not hypocalcemia, was involved in the elevation of blood pressure in rats fed with a calcium-deficient diet. Hypertension was not observed in rats fed with a vitamin D-deficient diet or treated with streptozotocin. These rats showed not only an increase in parathyroid hormone (PTH) but also a decrease in 1,25 (OH)2 D3. These results may suggest that the presence of 1,25 (OH)2D3 as well as the enhanced parathyroid function is necessary for the development of hypertension. The elevated blood pressure was reduced by a calcium antagonist, nifedipine, or by calcium supplementation, but not by an inhibitor of angiotensin-converting enzyme, captopril, or by calcitonin. This may indicate that hypertension due to nutritional hyperparathyroidism responds to the calcium antagonist nifedipine and to calcium supplementation, but does not depend on renin or salt. Furthermore, an acute hypotensive effect by human PTH (1-34) was not observed in the hypertension of calcium-deficient rats, suggesting the difference between acute and chronic effects of PTH. The hypertension
How the python heart separates pulmonary and systemic blood pressures and blood flows.
Jensen, Bjarke; Nielsen, Jan M; Axelsson, Michael; Pedersen, Michael; Löfman, Carl; Wang, Tobias
The multiple convergent evolution of high systemic blood pressure among terrestrial vertebrates has always been accompanied by lowered pulmonary pressure. In mammals, birds and crocodilians, this cardiac separation of pressures relies on the complete division of the right and left ventricles by a complete ventricular septum. However, the anatomy of the ventricle of most reptiles does not allow for complete anatomical division, but the hearts of pythons and varanid lizards can produce high systemic blood pressure while keeping the pulmonary blood pressure low. It is also known that these two groups of reptiles are characterised by low magnitudes of cardiac shunts. Little, however, is known about the mechanisms that allow for this pressure separation. Here we provide a description of cardiac structures and intracardiac events that have been revealed by ultrasonic measurements and angioscopy. Echocardiography revealed that the atrioventricular valves descend deep into the ventricle during ventricular filling and thereby greatly reduce the communication between the systemic (cavum arteriosum) and pulmonary (cavum pulmonale) ventricular chambers during diastole. Angioscopy and echocardiography showed how the two incomplete septa, the muscular ridge and the bulbuslamelle - ventricular structures common to all squamates - contract against each other in systole and provide functional division of the anatomically subdivided ventricle. Washout shunts are inevitable in the subdivided snake ventricle, but we show that the site of shunting, the cavum venosum, is very small throughout the cardiac cycle. It is concluded that the python ventricle is incapable of the pronounced and variable shunts of other snakes, because of its architecture and valvular mechanics.
[Shift work and night work: what effect on blood pressure?].
Cassat, M; Wuerzner, G; Burnier, M
Shift work has become more and more common for the last thirty years. By definition, shift work disturbs the circadian rhythm and the internal clock. Even if the pathophysiological mechanisms are not well understood, a greater cardiovascular risk has been attributed to shift work. Cross-sectional and cohort studies have identified an association between shift work and an elevated blood pressure. Shift workers also present a higher incidence of hypertension and progression than day workers. Unfortunately, the heterogeneity of the studies, the multiple confounding factors, as well as the complexity to achieve a suitable comparison group make it impossible to draw firm clinical evidence. Nevertheless, this population needs a medical follow-up focused on the cardiovascular risks and blood pressure.
A blood pressure survey in Nuevo Laredo, Mexico.
Caamano, A G; Cooper, R; Cedres, L; Barriero, L A; Dominquez, R C
A blood pressure survey was carried out in 1976 in the city of Nuevo Laredo, Mexico, which involved 6,351 persons 30-69 years old. The study sample was recruited so as to represent an approximation of the overall distribution of occupational classes in the urban population. Members of the population sample were relatively young and of low educational attainment. To the extent that comparisons among surveys are feasible, mean blood pressure levels and hypertension rates were roughly comparable to those found in the white population of the United States. Although no firm conclusions can be drawn from the survey, a trend toward somewhat higher hypertension rates within the professional and managerial class was observed in some age groups in Laredo. PMID:7063591
Lifestyle, stress, and blood pressure in a southern black community.
Dressler, W W
The effects of lifestyle incongruity on blood pressure were examined in research in an African-American community in the southern United States. Lifestyle incongruity is defined as the extent to which a high status style of life (based on possession of material goods and exposure to mass media) exceeds an individual's occupational class. In a sample of 186 25- to 55-year-olds, higher arterial blood pressure was related to higher lifestyle incongruity, especially among persons aged 40-55. These effects were independent of perceived chronic social role stressors, a self-report diagnosis of hypertension, age, sex, body mass, and skin color. Future research should examine more closely those social and psychological factors that might moderate the risk associated with lifestyle incongruity.
Boltz, Agnes; Schmidl, Doreen; Werkmeister, René M; Lasta, Michael; Kaya, Semira; Palkovits, Stefan; Told, Reinhard; Napora, Katarzyna J; Popa-Cherecheanu, Alina; Garhöfer, Gerhard; Schmetterer, Leopold
In the choroid, there is evidence that blood flow does not only depend on ocular perfusion pressure (OPP), but also on absolute mean arterial pressure (MAP) and intraocular pressure (IOP). The present study included 40 healthy subjects to investigate whether such behavior is also found in the optic nerve head (ONH). The ONH blood flow (ONHBF) was studied using laser Doppler flowmetry during a separate increase in IOP and MAP as well as during a combined elevation. Mean arterial pressure was increased by isometric exercise and IOP by the suction method. During both, the change in ONHBF was less pronounced than the change in OPP indicating autoregulation. Correlation analysis was performed for the combined experiments after pooling all data according to IOP and MAP values. A correlation between ONHBF and MAP was found at IOPs ⩽25 mm Hg (P<0.001), but not at IOPs>25 mm Hg (P=0.79). Optic nerve head blood flow and IOP were significantly correlated (P<0.001), and ONHBF was only slightly dependent on MAP. The data of the present study indicate a complex regulation of ONHBF during combined changes in MAP and IOP. Our results may be compatible with myogenic mechanisms underlying autoregulation, and indicate better ONHBF regulation during an increase in MAP than during an increase in IOP. PMID:23921903
Wearable Beat-to-Beat Blood Pressure Monitor
NASA Technical Reports Server (NTRS)
Lee, Yong Jin
Linea Research Corporation has developed a wearable noninvasive monitor that provides continuous blood pressure and heart rate measurements in extreme environments. Designed to monitor the physiological effects of astronauts' prolonged exposure to reduced-gravity environments as well as the effectiveness of various countermeasures, the device offers wireless connectivity to allow transfer of both real-time and historical data. It can be modified to monitor the health status of astronaut crew members during extravehicular missions.
Blood pressure, smoking and alcohol use, association with vascular dementia.
Peters, Ruth
The success of the ageing global population brings with it a growth in the number of dementia sufferers. Older adults are at highest risk of dementia and are likely to manifest both vascular and Alzheimer's pathology. Blood pressure also changes with ageing and there is evidence linking high blood pressure in midlife to an increased risk of later dementia. Data from later life is sparser. A number of intervention trials have been carried out with antihypertensives and have shown mixed results with regard to cognitive and dementia outcomes (both dementia overall and of vascular and Alzheimer's types). Meta-analyses have in general not found an association between blood pressure lowering and reduced dementia incidence, although the number of cases reported in the placebo controlled trials is invariably lower in the actively treated group. Systematic reviews and meta-analyses have also been published with regard to smoking and alcohol use and incident dementia. Despite mixed reports, overall smoking was associated with an increased risk of later dementia and alcohol with a 'U' or 'J' shaped relationship. Following the systematic reviews subsequent publications tend to report similar findings. The literature in this area suffers from differing populations, lengths of follow up and assessments of both risk factor and outcome. However, at present, maintenance of cognitive function would seem to be best served by treating cardiovascular risk factors in accordance with current guidelines, controlling blood pressure, reducing smoking and if consuming alcohol doing so in moderation. This review will concentrate on the prevention of dementia and attempt to provide an overview of the evidence relating to vascular related dementia and the potential risk factors of hypertension, alcohol use and smoking behaviour.
Self-Organization of Blood Pressure Regulation: Experimental Evidence
Fortrat, Jacques-Olivier; Levrard, Thibaud; Courcinous, Sandrine; Victor, Jacques
Blood pressure regulation is a prime example of homeostatic regulation. However, some characteristics of the cardiovascular system better match a non-linear self-organized system than a homeostatic one. To determine whether blood pressure regulation is self-organized, we repeated the seminal demonstration of self-organized control of movement, but applied it to the cardiovascular system. We looked for two distinctive features peculiar to self-organization: non-equilibrium phase transitions and hysteresis in their occurrence when the system is challenged. We challenged the cardiovascular system by means of slow, 20-min Tilt-Up and Tilt-Down tilt table tests in random order. We continuously determined the phase between oscillations at the breathing frequency of Total Peripheral Resistances and Heart Rate Variability by means of cross-spectral analysis. We looked for a significant phase drift during these procedures, which signed a non-equilibrium phase transition. We determined at which head-up tilt angle it occurred. We checked that this angle was significantly different between Tilt-Up and Tilt-Down to demonstrate hysteresis. We observed a significant non-equilibrium phase transition in nine healthy volunteers out of 11 with significant hysteresis (48.1 ± 7.5° and 21.8 ± 3.9° during Tilt-Up and Tilt-Down, respectively, p < 0.05). Our study shows experimental evidence of self-organized short-term blood pressure regulation. It provides new insights into blood pressure regulation and its related disorders. PMID:27065880
Longitudinal Impedance Tomography for Blood Pressure Characterization of Valve Deformation
Vahabi, Zahra; Amirfattahi, Rasool
Aorta is formed in a dynamic environment which gives rise to imbalances between many forces that tend to extend the diameter and length. Furthermore, internal forces tend to resist this extension. Impedance tomography can show this imbalance to stimulate the stenosis of aortic valve, growth of the elastic, collagen and to effectively reduce the stresses in the underlying tissue. In blood flow, auscultation noises occurred and in the echocardiography decrease in left ventricular ejection speed can be observed. In this paper, we have modeled an aorta based on anatomical studies to simulate natural, 20% and 30% stenosis as usual heart disease to early diagnosis. Valve deformation causes different impedance tomography in 3D mesh of aorta as blood pressure. Remodeling of aorta and its flow is found when a cylindrical slice of the fully retracted blood aorta is cut longitudinally through the wall. PMID:26120568
Aging, High Altitude, and Blood Pressure: A Complex Relationship.
Parati, Gianfranco; Ochoa, Juan Eugenio; Torlasco, Camilla; Salvi, Paolo; Lombardi, Carolina; Bilo, Grzegorz
Parati, Gianfranco, Juan Eugenio Ochoa, Camilla Torlasco, Paolo Salvi, Carolina Lombardi, and Grzegorz Bilo. Aging, high altitude, and blood pressure: A complex relationship. High Alt Biol Med 16:97-109, 2015.--Both aging and high altitude exposure may induce important changes in BP regulation, leading to significant increases in BP levels. By inducing atherosclerotic changes, stiffening of large arteries, renal dysfunction, and arterial baroreflex impairment, advancing age may induce progressive increases in systolic BP levels, promoting development and progression of arterial hypertension. It is also known, although mainly from studies in young or middle-aged subjects, that exposure to high altitude may influence different mechanisms involved in BP regulation (i.e., neural central and reflex control of sympathetic activity), leading to important increases in BP levels. The evidence is less clear, however, on whether and to what extent advancing age may influence the BP response to acute or chronic high altitude exposure. This is a question not only of scientific interest but also of practical relevance given the consistent number of elderly individuals who are exposed for short time periods (either for leisure or work) or live permanently at high altitude, in whom arterial hypertension is frequently observed. This article will review the evidence available on the relationship between aging and blood pressure levels at high altitude, the pathophysiological mechanisms behind this complex association, as well as some questions of practical interest regarding antihypertensive treatment in elderly subjects, and the effects of antihypertensive drugs on blood pressure response during high altitude exposure.
Lead exposure increases blood pressure by increasing angiotensinogen expression.
Jiao, Jiandong; Wang, Miaomiao; Wang, Yiqing; Sun, Na; Li, Chunping
Lead exposure can induce increased blood pressure. Several mechanisms have been proposed to explain lead-induced hypertension. Changes in angiotensinogen (AGT) expression levels or gene variants may also influence blood pressure. In this study, we hypothesized that AGT expression levels or gene variants contribute to lead-induced hypertension. A preliminary HEK293 cell model experiment was performed to analyze the association between AGT expression and lead exposure. In a population-based study, serum AGT level was measured in both lead-exposed and control populations. To further detect the influence of AGT gene single nucleotide polymorphisms (SNPs) in lead-induced hypertension, two SNPs (rs699 and rs4762) were genotyped in a case-control study including 219 lead-exposed subjects and 393 controls. Lead exposure caused an increase in AGT expression level in HEK 293 cell models (P < 0.001) compared to lead-free cells, and individuals exposed to lead had higher systolic and diastolic blood pressure (P < 0.001). Lead-exposed individuals had higher serum AGT levels compared to controls (P < 0.001). However, no association was found between AGT gene SNPs (rs699 and rs4762) and lead exposure. Nevertheless, the change in AGT expression level may play an important role in the development of lead-induced hypertension.
Sex Disparity in Blood Pressure Levels Among Nigerian Health Workers.
Adeoye, Abiodun M; Adebiyi, Adewole; Owolabi, Mayowa O; Lackland, Daniel T; Ogedegbe, Gbenga; Tayo, Bamidele O
Sex disparity in hypertension prevalence is well established in developed nations; however, there is paucity of data on the distribution of hypertension prevalence between the sexes in developing countries. Therefore, the authors examined sex differences in hypertension prevalence and cardiovascular risk factors in a sample of 352 healthy hospital workers in Nigeria. The mean ages of the men and women were 37.2±7.9 and 44.7±9.1 years, respectively. Thirty-five percent of participants were hypertensive, with 54% on treatment and 70% with controlled blood pressure. Men had a higher prevalence of hypertension (38.4% vs 33.0%) and prehypertension (37.6% vs 29.7%). Women had significantly higher odds of developing hypertension and of being on treatment. Mean blood pressure and fasting plasma glucose values were higher in men, while women were more often older, obese, and dyslipidemic and had a lower mean estimated glomerular filtration rate (P<.0001). These findings indicate sex disparity in blood pressure among hospital employees. Sex-focused management of hypertension is therefore advocated for hospital employees. PMID:26582436
Insulin as a potential factor influencing blood pressure in amputees.
Rose, H G; Yalow, R S; Schweitzer, P; Schwartz, E
War-injured, bilateral above-knee amputees are known to be at increased risk for cardiovascular mortality. To evaluate possible risk factors, we compared blood pressures and plasma glucose and insulin responses to orally administered glucose in 19 above-knee amputees from the Vietnam War (mean age, 36 +/- 1 years) with those of 12 age-matched unilateral below-elbow amputees. Body composition by densitometry and maximal oxygen consumption during arm or leg exercise were also determined. Nine of 19 leg amputees were hypertensive compared with one of 12 arm amputees. Their 3-hour average insulin responses were markedly increased (260 +/- 60 microU/ml) compared with those of normotensive leg (125 +/- 24 microU/ml) and arm amputees (101 +/- 20 microU/ml), and their mean body fat content (37.2%) also was elevated compared with that in both of these groups (23.2 and 22.6%, respectively). A unique finding was that both insulin response and body fat content were strongly and independently correlated with diastolic blood pressure (r = 0.55, p less than 0.01, and r = 0.62, p less than 0.01, respectively). We conclude that insulin may be a major factor in blood pressure regulation in the maturity-onset obesity that develops following traumatic leg amputation in young, healthy men.
Effects of nattokinase on blood pressure: a randomized, controlled trial.
Kim, Ji Young; Gum, Si Nae; Paik, Jean Kyung; Lim, Hyo Hee; Kim, Kyong-Chol; Ogasawara, Kazuya; Inoue, Kenichi; Park, Sungha; Jang, Yangsoo; Lee, Jong Ho
The objective of this study was to examine the effects of nattokinase supplementation on blood pressure in subjects with pre-hypertension or stage 1 hypertension. In a randomized, double-blind, placebo-controlled trial, 86 participants ranging from 20 to 80 years of age with an initial untreated systolic blood pressure (SBP) of 130 to 159 mmHg received nattokinase (2,000 FU/capsule) or a placebo capsule for 8 weeks. Seventy-three subjects completed the protocol. Compared with the control group, the net changes in SBP and diastolic blood pressure (DBP) were -5.55 mmHg (95% confidence interval [CI], -10.5 to -0.57 mmHg; p<0.05) and -2.84 mmHg (CI, -5.33 to -0.33 mmHg; p<0.05), respectively, after the 8-week intervention. The corresponding net change in renin activity was -1.17 ng/mL/h for the nattokinase group compared with the control group (p<0.05). In conclusion, nattokinase supplementation resulted in a reduction in SBP and DBP. These findings suggest that increased intake of nattokinase may play an important role in preventing and treating hypertension.
Sex Disparity in Blood Pressure Levels Among Nigerian Health Workers.
Adeoye, Abiodun M; Adebiyi, Adewole; Owolabi, Mayowa O; Lackland, Daniel T; Ogedegbe, Gbenga; Tayo, Bamidele O
Sex disparity in hypertension prevalence is well established in developed nations; however, there is paucity of data on the distribution of hypertension prevalence between the sexes in developing countries. Therefore, the authors examined sex differences in hypertension prevalence and cardiovascular risk factors in a sample of 352 healthy hospital workers in Nigeria. The mean ages of the men and women were 37.2±7.9 and 44.7±9.1 years, respectively. Thirty-five percent of participants were hypertensive, with 54% on treatment and 70% with controlled blood pressure. Men had a higher prevalence of hypertension (38.4% vs 33.0%) and prehypertension (37.6% vs 29.7%). Women had significantly higher odds of developing hypertension and of being on treatment. Mean blood pressure and fasting plasma glucose values were higher in men, while women were more often older, obese, and dyslipidemic and had a lower mean estimated glomerular filtration rate (P<.0001). These findings indicate sex disparity in blood pressure among hospital employees. Sex-focused management of hypertension is therefore advocated for hospital employees.
Risk Associated with Pulse Pressure on Out-of-Office Blood Pressure Measurement
Gu, Yu-Mei; Aparicio, Lucas S.; Liu, Yan-Ping; Asayama, Kei; Hansen, Tine W.; Niiranen, Teemu J.; Boggia, José; Thijs, Lutgarde; Staessen, Jan A.
Background Longitudinal studies have demonstrated that the risk of cardiovascular disease increases with pulse pressure (PP). However, PP remains an elusive cardiovascular risk factor with findings being inconsistent between studies. The 2013 ESH/ESC guideline proposed that PP is useful in stratification and suggested a threshold of 60 mm Hg, which is 10 mm Hg higher compared to that in the 2007 guideline; however, no justification for this increase was provided. Methodology Published thresholds of PP are based on office blood pressure measurement and often on arbitrary categorical analyses. In the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) and the International Database on HOme blood pressure in relation to Cardiovascular Outcome (IDHOCO), we determined outcome-driven thresholds for PP based on ambulatory or home blood pressure measurement, respectively. Results The main findings were that for people aged <60 years, PP did not refine risk stratification, whereas in older people the thresholds were 64 and 76 mm Hg for the ambulatory and home PP, respectively. However, PP provided little added predictive value over and beyond classical risk factors. PMID:26587443
Omboni, Stefano; Sala, Elisa
Randomized controlled trials have documented that a team of health care professionals which includes a physician, a nurse and a community pharmacist may improve the benefit and adherence of anti-hypertensive therapy. If such a health care model relies on blood pressure telemonitoring, it can promote a stronger relationship between health care professionals and patients, and further improve BP control of hypertension. The major benefit of this collaborative approach is to center the patient's management in a tailored way, providing comprehensive and preventive care based on health information technologies. In this review, the authors summarize recent clinical studies that evaluate the role of the community pharmacist in BP measurements, and in hypertension screening and control. The authors also describe the advantages of using blood pressure telemonitoring in home and ambulatory settings to evaluate potential alternatives to primary care in hypertension management.
Stergiou, George S; Parati, Gianfranco; Vlachopoulos, Charalambos; Achimastos, Apostolos; Andreadis, Emanouel; Asmar, Roland; Avolio, Alberto; Benetos, Athanase; Bilo, Grzegorz; Boubouchairopoulou, Nadia; Boutouyrie, Pierre; Castiglioni, Paolo; de la Sierra, Alejandro; Dolan, Eamon; Head, Geoffrey; Imai, Yutaka; Kario, Kazuomi; Kollias, Anastasios; Kotsis, Vasilis; Manios, Efstathios; McManus, Richard; Mengden, Thomas; Mihailidou, Anastasia; Myers, Martin; Niiranen, Teemu; Ochoa, Juan Eugenio; Ohkubo, Takayoshi; Omboni, Stefano; Padfield, Paul; Palatini, Paolo; Papaioannou, Theodore; Protogerou, Athanasios; Redon, Josep; Verdecchia, Paolo; Wang, Jiguang; Zanchetti, Alberto; Mancia, Giuseppe; O'Brien, Eoin
Office blood pressure measurement has been the basis for hypertension evaluation for almost a century. However, the evaluation of blood pressure out of the office using ambulatory or self-home monitoring is now strongly recommended for the accurate diagnosis in many, if not all, cases with suspected hypertension. Moreover, there is evidence that the variability of blood pressure might offer prognostic information that is independent of the average blood pressure level. Recently, advancement in technology has provided noninvasive evaluation of central (aortic) blood pressure, which might have attributes that are additive to the conventional brachial blood pressure measurement. This position statement, developed by international experts, deals with key research and practical issues in regard to peripheral blood pressure measurement (office, home, and ambulatory), blood pressure variability, and central blood pressure measurement. The objective is to present current achievements, identify gaps in knowledge and issues concerning clinical application, and present relevant research questions and directions to investigators and manufacturers for future research and development (primary goal).
Stergiou, George S; Parati, Gianfranco; Vlachopoulos, Charalambos; Achimastos, Apostolos; Andreadis, Emanouel; Asmar, Roland; Avolio, Alberto; Benetos, Athanase; Bilo, Grzegorz; Boubouchairopoulou, Nadia; Boutouyrie, Pierre; Castiglioni, Paolo; de la Sierra, Alejandro; Dolan, Eamon; Head, Geoffrey; Imai, Yutaka; Kario, Kazuomi; Kollias, Anastasios; Kotsis, Vasilis; Manios, Efstathios; McManus, Richard; Mengden, Thomas; Mihailidou, Anastasia; Myers, Martin; Niiranen, Teemu; Ochoa, Juan Eugenio; Ohkubo, Takayoshi; Omboni, Stefano; Padfield, Paul; Palatini, Paolo; Papaioannou, Theodore; Protogerou, Athanasios; Redon, Josep; Verdecchia, Paolo; Wang, Jiguang; Zanchetti, Alberto; Mancia, Giuseppe; O'Brien, Eoin
Office blood pressure measurement has been the basis for hypertension evaluation for almost a century. However, the evaluation of blood pressure out of the office using ambulatory or self-home monitoring is now strongly recommended for the accurate diagnosis in many, if not all, cases with suspected hypertension. Moreover, there is evidence that the variability of blood pressure might offer prognostic information that is independent of the average blood pressure level. Recently, advancement in technology has provided noninvasive evaluation of central (aortic) blood pressure, which might have attributes that are additive to the conventional brachial blood pressure measurement. This position statement, developed by international experts, deals with key research and practical issues in regard to peripheral blood pressure measurement (office, home, and ambulatory), blood pressure variability, and central blood pressure measurement. The objective is to present current achievements, identify gaps in knowledge and issues concerning clinical application, and present relevant research questions and directions to investigators and manufacturers for future research and development (primary goal). PMID:27214089
The diagnostic value of supine blood pressure in hypertension
Stańczyk, Adam; Gielerak, Grzegorz; Piotrowicz, Katarzyna; Banak, Małgorzata; Wójcik, Agnieszka
Introduction Correct blood pressure (BP) measurement is crucial in the diagnosis of arterial hypertension (AH), and controversy exists whether supine BP should be treated as equal to sitting BP. The aim of this study was to evaluate the relation of supine BP to sitting BP and ambulatory BP with regard to identification of diagnostic cut-offs for hypertension. Material and methods This study included 280 patients with AH (mean age: 44.3 ±10.6 years). The following measurements of BP were performed and analyzed: 1) sitting office blood pressure measurement (OSBP and ODBP); 2) supine BP (supSBP and supDBP), measured automatically (5 times with a 2-minute interval) during evaluation by the Niccomo device (Medis, Germany); 3) 24-hour ambulatory blood pressure (ABP) monitoring. Results The mean supSBP and supDBP were found to be lower than OSBP and ODBP (130.9 ±14.2 vs. 136.6 ±15.5 mm Hg and 84.8 ±9.4 vs. 87.8 ±10.2 mm Hg, respectively; p < 0.000001). The correlations between ABP and supBP/OBP were moderate and strong (correlation coefficients in range 0.55–0.76). The ROC analysis revealed that mean supBP ≥ 130/80 mm Hg was more precise than OBP ≥ 140/90 mm Hg in diagnosing hypertension (AUC: 0.820 vs. 0.550; sensitivity 80.7% vs. 57.4%; specificity 83.2% vs. 52.7%; p < 0.0001) and the additive value derived mostly from its higher predictive power of identifying patients with increased night-time BP. Conclusions In young and middle-aged hypertensive patients the blood pressure during a 10-minute supine rest was lower than in the sitting position. The supine blood pressure ≥ 130/80 mm Hg was found to be a specific and sensitive threshold for hypertension. PMID:27186174
Prediction of mean arterial blood pressure with linear stochastic models.
Genc, Sahika
A model-based approach that integrates known portion of the cardiovascular system and unknown portion through a parameter estimation to predict evolution of the mean arterial pressure is considered. The unknown portion corresponds to the neural portion that acts like a controller that takes corrective actions to regulate the arterial blood pressure at a constant level. The input to the neural part is the arterial pressure and output is the sympathetic nerve activity. In this model, heart rate is considered a proxy for sympathetic nerve activity. The neural portion is modeled as a linear discrete-time system with random coefficients. The performance of the model is tested on a case study of acute hypotensive episodes (AHEs) on PhysioNet data. TPRs and FPRs improve as more data becomes available during estimation period.
Hopfe, J; Schütze, J; Voss, A
We report on the comparison of simultaneous non-invasive measurements of finger blood pressure obtained at both hands with two Portapres systems. We investigated the impact of altering the measurement location on heart rate and blood pressure variability (HRV,BPV) parameters. Two 30 minutes recordings were done twice in 21 volunteers swapPing the systems. HRV and BPV parameters meanNN, sdNN, HF/P and Fw-Shannon were determined. Left and right side corresponding parameters were compared by U-test and correlations. Coincidence matrices were analysed by Mahalanobis distance. The minimal total divergence in HRV was 4.8%, in systolic BPV 6.7% and diastolic BPV 12.1%. These estimates recommend those parameters for multi-center studies that are insensitive to the measurement location. PMID:12465313
Guidoboni, Giovanna; Harris, Alon; Cassani, Simone; Arciero, Julia; Siesky, Brent; Amireskandari, Annahita; Tobe, Leslie; Egan, Patrick; Januleviciene, Ingrida; Park, Joshua
Purpose. This study investigates the relationship between intraocular pressure (IOP) and retinal hemodynamics and predicts how arterial blood pressure (BP) and blood flow autoregulation (AR) influence this relationship. Methods. A mathematical model is developed to simulate blood flow in the central retinal vessels and retinal microvasculature as current flowing through a network of resistances and capacitances. Variable resistances describe active and passive diameter changes due to AR and IOP. The model is validated by using clinically measured values of retinal blood flow and velocity. The model simulations for six theoretical patients with high, normal, and low BP (HBP-, NBP-, LBP-) and functional or absent AR (-wAR, -woAR) are compared with clinical data. Results. The model predicts that NBPwAR and HBPwAR patients can regulate retinal blood flow (RBF) as IOP varies between 15 and 23 mm Hg and between 23 and 29 mm Hg, respectively, whereas LBPwAR patients do not adequately regulate blood flow if IOP is 15 mm Hg or higher. Hemodynamic alterations would be noticeable only if IOP changes occur outside of the regulating range, which, most importantly, depend on BP. The model predictions are consistent with clinical data for IOP reduction via surgery and medications and for cases of induced IOP elevation. Conclusions. The theoretical model results suggest that the ability of IOP to induce noticeable changes in retinal hemodynamics depends on the levels of BP and AR of the individual. These predictions might help to explain the inconsistencies found in the clinical literature concerning the relationship between IOP and retinal hemodynamics. PMID:24876284
Rarefaction and blood pressure in systemic and pulmonary arteries.
Olufsen, Mette S; Hill, N A; Vaughan, Gareth D A; Sainsbury, Christopher; Johnson, Martin
The effects of vascular rarefaction (the loss of small arteries) on the circulation of blood are studied using a multiscale mathematical model that can predict blood flow and pressure in the systemic and pulmonary arteries. We augmented a model originally developed for the systemic arteries (Olufsen et al. 1998, 1999, 2000, 2004) to (a) predict flow and pressure in the pulmonary arteries, and (b) predict pressure propagation along the small arteries in the vascular beds. The systemic and pulmonary arteries are modelled as separate, bifurcating trees of compliant and tapering vessels. Each tree is divided into two parts representing the `large' and `small' arteries. Blood flow and pressure in the large arteries are predicted using a nonlinear cross-sectional area-averaged model for a Newtonian fluid in an elastic tube with inflow obtained from magnetic resonance measurements. Each terminal vessel within the network of the large arteries is coupled to a vascular bed of small `resistance' arteries, which are modelled as asymmetric structured trees with specified area and asymmetry ratios between the parent and daughter arteries. For the systemic circulation, each structured tree represents a specific vascular bed corresponding to major organs and limbs. For the pulmonary circulation, there are four vascular beds supplied by the interlobar arteries. This manuscript presents the first theoretical calculations of the propagation of the pressure and flow waves along systemic and pulmonary large and small arteries. Results for all networks were in agreement with published observations. Two studies were done with this model. First, we showed how rarefaction can be modelled by pruning the tree of arteries in the microvascular system. This was done by modulating parameters used for designing the structured trees. Results showed that rarefaction leads to increased mean and decreased pulse pressure in the large arteries. Second, we investigated the impact of decreasing vessel
Sudden Drops in Blood Pressure Tied to Higher Odds for Dementia
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Tighter Blood Pressure Control Could Save 100,000 U.S. Lives
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Women and Heart Disease | Healthy Blood Pressure | NIH MedlinePlus the Magazine
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Student Reactions During a Campus-Wide Blood Pressure Screening Program
ERIC Educational Resources Information Center
Stern, Carol; Hertz, Dorith
This blood pressure screening program met the goals of (1) detecting and treating asymptomatic hypertension among college students and (2) alerting the university community about high blood pressure. (MM)
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Spikes in Blood Pressure Don't Always Need ER Care
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[A model of blood pressure measurement which based on NN with raised accuracy].
Zhang, Weiqi
To address the accuracy problem of the oscillometric method in electronic blood pressure monitor, this paper introduces a more accurate new blood pressure measurement model, which based on ANN. And simulation checking method is put forward.
Increases in intramuscular pressure raise arterial blood pressure during dynamic exercise
NASA Technical Reports Server (NTRS)
Gallagher, K. M.; Fadel, P. J.; Smith, S. A.; Norton, K. H.; Querry, R. G.; Olivencia-Yurvati, A.; Raven, P. B.
This investigation was designed to determine the role of intramuscular pressure-sensitive mechanoreceptors and chemically sensitive metaboreceptors in affecting the blood pressure response to dynamic exercise in humans. Sixteen subjects performed incremental (20 W/min) cycle exercise to fatigue under four conditions: control, exercise with thigh cuff occlusion of 90 Torr (Cuff occlusion), exercise with lower body positive pressure (LBPP) of 45 Torr, and a combination of thigh cuff occlusion and LBPP (combination). Indexes of central command (heart rate, oxygen uptake, ratings of perceived exertion, and electromyographic activity), cardiac output, stroke volume, and total peripheral resistance were not significantly different between the four conditions. Mechanical stimulation during LBPP and combination conditions resulted in significant elevations in intramuscular pressure and mean arterial pressure from control at rest and throughout the incremental exercise protocol (P < 0.05). Conversely, there existed no significant changes in mean arterial pressure when the metaboreflex was stimulated by cuff occlusion. These findings suggest that under normal conditions the mechanoreflex is tonically active and is the primary mediator of exercise pressor reflex-induced alterations in arterial blood pressure during submaximal dynamic exercise in humans.
Sodium, potassium, blood pressure, and cardiovascular disease in humans.
Whelton, Paul K
The scientific underpinning for recommended levels of dietary sodium and potassium intake is of great importance to healthcare providers and policy decision-makers. Recent clinical trials and meta-analyses confirm the capacity of dietary sodium reduction and potassium supplementation to reduce blood pressure with no harmful effects on blood lipid levels in customary clinical settings. Blood pressure is thought to be a good surrogate for cardiovascular disease events and the most important preventable risk factor for mortality and disability-adjusted life years. Cohort analyses and related pooling studies that have been used to explore the relationship between dietary Na and CVD were all based on secondary analyses of datasets that were not designed for this purpose. Most are of insufficient quality to provide dependable information. The limited information available from clinical trial experience and cohort studies of higher quality suggests a reduction in dietary Na decreases CVD morbidity and mortality. Modeling studies suggest that a small reduction in dietary sodium would result in a sizable general population health benefit. Some countries have experienced a progressive decline in average dietary sodium consumption. However, there is no evidence of a corresponding trend in the United States, and almost the entire population is failing to meet dietary sodium and potassium guideline recommendations.
Association of Blood Lead level with Elevated Blood Pressure in Hypertensive Patients
Alghasham, Abdullah A.; Meki, Abdel-Raheim M.A.; Ismail, Hisham A.S.
Background: Lead is a metal with many important industrial uses. The relationship between lead exposure and the rise of blood pressure has received a great deal of attention as it was implicated that the mortality from cardiovascular diseases might be reduced by lowering lead levels in the environment. Objectives: The study was to investigate the correlation between the blood lead (B-Pb) levels and the values of blood pressure in hypertensive patients. Moreover, the plasma activities of angiotensin converting enzyme (ACE), plasma levels of nitric oxide (NO), total antioxidants (TAOX) and malondialdehyde (MDA) were estimated to investigate the correlations between the measured parameters and B-Pb levels in hypertensive patients. Methods: Fifty-five hypertensive patients were compared with fifty-three age and sex matched control group. The B-Pb levels were detected by flame atomic absorption spectrometry. The plasma levels of ACE activities, NO, TAOX and MDA were measured by colorimetric methods. Results: In the hypertensive patients, B-Pb levels were significantly higher than controls. Concomitantly, the plasma levels of ACE activities and MDA were significantly increased while the plasma levels of NO and TAOX were significantly reduced in the hypertensive patients in comparison with controls. There were significant positive correlations between B-Pb and each of MDA, and systolic as well as diastolic blood pressure. Conversely, a significant negative correlation was found between B-Pb and NO. Conclusions: Our study indicated that a positive relationship exists between blood pressure and B-Pb levels. The increased B-Pb levels were associated with oxidative stress. Moreover, The B-Pb level was negatively correlated with NO and this may clarify the implication of Pb as leading risk factor for the cardiovascular diseases and hypertension. These findings provide support for continued efforts to reduce lead concentration in the population at Qassim region. PMID:22489226
Differential control of systolic and diastolic blood pressure in blacks with essential hypertension.
Ayodele, Olugbenga E.; Alebiosu, C. Olutayo; Salako, Babatunde L.
OBJECTIVE: The risk of cardiovascular and renal diseases has been shown to be higher for systolic blood pressure than diastolic blood pressure. The aim of this study was to assess the differential control of systolic and diastolic blood pressure in Nigerians with primary hypertension. DESIGN AND SETTING: This was a prospective observational study carried out at the Medical Outpatient Department of the State Hospital, Abeokuta, Nigeria. Ethical approval for the study was obtained from the ethical committee of the hospital. METHODOLOGY: The study population consisted of 185 consecutive patients (65 males, 120 females), aged 35-85 years with primary hypertension who had been on drugs one- to 25 years prior to the onset of the study. Clinic blood pressure control was assessed during a year period. Six consecutive clinic blood pressure readings were recorded for each patient and the average calculated (systolic blood pressure and diastolic blood pressure separately). Patients were classified into subgroups based on the pattern of blood pressure control. RESULTS: Clinic systolic blood pressure and diastolic blood pressure was controlled in 58 patients (31.4%). Systolic blood pressure control was less frequent than diastolic blood pressure control (35.7% versus 51.4%, p<0.05). Patients with uncontrolled systolic blood pressure were significantly older than patients with only uncontrolled diastolic blood pressure (66.7+/-7.4 versus 52.9+/-8.7 years, p<0.001). CONCLUSION: Systolic blood pressure is less frequently controlled than diastolic blood pressure in Nigerians treated for primary hypertension. This may increase the patient's risk of developing stroke, and cardiovascular and renal complications. PMID:15040512
Baseline predictors of central aortic blood pressure: a PEAR substudy.
Rosenwasser, Rebecca F; Shah, Niren K; Smith, Steven M; Wen, Xuerong; Gong, Yan; Gums, John G; Nichols, Wilmer W; Chapman, Arlene B; Boerwinkle, Eric; Johnson, Julie; Epstein, Benjamin
Elevated central systolic blood pressure (BP) increases the risk of cardiovascular events and appears superior to peripheral BP for long term risk prediction. The objective of this study was to identify demographic and clinical factors associated with central pressures in patients with uncomplicated hypertension. We prospectively examined peripheral BP, central aortic BP, and arterial wall properties and wave reflection in 57 subjects with uncomplicated essential hypertension in the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR) Study. Significant predictors of central SBP included height, smoking status, heart rate (HR), and peripheral systolic BP (SBP), while central diastolic BP (DBP) was explained by peripheral DBP and HR. These variables accounted for nearly all of the variability in central SBP and central DBP (R(2) = 0.94 and R(2) = 0.98, respectively). Central pulse pressure variability was largely explained by gender, ex-smoking status, HR, peripheral SBP, and peripheral DBP (R(2) = 0.94). Central augmented pressure had a direct relationship with smoking status, peripheral SBP, and duration of hypertension, whereas it was indirectly related to height, HR, and peripheral DBP. Easily obtainable demographic and clinical factors are associated with central pressures in essential hypertensive persons. These relationships should be considered in future studies to improve assessment of BP to reduce cardiovascular risk and mortality.
Cakmak, Huseyin Altug; Cakmak, Burcu Dincgez; Yumru, Ayse Ender; Aslan, Serkan; Enhos, Asim; Kalkan, Ali Kemal; Coskun, Ebru Inci; Acikgoz, Abdullah Serdar; Karatas, Suat
Background Hypertension, diabetes mellitus, and osteoporosis are important comorbidities commonly seen in postmenopausal women. The aim of the present study was to investigate the relationships between blood pressure, blood glucose, and bone mineral density (BMD) in postmenopausal Turkish women. Methods In this cross-sectional study, 270 consecutive patients who were admitted to an outpatient clinic with vasomotor symptoms and/or at least 1 year of amenorrhea were included. The patients were categorized into three groups according to their blood pressure and metabolic status as follows: normotensive, hypertensive nondiabetics, and hypertensive diabetics. The T- and z-scores of the proximal femur and lumbar vertebrae were measured with the dual-energy X-ray absorptiometry method to assess the BMD of the study groups. Results Lumbar vertebral T-scores (P<0.001), lumbar vertebral z-scores (P<0.003), and proximal femoral T-scores (P<0.001) were demonstrated to be significantly lower in the hypertensive diabetic group compared to the hypertensive nondiabetic and normotensive groups. Systolic blood pressure was significantly inversely correlated with lumbar vertebral T-scores (r=−0.382; P=0.001), lumbar vertebral z-scores (r=−0.290; P=0.001), and proximal femoral T-scores (r=−0.340; P=0.001). Moreover, diastolic blood pressure was significantly inversely correlated with lumbar vertebral T-scores (r=−0.318; P=0.001), lumbar vertebral z-scores (r=−0.340; P=0.001), and proximal femoral T-scores (r=−0.304; P=0.001). Hypertension (odds ratio [OR]: 2.541, 95% confidence interval [CI]: 1.46–3.48, P=0.003), diabetes mellitus (OR: 2.136, 95% CI: 1.254–3.678, P=0.006), and age (OR: 1.069, 95% CI: 1.007–1.163, P=0.022) were found to be significant independent predictors of osteopenia in a multivariate analysis, after adjusting for other risk parameters. Conclusion The present study is the first to evaluate the relationships between blood pressure, blood glucose
Méline, Julie; Van Hulst, Andraea; Thomas, Frederique; Chaix, Basile
Associations between road traffic noise and hypertension have been repeatedly documented, whereas associations with rail or total road, rail, and air (RRA) traffic noise have rarely been investigated. Moreover, most studies of noise in the environment have only taken into account the residential neighborhood. Finally, few studies have taken into account individual/neighborhood confounders in the relationship between noise and hypertension. We performed adjusted multilevel regression analyses using data from the 7,290 participants of the RECORD Study to investigate the associations of outdoor road, rail, air, and RRA traffic noise estimated at the place of residence, at the workplace, and in the neighborhoods around the residence and workplace with systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension. Associations were documented between higher outdoor RRA and road traffic noise estimated at the workplace and a higher SBP [+1.36 mm of mercury, 95% confidence interval (CI): +0.12, +2.60 for 65-80 dB(A) vs 30-45 dB(A)] and DBP [+1.07 (95% CI: +0.28, +1.86)], after adjustment for individual/neighborhood confounders. These associations remained after adjustment for risk factors of hypertension. Associations were documented neither with rail traffic noise nor for hypertension. Associations between transportation noise at the workplace and blood pressure (BP) may be attributable to the higher levels of road traffic noise at the workplace than at the residence. To better understand why only noise estimated at the workplace was associated with BP, our future work will combine Global Positioning System (GPS) tracking, assessment of noise levels with sensors, and ambulatory monitoring of BP. PMID:26356373
Méline, Julie; Van Hulst, Andraea; Thomas, Frederique; Chaix, Basile
Associations between road traffic noise and hypertension have been repeatedly documented, whereas associations with rail or total road, rail, and air (RRA) traffic noise have rarely been investigated. Moreover, most studies of noise in the environment have only taken into account the residential neighborhood. Finally, few studies have taken into account individual/neighborhood confounders in the relationship between noise and hypertension. We performed adjusted multilevel regression analyses using data from the 7,290 participants of the RECORD Study to investigate the associations of outdoor road, rail, air, and RRA traffic noise estimated at the place of residence, at the workplace, and in the neighborhoods around the residence and workplace with systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension. Associations were documented between higher outdoor RRA and road traffic noise estimated at the workplace and a higher SBP [+1.36 mm of mercury, 95% confidence interval (CI): +0.12, +2.60 for 65-80 dB(A) vs 30-45 dB(A)] and DBP [+1.07 (95% CI: +0.28, +1.86)], after adjustment for individual/neighborhood confounders. These associations remained after adjustment for risk factors of hypertension. Associations were documented neither with rail traffic noise nor for hypertension. Associations between transportation noise at the workplace and blood pressure (BP) may be attributable to the higher levels of road traffic noise at the workplace than at the residence. To better understand why only noise estimated at the workplace was associated with BP, our future work will combine Global Positioning System (GPS) tracking, assessment of noise levels with sensors, and ambulatory monitoring of BP. PMID:26356373
77 FR 17060 - Announcement of Requirements and Registration for Beat Down Blood Pressure Challenge
Federal Register 2010, 2011, 2012, 2013, 2014
... HUMAN SERVICES Announcement of Requirements and Registration for Beat Down Blood Pressure Challenge... years, announces the launch of the Beat Down Blood Pressure Video Challenge. This challenge is an open... consumer e-health tools to manage high blood pressure. Health care providers are also encouraged to...
ERIC Educational Resources Information Center
Clark, Rodney
Examined the effects of subjective stress and coping resources on blood pressure reactivity among black college students. The interactive effects of subjective stress and coping resources predicted diastolic blood pressure reactivity. Higher levels of problem-focused coping related to more marked diastolic blood pressure changes under conditions…
21 CFR 868.1150 - Indwelling blood carbon dioxide partial pressure (PCO2) analyzer.
Code of Federal Regulations, 2013 CFR
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Indwelling blood carbon dioxide partial pressure....1150 Indwelling blood carbon dioxide partial pressure (PCO2) analyzer. (a) Identification. An indwelling blood carbon dioxide partial pressure PCO2 analyzer is a device that consists of a...
21 CFR 868.1150 - Indwelling blood carbon dioxide partial pressure (PCO2) analyzer.
Code of Federal Regulations, 2011 CFR
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Indwelling blood carbon dioxide partial pressure....1150 Indwelling blood carbon dioxide partial pressure (PCO2) analyzer. (a) Identification. An indwelling blood carbon dioxide partial pressure PCO2 analyzer is a device that consists of a...
21 CFR 868.1150 - Indwelling blood carbon dioxide partial pressure (PCO2) analyzer.
Code of Federal Regulations, 2010 CFR
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Indwelling blood carbon dioxide partial pressure....1150 Indwelling blood carbon dioxide partial pressure (PCO2) analyzer. (a) Identification. An indwelling blood carbon dioxide partial pressure PCO2 analyzer is a device that consists of a...
21 CFR 868.1150 - Indwelling blood carbon dioxide partial pressure (PCO2) analyzer.
Code of Federal Regulations, 2014 CFR
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Indwelling blood carbon dioxide partial pressure....1150 Indwelling blood carbon dioxide partial pressure (PCO2) analyzer. (a) Identification. An indwelling blood carbon dioxide partial pressure PCO2 analyzer is a device that consists of a...
21 CFR 868.1150 - Indwelling blood carbon dioxide partial pressure (PCO2) analyzer.
Code of Federal Regulations, 2012 CFR
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Indwelling blood carbon dioxide partial pressure....1150 Indwelling blood carbon dioxide partial pressure (PCO2) analyzer. (a) Identification. An indwelling blood carbon dioxide partial pressure PCO2 analyzer is a device that consists of a...
Blood pressure measurement: lessons learned from our ancestors.
Karamanou, Marianna; Papaioannou, Theodore G; Tsoucalas, Gregory; Tousoulis, Dimitris; Stefanadis, Christodoulos; Androutsos, George
The profound observations of William Harvey (1578-1657), in blood circulation and the progress of physical science laid the foundation for the development of the Iatrophysical School that contributed to the evolution of clinical sphygmomanometry. The pioneer work of Reverend Stephen Hales (1677-1761) demonstrated the dynamics of the vascular system. One century later the French physician Jean-Léonard-Marie Poiseuille (1797-1867) invented a U-tube mercury manometer and in 1860 the physiologist Etienne- Jules Marey (1830-1904) devised the first portable sphygmograph for recording the pulse wave. The non-invasive techniques of blood pressure measurement were completed by Scipione Riva-Rocci (1896-1937) sphygmomanometer and the description of "Korotkov sounds" by the Russian surgeon Nikolai- Sergeyevich Korotkov (1874-1920). PMID:25341864
Intraspecific scaling of arterial blood pressure in the Burmese python.
Enok, Sanne; Slay, Christopher; Abe, Augusto S; Hicks, James W; Wang, Tobias
Interspecific allometric analyses indicate that mean arterial blood pressure (MAP) increases with body mass of snakes and mammals. In snakes, MAP increases in proportion to the increased distance between the heart and the head, when the heart-head vertical distance is expressed as ρgh (where ρ is the density of blood, G: is acceleration due to gravity and h is the vertical distance above the heart), and the rise in MAP is associated with a larger heart to normalize wall stress in the ventricular wall. Based on measurements of MAP in Burmese pythons ranging from 0.9 to 3.7 m in length (0.20-27 kg), we demonstrate that although MAP increases with body mass, the rise in MAP is merely half of that predicted by heart-head distance. Scaling relationships within individual species, therefore, may not be accurately predicted by existing interspecific analyses.
Dietary sodium and health: more than just blood pressure.
Farquhar, William B; Edwards, David G; Jurkovitz, Claudine T; Weintraub, William S
Sodium is essential for cellular homeostasis and physiological function. Excess dietary sodium has been linked to elevations in blood pressure (BP). Salt sensitivity of BP varies widely, but certain subgroups tend to be more salt sensitive. The mechanisms underlying sodium-induced increases in BP are not completely understood but may involve alterations in renal function, fluid volume, fluid-regulatory hormones, the vasculature, cardiac function, and the autonomic nervous system. Recent pre-clinical and clinical data support that even in the absence of an increase in BP, excess dietary sodium can adversely affect target organs, including the blood vessels, heart, kidneys, and brain. In this review, the investigators review these issues and the epidemiological research relating dietary sodium to BP and cardiovascular health outcomes, addressing recent controversies. They also provide information and strategies for reducing dietary sodium.
Clinical research into the efficacy and safety of antihypertensives has used non-invasive automated ambulatory blood pressure monitoring (ABPM) for the last two decades. Different national validation requirements have standardized the equip;ment and the clinical use thereof. The European Standardization for Medical Devices (CEN/CENELEC) organization has recently approved requirements for new ABPM devices in most European countries. For the approval process of new antihypertensive drugs, ABPM today has a supportive role to play in the documentation. Increasingly, national regulatory bureaux demand ABPM data. For the US Food and Drug Administration (FDA) ABPM is still not a prerequisite for approval but the value of peak: trough evaluation has recently been debated by major advisory boards. A US-based Cooperative Research and Development Agreement (CRADA) has been established to evaluate ABPM data from controlled trials with versus without placebo controls. In major clinical trials it has been documented that the ABPM technique reduces sample size, reduces the number of placebo-controlled trials, provides detailed information concerning the first-dose effect, documents the duration of action and dose-response relationship and allows documentation of antihypertensive therapy throughout 24 h, including the night-time period. ABPM data are recommended to support the documentation of 24 h efficacy and safety of new antihypertensive dose regimens. ABPM has been discussed for the documentation of new drugs to treat angina pectoris, heart failure and arrhythmia. PMID:10226253
Blood pressure change in Africa: case study from Nigeria.
Kaufman, J S; Owoaje, E E; Rotimi, C N; Cooper, R S
Studies of migrants and comparisons of rural versus urban communities are potentially informative study designs because they allow examination of genetically similar population subgroups exposed to diverse environmental conditions. These designs have been underused in Africa, where recent urbanization has created many situations in which nearby communities of common ethnicity and culture live under different social and economic circumstances. The International Study of Hypertension in Blacks (ICSHIB) conducted several overlapping surveys in Nigeria starting in 1993. These surveys were based primarily in the rural village of Idere and the urban community of Idikan, both inhabited by people defined ethnically as Oyo Yoruba and sharing a common language and culture. Survey teams collected standardized blood pressure and anthropometric measurements, and some study participants provided 24-hr urine samples and questionnaire data on psychosocial stress and social integration. Rural and urban groups differed substantially in blood pressure and related characteristics. Age-adjusted prevalence of hypertension (blood pressure > or = 140/90 mm Hg) for participants aged 25 years and older was 7-8% in Idere and 24-27% in Idikan. The distributions of overweight, sodium/potassium ratio, perceived stress, and social integration scores all contributed to lower hypertension risk in Idere. The effects and interactions of these identified risk factors remain poorly understood, even among people who share a common genetic background, similar diet, and many other lifestyle features. Nonetheless, the rural-urban distinction is sufficiently salient to engender a nearly threefold difference in hypertension prevalence. This disparity in disease prevalence demonstrates the sensitivity of human beings to the environmental determinants of disease and provides a sobering example of the difficulty in identifying subtle genetic effects, which can be easily overwhelmed by small differences in
Evidence relating sodium intake to blood pressure and CVD.
O'Donnell, Martin; Mente, Andrew; Yusuf, Salim
Sodium is an essential nutrient, mostly ingested as salt (sodium chloride). Average sodium intake ranges from 3 to 6 g per day (7.5-15 g/day of salt) in most countries, with regional variations. Increasing levels of sodium intake have a positive association with higher blood pressure. Randomized controlled trials report a reduction in blood pressure with reducing sodium intake from moderate to low levels, which is the evidence that forms the basis for international guidelines recommending all people consume less than 2.0 g of sodium per day. However, no randomized trials have demonstrated that reducing sodium leads to a reduction in cardiovascular disease (CVD). In their absence, the next option is to examine the association between sodium consumption and CVD in prospective cohort studies. Several recent prospective cohort studies have indicated that while high intake of sodium (>6 g/d) is associated with higher risk of CVD compared to those with moderate intake (3 to 5 g/d), lower intake (<3 g/day) is also associated with a higher risk (despite lower blood pressure levels). However, most of these studies were conducted in populations at increased risk of cardiovascular disease. Current epidemiologic evidence supports that an optimal level of sodium intake is in the range of about 3-5 g/day, as this range is associated with lowest risk of CVD in prospective cohort studies. Randomized controlled trials, comparing the effect of low sodium intake to moderate intake on incidence of cardiovascular events and mortality, are required to truly define optimal intake range.
Identification of Normal Blood Pressure in Different Age Group
Lin, Jiunn-Diann; Chen, Yen-Lin; Wu, Chung-Ze; Hsieh, Chang-Hsun; Pei, Dee; Liang, Yao-Jen; Chang, Jin-Biou
Abstract The concept of using single criterion of normal blood pressure with systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg for all ages is still disputable. The aim of the study is to identify the cutoff value of normotension in different age and sex groups. Totally, 127,922 (63,724 men and 64,198 women) were enrolled for the analysis. Finally, four fifths of them were randomly selected as the study group and the other one fifths as the validation group. Due the tight relationship with comorbidities from cardiovascular disease (CVD), metabolic syndrome (MetS) was used as a surrogate to replace the actual cardiovascular outcomes in the younger subjects. For SBP, MetS predicted by our equation had a sensitivity of 55% and specificity of 67% in males and 65%, 83% in females, respectively. At the same time, they are 61%, 73% in males and 73%, 86% in females for DBP, respectively. These sensitivity, specificity, odds ratio, and area under the receiver operating characteristic curve from our equations are all better than those derived from the criteria of 140/90 or 130/85 mmHg in both genders. By using the presence of MetS as the surrogate of CVD, the regression equations between SBP, DBP, and age were built in both genders. These new criteria are proved to have better sensitivity and specificity for MetS than either 140/90 or 130/85 mmHg. These simple equations should be used in clinical settings for early prevention of CVD. PMID:27057846
Using simplified blood pressure tables to avoid underdiagnosing childhood hypertension
Sharma, Ajay P; Mohammed, Javed; Thomas, Benson; Singh, Ram N; Filler, Guido
BACKGROUND: Recent studies have revealed that hypertension remains underdiagnosed in a significant number of children despite their recorded office blood pressure (OBP) exceeding the recommended fourth report OBP thresholds. Simplified OBP thresholds have been proposed to reduce this underdiagnosis of hypertension in children. In clinical practice, OBP screened as elevated according to the fourth report OBP thresholds are referred for ambulatory blood pressure (ABP) monitoring to rule out 'white coat' hypertension. OBJECTIVES: The present study tested the usefulness of simplified OBP thresholds to screen abnormal OBP for ABP monitoring referral. METHODS: A total of 155 subjects were retrospectively analyzed with paired OBP and ABP recordings obtained from an outpatient referral clinic. OBP recordings were classified as abnormal according to the simplified and fourth report OBP thresholds. ABP measurements were classified as abnormal according to the ABP reference tables. RESULTS: Simplified blood pressure (BP) tables correctly identified all OBP classified as abnormal according to fourth report BP thresholds (kappa [κ] 0.72 [95% CI 0.61 to 0.83]) for systolic OBP; κ 0.92 [95% CI 0.86 to 0.99] for diastolic OBP). OBP classified as abnormal by the simplified BP thresholds and by the fourth report BP thresholds performed similarly for correctly identifying abnormal ABP measurements as per ABP references (overlapping 95% CIs of the sensitivity, specificity and predictive values and likelihood ratios). CONCLUSIONS: Simplified BP tables, proposed to reduce the underdiagnosis of hypertension in children, can serve as a useful screening tool to decide a referral for ABP monitoring. Future prospective studies are needed to establish these findings. PMID:26435668
Introducing Home Blood Pressure Telemonitoring for Children with Hypertension.
Bedra, McKenzie; Finkelstein, Joseph
The goal of this study was to introduce home blood pressure (BP) telemonitoring in children with hypertension and to assess the feasibility of this approach. Acceptance of the system was assessed by attitudinal survey and semi-structured qualitative interview. Qualitative interview results showed consistently positive comments for content, interface and process components. BP measurements obtained by self-testing were as reliable as Dinamap measurements. The home telemonitoring system was positively accepted, easy to use and found to be helpful by participants. Home-based BP telemonitoring has significant potential to improve patient-centered delivery in children with hypertension.
Why does arterial blood pressure rise actively during REM sleep?
Sei, H; Morita, Y
A large fluctuation in autonomic function is one of the most important characteristics of REM sleep. Arterial blood pressure (AP) increases during the transition from non-REM to REM sleep, showing phasic surges during REM sleep. REM-associated AP changes involve 1) a long-term recovery process after surgery, 2) circadian rhythm, 3) relationships with ambient temperature. REM-associated AP changes are mediated by sympathetic nerves, buffered by baroreflex, abolished in decerebrated cats, and related to hippocampal theta activity in rats. Furthermore, the midbrain dopaminergic system has been recently found to be involved in increases in REM-associated AP. PMID:10408152
Blood pressure demographics: nature or nurture ... ... genes or environment?
Tomson, Joseph; Lip, Gregory YH
Hypertension is a growing worldwide problem associated with an increased risk of cardiovascular morbidity and mortality. However, the rates of prevalence of hypertension are higher in some populations than others. Although ethnic and genetic factors have been implied in the past to explain this, the environmental influence and psychosocial factors may play a more important role than is widely accepted. Examining the non-genetic influences in future hypertension research may be necessary in order to clearly define the local blood pressure demographics and the global hypertensive disease burden. PMID:15638936
Engineering studies of vectorcardiographs in blood pressure measuring systems
NASA Technical Reports Server (NTRS)
Mark, R. G.
The following projects involving cardiovascular instrumentation were conducted: (1) the development and fabrication of a three-dimensional display measurement system for vectorcardiograms, (2) the development and fabrication of a cardiovascular monitoring system to noninvasively monitor beat-by-beat the blood pressure and heart rate using aortic pulse wave velocity, (3) the development of software for an interactive system to analyze systolic time interval data, and (4) the development of microprocessor-based physiologic instrumentation, focussing initially on EKG rhythm analysis. Brief descriptions of these projects were given.
Maternal blood pressure in pregnancy and newborn irritability.
Chisholm, J S; Woodson, R H; da Costa Woodson, E M
The neonatal period is being recognized as an important period for the development of patterns of interaction between mother and infant, and infant state has been shown to have a significant impact on mother--infant interactions. A major dimension of infant state, with implications for this interaction and for the development of later behaviour disorders, is the infant's irritability. Research with Navajo, Malay, Chinese and Tamil mothers and infants showed that normal variation in maternal blood pressure during pregnancy was related to newborn irritability as assessed with the Brazelton Scale. This relationship is discussed in terms of possible underlying mechanisms.
Blurred vision and high blood pressure in a young woman.
Flanagan, D. E.; Cole, C.; Crick, M. D.; Kerr, D.
A 41-year-old woman presented with a short history of blurred vision. She had a 6-year history of refractory hypertension which had been treated with a variety of drug regimens. She was found to have bilateral branch retinal vein occlusion. Retinal vein occlusion is a recognised complication of hypertension but simultaneous involvement of both eyes is extremely rare. Following this episode, blood pressure control has improved without change in drug therapy, suggesting that treatment compliance may partly explain the previous difficulties. Images Figure PMID:10211361
Pheochromocytoma supporting blood pressure in the setting of cardiogenic shock.
Ditkofsky, Noah; Workman, Chad
Sixty-seven-year-old male presented with abdominal pain, nausea, vomiting, and decreasing level of consciousness. He was tachycardic but not hypotensive. Computed tomography scan revealed a peripherally enhancing adrenal mass and evidence of low cardiac output state. He was admitted to the intensive care unit but expired within 12 h. Autopsy determined the cause of death as acute coronary insufficiency and identified the adrenal mass as a pheochromocytoma. The pheochromocytoma may have maintained blood pressure in the setting of cardiogenic shock and delayed diagnosis of myocardial infarction.
Dietary factors and higher blood pressure in African-Americans.
Chan, Queenie; Stamler, Jeremiah; Elliott, Paul
Adverse blood pressure (BP) is a major independent risk factor for epidemic cardiovascular diseases affecting almost one third of the US adult population. This review synthesizes results from studies published over the past few years on BP differences and prevalent hypertension between US blacks and whites and their different intakes of foods (e.g., fruits, vegetables, and dairy products) and micronutrients (e.g., vitamin D, calcium, potassium, and phosphorus). Studies have consistently reported higher prevalence of adverse BP levels and hypertension and less favorable dietary intakes in blacks than in whites, but the influence of specific dietary factors on high BP risk for blacks remains unclear.
Stephen Hales and the measurement of blood pressure.
Lewis, O
Natural philosopher and inventor, Stephen Hales (1677-1761), undertook a lengthy series of experiments on animals described in Haemastaticks (1733) which led to the first direct measurement of blood pressure. Hales retained his interest in health and disease throughout his life, and this prompted what he regarded as his most important work: the invention of ventilation systems for use in ships or prisons. Hales was the 'perpetual curate' of Teddington, Middlesex, and he combined a mechanistic, quantitative approach to his experimental work with a need and, as he saw it, a duty to discover and wonder at the wisdom and goodness of God by studying His creation. PMID:7884783
Hypertension, Blood Pressure Variability, and Target Organ Lesion.
Irigoyen, Maria-Cláudia; De Angelis, Kátia; Dos Santos, Fernando; Dartora, Daniela R; Rodrigues, Bruno; Consolim-Colombo, Fernanda Marciano
Hypertensive patients have a higher risk of developing health complications, particularly cardiovascular (CV) events, than individuals with normal blood pressure (BP). Severity of complications depends on the magnitude of BP elevation and other CV risk factors associated with the target organ damage. Therefore, BP control and management of organ damage may contribute to reduce this risk. BP variability (BPV) has been considered a physiological marker of autonomic nervous system control and may be implicated in increased CV risk in hypertension. This review will present some evidence relating BPV and target organ damage in hypertension in clinical and experimental settings.
Anger, stress and blood pressure in overweight children.
Nichols, Kimberly Hall; Rice, Marti; Howell, Carol
Among adults, trait anger, patterns of anger expression, and stress have been associated with blood pressure (BP). Less apparent is the effect of these variables on BP in overweight and obese children. To characterize the relationships between these psychological variables and BP, the authors conducted a secondary analysis of data from 73 overweight and obese 9- to 11-year-old children. Findings indicate a positive correlation between trait anger and systolic BP (SBP). Regression results indicate that the overall model significantly predicted SBP by explaining 15.4% of the variance and that trait anger was a significant predictor of SBP.
[The role of nursing documentation in the analysis of the risk of pressure ulcers].
Iveta, Vedrana; Krecak, Antonija; Kalogjera, Marija; Milić, Dorde
The aim of the study was to analyze the risk of pressure ulcers in Dubrovnik General Hospital based on data from nursing documentation and records on the number of nurses on duty. Specifically, the intent was to show the importance of analyzing serum proteins in patients with a documented risk (Braden's scale) of pressure ulcers and to assess the incidence of pressure ulcers recorded during holidays/weekends when the number of nurses on duty is, generally, lower. The study included patients admitted to the hospital during the year 2012. Nursing documentation was the source of patient data. The risk of pressure ulcers was assessed in 34% of patients. Pressure ulcers were recorded in 185 patients, initially estimated as very high risk (32.3%), high risk (40%), moderate risk (7%) and no risk (20.7%). Analysis of total serum protein showed a significantly lower value in patients with ulcers in comparison with patients without pressure ulcer. During a one-month period (December 2012), the number of recorded pressure ulcers was analyzed at Department of Neurology according to weekends/holidays and other weekdays. Results showed the weekends/holidays to be more risky for the development of pressure ulcers (72% vs. 28%). At the same time, given the regulations on minimum requirements, about 33% of nurses are missing every day. However, over the weekend, this disadvantage can hardly compensate for the often demanding emergency admission patients. Therefore, our results suggest a possible reallocation of working hours for nurses respecting week routine and the need for the weekend. Continuous monitoring, documentation and evaluation of nursing work through documentation have created a prerequisite for professional communication that leads to good results and recognition of the profession. Good health care organization can significantly influence the overall treatment, which has professional and financial effects on the health care in general. PMID:24979892
Regulation of blood pressure in the land crab Cardisoma guanhumi.
Wilkens, J L; Young, R E
We examined the cardiovascular responses to acute and chronic changes in blood volume (BV) in the land crab Cardisoma guanhumi. Acute reduction in BV caused an increase in activity in the dorsoventral muscles (DVMs) and to a lesser extent in the epimeral attractor muscles (EAMs). Contraction of the DVMs and EAMs will decrease the volume of the dorsal sinus and the thorax as a whole, respectively. BV reduction also caused bradycardia with frequent periods of cardiac arrest. There was a small drop in hemolymph pressure. BV expansion had the reciprocal effect on DVM and EAM activity but had no effect on heart rate (fH). After the cardioregulatory nerves were cut, acute hypovolemia had no effect on fH but still caused a moderate increase in DVM activity. After dehydration-induced BV reduction, DVM activity increased, whereas hemolymph pressure, fH, and EAM activity were maintained close to control levels.
Engineering studies of vectorcardiographs in blood pressure measuring systems, appendix 2
NASA Technical Reports Server (NTRS)
Mark, R. G.
The development of a cardiovascular monitoring system to noninvasively monitor the blood pressure and heart rate using pulse wave velocity was described. The following topics were covered: (1) pulse wave velocity as a measure of arterial blood pressure, (2) diastolic blood pressure and pulse wave velocity in humans, (3) transducer development for blood pressure measuring device, and (4) cardiovascular monitoring system. It was found, in experiments on dogs, that the pulse wave velocity is linearly related to diastolic blood pressure over a wide range of blood pressure and in the presence of many physiological perturbations. A similar relationship was observed in normal, young human males over a moderate range of pressures. Past methods for monitoring blood pressure and a new method based on pulse wave velocity determination were described. Two systems were tested: a Doppler ultrasonic transducer and a photoelectric plethysmograph. A cardiovascular monitoring system was described, including operating instructions.
2014 CRL Blood Pressure Study of Life Insurance Applicants.
Fulks, Michael; Dolan, Vera F; Stout, Robert L
Objective .- Define the relative mortality risk by systolic (SBP) and diastolic blood pressure (DBP) in a relatively healthy cohort split by age and sex with adjustment for smoking status, other findings and admitted heart disease history. Method .- Blood pressure (BP in mm Hg), build, laboratory studies and limited medical history are collected when people apply for individual life insurance. Information on 2,472,706 applicants tested by Clinical Reference Laboratory from 1993 to 2007 was utilized with follow-up for vital status using the September 2011 Social Security Death Master File identifying 31,033 deaths. Data was analyzed by SBP and DBP split by age and sex accounting for smoking and for BMI, urine protein/creatinine ratio and history of heart disease in a Cox multivariate survival analysis. Separate analysis by admitted hypertension history was also conducted. Results are presented by SBP and DBP for 4 age-sex groups with and without added covariates beyond age and smoking status. Results .- Relative mortality progressively increased by SBP level from the 90 to 119 band (down to 80 in younger women) upward with little additional impact by DBP. Addition of covariates beyond age and smoking resulted in a 5% to 10% reduction in relative risk. Although high DBP had limited impact, a pulse pressure/SBP ratio >½ identified 1% of applicants at high mortality risk, with little difference in risk for ratios ≤½. Hypertension history with current BP control was associated with a 10% to 25% increase in relative mortality risk as compared to those with similar BP but no such history. Conclusion .- Increasing SBP is closely associated with increasing relative mortality, starting from the lowest SBP. Increasing DBP has little additional impact, but a pulse pressure/SBP ratio >½ is a potent marker of increased risk as well. Accounting for build and other laboratory findings reduces risk modestly. A history of hypertension with current control increases risk. PMID
2014 CRL Blood Pressure Study of Life Insurance Applicants.
Fulks, Michael; Dolan, Vera F; Stout, Robert L
Objective .- Define the relative mortality risk by systolic (SBP) and diastolic blood pressure (DBP) in a relatively healthy cohort split by age and sex with adjustment for smoking status, other findings and admitted heart disease history. Method .- Blood pressure (BP in mm Hg), build, laboratory studies and limited medical history are collected when people apply for individual life insurance. Information on 2,472,706 applicants tested by Clinical Reference Laboratory from 1993 to 2007 was utilized with follow-up for vital status using the September 2011 Social Security Death Master File identifying 31,033 deaths. Data was analyzed by SBP and DBP split by age and sex accounting for smoking and for BMI, urine protein/creatinine ratio and history of heart disease in a Cox multivariate survival analysis. Separate analysis by admitted hypertension history was also conducted. Results are presented by SBP and DBP for 4 age-sex groups with and without added covariates beyond age and smoking status. Results .- Relative mortality progressively increased by SBP level from the 90 to 119 band (down to 80 in younger women) upward with little additional impact by DBP. Addition of covariates beyond age and smoking resulted in a 5% to 10% reduction in relative risk. Although high DBP had limited impact, a pulse pressure/SBP ratio >½ identified 1% of applicants at high mortality risk, with little difference in risk for ratios ≤½. Hypertension history with current BP control was associated with a 10% to 25% increase in relative mortality risk as compared to those with similar BP but no such history. Conclusion .- Increasing SBP is closely associated with increasing relative mortality, starting from the lowest SBP. Increasing DBP has little additional impact, but a pulse pressure/SBP ratio >½ is a potent marker of increased risk as well. Accounting for build and other laboratory findings reduces risk modestly. A history of hypertension with current control increases risk.
Gender differences in blood pressure regulation following artificial gravity exposure
NASA Astrophysics Data System (ADS)
Evans, Joyce; Goswami, Nandu; Kostas, Vladimir; Zhang, Qingguang; Ferguson, Connor; Moore, Fritz; Stenger, Michael, , Dr; Serrador, Jorge; W, Siqi
Introduction. Before countermeasures to space flight cardiovascular deconditioning are established, gender differences in cardiovascular responses to orthostatic stress, in general, and to orthostatic stress following exposure to artificial gravity (AG), in particular, need to be determined. Our recent determination that a short exposure to AG improved the orthostatic tolerance limit (OTL) of cardiovascularly deconditioned subjects drives the current effort to determine mechanisms of that improvement in men and in women. Methods. We determined the OTL of 9 men and 8 women following a 90 min exposure to AG compared to that following 90 min of head down bed rest (HDBR). On both days (21 days apart), subjects were made hypovolemic (low salt diet plus 20 mg intravenous furosemide) and orthostatic tolerance was determined from a combination of head up tilt and increasing lower body negative pressure until presyncope. Mean values and correlations with OTL were determined for heart rate, blood pressure, stroke volume, cardiac output, total peripheral resistance (Finometer), middle cerebral artery flow velocity (DWL), partial pressure of carbon dioxide (Novametrics) and body segmental impedance (UFI THRIM) at supine baseline, during orthostatic stress to presyncope and at supine recovery. Results. Orthostatic tolerance of these hypovolemic subjects was significantly greater following AG than following HDBR. Exposure to AG increased cardiac output in both men and women and increased stroke volume in women. In addition, AG decreased systolic blood pressure in men, but not women, and increased cerebral flow in women, but not men. In both men and women, AG exposure decreased peripheral resistance and decreased cerebrovascular resistance in women. Men's heart rate rose more at the end of OTL on their AG, compared to their HDBR, day but women's fell. Presyncopal stroke volume reached the same level on each day of study for both men and women. Conclusions. In the present
Maternal nutritional status in pregnancy and blood pressure in childhood.
Godfrey, K M; Forrester, T; Barker, D J; Jackson, A A; Landman, J P; Hall, J S; Cox, V; Osmond, C
In the early 1990s, researchers followed up on 77 children, 10.4-12.2 years old, who had attended the outpatient clinic at the University Hospital of the West Indies in Kingston, Jamaica, as infants during 1979-1981 to determine whether maternal nutrition during pregnancy sets the stage for adult hypertension. The mothers had received prenatal care early in the pregnancy. The overall mean systolic pressure was 94.8 mmHg. For each log mm decrease in the mother's triceps skinfold thickness at 15 weeks gestation, the child's systolic pressure increased by 10.7 mmHg (p = 0.0001). For each 1 kg reduction in maternal weight gain between 15 and 35 weeks gestation, child's systolic pressure increased by 0.6 mmHg (p = 0.02). Mothers with a lower hemoglobin level had thinner skinfold thicknesses, particularly of the triceps (p = 0.005). The child's systolic blood pressure increased by 2.6 mmHg for each 1 g/dl decline in the mother's hemoglobin (p = 0.01), but this effect was not consistent or strong. Nevertheless, it adds more credence to the theory that poor maternal nutrition status is linked to the programming of hypertension in fetuses. These findings correspond to findings of experiments with rats. Further research is needed to confirm these findings. These findings illustrate the need to expand our knowledge about how maternal nutrition affects the fetus and how the fetus responds to poor maternal nutrition.
Blood pressure profile in continuous ambulatory peritoneal dialysis patients
Cader, Rizna Abdul; Gafor, Halim Abdul; Mohd, Rozita; Ibrahim, Suriani; Wan Haslina, W.H.; Bain, Arba'iyah; Kong, Norella CT
Background: Cardiovascular mortality is the leading cause of death in end stage renal disease. Despite being on continuous ambulatory peritoneal dialysis (CAPD), blood pressure (BP) remains poorly controlled. A higher pulse pressure and non dipping are associated with increased cardiovascular mortality. We studied BP control and the prevalence of non dipping in CAPD patients. Methods: All patients undergoing CAPD at our institution who met the inclusion criteria were recruited. We compared BP control and dipping status in diabetic and non diabetic patients on CAPD. We also determined whether BP and peritoneal membrane permeability were associated. Results: Forty six patients with a mean age 45 ± 13 years were enrolled. Diabetic patients were older (mean age 54 ± 13 vs. 40 ± 11 yrs, p <0.001), had a lower mean diastolic BP (80 ± 14 vs. 90 ± 14 mmHg, p = 0.025) and a higher mean pulse pressure (59 ± 17 vs. 49 ± 14 mmHg, p = 0.035). They were also non dippers (n = 15 vs. n = 1, p = 0.007). The low and low average transporters tended to have a higher systolic BP (p = 0.054) and a higher pulse pressure (p = 0.058). On multivariate analysis, age was the main predictor of pulse pressure. Conclusion: Despite being on chronic maintenance PD, BP was not well controlled. Diabetic patients had a higher pulse pressure and were non dippers thereby increasing their cardiovascular risk. We should therefore optimize BP control and aim to restore the nocturnal dip in these patients. PMID:27366136
Arterial blood oxygen saturation during blood pressure cuff-induced hypoperfusion
NASA Astrophysics Data System (ADS)
Kyriacou, P. A.; Shafqat, K.; Pal, S. K.
Pulse oximetry has been one of the most significant technological advances in clinical monitoring in the last two decades. Pulse oximetry is a non-invasive photometric technique that provides information about the arterial blood oxygen saturation (SpO2) and heart rate, and has widespread clinical applications. When peripheral perfusion is poor, as in states of hypovolaemia, hypothermia and vasoconstriction, oxygenation readings become unreliable or cease. The problem arises because conventional pulse oximetry sensors must be attached to the most peripheral parts of the body, such as finger, ear or toe, where pulsatile flow is most easily compromised. Pulse oximeters estimate arterial oxygen saturation by shining light at two different wavelengths, red and infrared, through vascular tissue. In this method the ac pulsatile photoplethysmographic (PPG) signal associated with cardiac contraction is assumed to be attributable solely to the arterial blood component. The amplitudes of the red and infrared ac PPG signals are sensitive to changes in arterial oxygen saturation because of differences in the light absorption of oxygenated and deoxygenated haemoglobin at these two wavelengths. From the ratios of these amplitudes, and the corresponding dc photoplethysmographic components, arterial blood oxygen saturation (SpO2) is estimated. Hence, the technique of pulse oximetry relies on the presence of adequate peripheral arterial pulsations, which are detected as photoplethysmographic (PPG) signals. The aim of this study was to investigate the effect of pressure cuff-induced hypoperfusion on photoplethysmographic signals and arterial blood oxygen saturation using a custom made finger blood oxygen saturation PPG/SpO2 sensor and a commercial finger pulse oximeter. Blood oxygen saturation values from the custom oxygen saturation sensor and a commercial finger oxygen saturation sensor were recorded from 14 healthy volunteers at various induced brachial pressures. Both pulse
[Features of diurnal profile of blood pressure in workers having serum aromatic hydrocarbons level].
Baĭdina, A S; Safonova, M A; Alekseev, V B
Features of diurnal profile of blood pressure in workers having serum level of benzol and ethylbenzene are high systolic and diastolic arterial blood pressure during the day, index of systolic arterial pressure time and index diastolic arterial pressure time was also high. These features should be considered in anti-hypertensives prescription.
Najafipour, Hamid; Beik, Ahmad
Aim: Substance abuse has become a universal crisis in our modern age. Among illegal substances, opium and its derivatives have been ranked second in terms of usage after cannabis in the world. In many Asian regions, the use of opium enjoys a high social acceptance; hence, some common people and even medical practitioners believe that opium lowers blood glucose and pressure and treat dyslipidemia. How much this belief is scientifically justified? Method: The results of available studies on both humans and animals searched in different search engines up to mid-2016 were integrated (78 articles). Upon the findings we try to offer a more transparent picture of the effects of opium on the mentioned factors along with the probable underlying mechanisms of its action. Results: Taken together, a variety of evidences suggest that the consumption of opium has no scientific justification for amendment of these biochemical variables. The mechanisms proposed so far for the action of opium in the three above disorders are summarized at the end of the article. Short term effects seems to be mostly mediated through central nervous system (neural and hormonal mechanisms), but long term effects are often due to the structural and functional alterations in some body organs. Conclusion: Although opium may temporarily reduce blood pressure, but it increases blood glucose and most of blood lipids. Moreover its long term use has negative impacts and thus it aggravates diabetes, dyslipidemia and hypertension. Accordingly, it is necessary to inform societies about the potential disadvantages of unauthorized opium consumption. PMID:27790151
Risk, prevention and treatment of pressure ulcers--nursing staff knowledge and documentation.
Gunningberg, L; Lindholm, C; Carlsson, M; Sjödén, P O
The aims were to investigate (i) registered nurses' and nursing assistants' knowledge of risk, prevention and treatment of pressure ulcer before implementing a system for risk assessment and pressure ulcer classification for patients with hip fracture (ii) interventions documented in the patient's records by registered nurses, and (iii) to what extent reported and documented interventions accord with the Swedish quality guidelines. Nursing staff (n=85) completed a questionnaire, and patient's records (n=55) were audited retrospectively. The majority of the nursing staff reported that they performed risk assessment when caring for a patient with hip fracture. These risk assessments were, however, not comprehensive. The most frequently reported preventive interventions were repositioning, use of lotion, mattresses/overlays and cushions for the heels. These interventions were to some extent documented in the patient's records. Nutritional support, reduction of shear and friction, hygiene and skin moisture, and patient's education were reported to a small extent and not documented at all. The Swedish quality guidelines regarding prevention and treatment of pressure ulcers were not fully implemented in clinical practice. It was concluded that nursing staff's knowledge and documentation of risk, prevention and treatment of pressure ulcers for patients with hip fractures could be improved.
Ambulatory blood pressure monitoring in solid organ transplantation.
Ramesh Prasad, G V
Solid organ transplant recipients are at an increased risk for hypertension and cardiovascular disease. To assist in their management, 24-h ambulatory blood pressure monitoring (ABPM) has become increasingly used in both clinical research settings and practice. ABPM has been used to better define post-transplant hypertension incidence and prevalence in different solid organ transplantation populations. ABPM provides additional information on cardiovascular risk beyond that obtained by clinic-based readings, based on its ability to assess 24-h blood pressure (BP) load, detect nocturnal non-dipping, and predict target organ damage. It has provided some assurance about the safety of living kidney donation. Information from ABPM can be used to guide living kidney donor selection, and because ABPM-related data has been correlated with clinically important kidney and heart transplant recipient outcomes, it may be a valuable adjunct in their management. Despite these advantages, barriers to wider use of ABPM include expense, clinical inertia in hypertension management, lack of prospective clinical trial data, and clinical problems that compete with hypertension for attention such as acute or chronic allograft dysfunction. The increasing amount of research and clinical use for ABPM may allow for closer assessment and intervention to help address the increased cardiovascular risk faced by many solid organ transplant recipients. PMID:22220828
The ecological context of soundscapes for children's blood pressure
Lercher, Peter; Evans, Gary W.; Widmann, Ulrich
Although the majority of studies on community noise levels and children's physiological stress responses are positive, effect sizes vary considerably, and some studies do not confirm these effects. Employing a contextual perspective congruent with soundscapes, a carefully constructed sample of children (N = 115, M = 10.1 yr) living in households in relatively high (>60 dBA) or low (<50 dBA) noise areas created by proximity to major traffic arterials in Austria was reanalyzed. Several personal and environmental factors known to affect resting cardiovascular parameters measured under well-controlled, clinical conditions were incorporated into the analyses. Children with premature births and elevated chronic stress (i.e., overnight cortisol) were more susceptible to adverse blood pressure responses to road traffic noise. Residence in a multi-dwelling unit as well as standardized assessments of perceived quietness of the area did not modify the traffic noise impacts but each had its own, independent effect on resting blood pressure. A primary air pollutant associated with traffic volume (NO2) had no influence on any of these results. The scope of environmental noise assessment and management would benefit from incorporation of a more contextualized approach as suggested by the soundscape perspective. PMID:23862883
Comparing Angiotensin II Receptor Blockers on Benefits Beyond Blood Pressure
The renin-angiotensin-aldosterone system (RAAS) is one of the main regulators of blood pressure, renal hemodynamics, and volume homeostasis in normal physiology, and contributes to the development of renal and cardiovascular (CV) diseases. Therefore, pharmacologic blockade of RAAS constitutes an attractive strategy in preventing the progression of renal and CV diseases. This concept has been supported by clinical trials involving patients with hypertension, diabetic nephropathy, and heart failure, and those after myocardial infarction. The use of angiotensin II receptor blockers (ARBs) in clinical practice has increased over the last decade. Since their introduction in 1995, seven ARBs have been made available, with approved indications for hypertension and some with additional indications beyond blood pressure reduction. Considering that ARBs share a similar mechanism of action and exhibit similar tolerability profiles, it is assumed that a class effect exists and that they can be used interchangeably. However, pharmacologic and dosing differences exist among the various ARBs, and these differences can potentially influence their individual effectiveness. Understanding these differences has important implications when choosing an ARB for any particular condition in an individual patient, such as heart failure, stroke, and CV risk reduction (prevention of myocardial infarction). A review of the literature for existing randomized controlled trials across various ARBs clearly indicates differences within this class of agents. Ongoing clinical trials are evaluating the role of ARBs in the prevention and reduction of CV rates of morbidity and mortality in high-risk patients. PMID:20524096
Blood Pressure Mobile Monitoring for Pregnant Woman Based Android System
NASA Astrophysics Data System (ADS)
Supriyanti, Retno; Erfayanto, Uji; Ramadani, Yogi; Murdyantoro, Eko; Widodo, Haris B.
Currently, at least 18,000 women die every year in Indonesia due to pregnancy or childbirth. It means that every half hour a woman dies due to pregnancy or childbirth. As a result, every year 36,000 children became orphans. The high maternal mortality rate was put Indonesia on top in ASEAN. The main causes of maternal mortality are high-risk pregnancy. Mothers who have diseases like high blood pressure, pre-eclampsia, diabetes, hyperthyroidism, and already over 40 years old and infectious diseases such as rubella, hepatitis and HIV can be factors that lead to high-risk pregnancy. This paper will discuss the development of a blood pressure monitoring device that is suitable for pregnant women. It is based on convenience for pregnant women to get the equipment that is flexible with her presence. Results indicate that the equipment is in use daily support for pregnant women therefore, one of the causes of maternal mortality can be detected earlier.
The Role of Metabolic Surgery on Blood Pressure Control.
Schiavon, Carlos Aurelio; Drager, Luciano F; Bortolotto, Luiz A; Amodeo, Celso; Ikeoka, Dimas; Berwanger, Otávio; Cohen, Ricardo Vitor
Obesity and hypertension are growing epidemics in the modern world. Lifestyle changes and medical treatment for obesity have disappointing long-term results and albeit drugs for hypertension are usually very effective, the necessity of multiple pills and frequent side effects make the adherence to treatment a huge challenge for healthcare systems. Bariatric/metabolic surgery is a very effective treatment and an exponential number of studies have been showing its positive impact beyond weight loss, mainly on type 2 diabetes. There is also growing evidence suggesting that bariatric/metabolic surgery is associated with reduced incidence of cardiovascular events, but the impact on hypertension and other components of metabolic syndrome usually derive from trials' secondary end points. Taking this limitation in mind, bariatric/metabolic surgery action on blood pressure is reaching a significant proportion of hypertension resolution or improvement. In this review, we discussed the current evidence on the impact of bariatric/metabolic surgery on blood pressure control and pointed out perspectives in this research area. PMID:27324638
Regulation of Blood Pressure and Salt Homeostasis by Endothelin
Endothelin (ET) peptides and their receptors are intimately involved in the physiological control of systemic blood pressure and body Na homeostasis, exerting these effects through alterations in a host of circulating and local factors. Hormonal systems affected by ET include natriuretic peptides, aldosterone, catecholamines, and angiotensin. ET also directly regulates cardiac output, central and peripheral nervous system activity, renal Na and water excretion, systemic vascular resistance, and venous capacitance. ET regulation of these systems is often complex, sometimes involving opposing actions depending on which receptor isoform is activated, which cells are affected, and what other prevailing factors exist. A detailed understanding of this system is important; disordered regulation of the ET system is strongly associated with hypertension and dysregulated extracellular fluid volume homeostasis. In addition, ET receptor antagonists are being increasingly used for the treatment of a variety of diseases; while demonstrating benefit, these agents also have adverse effects on fluid retention that may substantially limit their clinical utility. This review provides a detailed analysis of how the ET system is involved in the control of blood pressure and Na homeostasis, focusing primarily on physiological regulation with some discussion of the role of the ET system in hypertension. PMID:21248162
Challenges in Treating Low Blood Pressure in Preterm Infants
Dempsey, Eugene M.
Whilst the prevalence of low blood pressure in preterm infants seems to have fallen over the last number of years, the problem is still frequently encountered in the neonatal intensive care unit and many babies continue to receive intervention. Great variability in practice persists, with a significant number of extremely low gestational age newborns in some institutions receiving some form of intervention, and in other units substantially less. A great degree of this variability relates to the actual criteria used to define hypotension, with some using blood pressure values alone to direct therapy and others using a combination of clinical, biochemical and echocardiography findings. The choice of intervention remains unresolved with the majority of centres continuing to administer volume followed by dopamine as a first line inotrope/vasopressor agent. Despite over 40 years of use there is little evidence that dopamine is of benefit both in the short term and long-term. Long-term follow up is available in only two randomised trials, which included a total of 99 babies. An under recognized problem relates to the administration of inotrope infusions in very preterm infants. There are no pediatric specific inotrope formulations available and so risks of errors in preparation and administration remain. This manuscript outlines these challenges and proposes some potential solutions. PMID:27417363
Impact of sugar-sweetened beverages on blood pressure.
Malik, Aaqib Habib; Akram, Yasir; Shetty, Suchith; Malik, Senada Senda; Yanchou Njike, Valentine
The impact of sugar-sweetened beverages (SSBs) on blood pressure (BP) has been debated, with some evidence suggesting that their increased intake is related to higher risk of developing hypertension. We conducted a systematic review exploring the relation between consumption of SSB and BP. A comprehensive search in 5 electronic databases along with a bibliography search was performed. The keywords "sugar sweetened beverages," "sugary drinks," "added sugars," "blood pressure," and "hypertension" were indexed in all combinations. Studies were included that reported the effects of intake of SSBs on BP. We excluded studies with <100 subjects and those involving subjects aged <12 years. Of 605 potentially relevant studies, a total of 12 studies (409,707 participants) met our inclusion criteria; 6 were cross sectional studies, whereas the rest were prospective cohort studies. All 12 studies showed positive relation between increased SSB intake and hypertension; however, statistical significance was reported in 10 of these studies. Of the 12 studies, 5 reported an increase in mean BP whereas 7 reported an increase in the incidence of high BP. In conclusion, our systematic review shows that the consumption of SSBs is associated with higher BP, leading to increased incidence of hypertension. Restriction on SSB consumption should be incorporated in the recommendations of lifestyle modifications for the treatment of hypertension. Interventions to reduce intake of SSBs should be an integral part of public health strategy to reduce the incidence of hypertension. PMID:24630785
Targeting blood pressure in people with diabetes mellitus.
Brimble, K Scott
Hypertension is a strong risk factor for cardiovascular (CV)-related morbidity and mortality, and its treatment has been shown to be beneficial. Hypertension is common in people with diabetes mellitus, and the combination of these conditions markedly increases CV risk in comparison with individuals with neither condition. Although there is increasing clarity as to blood pressure (BP) targets in numerous conditions, the target in people with diabetes remains unclear, and, as a result, many clinical practice guidelines differ on the optimal BP goal. The ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial did not demonstrate benefit when systolic BP (SBP) was lowered to less than 120 mmHg compared with a target of less than 140 mmHg. This was in contrast to the recent SPRINT trial (Systolic Blood Pressure Intervention Trial), which demonstrated the superiority of a target SBP of less than 120 mmHg in reducing CV events. However, people with diabetes mellitus were excluded. Recent meta-analyses have suggested that lowering BP in patients with diabetes mellitus should be reserved for a baseline SBP greater than 140 mmHg, targeting an SBP of between 130 and 140 mmHg. Lower targets may reduce the risk of stroke but may also be harmful with respect to other important CV outcomes. The methodological limitations of these meta-analyses highlight the need for a large randomized controlled trial comparing lower and standard BP targets in people with diabetes mellitus.
Achieving blood pressure goals: why aren't we?
Cushman, William C; Basile, Jan
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends a blood pressure (BP) goal of <140/90 mm Hg in patients with hypertension and <130/80 mm Hg in those with diabetes or chronic kidney disease. Achievement of BP goals is associated with significant benefits in cardiovascular morbidity and mortality. Although evidence suggests these goals are attainable, only about one third of patients are meeting them. There is a significant gap between treatment guideline recommendations and their implementation in clinical practice. Many clinicians appear satisfied with modest BP reductions and do not make the necessary treatment adjustments to achieve BP goals. Patient nonadherence is another important reason for lack of BP control. For the success of clinical trials to be reproduced in clinical practice, clinicians must recognize the importance of treating BP to goal, emphasize to patients the need to adhere to treatments, and provide persistent, goal-targeted therapy. PMID:17170612
Gonokami, Kenta; Obara, Taku; Kobayashi, Mitsuru; Katada, Sakiko; Hara, Azusa; Metoki, Hirohito; Asayama, Kei; Kikuya, Masahiro; Ohkubo, Takayoshi; Imai, Yutaka
The effects and duration of action of bedtime administration of doxazosin 2 mg for 4 weeks on uncontrolled morning home hypertension were investigated. Morning home blood pressure (HBP) was significantly lowered by bedtime administration of doxazosin. Doxazosin significantly lowered evening HBP only in the subgroup of patients with an uncontrolled evening HBP. The evening (E)/morning (M) ratio was greater in patients with an uncontrolled evening HBP than in those with a controlled evening HBP. The results suggest that bedtime administration of doxazosin effectively suppresses morning HBP in uncontrolled morning hypertensives and lowers evening HBP in uncontrolled evening hypertensives.
Ambulatory blood pressure monitoring is a useful clinical tool in nephrology.
Mansoor, G A; White, W B
Hypertension is a key factor in the genesis and deterioration of many renal diseases and is also a risk factor for death in patients with end-stage renal disease. However, the standard methods of measurement are prone to variability, especially in patients undergoing dialysis. The technique of ambulatory blood pressure monitoring allows a better assessment of overall blood pressure levels and promises to assume a bigger role in the care of renal patients. Ambulatory blood pressure monitoring is widely used in hypertension trials, and the reports of several consensus meetings on the clinical uses of ambulatory blood pressure monitoring have been published. Two similar validation protocols now exist for ambulatory blood pressure monitors, and tables of population-based normal blood pressures for age and gender are available. The available evidence suggests that ambulatory blood pressure compared with blood pressure measured in the physician's office is better correlated to left ventricular mass in subjects with chronic renal disease. Furthermore, studies in subjects with chronic renal disease and those undergoing renal replacement therapy show that blood pressure control is suboptimal in many patients and that nocturnal blood pressure is generally higher than in control subjects. Further insights into overall blood pressure behavior in this population will certainly emerge in the future. PMID:9370174
Ambulatory Blood Pressure Monitoring in Spinal Cord Injury: Clinical Practicability
Hubli, Michèle
Abstract Trauma to the spinal cord often results not only in sensorimotor but also autonomic impairments. The loss of autonomic control over the cardiovascular system can cause profound blood pressure (BP) derangements in subjects with spinal cord injury (SCI) and may therefore lead to increased cardiovascular disease (CVD) risk in this population. The use of ambulatory blood pressure monitoring (ABPM) allows insights into circadian BP profiles, which have been shown to be of good prognostic value for cardiovascular morbidity and mortality in able-bodied subjects. Past studies in SCI subjects using ABPM have shown that alterations in circadian BP patterns are dependent on the spinal lesion level. Tetraplegic subjects with sensorimotor complete lesions have a decreased daytime arterial BP, loss of the physiological nocturnal BP dip, and higher circadian BP variability, including potentially life-threatening hypertensive episodes known as autonomic dysreflexia (AD), compared with paraplegic and able-bodied subjects. The proposed underlying mechanisms of these adverse BP alterations mainly are attributed to a lost or decreased central drive to sympathetic spinal preganglionic neurons controlling the heart and blood vessels. In addition, several maladaptive anatomical changes within the spinal cord and the periphery, as well as the general decrease of physical daily activity in SCI subjects, account for adverse BP changes. ABPM enables the identification of adverse BP profiles and the associated increased risk for CVD in SCI subjects. Concurrently, it also might provide a useful clinical tool to monitor improvements of AD and lost nocturnal dip after appropriate treatments in the SCI population. PMID:24175653
Kitagawa, Noriyuki; Okada, Hiroshi; Tanaka, Muhei; Hashimoto, Yoshitaka; Kimura, Toshihiro; Nakano, Koji; Yamazaki, Masahiro; Hasegawa, Goji; Nakamura, Naoto; Fukui, Michiaki
The aim of this study was to investigate whether central systolic blood pressure (SBP) was associated with albuminuria, defined as urinary albumin excretion (UAE) ≥30 mg/g creatinine, and, if so, whether the relationship of central SBP with albuminuria was stronger than that of peripheral SBP in patients with type 2 diabetes. The authors performed a cross-sectional study in 294 outpatients with type 2 diabetes. The relationship between peripheral SBP or central SBP and UAE using regression analysis was evaluated, and the odds ratios of peripheral SBP or central SBP were calculated to identify albuminuria using logistic regression model. Moreover, the area under the receiver operating characteristic curve (AUC) of central SBP was compared with that of peripheral SBP to identify albuminuria. Multiple regression analysis demonstrated that peripheral SBP (β=0.255, P<.0001) or central SBP (r=0.227, P<.0001) was associated with UAE. Multiple logistic regression analysis demonstrated that peripheral SBP (odds ratio, 1.029; 95% confidence interval, 1.016-1.043) or central SBP (odds ratio, 1.022; 95% confidence interval, 1.011-1.034) was associated with an increased odds of albuminuria. In addition, AUC of peripheral SBP was significantly greater than that of central SBP to identify albuminuria (P=0.035). Peripheral SBP is superior to central SBP in identifying albuminuria, although both peripheral and central SBP are associated with UAE in patients with type 2 diabetes.
ERIC Educational Resources Information Center
National Institutes of Health (DHEW), Bethesda, MD. High Blood Pressure Information Center.
This curriculum guide on high blood pressure (hypertension) for nursing educators has five sections: (1) Introduction and Objectives provides information regarding the establishment and objectives of the National Task Force on the Role of Nursing in High Blood Pressure Control and briefly discusses nursing's role in hypertension control; (2) Goals…
Clinical implications of non-invasive measurement of central aortic blood pressure.
Stepień, Mariusz; Banach, Maciej; Jankowski, Piotr; Rysz, Jacek
Central arterial systolic blood pressure is a very important factor in the pathophysiology of cardiovascular diseases. Central arterial pressure is a better predictor of cardiovascular risk than peripheral brachial blood pressure. Measurement of central blood pressure is useful for a diagnosis of spurious systolic hypertension in young people. Antihypertensive drugs have a different impact on central blood pressure, for example angiotensin converting enzyme inhibitors, antagonists of angiotensin II receptors, calcium channel blockers more effectively lower central blood pressure than betablockers, despite all of those drugs (including beta-blockers) having a similar impact on peripheral pressure. This mechanism may be responsible for the beneficial effect of some antihypertensive drugs on cardiovascular end points observed in clinical trials, despite a low peripheral hypotensive effect. However, further clinical trials are required to provide more evidence for the prognostic and therapeutic implications of the measurement of central blood pressure before adopting its routine application in clinical practice.
The vascular Ca2+-sensing receptor regulates blood vessel tone and blood pressure.
Schepelmann, M; Yarova, P L; Lopez-Fernandez, I; Davies, T S; Brennan, S C; Edwards, P J; Aggarwal, A; Graça, J; Rietdorf, K; Matchkov, V; Fenton, R A; Chang, W; Krssak, M; Stewart, A; Broadley, K J; Ward, D T; Price, S A; Edwards, D H; Kemp, P J; Riccardi, D
The extracellular calcium-sensing receptor CaSR is expressed in blood vessels where its role is not completely understood. In this study, we tested the hypothesis that the CaSR expressed in vascular smooth muscle cells (VSMC) is directly involved in regulation of blood pressure and blood vessel tone. Mice with targeted CaSR gene ablation from vascular smooth muscle cells (VSMC) were generated by breeding exon 7 LoxP-CaSR mice with animals in which Cre recombinase is driven by a SM22α promoter (SM22α-Cre). Wire myography performed on Cre-negative [wild-type (WT)] and Cre-positive (SM22α)CaSR(Δflox/Δflox) [knockout (KO)] mice showed an endothelium-independent reduction in aorta and mesenteric artery contractility of KO compared with WT mice in response to KCl and to phenylephrine. Increasing extracellular calcium ion (Ca(2+)) concentrations (1-5 mM) evoked contraction in WT but only relaxation in KO aortas. Accordingly, diastolic and mean arterial blood pressures of KO animals were significantly reduced compared with WT, as measured by both tail cuff and radiotelemetry. This hypotension was mostly pronounced during the animals' active phase and was not rescued by either nitric oxide-synthase inhibition with nitro-l-arginine methyl ester or by a high-salt-supplemented diet. KO animals also exhibited cardiac remodeling, bradycardia, and reduced spontaneous activity in isolated hearts and cardiomyocyte-like cells. Our findings demonstrate a role for CaSR in the cardiovascular system and suggest that physiologically relevant changes in extracellular Ca(2+) concentrations could contribute to setting blood vessel tone levels and heart rate by directly acting on the cardiovascular CaSR.
Loomba, Rohit S.; Arora, Rohit; Shah, Parinda H.; Chandrasekar, Suraj; Molnar, Janos
There are a handful of studies that have been done investigating the effect of music on various vital signs, namely systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Many studies have also assessed effects of music on self-reported anxiety level, attributing some degree of music-induced anxiety relief to the beneficial impacts of music on vital signs. Several randomised studies have shown varying effects of music on these vital parameters and so a metaanalysis was done to compare the effect of music on them. The fixed effects model was used as studies were homogenous. A two-sided alpha error < 0.05 was considered to be statistically significant. Compared to those who did not receive music therapy, those who did receive music therapy had a significantly greater decrease in SBP before and after (difference in means, −2.629, confidence interval (CI), −3.914 to −1.344, P < 0.001), a significantly greater decrease in DBP (difference in means, −1.112, CI, −1.692 to −0.532, P < 0.001), and a significantly greater decrease in HR (difference in means, −3.422, CI, −5.032 to −1.812, P < 0.001). PMID:22664817
ERIC Educational Resources Information Center
Burt, Lorna; Lewandowski, Carol
This workbook, designed for workplace literacy courses, contains materials for a course on documentation. The six sessions of the course cover the following topics: (1) general principles of procedure writing; (2) principles of clear communication (clarity, audience, visuals) and identification of systems types, accounts, and customer requests;…
Gurfinkel, Iu I; Vasin, A L; Matveeva, T A; Sasonko, M L
Impact of attenuated magnetic field (MF) on human health is a hard-core issue of present-day cosmonautics. A series of experiments with animals exposed in attenuated MF revealed violent disorders in cardiovascular system development. Purpose of the work was to study effects of the hypomagnetic environment (HME) on capillary blood circulation, blood pressure (BP) and heart rate (HR) in normal people. Participants (n = 34) were 24 men and 10 women free from cardiovascular symptoms. Mean age was 43.3 +/- 15.4 years. Thirteen participants, i.e. 8 men and 5 women, were randomly selected for a repeated investigation in the usual conditions (imaginary exposure); mean age in the group made up 47.9 +/- 18 years. Cardiac rhythm and heart rate were recorded using cardiac monitor Astrocard (Russia). BP was measured with the help of automatic blood pressure monitor Tonocard (Russia). Capillary circulation was determined using a digital capillaroscope (Russia) with high-speed CMOS-camera (100 frames/s). Time of HME exposure was 60 min. It was demonstrated that in healthy people free from cardiovascular symptoms HME increases capillary circulation rate by 22.4% as compared with records made under the usual conditions. There was a reliable HR reduction by the end of HME exposure with reference to the measurements taken at the onset. At the end of exposure, diastolic BP dropped considerably relative to mid-exposure values and systolic BP, on the contrary, made a significant rise.
Relationship of blood pressures with hair mineral concentrations in South Carolina adolescents
Medeiros, D.M.; Borgman, R.F.
The relationships of hair mineral concentrations to blood pressures in adolescents from the coastal portion of South Carolina are examined. Blood pressure was measured and hair samples were prepared for mineral analysis by atomic absorption spectrophotometry. Results show that higher hair zinc concentrations were associated with lower pulse pressures. Higher hair copper concentrations were associated with higher systolic pressures. Higher hair nickel was associated with lower systolic and pulse pressures. Hair cadmium concentrations were related to lower systolic and diastolic pressures. Higher lead concentrations were associated with higher systolic pressures and slightly lower diastolic pressures. Higher copper to zinc ratios were associated with slightly greater systolic and pulse pressures. (JMT)
Prenatal Air Pollution Exposure and Newborn Blood Pressure
Rifas-Shiman, Sheryl L.; Melly, Steven J.; Kloog, Itai; Luttmann-Gibson, Heike; Zanobetti, Antonella; Coull, Brent A.; Schwartz, Joel D.; Mittleman, Murray A.; Oken, Emily; Gillman, Matthew W.; Koutrakis, Petros; Gold, Diane R.
Background Air pollution exposure has been associated with increased blood pressure in adults. Objective: We examined associations of antenatal exposure to ambient air pollution with newborn systolic blood pressure (SBP). Methods: We studied 1,131 mother–infant pairs in a Boston, Massachusetts, area pre-birth cohort. We calculated average exposures by trimester and during the 2 to 90 days before birth for temporally resolved fine particulate matter (≤ 2.5 μm; PM2.5), black carbon (BC), nitrogen oxides, nitrogen dioxide, ozone (O3), and carbon monoxide measured at stationary monitoring sites, and for spatiotemporally resolved estimates of PM2.5 and BC at the residence level. We measured SBP at a mean age of 30 ± 18 hr with an automated device. We used mixed-effects models to examine associations between air pollutant exposures and SBP, taking into account measurement circumstances; child's birth weight; mother's age, race/ethnicity, socioeconomic position, and third-trimester BP; and time trend. Estimates represent differences in SBP associated with an interquartile range (IQR) increase in each pollutant. Results: Higher mean PM2.5 and BC exposures during the third trimester were associated with higher SBP (e.g., 1.0 mmHg; 95% CI: 0.1, 1.8 for a 0.32-μg/m3 increase in mean 90-day residential BC). In contrast, O3 was negatively associated with SBP (e.g., –2.3 mmHg; 95% CI: –4.4, –0.2 for a 13.5-ppb increase during the 90 days before birth). Conclusions: Exposures to PM2.5 and BC in late pregnancy were positively associated with newborn SBP, whereas O3 was negatively associated with SBP. Longitudinal follow-up will enable us to assess the implications of these findings for health during later childhood and adulthood. Citation: van Rossem L, Rifas-Shiman SL, Melly SJ, Kloog I, Luttmann-Gibson H, Zanobetti A, Coull BA, Schwartz JD, Mittleman MA, Oken E, Gillman MW, Koutrakis P, Gold DR. 2015. Prenatal air pollution exposure and newborn blood pressure
Target Blood Pressure in Patients with Diabetes: Asian Perspective.
Park, Sungha; Kario, Kazuomi; Park, Chang Gyu; Huang, Qi Fang; Cheng, Hao Min; Hoshide, Satoshi; Wang, Ji Guang; Chen, Chen Huan
Recently, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) trial enrolled 4733 participants with type 2 diabetes and randomized them to a target systolic blood pressure (SBP) of less than 120 mm Hg or 140 mm Hg. Despite the significant difference in the achieved SBP, there was no significant difference in the incidence of primary outcomes. Based on this evidence, the target SBP for diabetics has been revised in the majority of major guidelines. However, there is a steeper association between SBP and stroke in Asians than other ethnicities, with stroke being the leading cause of cardiovascular mortality. This suggests that target BP in the Asian region should be tailored towards prevention of stroke. In the ACCORD study, the intensive BP treatment was associated with significant reductions in both total stroke and non-fatal stroke. The results from the ACCORD study are supported by a subgroup analysis from the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study, which showed that, in diabetic patients, the risk of stroke continues to decrease to a SBP value of 115 mm Hg with no evidence of J curve. As diabetes is highly associated with underlying coronary artery disease, there is a justified concern for adverse effects resulting from too much lowering of BP. In a post hoc analysis of 6400 diabetic subjects enrolled in the International Verapamil SR-Trandolapril (INVEST) study, subjects with SBP of less than 110 mm Hg were associated with a significant increase in all-cause mortality. In the ONTARGET study, at any levels of achieved SBP, diastolic blood pressure (DBP) below 67 mm Hg was associated with increased risk for cardiovascular outcomes. As such, a prudent approach would be to target a SBP of 130-140 mm Hg and DBP of above 60 mm Hg in diabetics with coronary artery disease. In conclusion, hypertension, in association with diabetes, has been found to be significantly correlated
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... COMMISSION Notice of Availability of Final Interim Staff Guidance Document No. 25 ``Pressure and Helium... Guidance Document No. 25 (ISG-25) ``Pressure and Helium Leakage Testing of the Confinement Boundary of... helium leakage testing and ASME Code required pressure (hydrostatic/pneumatic) testing that is...
Habitual intake of fruit juice predicts central blood pressure.
Pase, Matthew P; Grima, Natalie; Cockerell, Robyn; Pipingas, Andrew
Despite a common perception that fruit juice is healthy, fruit juice contains high amounts of naturally occurring sugar without the fibre content of the whole fruit. Frequent fruit juice consumption may therefore contribute to excessive sugar consumption typical of the Western society. Although excess sugar intake is associated with high blood pressure (BP), the association between habitual fruit juice consumption and BP is unclear. The present study investigated the association of fruit juice consumption with brachial and central (aortic) BP in 160 community dwelling adults. Habitual fruit juice consumption was measured using a 12 month dietary recall questionnaire. On the same day, brachial BP was measured and central (aortic) BP was estimated through radial artery applanation. Frequency of fruit juice consumption was classified as rare, occasional or daily. Those who consumed fruit juice daily, versus rarely or occasionally, had significantly higher central systolic BP (F (2, 134) = 6.09, p <0.01), central pulse pressure (F (2, 134) = 4.16, p <0.05), central augmentation pressure (F (2, 134) = 5.98, p <0.01) and central augmentation index (F (2, 134) = 3.29, p <0.05) as well as lower pulse pressure amplification (F (2, 134) = 4.36, p <0.05). There were no differences in brachial BP. Central systolic BP was 3-4 mmHg higher for those who consumed fruit juice daily rather than rarely or occasionally. In conclusion, more frequent fruit juice consumption was associated with higher central BPs.
Qualitative study of telemonitoring of blood glucose and blood pressure in type 2 diabetes
Hanley, Janet; Fairbrother, Peter; Pagliari, Claudia; Paterson, Mary; Pinnock, Hilary; Sheikh, Aziz; Wild, Sarah; McKinstry, Brian
Objectives To explore the experiences of patients and professionals taking part in a randomised controlled trial (RCT) of blood glucose, blood pressure (BP) and weight telemonitoring in type 2 diabetes supported by primary care, and identify factors facilitating or hindering the effectiveness of the intervention and those likely to influence its potential translation to routine practice. Design Qualitative study adopting an interpretive descriptive approach. Participants 23 patients, 6 nurses and 4 doctors who were participating in a RCT of blood glucose and BP telemonitoring. A maximum variation sample of patients from within the trial based on age, sex and deprivation status of the practice was sought. Setting 12 primary care practices in Scotland and England. Method Data were collected via recorded semistructured interviews. Analysis was inductive with themes presented within an overarching thematic framework. Multiple strategies were employed to ensure that the analysis was credible and trustworthy. Results Telemonitoring of blood glucose, BP and weight by people with type 2 diabetes was feasible. The data generated by telemonitoring supported self-care decisions and medical treatment decisions. Motivation to self-manage diet was increased by telemonitoring of blood glucose, and the 'benign policing' aspect of telemonitoring was considered by patients to be important. The convenience of home monitoring was very acceptable to patients although professionals had some concerns about telemonitoring increasing workload and costs. Conclusions Telemonitoring of blood glucose, BP and weight in primary care is a promising way of improving diabetes management which would be highly acceptable to the type of patients who volunteered for this study. Trial registration number ISRCTN71674628; Pre-results. PMID:26700275
Ditto, Blaine; Lavoie, Kim L; Campbell, Tavis S; Gordon, Jennifer; Arsenault, Andre; Bacon, Simon L
Sustained and acute increases in blood pressure can dampen pain in experimental animals and humans. The most important clinical implication of this relationship may be the phenomenon of silent cardiac ischemia. High blood pressure is common in people at risk for cardiac ischemia and may reduce angina, the key symptom of life-threatening ischemia. The relationship between resting blood pressure and angina was examined in 904 people undergoing exercise stress testing for coronary artery disease. The presence or absence of ischemia was documented with single photon emission computed tomography (SPECT). Participants with ischemia had higher scores on the McGill Pain Questionnaire (MPQ) following exercise though this was moderated significantly by diastolic blood pressure (DBP), especially in women. People with higher pre-exercise resting DBP who displayed SPECT-diagnosed ischemia had MPQ scores comparable to people who did not display ischemia, independent of age, exercise duration, medication, and cardiac history. Awareness of the potential association between blood pressure and angina may provide patients with coronary artery disease and their physicians' important guidance.
Barriers to and Strategies for Effective Blood Pressure Control
Siegel, David
There are major differences between the current knowledge of the treatment of cardiac conditions derived from evidence-based medicine and the widespread application of this knowledge. This is particularly true in the treatment of hypertension. Hypertension is the most common chronic cardiovascular condition, affecting more than 50 million Americans and approximately 1 billion individuals worldwide. However, many hypertensive patients are not receiving treatment, and of those that are, many are not adequately controlled. There is evidence that there are methods to improve blood pressure control and improve compliance with expert recommendations for the treatment of hypertension. These methods range from local initiatives such as academic detailing to national performance measures as have been developed by the US Department of Veterans Affairs. A challenge for the future will be to identify and broadly apply these and other programs to improve the quality and efficiency of hypertensive treatment. PMID:17319093
Diurnal blood pressure variation and related behavioral factors.
Kawano, Yuhei
Blood pressure (BP) varies according to many internal and external factors, and behavioral factors have an important role in diurnal BP variation. BP rises sharply on waking in the morning and falls during sleep at night, although it varies throughout the day and night. These changes in BP are closely related to mental and physical activities, and the sympathetic nervous system mainly contributes to the diurnal variation in BP. Other behavioral factors, such as food consumption and obesity, dietary intake of sodium, drinking and smoking habits, consumption of coffee and tea, and bathing, also affect the diurnal variation in BP. Alterations in diurnal BP variation due to behavioral factors are frequently seen in patients with hypertension and can be classified as morning hypertension, daytime hypertension and nighttime hypertension. Appropriate lifestyle modifications may normalize or improve both the level and rhythm of BP in these patients.
Blood Pressure in Older Adults: the Importance of Frailty.
Odden, Michelle C; Beilby, Pamela R; Peralta, Carmen A
The importance of high blood pressure (BP) and the effect of BP lowering in older adults remain controversial due to the mixed evidence in this population. Frailty status may resolve the apparently conflicting findings and identify subpopulations who share common risk. Emerging evidence demonstrates that low BP is associated with poor outcomes in older frail adults or those with poor functional status. In contrast, in non-frail older adults, low BP appears beneficial. Frail older adults may be at increased risk of hypotension, serious fall injuries, and polypharmacy. Additionally, peripheral BP may not be the best prognostic measure in this population. The majority of clinical practice guidelines give little recommendation for frail older adults, which is likely due to their systematic underrepresentation in randomized controlled trials. Future studies need to consider modifications to safely include frail older adults, and guidelines should consider inclusion of evidence beyond randomized controlled trials.
Wearable PWV technologies to measure Blood Pressure: eliminating brachial cuffs.
Solá, J; Proença, M; Chételat, O
The clinical demand for technologies to monitor Blood Pressure (BP) in ambulatory scenarios with minimal use of inflation cuffs is strong: new generation of BP monitors are expected to be not only accurate, but also non-occlusive. In this paper we review recent advances on the use of the so-called Pulse Wave Velocity (PWV) technologies to estimate BP in a beat-by-beat basis. After introducing the working principle and underlying methodological limitations, two implementation examples are provided. Pilot studies have demonstrated that novel PWV-based BP monitors depict accuracy scores falling within the limits of the British Hypertensive Society (BHS) Grade A standard. The reported techniques pave the way towards ambulatory-compliant, continuous and non-occlusive BP monitoring devices, where the use of inflation cuffs is drastically reduced. PMID:24110633
Practical Aspects of Home and Ambulatory Blood Pressure Monitoring
Peixoto, Aldo J.
Out-of-office blood pressure (BP) monitoring is becoming increasingly important in the diagnosis and management of hypertension. Home BP and ambulatory BP monitoring (ABPM) are the two forms of monitoring BP in the out-of-office environment. Home BP monitoring is easy to perform, inexpensive, and engages patients in the care of their hypertension. Although ABPM is expensive and not widely available, it remains the gold standard for diagnosing hypertension. Observational studies show that both home BP and ABPM are stronger predictors of hypertension-related outcomes than office BP monitoring. There are no clinical trials showing their superiority over office BP monitoring in guiding the treatment of hypertension, but the consistency of observational data make a compelling case for their preferential use in clinical practice. PMID:27057289
The Relationship of Diet to Blood Pressure Control
Jones, Walretta O.; Brown, Jay
Sodium restriction has become an integral part of the medical management of hypertension. In general the degree of sodium restriction recommended by physicians depends upon the severity of the disease. The commonly prescribed sodium restricted diets are classified as mild and moderate. Mild sodium restriction refers to a diet in which 3.0-4.0 gm of sodium are allowed per day. Moderate sodium restriction is indicated when hypertension is more severe; 1-2 gm of sodium are allowed daily. Sodium added in the processing of foods contributes significantly to the sodium content of the diet. "Convenience" and "fast" foods are high in sodium and are not allowed the hypertensive patients. Significant advances have occurred in the past decade in the medical management of hypertension. The sodium-restricted diet remains the cornerstone of effective blood pressure control. Therefore, nutrition must become an integral part of the hypertensive treatment program. PMID:529319
[Is blood pressure control different in women than in men?].
Oliveras, A; Sans-Atxer, L; Vázquez, S
Blood pressure (BP) evolves with age; until the 50's it is higher in men than in women, equaling and even then increasing in women. The prevalence of controlled BP appears to be similar between the sexes, but the prevalence of cardiovascular disease is higher in women than in men. The possibility that BP influences the cardiovascular risk differently according to sex must therefore be considered. While some studies suggest no difference exists, others have shown evidence of an increased risk in women with respect to men despite equal BP. In this way, it seems that the measurement of ambulatory BP, but not office BP, would mark the differences in the association between BP-gender and cardiovascular risk. It should therefore be investigated the possibility of a different BP goal for women and men, especially by evaluating ambulatory BP.
Mechanisms and pharmacogenetic signals underlying thiazide diuretics blood pressure response.
Shahin, Mohamed H; Johnson, Julie A
Thiazide (TZD) diuretics are among the most commonly prescribed antihypertensives globally; however their chronic blood pressure (BP) lowering mechanism remains unclear. Herein we discuss the current evidence regarding specific mechanisms regulating the antihypertensive effects of TZDs, suggesting that TZDs act via multiple complex and interacting mechanisms, including natriuresis with short term use and direct vasodilatory effects chronically. Additionally, we review pharmacogenomics signals that have been associated with TZDs BP-response in several cohorts (i.e. NEDD4L, PRKCA, EDNRA-GNAS, and YEATS4) and discuss how these genes might be related to TZD BP-response mechanism. Understanding the association between these genes and TZD BP mechanism might facilitate the development of new drugs and therapeutic approaches based on a deeper understanding of the determinants of BP-response.
Locally-brewed Nigerian lager beers and high blood pressure
Adeniyi, F.A.A.
Volunteers who consumed 88g alcohol/day (= 2.48L of lager beer) had elevated levels of systolic and mean arterial Blood Pressure. The association between consumption of locally brewed Nigerian lager beer with arterial hypertension was independent of age and weight. The true mechanism for the development of hypertension in these alcohol-users is at present not clear. All brands of lager beer investigated contain as much as five times the sodium content of potable water. It is desirable to evaluate the consequences of ingesting such quantities of sodium in lager beers. The effect of alcohol on other monovalent and divalent cations may shed some light onto the true mechanism for the pathogenesis of alcohol-induced hypertension. 15 references, 3 tables.
[Is blood pressure control different in women than in men?].
Oliveras, A; Sans-Atxer, L; Vázquez, S
Blood pressure (BP) evolves with age; until the 50's it is higher in men than in women, equaling and even then increasing in women. The prevalence of controlled BP appears to be similar between the sexes, but the prevalence of cardiovascular disease is higher in women than in men. The possibility that BP influences the cardiovascular risk differently according to sex must therefore be considered. While some studies suggest no difference exists, others have shown evidence of an increased risk in women with respect to men despite equal BP. In this way, it seems that the measurement of ambulatory BP, but not office BP, would mark the differences in the association between BP-gender and cardiovascular risk. It should therefore be investigated the possibility of a different BP goal for women and men, especially by evaluating ambulatory BP. PMID:26486463
Effect of urbanisation on blood pressure in Ethiopian immigrants.
Grossman, E; Rosenthal, T
Blood pressure, heart rate, height and weight were measured in a group of Ethiopian immigrants who arrived in Israel in 1991 after waiting some 6 months in Addis Ababa. The findings were compared with a previous group of Ethiopians who immigrated immediately after physical hardships and malnutrition. The recent arrivals had higher BP levels and higher Quetelet indices than the earlier group. BP values of > 140 mmHg systolic or 90 mmHg diastolic were found in 15 of 102 newcomers (14.7%) in 1991, in contrast to < 1% in the earlier group. Our findings demonstrate an important effect of urbanisation in the same environment on rise in BP, probably through changes in lifestyle.
Improving identification and documentation of pressure ulcers at an urban academic hospital
Dahlstrom, Marcus; Best, Thomas; Baker, Christine; Doeing, Diane; Davis, Andrew; Doty, Judith; Arora, Vineet M.
Background A two-year quality improvement campaign at a single teaching hospital was launched to improve the identification, documentation, and treatment of pressure ulcers (PUs) after Centers for Medicare & Medicaid Services (CMS) declared severe hospital-acquired PUs are "never-events." Method The campaign included (1) reference materials, (2) new documentation templates, (3) staff education, and (4) hospital-wide mattress replacement. An ongoing retrospective chart review of frail older patients determined the presence of PU documentation, which provider (nurse or physician) documented the PU, and which descriptors (stage, size, or location) were used. Results The campaign significantly increased the proportion of PUs completely documented by nurses from 27% to 55% following mattress replacement and resident education (OR 3.68, p = 0.001, 95% CI: 1.68–8.08). A similar improvement was observed for physician documentation increasing from 12% to 36% following the same interventions however this change was not statistically significant (OR 2.11, p = 0.12, 95% CI: 0.82–5.39). These improvements were short-lived due to the implementation of electronic medical records (EMR) for nursing notes. Although the percentage of PUs completely documented by nurses decreased following EMR implementation, it increased in the following months, above the pre-campaign baseline as nurses adapted to the new documentation system. However, after EMR implementation, complete PU documentation by physicians fell to a nadir of 0% and did not recover. Discussion A multi-component campaign to improve the quality of PU documentation by both physicians and nurses can yield positive gains. However, these improvements were short-lived due to EMR implementation, which acutely worsened documentation of PUs. This emphasizes the importance of frequent and repeated interventions to sustain quality improvement successes. PMID:21500755
Krupp, Danika; Shi, Lijie; Remer, Thomas
Diets high in sulfur-rich protein and low in fruits and vegetables affect human acid-base balance adversely. Corresponding subclinical forms of metabolic acidosis have been linked to hypertension in adults. We longitudinally examined relations of dietary acid load with blood pressure in 257 healthy prepuberty children with 3 or more parallel 3-day weighed dietary records, 24-h urine, and blood pressure measurements. Urinary net acid excretion and the potential renal acid load (PRAL), determined as the difference of major urinary nonbicarbonate anions and mineral cations, were used to predict dietary acid load. PRAL was also calculated from dietary data. In repeated-measures regression analyses, adjusted for body size and dietary fiber, an intraindividual increase of 10 mEq above the 'usual' net acid excretion or urine PRAL were each significantly related to a 0.6-0.7 mm Hg increased systolic blood pressure. Differences in urine PRAL among the children also significantly predicted between-person differences in systolic blood pressure. A higher individual net acid excretion or urine PRAL and intraindividual increase in urine PRAL were significantly related to higher diastolic blood pressure. Blood pressure associations were nonsignificant for dietary PRAL and urinary sodium. Thus, in healthy children, renal biomarker analyses reveal an association of proton load with higher blood pressure. Especially for systolic blood pressure, a more alkalizing nutrition may be beneficial for blood pressure development within a given individual. Experimental confirmation of a causal acid load-blood pressure link is required.
Heart rate and blood pressure variability in subjects exposed to simulated increases in gravity.
McKenzie, I
The effect of simulated increases in gravity (G) force on blood pressure and heart rate variability was investigated in seven normal healthy subjects using a man-carrying centrifuge. Subjects were exposed to G forces up to 3.6 times the gravity at the earth's surface (3.6 G). Blood pressure was measured non-invasively using a finger cuff (Finapres), while the subjects breathed at a fixed rate and depth. The blood pressure waveform was digitized and systolic blood pressure, diastolic blood pressure and beat-to-beat intervals were extracted from these data. Power spectra were produced from these values. Increases in G force produced increases in spectral power of systolic blood pressure and diastolic blood pressure at the respiratory frequency (0.2 Hz) and less conspicuous but significant increases in spectral power at lower frequencies (0.045-0.15 Hz). The spectral power of beat-to-beat interval did not change. It is postulated that the reduction in central blood volume produced by increased gravity is affecting blood pressure control in a similar way to that seen in hypovolaemic animals. The marked increase in blood pressure fluctuations induced by respiration at the higher G levels may be a result of the alteration in venous return to the right atrium, ultimately reflected as fluctuating left ventricular output and pressure.
Epistatic study reveals two genetic interactions in blood pressure regulation
Background Although numerous candidate gene and genome-wide association studies have been performed on blood pressure, a small number of regulating genetic variants having a limited effect have been identified. This phenomenon can partially be explained by possible gene-gene/epistasis interactions that were little investigated so far. Methods We performed a pre-planned two-phase investigation: in phase 1, one hundred single nucleotide polymorphisms (SNPs) in 65 candidate genes were genotyped in 1,912 French unrelated adults in order to study their two-locus combined effects on blood pressure (BP) levels. In phase 2, the significant epistatic interactions observed in phase 1 were tested in an independent population gathering 1,755 unrelated European adults. Results Among the 9 genetic variants significantly associated with systolic and diastolic BP in phase 1, some may act through altering the corresponding protein levels: SNPs rs5742910 (Padjusted≤0.03) and rs6046 (Padjusted =0.044) in F7 and rs1800469 (Padjusted ≤0.036) in TGFB1; whereas some may be functional through altering the corresponding protein structure: rs1800590 (Padjusted =0.028, SE=0.088) in LPL and rs2228570 (Padjusted ≤9.48×10-4) in VDR. The two epistatic interactions found for systolic and diastolic BP in the discovery phase: VCAM1 (rs1041163) * APOB (rs1367117), and SCGB1A1 (rs3741240) * LPL (rs1800590), were tested in the replication population and we observed significant interactions on DBP. In silico analyses yielded putative functional properties of the SNPs involved in these epistatic interactions trough the alteration of corresponding protein structures. Conclusions These findings support the hypothesis that different pathways and then different genes may act synergistically in order to modify BP. This could highlight novel pathophysiologic mechanisms underlying hypertension. PMID:23298194
Natural variances in blood pressure category among Chinese adults.
Hu, Jihong; Wu, Yangfeng; Zhao, Liancheng; Lilo, Ying; Zhou, Beifan
Little is known about the natural progression and regression of blood pressure status, even though such knowledge would help determine the best intervention strategies. Our study aimed to explore natural changes in blood pressure status in a middle-aged Chinese population. A total of 6,129 Chinese men and women, aged 35 to 59 years at baseline, from the China Multi-center Collaborative Study of Cardiovascular Epidemiology, were reexamined 6 years later to determine the probability of progression (from non-hypertension to hypertension) and regression (from hypertension to non-hypertension). The majority (80%) of non-hypertensives among the respondents in this study remained normal or pre-hypertensive; about two-thirds of stage 1 hypertensives either stayed at the same stage or regressed to non-hypertension. However, only 9% of stage 2 hypertensives regressed to non-hypertension. Multi-variable logistic regression analysis showed that the stage 1 hypertension group had a 5-fold chance of regressing to non-hypertension in comparison with the stage 2 hypertension group (odds ratio [OR] = 0.2, 95% confidence interval [CI]: 0.1-0.3), whereas the pre-hypertension group had a 4-fold likelihood of progressing to hypertension compared with normotensive subjects (OR = 4.4, 95% CI: 3.7-5.3). After excluding participants ever on drug treatment in either examinations, the OR of regression for stage 2 hypertension was over twice that for stage 1 hypertension (OR = 0.5, 95% CI: 0.3-0.7), and the possibility of progression decreased, though very slightly (OR = 4.3, 95% CI: 3.6-5.1). Weight change significantly influenced progression and regression. Alcohol drinking affected progression significantly. In conclusion, the present findings support the strategy of intensively treating stage 2 hypertension and moderately treating stage 1 hypertension. Persons with pre-hypertension should be monitored for progression and advice on lifestyle modifications should be used.
A Simplified Two-Component Model of Blood Pressure Fluctuation
Brychta, Robert J.; Shiavi, Richard; Robertson, David; Biaggioni, Italo; Diedrich, André
We propose a simple moving-average (MA) model that uses the low-frequency (LF) component of the peroneal muscle sympathetic nerve spike rate (LFspike rate) and the high-frequency (HF) component of respiration (HFResp) to describe the LF neurovascular fluctuations and the HF mechanical oscillations in systolic blood pressure (SBP), respectively. This method was validated by data from eight healthy subjects (23–47 yr old, 6 male, 2 female) during a graded tilt (15° increments every 5 min to a 60° angle). The LF component of SBP (LFSBP) had a strong baroreflex-mediated feedback correlation with LFspike rate (r = −0.69 ± 0.05) and also a strong feedforward relation to LFspike rate [r = 0.58 ± 0.03 with LFSBP delay (τ) = 5.625 ± 0.15 s]. The HF components of spike rate (HFspike rate) and SBP (HFSBP) were not significantly correlated. Conversely, HFResp and HFSBP were highly correlated (r = −0.79 ± 0.04), whereas LFResp and LFSBP were significantly less correlated (r = 0.45 ± 0.08). The mean correlation coefficients between the measured and model-predicted LFSBP (r = 0.74 ± 0.03) in the supine position did not change significantly during tilt. The mean correlation between the measured and model-predicted HFSBP was 0.89 ± 0.02 in the supine position. R2 values for the regression analysis of the model-predicted and measured LF and HF powers indicate that 78 and 91% of the variability in power can be explained by the linear relation of LFspike rate to LFSBP and HFResp to HFSBP. We report a simple two-component model using neural sympathetic and mechanical respiratory inputs that can explain the majority of blood pressure fluctuation at rest and during orthostatic stress in healthy subjects. PMID:17012354
Salt intake and blood pressure in rural and metropolitan Mexico.
Sánchez-Castillo, C P; Solano, M L; Flores, J; Franklin, M F; Limón, N; Martínez del Cerro, V; Velázquez, C; Villa, A R; James, W P
A selected group of 155 Mexican adults aged 20-64 years were studied to investigate the role of sodium (Na) intake in explaining blood pressure (BP) differences in a rural town and urban Mexico City. The subjects had their BP, height, weight and skinfolds measured and they collected 3 continuous 24 h urines. Adjusted for age differences, average BPs were significantly higher (p < .05) for the urban (112.7 systolic: 73.6 diastolic mmHg) than for the rural group (108.4 systolic: 70.8 diastolic mmHg). They were also higher for men (111.8 systolic: 74.3 diastolic mmHg) than for women (109.6 systolic: 70.2 diastolic mmHg), the diastolic BP difference being significant (p < 0.05). The average daily Na excretion was also higher in the urban (122.2 mmol/day) than in the rural community (98.0 mmol/day) (p < 0.01). Potassium excretion rates showed similar differences. The differences in sodium excretion and blood pressure among communities were particularly marked in those over 30 years of age. The means for the four community-sex groups had the same rank order for both BP and Na. However, although some large surveys have suggested that half the observed differences in BP might be explained by different Na intakes, in this study the relationship between Na excretion and BP did not achieve statistical significance. Differences in the body mass index (BMI) accounted for 41% of the observed variance in BP.
Automatic Office Blood Pressure Measured without Doctors or Nurses Present
Ishikawa, Joji; Nasothimiou, Efthimia G; Karpettas, Nikos; McDoniel, Scott; Feltheimer, Seth D; Stergiou, George S; Pickering, Thomas G; Schwartz, Joseph E
Backgrounds We evaluated the agreement between office blood pressure (OBP) measured by mercury sphygmomanometer (Sphyg) and automatic (Auto) device without any observers, and compared Auto and Sphyg OBP to ambulatory (ABP) and home blood pressure (HBP). Methods OBP was measured in 75 hypertensive patients at 2 sites using an automatic monitor without a doctor or nurse present and by Sphyg during 3 clinic visits. Between visits, ABP and HBP monitoring were also performed. Results Mean Auto OBP was similar to Sphyg OBP and they were closely correlated (ICC=0.84 for systolic and 0.91 for diastolic OBPs); however, the difference between Auto and Sphyg systolic OBP (1.6±8.2 mmHg) varied by the first office visit, gender, and the site. Auto systolic OBP was lower than both systolic awake ABP (137.1±14.7 mmHg) and HBP (139.2±15.6 mmHg). Auto systolic OBP and Sphyg OBP were similarly correlated with systolic awake ABP (both r=0.59, P<0.001). Mean Auto diastolic OBP was similar to Sphyg OBP (81.1±11.3 vs. 80.3±13.3 mmHg, P=0.20, ICC=0.91), diastolic awake ABP and HBP. Auto diastolic OBP and Sphyg OBP were related to diastolic awake ABP (both r>0.68, P<0.001). In multivariable analyses, neither OBP measure was a significantly stronger predictor of out-of-office BP than the other. Conclusion Auto systolic OBP measured without a doctor or nurse present was lower than systolic awake ABP and HBP. Auto and rigorously assessed Sphyg OBP had similar means and were similarly related to awake ABP. Auto OBP might be an advantageous alternative to Sphyg measurements in the usual clinic setting. PMID:22425703
Trends in blood pressure among adults with hypertension: United States, 2003 to 2012.
Yoon, Sung Sug; Gu, Qiuping; Nwankwo, Tatiana; Wright, Jacqueline D; Hong, Yuling; Burt, Vicki
The aim of this study is to describe trends in the awareness, treatment, and control of hypertension; mean blood pressure; and the classification of blood pressure among US adults 2003 to 2012. Using data from the National Health and Nutrition Examination Survey 2003 to 2012, a total of 9255 adult participants aged ≥18 years were identified as having hypertension, defined as measured blood pressure ≥140/90 mm Hg or taking prescription medication for hypertension. Awareness and treatment among hypertensive adults were ascertained via an interviewer administered questionnaire. Controlled hypertension among hypertensive adults was defined as systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg. Blood pressure was categorized as optimal blood pressure, prehypertension, and stage I and stage II hypertension. Between 2003 and 2012, the percentage of adults with controlled hypertension increased (P-trend <0.01). Hypertensive adults with optimal blood pressure and with prehypertension increased from 13% to 19% and 27% to 33%, respectively (P-trend <0.01 for both groups). Among hypertensive adults who were taking antihypertensive medication, uncontrolled hypertension decreased from 38% to 30% (P-trend <0.01). Similarly, a decrease in mean systolic blood pressure was observed (P-trend <0.01); however, mean diastolic blood pressure remained unchanged. The trend in the control of blood pressure has improved among hypertensive adults resulting in a higher percentage with blood pressure at the optimal or prehypertension level and a lower percentage in stage I and stage II hypertension. Overall, mean systolic blood pressure decreased as did the prevalence of uncontrolled hypertension among the treated hypertensive population.
Blood pressure response to patterns of weather fluctuations and effect on mortality.
Aubinière-Robb, Louise; Jeemon, Panniyammakal; Hastie, Claire E; Patel, Rajan K; McCallum, Linsay; Morrison, David; Walters, Matthew; Dawson, Jesse; Sloan, William; Muir, Scott; Dominiczak, Anna F; McInnes, Gordon T; Padmanabhan, Sandosh
Very few studies have looked at longitudinal intraindividual blood pressure responses to weather conditions. There are no data to suggest that specific response to changes in weather will have an impact on survival. We analyzed >169 000 clinic visits of 16 010 Glasgow Blood Pressure Clinic patients with hypertension. Each clinic visit was mapped to the mean West of Scotland monthly weather (temperature, sunshine, rainfall) data. Percentage change in blood pressure was calculated between pairs of consecutive clinic visits, where the weather alternated between 2 extreme quartiles (Q(1)-Q(4) or Q(4)-Q(1)) or remained in the same quartile (Q(n)-Q(n)) of each weather parameter. Subjects were also categorized into 2 groups depending on whether their blood pressure response in Q(1)-Q(4) or Q(4)-Q(1) were concordant or discordant to Q(n)-Q(n). Generalized estimating equations and Cox proportional hazards model were used to model the effect on longitudinal blood pressure and mortality, respectively. Q(n)-Q(n) showed a mean 2% drop in blood pressure consistently, whereas Q(4)-Q(1) showed a mean 2.1% and 1.6% rise in systolic and diastolic blood pressure, respectively. However, Q(1)-Q(4) did not show significant changes in blood pressure. Temperature-sensitive subjects had significantly higher mortality (1.35 [95% confidence interval, 1.06-1.71]; P=0.01) and higher follow-up systolic blood pressure (1.85 [95% confidence interval, 0.24-3.46]; P=0.02) compared with temperature-nonsensitive subjects. Blood pressure response to temperature may be one of the underlying mechanisms that determine long-term blood pressure variability. Knowing a patient's blood pressure response to weather can help reduce unnecessary antihypertensive treatment modification, which may in turn increase blood pressure variability and, thus, risk.
Integrative network analysis reveals molecular mechanisms of blood pressure regulation.
Huan, Tianxiao; Meng, Qingying; Saleh, Mohamed A; Norlander, Allison E; Joehanes, Roby; Zhu, Jun; Chen, Brian H; Zhang, Bin; Johnson, Andrew D; Ying, Saixia; Courchesne, Paul; Raghavachari, Nalini; Wang, Richard; Liu, Poching; O'Donnell, Christopher J; Vasan, Ramachandran; Munson, Peter J; Madhur, Meena S; Harrison, David G; Yang, Xia; Levy, Daniel
Genome-wide association studies (GWAS) have identified numerous loci associated with blood pressure (BP). The molecular mechanisms underlying BP regulation, however, remain unclear. We investigated BP-associated molecular mechanisms by integrating BP GWAS with whole blood mRNA expression profiles in 3,679 individuals, using network approaches. BP transcriptomic signatures at the single-gene and the coexpression network module levels were identified. Four coexpression modules were identified as potentially causal based on genetic inference because expression-related SNPs for their corresponding genes demonstrated enrichment for BP GWAS signals. Genes from the four modules were further projected onto predefined molecular interaction networks, revealing key drivers. Gene subnetworks entailing molecular interactions between key drivers and BP-related genes were uncovered. As proof-of-concept, we validated SH2B3, one of the top key drivers, using Sh2b3(-/-) mice. We found that a significant number of genes predicted to be regulated by SH2B3 in gene networks are perturbed in Sh2b3(-/-) mice, which demonstrate an exaggerated pressor response to angiotensin II infusion. Our findings may help to identify novel targets for the prevention or treatment of hypertension.
Integrative network analysis reveals molecular mechanisms of blood pressure regulation.
Huan, Tianxiao; Meng, Qingying; Saleh, Mohamed A; Norlander, Allison E; Joehanes, Roby; Zhu, Jun; Chen, Brian H; Zhang, Bin; Johnson, Andrew D; Ying, Saixia; Courchesne, Paul; Raghavachari, Nalini; Wang, Richard; Liu, Poching; O'Donnell, Christopher J; Vasan, Ramachandran; Munson, Peter J; Madhur, Meena S; Harrison, David G; Yang, Xia; Levy, Daniel
Genome-wide association studies (GWAS) have identified numerous loci associated with blood pressure (BP). The molecular mechanisms underlying BP regulation, however, remain unclear. We investigated BP-associated molecular mechanisms by integrating BP GWAS with whole blood mRNA expression profiles in 3,679 individuals, using network approaches. BP transcriptomic signatures at the single-gene and the coexpression network module levels were identified. Four coexpression modules were identified as potentially causal based on genetic inference because expression-related SNPs for their corresponding genes demonstrated enrichment for BP GWAS signals. Genes from the four modules were further projected onto predefined molecular interaction networks, revealing key drivers. Gene subnetworks entailing molecular interactions between key drivers and BP-related genes were uncovered. As proof-of-concept, we validated SH2B3, one of the top key drivers, using Sh2b3−/− mice. We found that a significant number of genes predicted to be regulated by SH2B3 in gene networks are perturbed in Sh2b3−/− mice, which demonstrate an exaggerated pressor response to angiotensin II infusion. Our findings may help to identify novel targets for the prevention or treatment of hypertension.
Ankle blood pressure as a predictor of total and cardiovascular mortality
Hietanen, Heikki; Pääkkönen, Rauni; Salomaa, Veikko
Background The ankle blood pressure is commonly used as a ratio to the brachial blood pressure, called ankle-brachial index (ABI). Very few studies have considered the independent value of the ankle blood pressure without indexing it to the brachial blood pressure. We examined the value of ankle blood pressure, together with the exercise blood pressure, as a predictor of cardiovascular (CVD) and total mortality. Methods A prospective follow-up study of 3,858 consecutive ambulatory patients (mean age 51 years, 65,9% male) referred to a symptom-limited exercise test between August 1989 and December 1995. The cohort was followed up for all-cause and CVD mortality until December 31, 2004, by record linkage with the National Causes-of-Death Register. The independent value of ankle blood pressure as a predictor of cardiovascular and total mortality was assessed using Cox proportional hazards modelling. Results The average follow-up time was 14 years, during which 346 persons died, 108 of them due to CVD. Persons with normal (<140 mmHg) resting brachial blood pressure, ankle blood pressure < 175 mmHg and exercise blood pressure at moderate exercise level ≤215 mmHg at baseline investigation, had the best prognosis and were taken as the reference category. Among persons with elevated ankle blood pressure (≥175 mmHg) but normal or borderline resting brachial pressure and normal exercise blood pressure (≤215 mmHg) at moderate exercise level the multivariate-adjusted hazard ratios (HR, 95% confidence interval) for CVD and total mortality were 2.70 (1.52 – 4.80) and 2.13 (1.58 – 2.85), respectively. Similar and equally significant HRs were observed in persons with both elevated ankle blood pressure and elevated exercise blood pressure, as well as in those persons with elevated exercise blood pressure but ankle blood pressure < 175 mmHg. Conclusion These results suggest that the ankle blood pressure has an independent value as a marker of arterial stiffness or
Chu, N. F.; Liou, S. H.; Wu, T. N.; Chang, P. Y.
OBJECTIVES: The relation between blood lead concentration (PbB) and blood pressure was examined in a Taiwan nationwide population survey of PbB from July 1993 to June 1994. METHODS: After multistage sampling procedures, 2800 subjects (1471 males and 1329 females) with a mean (range) age of 44 (15-85) years were enrolled in this study. Anthropometric, blood pressure, and lifestyle factors were measured during household visits. The PbB was measured with a flameless atomic absorption spectrophotometer and all specimens were analysed in triplicate. RESULTS: The mean (range) PbB among all study subjects was 6.5 (0.1-69.1) micrograms/dl; among males it was 7.3 (0.1-69.1) micrograms/dl and among females 5.7 (0.1-40.1) micrograms/dl). The mean (range) systolic blood pressure among all subjects was 123 (80-210) mm Hg, among males it was 127 (80-200) mm Hg and among females 119 (80- 210) mm Hg. The diastolic blood pressure among all subjects was 78 (40- 150) mm Hg; among males it was 80 (40-130) mm Hg; and among females 75 (40-150) mm Hg. Age, body height, body weight, and body mass index (BMI) were significantly correlated with systolic blood pressure or diastolic blood pressure in both sexes. The PbB (or the natural logarithmic transformed PbB) was not significantly correlated with blood pressure among males or females. After adjustment for the potential confounders of age, age2, BMI, milk intake, alcohol consumption, and cigarette smoking, systolic blood pressure was significantly associated with PbB among males with a regression coefficient (beta) of 0.185 (p = 0.015). No significant association between PbB and blood pressure was found among females. CONCLUSIONS: From this study, only a weak association between systolic blood pressure and PbB was found among males. There was no strong evidence that PbB was a good predictor of blood pressure. However, the possibility that long term high body lead burden could cause high blood pressure could not be ruled out on the basis
Li, B; Yang, M; Liu, J W
This study investigated the STK39 expression in peripheral blood of hypertension patients and the relation between its genetic polymorphism and blood pressure. The observation group comprised of 42 primary hypertension patients admitted to our hospital, and the control group comprised of 30 healthy individuals who underwent physical examination in our hospital during the same period. Fasting venous blood was collected from both groups in the morning to determine the STK39 mRNA and protein levels in peripheral blood using quantitative real-time PCR and western blot. STK39 gene SNP (rs6433027) was sequenced using PCR and its genetic variation was analyzed. The relationship between STK39 protein level, genetic variation, and diastolic and systolic blood pressure was also analyzed. The observation group showed increased STK39 mRNA and protein levels in peripheral blood compared to the control group, and the difference was statistically significant (P < 0.05), suggesting C/T mutation in STK39 gene SNP (rs6433027). Correlation analysis showed positive association between STK39 protein level and diastolic and systolic blood pressure (P < 0.05), indicating a positive association between C/T genetic mutation and diastolic and systolic blood pressure (P < 0.05). In conclusion, STK39 mRNA and protein express abnormally in primary hypertension patients with genetic variation, which is related to the blood pressure.
Seeking a blood pressure-independent measure of vascular properties.
Steppan, Jochen; Sikka, Gautam; Hori, Daijiro; Nyhan, Daniel; Berkowitz, Dan E; Gottschalk, Allan; Barodka, Viachaslau
Pulse wave velocity (PWV) and pulse pressure (PP) are blood pressure (BP)-dependent surrogates for vascular stiffness. Considering that there are no clinically useful markers for arterial stiffness that are BP-independent, our objective was to identify novel indices of arterial stiffness and compare them with previously described markers. PWV and PP were measured in young and old male Fisher rats and in young and old male spontaneously hypertensive rats (SHR) over a wide range of BPs. The BP dependence of these and several other indices of vascular stiffness were evaluated. An index incorporating PWV and PP was also constructed. Both PWV and PP increase in a non-linear manner with rising BP for both strains of animals (Fisher and SHRs). Age markedly changes the relationship between PWV or PP and BP. The previously described Ambulatory Arterial Stiffness Index (AASI) was able to differentiate between young and old vasculature, whereas the Cardio-Ankle Vascular Index (CAVI) did not reliably differentiate between the two. The novel Arterial Stiffness Index (ASI) differentiated stiffer from more compliant vasculature. Considering the limitations of the currently available indices of arterial stiffness, we propose a novel index of intrinsic arterial stiffness, the ASI, which is robust over a range of BPs and allows one to distinguish between compliant and stiff vasculature in both Fisher rats and SHRs. Further studies are necessary to validate this index in other settings.
Seeking a blood pressure-independent measure of vascular properties.
Steppan, Jochen; Sikka, Gautam; Hori, Daijiro; Nyhan, Daniel; Berkowitz, Dan E; Gottschalk, Allan; Barodka, Viachaslau
Pulse wave velocity (PWV) and pulse pressure (PP) are blood pressure (BP)-dependent surrogates for vascular stiffness. Considering that there are no clinically useful markers for arterial stiffness that are BP-independent, our objective was to identify novel indices of arterial stiffness and compare them with previously described markers. PWV and PP were measured in young and old male Fisher rats and in young and old male spontaneously hypertensive rats (SHR) over a wide range of BPs. The BP dependence of these and several other indices of vascular stiffness were evaluated. An index incorporating PWV and PP was also constructed. Both PWV and PP increase in a non-linear manner with rising BP for both strains of animals (Fisher and SHRs). Age markedly changes the relationship between PWV or PP and BP. The previously described Ambulatory Arterial Stiffness Index (AASI) was able to differentiate between young and old vasculature, whereas the Cardio-Ankle Vascular Index (CAVI) did not reliably differentiate between the two. The novel Arterial Stiffness Index (ASI) differentiated stiffer from more compliant vasculature. Considering the limitations of the currently available indices of arterial stiffness, we propose a novel index of intrinsic arterial stiffness, the ASI, which is robust over a range of BPs and allows one to distinguish between compliant and stiff vasculature in both Fisher rats and SHRs. Further studies are necessary to validate this index in other settings. PMID:26490088
Noninvasive and Nonocclusive Blood Pressure Estimation Via a Chest Sensor.
Solà, Josep; Proença, Martin; Ferrario, Damien; Porchet, Jacques-André; Falhi, Abdessamad; Grossenbacher, Olivier; Allemann, Yves; Rimoldi, Stefano F; Sartori, Claudio
The clinical demand for a device to monitor blood pressure (BP) in ambulatory scenarios with minimal use of inflation cuffs is increasing. Based on the so-called pulse wave velocity (PWV) principle, this paper introduces and evaluates a novel concept of BP monitor that can be fully integrated within a chest sensor. After a preliminary calibration, the sensor provides nonocclusive beat-by-beat estimations of mean arterial pressure (MAP) by measuring the pulse transit time (PTT) of arterial pressure pulses travelling from the ascending aorta toward the subcutaneous vasculature of the chest. In a cohort of 15 healthy male subjects, a total of 462 simultaneous readings consisting of reference MAP and chest PTT were acquired. Each subject was recorded at three different days: D, D+3, and D+14. Overall, the implemented protocol induced MAP values to range from 80 ± 6 mmHg in baseline, to 107 ± 9 mmHg during isometric handgrip maneuvers. Agreement between reference and chest-sensor MAP values was tested by using intraclass correlation coefficient (ICC = 0.78) and Bland-Altman analysis (mean error = 0.7 mmHg, standard deviation = 5.1 mmHg). The cumulative percentage of MAP values provided by the chest sensor falling within a range of ±5 mmHg compared to reference MAP readings was of 70%, within ±10 mmHg was of 91%, and within ±15 mmHg was of 98%. These results point at the fact that the chest sensor complies with the British Hypertension Society requirements of Grade A BP monitors, when applied to MAP readings. Grade A performance was maintained even two weeks after having performed the initial subject-dependent calibration. In conclusion, this paper introduces a sensor and a calibration strategy to perform MAP measurements at the chest. The encouraging performance of the presented technique paves the way toward an ambulatory compliant, continuous, and nonocclusive BP monitoring system. PMID:23864147
Lurbe, Empar; Agabiti-Rosei, Enrico; Cruickshank, J Kennedy; Dominiczak, Anna; Erdine, Serap; Hirth, Asle; Invitti, Cecilia; Litwin, Mieczyslaw; Mancia, Giuseppe; Pall, Denes; Rascher, Wolfgang; Redon, Josep; Schaefer, Franz; Seeman, Tomas; Sinha, Manish; Stabouli, Stella; Webb, Nicholas J; Wühl, Elke; Zanchetti, Alberto
Increasing prevalence of hypertension (HTN) in children and adolescents has become a significant public health issue driving a considerable amount of research. Aspects discussed in this document include advances in the definition of HTN in 16 year or older, clinical significance of isolated systolic HTN in youth, the importance of out of office and central blood pressure measurement, new risk factors for HTN, methods to assess vascular phenotypes, clustering of cardiovascular risk factors and treatment strategies among others. The recommendations of the present document synthesize a considerable amount of scientific data and clinical experience and represent the best clinical wisdom upon which physicians, nurses and families should base their decisions. In addition, as they call attention to the burden of HTN in children and adolescents, and its contribution to the current epidemic of cardiovascular disease, these guidelines should encourage public policy makers to develop a global effort to improve identification and treatment of high blood pressure among children and adolescents. PMID:27467768
Boubouchairopoulou, Nadia; Karpettas, Nikos; Athanasakis, Kostas; Kollias, Anastasios; Protogerou, Athanase D; Achimastos, Apostolos; Stergiou, George S
This study aims at estimating the resources consumed and subsequent costs for hypertension management, using home blood pressure (BP) monitoring (HBPM) alone versus combined clinic measurements and ambulatory blood pressure monitoring (C/ABPM). One hundred sixteen untreated hypertensive subjects were randomized to use HBPM or C/ABPM for antihypertensive treatment initiation and titration. Health resources utilized within 12-months follow-up, their respective costs, and hypertension control were assessed. The total cost of the first year of hypertension management was lower in HBPM than C/ABPM arm (€1336.0 vs. €1473.5 per subject, respectively; P < .001). Laboratory tests' cost was identical in both arms. There was no difference in achieved BP control and drug expenditure (HBPM: €233.1 per subject; C/ABPM: €247.6 per subject; P = not significant), whereas the cost of BP measurements and/or visits was higher in C/ABPM arm (€393.9 vs. €516.9, per patient, respectively P < .001). The cost for subsequent years (>1) was €348.9 and €440.2 per subject, respectively for HBPM and C/ABPM arm and €2731.4 versus €3234.3 per subject, respectively (P < .001) for a 5-year projection. HBPM used alone for the first year of hypertension management presents lower cost than C/ABPM, and the same trend is observed in 5-year projection. The results on the resources consumption can be used to make cost estimates for other health-care systems.
[The burden of blood pressure in the first half of pregnancy].
Baszak, E; Radomański, T; Sikorski, R
In the study, ambulatory blood pressure monitoring (ABPM) was estimated in 23 pregnant women in the first half of normal pregnancy and in 34 nonpregnant women. On the basis of ABPM, blood pressure load (BPL) were evaluated, as the exponent of blood pressure variability. In pregnant women BPL were lower in diastolic blood pressure component than those in nonpregnant women. It may testify stable character of diastolic blood pressure in healthy pregnant women. In the present decade the increasing importance of blood pressure variability is observed, because of its correlation with organ damage in hypertension. Authors emphasised the BPL examination necessity in healthy pregnant women and in pregnancy complicated by pregnancy induced hypertension (PIH). PMID:10224806
Reynolds, Kristi; Bowling, C Barrett; Sim, John J; Sridharan, Lakshmi; Harrison, Teresa N; Shimbo, Daichi
The beneficial effect of antihypertensive medication on reducing the risk of cardiovascular disease (CVD) events is supported by data from randomized controlled trials of older adults with hypertension. However, in clinical practice, overtreatment of hypertension in older adults may lead to side effects and an increased risk of falls. The diagnosis and treatment of hypertension is primarily based on blood pressure measurements obtained in the clinic setting. Ambulatory blood pressure monitoring (ABPM) complements clinic blood pressure by measuring blood pressure in the out-of-clinic setting. ABPM can be used to identify white coat hypertension, defined as elevated clinic blood pressure and non-elevated ambulatory blood pressure. White coat hypertension is common in older adults but does not appear to be associated with an increased risk of CVD events among this population. Herein, we review the current literature on ABPM in the diagnoses of white coat hypertension in older adults, including its potential role in preventing overtreatment.
Krönig, B
Blood pressure readings are the central parameter in the diagnosis and therapeutic monitoring of arterial hypertension. Frequent measurements are therefore necessary because the blood pressures of healthy people, and in particular of patients with hypertension, are subject to considerable variability. Emotional factors, physical strain and diurnal differences have a modifying effect. Attempts to standardize a single measurement such as has been tried in the determination of the basic blood pressure or the diastolic levels have proved of little relevance for information on the daily blood pressure profile. The frequent determination of a random blood pressure after 2 to 3 minutes rest is a logical alternative. Regular monitoring is almost ideally obtained, especially under antihypertensive drug therapy, by the patient measuring his own blood pressure.
Reynolds, Kristi; Bowling, C Barrett; Sim, John J; Sridharan, Lakshmi; Harrison, Teresa N; Shimbo, Daichi
The beneficial effect of antihypertensive medication on reducing the risk of cardiovascular disease (CVD) events is supported by data from randomized controlled trials of older adults with hypertension. However, in clinical practice, overtreatment of hypertension in older adults may lead to side effects and an increased risk of falls. The diagnosis and treatment of hypertension is primarily based on blood pressure measurements obtained in the clinic setting. Ambulatory blood pressure monitoring (ABPM) complements clinic blood pressure by measuring blood pressure in the out-of-clinic setting. ABPM can be used to identify white coat hypertension, defined as elevated clinic blood pressure and non-elevated ambulatory blood pressure. White coat hypertension is common in older adults but does not appear to be associated with an increased risk of CVD events among this population. Herein, we review the current literature on ABPM in the diagnoses of white coat hypertension in older adults, including its potential role in preventing overtreatment. PMID:26400076
Engeli, Stefan; Jordan, Jens
Hypertension and obesity often coexist, exposing patients to cardiovascular and metabolic risks, particularly type 2 diabetes mellitus. Moreover, obesity may render hypertensive patients treatment resistant. We review how drugs recently approved for obesity or type 2 diabetes mellitus treatment affect blood pressure. The weight-reducing drug lorcaserin induces modest reductions in body weight while slightly improving blood pressure. The fixed low-dose topiramate/phentermine combinations elicit larger reductions in body weight and blood pressure. Concomitant improvements in glucose metabolism, adiposity, and blood pressure differentiate the first clinically available SGLT2 inhibitor dapagliflozin from other oral antidiabetic drugs. Yet, the mechanisms through which metabolic drugs affect blood pressure and their interaction with antihypertensive drugs are poorly understood. Blood pressure-lowering effects of metabolic drugs could be exploited in the clinical management of obese hypertensive patients with and without type 2 diabetes mellitus, particularly in patients with difficult to control arterial hypertension. PMID:23933756
Kashif, Faisal M.; Verghese, George C.; Novak, Vera; Czosnyka, Marek; Heldt, Thomas
Intracranial pressure (ICP) is affected in many neurological conditions. Clinical measurement of pressure on the brain currently requires placing a probe in the cerebrospinal fluid compartment, the brain tissue, or other intracranial space. This invasiveness limits the measurement to critically ill patients. As ICP is also clinically important in conditions ranging from brain tumors and hydrocephalus to concussions, noninvasive determination of ICP would be desirable. Our model-based approach to continuous estimation and tracking of ICP uses routinely obtainable time-synchronized, noninvasive (or minimally invasive) measurements of peripheral arterial blood pressure and blood flow velocity in the middle cerebral artery (MCA), both at intra-heartbeat resolution. A physiological model of cerebrovascular dynamics provides mathematical constraints that relate the measured waveforms to ICP. Our algorithm produced patient-specific ICP estimates with no calibration or training. Using 35 hours of data from 37 patients with traumatic brain injury, we generated ICP estimates on 2,665 non-overlapping 60-beat data windows. Referenced against concurrently recorded invasive parenchymal ICP that varied over 100 mmHg across all records, our estimates achieved a mean error (bias) of 1.6 mmHg and standard deviation of error (SDE) of 7.6 mmHg. For the 1,673 data windows over 22 hours in which blood flow velocity recordings were available from both the left and right MCA, averaging the resulting bilateral ICP estimates reduced the bias to 1.5 mmHg and SDE to 5.9 mmHg. This accuracy is already comparable to that of some invasive ICP measurement methods in current clinical use. PMID:22496546
Tissue-Informative Mechanism for Wearable Non-invasive Continuous Blood Pressure Monitoring
NASA Astrophysics Data System (ADS)
Woo, Sung Hun; Choi, Yun Young; Kim, Dae Jung; Bien, Franklin; Kim, Jae Joon
Accurate continuous direct measurement of the blood pressure is currently available thru direct invasive methods via intravascular needles, and is mostly limited to use during surgical procedures or in the intensive care unit (ICU). Non-invasive methods that are mostly based on auscultation or cuff oscillometric principles do provide relatively accurate measurement of blood pressure. However, they mostly involve physical inconveniences such as pressure or stress on the human body. Here, we introduce a new non-invasive mechanism of tissue-informative measurement, where an experimental phenomenon called subcutaneous tissue pressure equilibrium is revealed and related for application in detection of absolute blood pressure. A prototype was experimentally verified to provide an absolute blood pressure measurement by wearing a watch-type measurement module that does not cause any discomfort. This work is supposed to contribute remarkably to the advancement of continuous non-invasive mobile devices for 24-7 daily-life ambulatory blood-pressure monitoring.
Non-invasive pulmonary blood flow analysis and blood pressure mapping derived from 4D flow MRI
NASA Astrophysics Data System (ADS)
Delles, Michael; Rengier, Fabian; Azad, Yoo-Jin; Bodenstedt, Sebastian; von Tengg-Kobligk, Hendrik; Ley, Sebastian; Unterhinninghofen, Roland; Kauczor, Hans-Ulrich; Dillmann, Rüdiger
In diagnostics and therapy control of cardiovascular diseases, detailed knowledge about the patient-specific behavior of blood flow and pressure can be essential. The only method capable of measuring complete time-resolved three-dimensional vector fields of the blood flow velocities is velocity-encoded magnetic resonance imaging (MRI), often denoted as 4D flow MRI. Furthermore, relative pressure maps can be computed from this data source, as presented by different groups in recent years. Hence, analysis of blood flow and pressure using 4D flow MRI can be a valuable technique in management of cardiovascular diseases. In order to perform these tasks, all necessary steps in the corresponding process chain can be carried out in our in-house developed software framework MEDIFRAME. In this article, we apply MEDIFRAME for a study of hemodynamics in the pulmonary arteries of five healthy volunteers. The study included measuring vector fields of blood flow velocities by phase-contrast MRI and subsequently computing relative blood pressure maps. We visualized blood flow by streamline depictions and computed characteristic values for the left and the right pulmonary artery (LPA and RPA). In all volunteers, we observed a lower amount of blood flow in the LPA compared to the RPA. Furthermore, we visualized blood pressure maps using volume rendering and generated graphs of pressure differences between the LPA, the RPA and the main pulmonary artery. In most volunteers, blood pressure was increased near to the bifurcation and in the proximal LPA, leading to higher average pressure values in the LPA compared to the RPA.
[Mobile Health: IEEE Standard for Wearable Cuffless Blood Pressure Measuring Devices].
Zhou, Xia; Wu, Wenli; Bao, Shudi
IEEE Std 1708-2014 breaks through the traditional standards of cuff based blood pressure measuring devices and establishes a normative definition of wearable cuffless blood pressure measuring devices and the objective performance evaluation of this kind of devices. This study firstly introduces the background of the new standard. Then, the standard details will be described, and the impact of cuffless blood pressure measuring devices with the new standard on manufacturers and end users will be addressed.
Associations of ambulatory blood pressure with urinary caffeine and caffeine metabolite excretions.
Guessous, Idris; Pruijm, Menno; Ponte, Belén; Ackermann, Daniel; Ehret, Georg; Ansermot, Nicolas; Vuistiner, Philippe; Staessen, Jan; Gu, Yumei; Paccaud, Fred; Mohaupt, Markus; Vogt, Bruno; Pechère-Bertschi, Antoinette; Pechère-Berstchi, Antoinette; Martin, Pierre-Yves; Burnier, Michel; Eap, Chin B; Bochud, Murielle
Intake of caffeinated beverages might be associated with reduced cardiovascular mortality possibly via the lowering of blood pressure. We estimated the association of ambulatory blood pressure with urinary caffeine and caffeine metabolites in a population-based sample. Families were randomly selected from the general population of Swiss cities. Ambulatory blood pressure monitoring was conducted using validated devices. Urinary caffeine, paraxanthine, theophylline, and theobromine excretions were measured in 24 hours urine using ultrahigh performance liquid chromatography tandem mass spectrometry. We used mixed models to explore the associations of urinary excretions with blood pressure although adjusting for major confounders. The 836 participants (48.9% men) included in this analysis had mean age of 47.8 and mean 24-hour systolic and diastolic blood pressure of 120.1 and 78.0 mm Hg. For each doubling of caffeine excretion, 24-hour and night-time systolic blood pressure decreased by 0.642 and 1.107 mm Hg (both P values <0.040). Similar inverse associations were observed for paraxanthine and theophylline. Adjusted night-time systolic blood pressure in the first (lowest), second, third, and fourth (highest) quartile of paraxanthine urinary excretions were 110.3, 107.3, 107.3, and 105.1 mm Hg, respectively (P trend <0.05). No associations of urinary excretions with diastolic blood pressure were generally found, and theobromine excretion was not associated with blood pressure. Anti-hypertensive therapy, diabetes mellitus, and alcohol consumption modify the association of caffeine urinary excretion with systolic blood pressure. Ambulatory systolic blood pressure was inversely associated with urinary excretions of caffeine and other caffeine metabolites. Our results are compatible with a potential protective effect of caffeine on blood pressure. PMID:25489060
A population-based study on blood pressure and brain atrophy in 85-year-olds.
Skoog, I; Andreasson, L A; Landahl, S; Lernfelt, B
In the general population, mean systolic and diastolic blood pressure increases up to age 75 years but decreases thereafter. The brain has a role in blood pressure regulation; it is not clear whether the cerebral changes that occur with aging contribute to the decline in blood pressure in the very elderly. We examined a population-based sample of 484 85-year-old persons (344 nondemented and 140 demented, 61 with Alzheimer's disease, 65 with vascular dementia, and 14 with other types of dementia) with a neuropsychiatric examination and blood pressure measurements. Dementia was diagnosed according to the criteria proposed in the Diagnostic and Statistical Manual of Mental Disorders, edition 3, revised. Brain atrophy was measured by CT of the brain. In the nondemented group, frontal (r=-0.18, P=0.037) and parietal (r=-0.23, P=0.008) cortical atrophy and bifrontal ratio (r=-0.20, P=0.013) were associated with lower systolic blood pressure, and frontal (r=-0.23, P=0.010) and parietal (r=-0.24, P=0.008) cortical atrophy and bifrontal ratio (r=-0.23, P=0.006) with lower diastolic blood pressure. Systolic blood pressure was lower in subjects with Alzheimer's disease and vascular dementia, and diastolic blood pressure was lower in those with vascular dementia compared with the nondemented. Systolic (r=-0.27, P<0.0001) and diastolic (r=-0.10, P=0.020) blood pressure was negatively correlated to dementia severity. In the demented subjects, frontal cortical atrophy was correlated to lower diastolic blood pressure (r=-0.21, P=0.043). Our findings suggest that age-related changes in brain structure may contribute to the decrease in blood pressure in the very elderly and that low blood pressure in dementia disorders is mainly a secondary phenomenon. PMID:9740603
Associations of ambulatory blood pressure with urinary caffeine and caffeine metabolite excretions.
Guessous, Idris; Pruijm, Menno; Ponte, Belén; Ackermann, Daniel; Ehret, Georg; Ansermot, Nicolas; Vuistiner, Philippe; Staessen, Jan; Gu, Yumei; Paccaud, Fred; Mohaupt, Markus; Vogt, Bruno; Pechère-Bertschi, Antoinette; Pechère-Berstchi, Antoinette; Martin, Pierre-Yves; Burnier, Michel; Eap, Chin B; Bochud, Murielle
Intake of caffeinated beverages might be associated with reduced cardiovascular mortality possibly via the lowering of blood pressure. We estimated the association of ambulatory blood pressure with urinary caffeine and caffeine metabolites in a population-based sample. Families were randomly selected from the general population of Swiss cities. Ambulatory blood pressure monitoring was conducted using validated devices. Urinary caffeine, paraxanthine, theophylline, and theobromine excretions were measured in 24 hours urine using ultrahigh performance liquid chromatography tandem mass spectrometry. We used mixed models to explore the associations of urinary excretions with blood pressure although adjusting for major confounders. The 836 participants (48.9% men) included in this analysis had mean age of 47.8 and mean 24-hour systolic and diastolic blood pressure of 120.1 and 78.0 mm Hg. For each doubling of caffeine excretion, 24-hour and night-time systolic blood pressure decreased by 0.642 and 1.107 mm Hg (both P values <0.040). Similar inverse associations were observed for paraxanthine and theophylline. Adjusted night-time systolic blood pressure in the first (lowest), second, third, and fourth (highest) quartile of paraxanthine urinary excretions were 110.3, 107.3, 107.3, and 105.1 mm Hg, respectively (P trend <0.05). No associations of urinary excretions with diastolic blood pressure were generally found, and theobromine excretion was not associated with blood pressure. Anti-hypertensive therapy, diabetes mellitus, and alcohol consumption modify the association of caffeine urinary excretion with systolic blood pressure. Ambulatory systolic blood pressure was inversely associated with urinary excretions of caffeine and other caffeine metabolites. Our results are compatible with a potential protective effect of caffeine on blood pressure.
Longitudinal Assessment of High Blood Pressure in Children with Nonalcoholic Fatty Liver Disease
Schwimmer, Jeffrey B.; Zepeda, Anne; Newton, Kimberly P.; Xanthakos, Stavra A.; Behling, Cynthia; Hallinan, Erin K.; Donithan, Michele; Tonascia, James
Objective Nonalcoholic fatty liver disease (NAFLD) affects 9.6% of children and may put these children at elevated risk of high blood pressure and subsequent cardiovascular morbidity and mortality. Therefore, we sought to determine the prevalence of and risk factors for high blood pressure in children with NAFLD. Methods Cohort study performed by the NIDDK NASH Clinical Research Network. There were 484 children with NAFLD ages 2 to 17 at enrollment; 382 children were assessed both at enrollment and 48 weeks afterwards. The main outcomes were high blood pressure at baseline and persistent high blood pressure at both baseline and 48 weeks. Results Prevalence of high blood pressure at baseline was 35.8% and prevalence of persistent high blood pressure was 21.4%. Children with high blood pressure were significantly more likely to have worse steatosis than children without high blood pressure (mild 19.8% vs. 34.2%, moderate 35.0% vs. 30.7%, severe 45.2% vs. 35.1%; P = 0.003). Higher body mass index, low-density lipoprotein, and uric acid were independent risk factors for high blood pressure (Odds Ratios: 1.10 per kg/m2, 1.09 per 10 mg/dL, 1.25 per mg/dL, respectively). Compared to boys, girls with NAFLD were significantly more likely to have persistent high blood pressure (28.4% vs.18.9%; P = 0.05). Conclusions In conclusion, NAFLD is a common clinical problem that places children at substantial risk for high blood pressure, which may often go undiagnosed. Thus blood pressure evaluation, control, and monitoring should be an integral component of the clinical management of children with NAFLD. PMID:25419656
Bacopa monnieri increases cerebral blood flow in rat independent of blood pressure.
Kamkaew, Natakorn; Norman Scholfield, C; Ingkaninan, Kornkanok; Taepavarapruk, Niwat; Chootip, Krongkarn
Bacopa monnieri (L.) Wettst. (Brahmi in India and Thailand) is an ayurvedic dementia treatment, but its effect on cerebral blood flow (CBF) is still unknown. We sought to test its chronic and acute effects on CBF compared with Ginkgo biloba and donepezil. CBF was measured by laser Doppler from rat cerebral cortex after 8 weeks of daily oral dosing of these drugs. Systolic blood pressure was also measured using the tail cuff method or via arterial cannulation. In rats treated with B. monnieri (40 mg/kg), CBF was 25% increased [2927 ± 123 perfusion units, (PU)] compared with shams (2337 ± 217 PU, p < 0.05, nine rats). G. biloba (60 mg/kg) also increased CBF (by 29% to 3019 ± 208 PU, p < 0.05, nine rats). No clear effect was obtained with donepezil (1 mg/kg). Chronic administration of the preparations had no effect on blood pressure. In contrast, intravenous acute infusion of these herbals (20-60 mg/kg) had marked dose-dependent hypotensive actions (diastolic ~31 mmHg lower with 40 mg/kg of either extract), which correspondingly reduced CBF by ~15%. Likewise, CBF fell slightly with acute intravenous sodium nitroprusside and rose with noradrenaline. Donepezil (1 mg/kg) was slightly hypotensive without affecting CBF. Increased CBF with B. monnieri may account for its reported procognitive effect, and its further exploration as an alternative nootropic drug is worthwhile.
Gao, Mingwu; Rose, William C; Fetics, Barry; Kass, David A; Chen, Chen-Huan; Mukkamala, Ramakrishna
Generalized transfer functions (GTFs) are available to compute the more relevant central blood pressure (BP) waveform from a more easily measured radial BP waveform. However, GTFs are population averages and therefore may not adapt to variations in pulse pressure (PP) amplification (ratio of radial to central PP). A simple adaptive transfer function (ATF) was developed. First, the transfer function is defined in terms of the wave travel time and reflection coefficient parameters of an arterial model. Then, the parameters are estimated from the radial BP waveform by exploiting the observation that central BP waveforms exhibit exponential diastolic decays. The ATF was assessed using the original data that helped popularize the GTF. These data included radial BP waveforms and invasive reference central BP waveforms from cardiac catheterization patients. The data were divided into low, middle, and high PP amplification groups. The ATF estimated central BP with greater accuracy than GTFs in the low PP amplification group (e.g., central systolic BP and PP root-mean-square-errors of 3.3 and 4.2 mm Hg versus 6.2 and 7.1 mm Hg; p ≤ 0.05) while showing similar accuracy in the higher PP amplification groups. The ATF may permit more accurate, non-invasive central BP monitoring in elderly and hypertensive patients. PMID:27624389
Gao, Mingwu; Rose, William C.; Fetics, Barry; Kass, David A.; Chen, Chen-Huan; Mukkamala, Ramakrishna
Generalized transfer functions (GTFs) are available to compute the more relevant central blood pressure (BP) waveform from a more easily measured radial BP waveform. However, GTFs are population averages and therefore may not adapt to variations in pulse pressure (PP) amplification (ratio of radial to central PP). A simple adaptive transfer function (ATF) was developed. First, the transfer function is defined in terms of the wave travel time and reflection coefficient parameters of an arterial model. Then, the parameters are estimated from the radial BP waveform by exploiting the observation that central BP waveforms exhibit exponential diastolic decays. The ATF was assessed using the original data that helped popularize the GTF. These data included radial BP waveforms and invasive reference central BP waveforms from cardiac catheterization patients. The data were divided into low, middle, and high PP amplification groups. The ATF estimated central BP with greater accuracy than GTFs in the low PP amplification group (e.g., central systolic BP and PP root-mean-square-errors of 3.3 and 4.2 mm Hg versus 6.2 and 7.1 mm Hg; p ≤ 0.05) while showing similar accuracy in the higher PP amplification groups. The ATF may permit more accurate, non-invasive central BP monitoring in elderly and hypertensive patients. PMID:27624389
Olafiranye, Oladipupo; Ibrahim, Mediha; Kamran, Haroon; Venner-Jones, Kinda; McFarlane, Samy I; Salciccioli, Louis; Lazar, Jason M
The left ventricular (LV) aortoseptal angle (ASA) decreases with age, and is associated with basal septal hypertrophy (septal bulge). Enhanced arterial pressure wave reflection is known to impact LV hypertrophy. We assessed whether ASA is related to central blood pressure (BP) and augmentation index (AI), a measure of the reflected pressure wave. We studied 75 subjects (age 62 ± 16 years; 66% female) who were referred for transthoracic echocardiography and had radial artery applanation tonometry within 24 h. Peripheral systolic BP (P-SBP), peripheral diastolic BP (P-DBP), and peripheral pulse pressure (P-PP) were obtained by sphygmomanometry. Central BPs (C-SBP, C-DBP, C-PP) and AI were derived from applanation tonometry. AI was corrected for heart rate (AI75). The basal septal wall thickness (SWT), mid SWT and ASA were measured using the parasternal long axis echocardiographic view. Mean ASA and AI75 were 117 ± 11° and 22 ± 11%, respectively. ASA correlated with AI75 (r = -0.31, p ≤ 0.01), C-SBP (r = -0.24, p = 0.04), C-PP (r = -0.29, p = 0.01), but only showed a trend towards significance with P-SBP (r = -0.2, p = 0.09) and P-PP (r = -0.21, p = 0.08). Interestingly, C-PP was correlated with basal SWT (r = 0.27, p = 0.02) but not with mid SWT (r = 0.19, p = 0.11). On multivariate linear regression analysis, adjusted for age, gender, weight, and mean arterial pressure, AI75 was an independent predictor of ASA (p = 0.02). Our results suggest that a narrowed ASA is related to increased pressure wave reflection and higher central BP. Further studies are needed to determine whether narrowed LV ASA is a cause or consequence of enhanced wave reflection and whether other factors are involved.
Smartphone-based Continuous Blood Pressure Measurement Using Pulse Transit Time.
Gholamhosseini, Hamid; Meintjes, Andries; Baig, Mirza; Linden, Maria
The increasing availability of low cost and easy to use personalized medical monitoring devices has opened the door for new and innovative methods of health monitoring to emerge. Cuff-less and continuous methods of measuring blood pressure are particularly attractive as blood pressure is one of the most important measurements of long term cardiovascular health. Current methods of noninvasive blood pressure measurement are based on inflation and deflation of a cuff with some effects on arteries where blood pressure is being measured. This inflation can also cause patient discomfort and alter the measurement results. In this work, a mobile application was developed to collate the PhotoPlethysmoGramm (PPG) waveform provided by a pulse oximeter and the electrocardiogram (ECG) for calculating the pulse transit time. This information is then indirectly related to the user's systolic blood pressure. The developed application successfully connects to the PPG and ECG monitoring devices using Bluetooth wireless connection and stores the data onto an online server. The pulse transit time is estimated in real time and the user's systolic blood pressure can be estimated after the system has been calibrated. The synchronization between the two devices was found to pose a challenge to this method of continuous blood pressure monitoring. However, the implemented continuous blood pressure monitoring system effectively serves as a proof of concept. This combined with the massive benefits that an accurate and robust continuous blood pressure monitoring system would provide indicates that it is certainly worthwhile to further develop this system.
Smooth muscle BK channel activity influences blood pressure independent of vascular tone in mice
Sachse, Gregor; Faulhaber, Jörg; Seniuk, Anika; Ehmke, Heimo; Pongs, Olaf
The large conductance voltage- and Ca2+-activated K+ (BK) channel is an important determinant of vascular tone and contributes to blood pressure regulation. Both activities depend on the ancillary BKβ1 subunit. To determine the significance of smooth muscle BK channel activity for blood pressure regulation, we investigated the potential link between changes in arterial tone and altered blood pressure in BKβ1 knockout (BKβ1−/−) mice from three different genetically defined strains. While vascular tone was consistently increased in all BKβ1−/− mice independent of genetic background, BKβ1−/− strains exhibited increased (strain A), unaltered (strain B) or decreased (strain C) mean arterial blood pressures compared to their corresponding BKβ1+/+ controls. In agreement with previous data on aldosterone regulation by renal/adrenal BK channel function, BKβ1−/− strain A mice have increased plasma aldosterone and increased blood pressure. Consistently, blockade of mineralocorticoid receptors by spironolactone treatment reversibly restored the elevated blood pressure to the BKβ1+/+ strain A level. In contrast, loss of BKβ1 did not affect plasma aldosterone in strain C mice. Smooth muscle-restricted restoration of BKβ1 expression increased blood pressure in BKβ1−/− strain C mice, implying that impaired smooth muscle BK channel activity lowers blood pressure in these animals. We conclude that BK channel activity directly affects vascular tone but influences blood pressure independent of this effect via different pathways. PMID:24687584
Smartphone-based Continuous Blood Pressure Measurement Using Pulse Transit Time.
Gholamhosseini, Hamid; Meintjes, Andries; Baig, Mirza; Linden, Maria
The increasing availability of low cost and easy to use personalized medical monitoring devices has opened the door for new and innovative methods of health monitoring to emerge. Cuff-less and continuous methods of measuring blood pressure are particularly attractive as blood pressure is one of the most important measurements of long term cardiovascular health. Current methods of noninvasive blood pressure measurement are based on inflation and deflation of a cuff with some effects on arteries where blood pressure is being measured. This inflation can also cause patient discomfort and alter the measurement results. In this work, a mobile application was developed to collate the PhotoPlethysmoGramm (PPG) waveform provided by a pulse oximeter and the electrocardiogram (ECG) for calculating the pulse transit time. This information is then indirectly related to the user's systolic blood pressure. The developed application successfully connects to the PPG and ECG monitoring devices using Bluetooth wireless connection and stores the data onto an online server. The pulse transit time is estimated in real time and the user's systolic blood pressure can be estimated after the system has been calibrated. The synchronization between the two devices was found to pose a challenge to this method of continuous blood pressure monitoring. However, the implemented continuous blood pressure monitoring system effectively serves as a proof of concept. This combined with the massive benefits that an accurate and robust continuous blood pressure monitoring system would provide indicates that it is certainly worthwhile to further develop this system. PMID:27225558
Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk.
Ehret, Georg B; Munroe, Patricia B; Rice, Kenneth M; Bochud, Murielle; Johnson, Andrew D; Chasman, Daniel I; Smith, Albert V; Tobin, Martin D; Verwoert, Germaine C; Hwang, Shih-Jen; Pihur, Vasyl; Vollenweider, Peter; O'Reilly, Paul F; Amin, Najaf; Bragg-Gresham, Jennifer L; Teumer, Alexander; Glazer, Nicole L; Launer, Lenore; Zhao, Jing Hua; Aulchenko, Yurii; Heath, Simon; Sõber, Siim; Parsa, Afshin; Luan, Jian'an; Arora, Pankaj; Dehghan, Abbas; Zhang, Feng; Lucas, Gavin; Hicks, Andrew A; Jackson, Anne U; Peden, John F; Tanaka, Toshiko; Wild, Sarah H; Rudan, Igor; Igl, Wilmar; Milaneschi, Yuri; Parker, Alex N; Fava, Cristiano; Chambers, John C; Fox, Ervin R; Kumari, Meena; Go, Min Jin; van der Harst, Pim; Kao, Wen Hong Linda; Sjögren, Marketa; Vinay, D G; Alexander, Myriam; Tabara, Yasuharu; Shaw-Hawkins, Sue; Whincup, Peter H; Liu, Yongmei; Shi, Gang; Kuusisto, Johanna; Tayo, Bamidele; Seielstad, Mark; Sim, Xueling; Nguyen, Khanh-Dung Hoang; Lehtimäki, Terho; Matullo, Giuseppe; Wu, Ying; Gaunt, Tom R; Onland-Moret, N Charlotte; Cooper, Matthew N; Platou, Carl G P; Org, Elin; Hardy, Rebecca; Dahgam, Santosh; Palmen, Jutta; Vitart, Veronique; Braund, Peter S; Kuznetsova, Tatiana; Uiterwaal, Cuno S P M; Adeyemo, Adebowale; Palmas, Walter; Campbell, Harry; Ludwig, Barbara; Tomaszewski, Maciej; Tzoulaki, Ioanna; Palmer, Nicholette D; Aspelund, Thor; Garcia, Melissa; Chang, Yen-Pei C; O'Connell, Jeffrey R; Steinle, Nanette I; Grobbee, Diederick E; Arking, Dan E; Kardia, Sharon L; Morrison, Alanna C; Hernandez, Dena; Najjar, Samer; McArdle, Wendy L; Hadley, David; Brown, Morris J; Connell, John M; Hingorani, Aroon D; Day, Ian N M; Lawlor, Debbie A; Beilby, John P; Lawrence, Robert W; Clarke, Robert; Hopewell, Jemma C; Ongen, Halit; Dreisbach, Albert W; Li, Yali; Young, J Hunter; Bis, Joshua C; Kähönen, Mika; Viikari, Jorma; Adair, Linda S; Lee, Nanette R; Chen, Ming-Huei; Olden, Matthias; Pattaro, Cristian; Bolton, Judith A Hoffman; Köttgen, Anna; Bergmann, Sven; Mooser, Vincent; Chaturvedi, Nish; Frayling, Timothy M; Islam, Muhammad; Jafar, Tazeen H; Erdmann, Jeanette; Kulkarni, Smita R; Bornstein, Stefan R; Grässler, Jürgen; Groop, Leif; Voight, Benjamin F; Kettunen, Johannes; Howard, Philip; Taylor, Andrew; Guarrera, Simonetta; Ricceri, Fulvio; Emilsson, Valur; Plump, Andrew; Barroso, Inês; Khaw, Kay-Tee; Weder, Alan B; Hunt, Steven C; Sun, Yan V; Bergman, Richard N; Collins, Francis S; Bonnycastle, Lori L; Scott, Laura J; Stringham, Heather M; Peltonen, Leena; Perola, Markus; Vartiainen, Erkki; Brand, Stefan-Martin; Staessen, Jan A; Wang, Thomas J; Burton, Paul R; Soler Artigas, Maria; Dong, Yanbin; Snieder, Harold; Wang, Xiaoling; Zhu, Haidong; Lohman, Kurt K; Rudock, Megan E; Heckbert, Susan R; Smith, Nicholas L; Wiggins, Kerri L; Doumatey, Ayo; Shriner, Daniel; Veldre, Gudrun; Viigimaa, Margus; Kinra, Sanjay; Prabhakaran, Dorairaj; Tripathy, Vikal; Langefeld, Carl D; Rosengren, Annika; Thelle, Dag S; Corsi, Anna Maria; Singleton, Andrew; Forrester, Terrence; Hilton, Gina; McKenzie, Colin A; Salako, Tunde; Iwai, Naoharu; Kita, Yoshikuni; Ogihara, Toshio; Ohkubo, Takayoshi; Okamura, Tomonori; Ueshima, Hirotsugu; Umemura, Satoshi; Eyheramendy, Susana; Meitinger, Thomas; Wichmann, H-Erich; Cho, Yoon Shin; Kim, Hyung-Lae; Lee, Jong-Young; Scott, James; Sehmi, Joban S; Zhang, Weihua; Hedblad, Bo; Nilsson, Peter; Smith, George Davey; Wong, Andrew; Narisu, Narisu; Stančáková, Alena; Raffel, Leslie J; Yao, Jie; Kathiresan, Sekar; O'Donnell, Christopher J; Schwartz, Stephen M; Ikram, M Arfan; Longstreth, W T; Mosley, Thomas H; Seshadri, Sudha; Shrine, Nick R G; Wain, Louise V; Morken, Mario A; Swift, Amy J; Laitinen, Jaana; Prokopenko, Inga; Zitting, Paavo; Cooper, Jackie A; Humphries, Steve E; Danesh, John; Rasheed, Asif; Goel, Anuj; Hamsten, Anders; Watkins, Hugh; Bakker, Stephan J L; van Gilst, Wiek H; Janipalli, Charles S; Mani, K Radha; Yajnik, Chittaranjan S; Hofman, Albert; Mattace-Raso, Francesco U S; Oostra, Ben A; Demirkan, Ayse; Isaacs, Aaron; Rivadeneira, Fernando; Lakatta, Edward G; Orru, Marco; Scuteri, Angelo; Ala-Korpela, Mika; Kangas, Antti J; Lyytikäinen, Leo-Pekka; Soininen, Pasi; Tukiainen, Taru; Würtz, Peter; Ong, Rick Twee-Hee; Dörr, Marcus; Kroemer, Heyo K; Völker, Uwe; Völzke, Henry; Galan, Pilar; Hercberg, Serge; Lathrop, Mark; Zelenika, Diana; Deloukas, Panos; Mangino, Massimo; Spector, Tim D; Zhai, Guangju; Meschia, James F; Nalls, Michael A; Sharma, Pankaj; Terzic, Janos; Kumar, M V Kranthi; Denniff, Matthew; Zukowska-Szczechowska, Ewa; Wagenknecht, Lynne E; Fowkes, F Gerald R; Charchar, Fadi J; Schwarz, Peter E H; Hayward, Caroline; Guo, Xiuqing; Rotimi, Charles; Bots, Michiel L; Brand, Eva; Samani, Nilesh J; Polasek, Ozren; Talmud, Philippa J; Nyberg, Fredrik; Kuh, Diana; Laan, Maris; Hveem, Kristian; Palmer, Lyle J; van der Schouw, Yvonne T; Casas, Juan P; Mohlke, Karen L; Vineis, Paolo; Raitakari, Olli; Ganesh, Santhi K; Wong, Tien Y; Tai, E Shyong; Cooper, Richard S; Laakso, Markku; Rao, Dabeeru C; Harris, Tamara B; Morris, Richard W; Dominiczak, Anna F; Kivimaki, Mika; Marmot, Michael G; Miki, Tetsuro; Saleheen, Danish; Chandak, Giriraj R; Coresh, Josef; Navis, Gerjan; Salomaa, Veikko; Han, Bok-Ghee; Zhu, Xiaofeng; Kooner, Jaspal S; Melander, Olle; Ridker, Paul M; Bandinelli, Stefania; Gyllensten, Ulf B; Wright, Alan F; Wilson, James F; Ferrucci, Luigi; Farrall, Martin; Tuomilehto, Jaakko; Pramstaller, Peter P; Elosua, Roberto; Soranzo, Nicole; Sijbrands, Eric J G; Altshuler, David; Loos, Ruth J F; Shuldiner, Alan R; Gieger, Christian; Meneton, Pierre; Uitterlinden, Andre G; Wareham, Nicholas J; Gudnason, Vilmundur; Rotter, Jerome I; Rettig, Rainer; Uda, Manuela; Strachan, David P; Witteman, Jacqueline C M; Hartikainen, Anna-Liisa; Beckmann, Jacques S; Boerwinkle, Eric; Vasan, Ramachandran S; Boehnke, Michael; Larson, Martin G; Järvelin, Marjo-Riitta; Psaty, Bruce M; Abecasis, Gonçalo R; Chakravarti, Aravinda; Elliott, Paul; van Duijn, Cornelia M; Newton-Cheh, Christopher; Levy, Daniel; Caulfield, Mark J; Johnson, Toby
Blood pressure is a heritable trait influenced by several biological pathways and responsive to environmental stimuli. Over one billion people worldwide have hypertension (≥140 mm Hg systolic blood pressure or ≥90 mm Hg diastolic blood pressure). Even small increments in blood pressure are associated with an increased risk of cardiovascular events. This genome-wide association study of systolic and diastolic blood pressure, which used a multi-stage design in 200,000 individuals of European descent, identified sixteen novel loci: six of these loci contain genes previously known or suspected to regulate blood pressure (GUCY1A3-GUCY1B3, NPR3-C5orf23, ADM, FURIN-FES, GOSR2, GNAS-EDN3); the other ten provide new clues to blood pressure physiology. A genetic risk score based on 29 genome-wide significant variants was associated with hypertension, left ventricular wall thickness, stroke and coronary artery disease, but not kidney disease or kidney function. We also observed associations with blood pressure in East Asian, South Asian and African ancestry individuals. Our findings provide new insights into the genetics and biology of blood pressure, and suggest potential novel therapeutic pathways for cardiovascular disease prevention.
Twenty-Four-Hour Ambulatory Blood Pressure Monitoring in Hypertension
Executive Summary Objective The objective of this health technology assessment was to determine the clinical effectiveness and cost-effectiveness of 24-hour ambulatory blood pressure monitoring (ABPM) for hypertension. Clinical Need: Condition and Target Population Hypertension occurs when either systolic blood pressure, the pressure in the artery when the heart contracts, or diastolic blood pressure, the pressure in the artery when the heart relaxes between beats, are consistently high. Blood pressure (BP) that is consistently more than 140/90 mmHg (systolic/diastolic) is considered high. A lower threshold, greater than 130/80 mmHg (systolic/diastolic), is set for individuals with diabetes or chronic kidney disease. In 2006 and 2007, the age-standardized incidence rate of diagnosed hypertension in Canada was 25.8 per 1,000 (450,000 individuals were newly diagnosed). During the same time period, 22.7% of adult Canadians were living with diagnosed hypertension. A smaller proportion of Canadians are unaware they have hypertension; therefore, the estimated number of Canadians affected by this disease may be higher. Diagnosis and management of hypertension are important, since elevated BP levels are related to the risk of cardiovascular disease, including stroke. In Canada in 2003, the costs to the health care system related to the diagnosis, treatment, and management of hypertension were over $2.3 billion (Cdn). Technology The 24-hour ABPM device consists of a standard inflatable cuff attached to a small computer weighing about 500 grams, which is worn over the shoulder or on a belt. The technology is noninvasive and fully automated. The device takes BP measurements every 15 to 30 minutes over a 24-to 28-hour time period, thus providing extended, continuous BP recordings even during a patient's normal daily activities. Information on the multiple BP measurements can be downloaded to a computer. The main detection methods used by the device are auscultation and
Chia flour supplementation reduces blood pressure in hypertensive subjects.
Toscano, Luciana Tavares; da Silva, Cássia Surama Oliveira; Toscano, Lydiane Tavares; de Almeida, Antônio Eduardo Monteiro; Santos, Amilton da Cruz; Silva, Alexandre Sérgio
The aim of this study was to investigate the effect of chia supplementation (Salvia hispanica L.) on blood pressure (BP) and its associated cardiometabolic factors in treated and untreated hypertensive individuals. The subjects were randomly assigned to one of the following groups: the hypertensive-drug treated (CHIA-MD, n = 10), hypertensive untreated (CHIA-NM, n = 9) and placebo (PLA-MD, n = 7) groups. The subjects consumed 35 g/day of either chia flour or a placebo for 12 weeks. The clinical and ambulatory BP, inflammation, oxidative stress and markers for nitric oxide were measured. While the PLA-MD group showed no changes in BP, there was a reduction in the mean clinical blood pressure (MBP) in the CHIA (111.5 ± 1.9 to 102.7 ± 1.5 mmHg, p < 0.001) and CHIA-MD (111.3 ± 2.2 to 100.1 ± 1.8 mmHg, p < 0.001) groups. The CHIA-NM group showed no reduction in the MBP but did show a decreased systolic BP (146.8 ± 3.8 to 137.3 ± 3.1 mmHg, p < 0.05). The clinical BP reduction was demonstrated by a 24 h ambulatory systolic reduction in all of the supplemented groups. However, the mean ambulatory BP was reduced only in the CHIA (98.1 ± 2.4 to 92.8 ± 2.2 mmHg, p < 0.05) group, and there was no change in the diastolic component in either of the CHIA groups. The lipid peroxidation was reduced in the CHIA (p = 0.04) and CHIA-NM (p = 0.02) groups compared with the PLA-MD group. A reduction in the plasma nitrite levels was observed only in the CHIA group (p = 0.02). Chia flour has the ability to reduce ambulatory and clinical BP in both treated and untreated hypertensive individuals.
Analysis of blood pressure rhythms for drug efficacy evaluation.
Germanò, G; Federico, L; Angotti, S; Codispoti, P; Muscolo, M; Bravo, S; Damiani, S
This study analyzes some methods of evaluating the effects of antihypertensive drugs on blood pressure circadian rhythm. We reviewed four different approaches: hourly averages, trough-to-peak ratio, cosinor method, and Fourier series applied to the same data to prove the time course of the effects of isradipine administered once daily. A total of 141 patients of both sexes (mean age 53 years, range 30-76) with mild to moderate essential hypertension were enrolled in this multicenter trial after a 2-week placebo run-in. Treatment with isradipine SRO 5 mg/day administered between 8 and 9 AM was started. Each patient underwent ambulatory BP monitoring at the time of entry and after 6 weeks of treatment. Calculation of hourly averages showed decreases after 4 AM, and from about 8-9 AM, when the drug was administered, and the decreases practically did not vary until about 10 PM. Subsequently, the decreases became smaller and indicated reduced drug activity. However, this hypothesis no longer held after 4 AM. The trough-to-peak ratio was calculated including hourly averages after the dose divided by the lowest hourly average. Both systolic and diastolic blood pressure showed constant reduction from 3 PM (time of peak) to 11 PM. However, after 11 PM, higher trough-to-peak ratios paradoxically occurred due to a major reduction obtained with placebo, and the negative percentages just before the next dose cannot be attributed to treatment. Applying the cosinor method, maximal values were greatly underestimated, nocturnal values were overestimated, and the absolute maximum occurred in proximity to the minimum relating to postprandial dip. The generalized cosinor model, known as Fourier partial series, was always curtailed to the third harmonic. Fourier analysis was able to describe the daily trend of BP both before and after isradipine administration. We used statistical tests to determine if the differences described by the models were significant. The tests indicated
Ambulatory Blood Pressure Monitoring: Five Decades of More Light and Less Shadows
Nobre, Fernando; Mion Junior, Décio
Casual blood pressure measurements have been extensively questioned over the last five decades. A significant percentage of patients have different blood pressure readings when examined in the office or outside it. For this reason, a change in the paradigm of the best manner to assess blood pressure has been observed. The method that has been most widely used is the Ambulatory Blood Pressure Monitoring - ABPM. The method allows recording blood pressure measures in 24 hours and evaluating various parameters such as mean BP, pressure loads, areas under the curve, variations between daytime and nighttime, pulse pressure variability etc. Blood pressure measurements obtained by ABPM are better correlated, for example, with the risks of hypertension. The main indications for ABPM are: suspected white coat hypertension and masked hypertension, evaluation of the efficacy of the antihypertensive therapy in 24 hours, and evaluation of symptoms. There is increasing evidence that the use of ABPM has contributed to the assessment of blood pressure behaviors, establishment of diagnoses, prognosis and the efficacy of antihypertensive therapy. There is no doubt that the study of 24-hour blood pressure behavior and its variations by ABPM has brought more light and less darkness to the field, which justifies the title of this review. PMID:27168473
Ambulatory Blood Pressure Monitoring: Five Decades of More Light and Less Shadows.
Nobre, Fernando; Mion Junior, Décio
Casual blood pressure measurements have been extensively questioned over the last five decades. A significant percentage of patients have different blood pressure readings when examined in the office or outside it. For this reason, a change in the paradigm of the best manner to assess blood pressure has been observed. The method that has been most widely used is the Ambulatory Blood Pressure Monitoring - ABPM. The method allows recording blood pressure measures in 24 hours and evaluating various parameters such as mean BP, pressure loads, areas under the curve, variations between daytime and nighttime, pulse pressure variability etc. Blood pressure measurements obtained by ABPM are better correlated, for example, with the risks of hypertension. The main indications for ABPM are: suspected white coat hypertension and masked hypertension, evaluation of the efficacy of the antihypertensive therapy in 24 hours, and evaluation of symptoms. There is increasing evidence that the use of ABPM has contributed to the assessment of blood pressure behaviors, establishment of diagnoses, prognosis and the efficacy of antihypertensive therapy. There is no doubt that the study of 24-hour blood pressure behavior and its variations by ABPM has brought more light and less darkness to the field, which justifies the title of this review. PMID:27168473
Evaluation of Two New Indices of Blood Pressure Variability Using Postural Change in Older Fallers
Goh, Choon-Hian; Ng, Siew-Cheok; Kamaruzzaman, Shahrul B.; Chin, Ai-Vyrn; Poi, Philip J. H.; Chee, Kok Han; Imran, Z. Abidin; Tan, Maw Pin
Abstract To evaluate the utility of blood pressure variability (BPV) calculated using previously published and newly introduced indices using the variables falls and age as comparators. While postural hypotension has long been considered a risk factor for falls, there is currently no documented evidence on the relationship between BPV and falls. A case-controlled study involving 25 fallers and 25 nonfallers was conducted. Systolic (SBPV) and diastolic blood pressure variability (DBPV) were assessed using 5 indices: standard deviation (SD), standard deviation of most stable continuous 120 beats (staSD), average real variability (ARV), root mean square of real variability (RMSRV), and standard deviation of real variability (SDRV). Continuous beat-to-beat blood pressure was recorded during 10 minutes' supine rest and 3 minutes' standing. Standing SBPV was significantly higher than supine SBPV using 4 indices in both groups. The standing-to-supine-BPV ratio (SSR) was then computed for each subject (staSD, ARV, RMSRV, and SDRV). Standing-to-supine ratio for SBPV was significantly higher among fallers compared to nonfallers using RMSRV and SDRV (P = 0.034 and P = 0.025). Using linear discriminant analysis (LDA), 3 indices (ARV, RMSRV, and SDRV) of SSR SBPV provided accuracies of 61.6%, 61.2%, and 60.0% for the prediction of falls which is comparable with timed-up and go (TUG), 64.4%. This study suggests that SSR SBPV using RMSRV and SDRV is a potential predictor for falls among older patients, and deserves further evaluation in larger prospective studies. PMID:27175670
Evaluation of blood pressure changes using vascular transit time.
Foo, Jong Yong Abdiel; Lim, Chu Sing; Wang, Ping
Imbalance of the human haemodynamic system can provide a prognosis of syncope, dizziness or hypertension. This can be assessed by monitoring its responses to postural change. Examining variations in blood pressure (BP) is deemed an effective means to identify symptoms of this associated condition. However, conventional methods do not promote prolonged monitoring due to the discomfort caused to patients. Established correlations between BP and pulse wave transmission have shown its usefulness in clinical applications. In this study, photoplethysmography and phonocardiography were used to estimate BP changes via observed variations in delay transmission or vascular transit time (VTT) at the upper limb. Thirty-one healthy adults (21 male) were recruited to perform three test activities, namely the arm held at heart level, fully raised up and held down. Association of the three BP indices and heart rate variations with transit time changes was then computed. The results showed that observed VTT changes were related to systolic BP (R(2) = 0.820; p < 0.05), diastolic BP (R(2) = 0.517; p < 0.05), mean arterial pressure (R(2) = 0.673; p < 0.05) and heart rate (R(2) = 0.000; p > 0.05). As systolic BP had the strongest correlation, a regression equation was formulated to associate the two parameters. The non-invasive measuring nature of VTT can be more accommodating to patients, especially during continual monitoring. Moreover, it has the added advantage that the pre-ejection period is not included in its time-related derivations.
Prediabetes is associated with abnormal circadian blood pressure variability.
Gupta, A K; Greenway, F L; Cornelissen, G; Pan, W; Halberg, F
Blood pressure (BP) exhibits a circadian variation characterized by a morning increase, followed by a small postprandial valley and a deeper descent during nocturnal rest. Although abnormal 24-h variability (abnormal circadian variability (ACV)) predicts adverse cardiovascular disease (CVD) outcomes, a 7-day automatic ambulatory BP monitoring (ABPM) and subsequent chronobiologic analysis of the gathered data, permits identification of consistency of any abnormal circadian variation. To test whether normal overweight healthy men and women with prediabetes differed from subjects with normoglycemia in having ACV with a 7-day ABPM. Consent for a 7-day ABPM was obtained from subjects with family history of diabetes mellitus, who were participating in the screening phase for a randomized, double blind, placebo-controlled weight loss trial in prediabetics to prevent progression to diabetes mellitus. The automatic 7-day ABPM device recorded BP and heart rate every 30 min during the day and every 60 min during the night. Normoglycemic and prediabetic subjects matched for age, sex, race, BP, BMI, waist circumference and glycemic control, differed statistically significantly only in their fasting and/or 2-h postprandial serum glucose concentrations. Chronobiologically-interpreted 7-day ABPM uncovered no abnormalities in normoglycemics, whereas prediabetics had a statistically significantly higher incidence of high mean BP (MESOR-hypertension), excessive pulse pressure and/or circadian hyper-amplitude-tension (CHAT) (P<0.001). ACV detected with 7-day ABPM may account for the enhanced CVD risk in prediabetes. These findings provide a basis for larger-scale studies to assess the predictive value of 7-day ABPM over the long term. PMID:18480832
Ambulatory blood pressure and physical activity in heart failure.
Tai, Mei-Kuei; Meininger, Janet C; Frazier, Lorraine Q; Chan, Wenyaw
This observational study used repeated measures over 24 hr to investigate ambulatory blood pressure (BP) and physical activity (PA) profiles in community-based individuals with heart failure (HF). The aims were to (a) compare BP dipping and PA between two groups of HF patients with different functional statuses, and (b) determine whether the strength of the association between ambulatory BP and PA varies by functional status in HF. Ambulatory BP was measured every 30 min with a SpaceLabs 90207; a Basic Motionlogger actigraph was used to measure PA minute-by-minute. Fifty-six participants (54% female, age 66.96 + or - 12.35 years) completed data collection. Functional status was based on New York Heart Association (NYHA) ratings. Twenty-seven patients had no limitation of PA (NYHA Class I HF), whereas 29 had some limitation of PA but no discomfort at rest (NYHA Class II or III HF). Patients with Class I HF had a significantly greater degree of BP dipping than those with Class II/III HF after controlling for left ventricular ejection fraction. In a mixed-model analysis, PA was significantly related to ambulatory systolic and diastolic BP and mean arterial pressure. The strength of the association between PA and BP was not significantly different for the two groups of patients. These findings demonstrate differences between Class I and Class II/II HF in BP dipping status and ambulatory BP but not PA. Longitudinal research is recommended to improve understanding of the influence of disease progression on changes in 24-hr PA and BP profiles of patients with HF. PMID:19617234
Slow breathing training reduces resting blood pressure and the pressure responses to exercise.
Jones, C U; Sangthong, B; Pachirat, O; Jones, D A
Slow breathing training reduces resting blood pressure, probably by modifying central autonomic control, but evidence for this is lacking. The pressor response to static handgrip exercise is a measure of autonomic control and the aim of this study was to determine whether slow breathing training modulates the pressor responses to exercise of untrained muscles. Twenty hypertensive patients trained for 8 weeks, 10 with unloaded slow breathing (Unloaded) and 10 breathing against an inspiratory load of 20 cm H(2)O (Loaded). Ten subjects were untrained controls. Subjects performed a 2 min handgrip pressor test (30 % MVC) pre- and post-training, and blood pressure and heart rate (HR) were measured before the contraction, at the end and following 2 min recovery. Resting systolic (sBP) and HR were reduced as a result of training, as reported previously. After training there was both a smaller pressor response to hand grip exercise and a more rapid recovery of sBP and HR compared to pre-training. There were no changes in the Controls and no differences between the Unloaded and Loaded groups. Combining the two training groups, the sBP response to handgrip exercise after training was reduced by 10 mm Hg (95 % CI: -7, -13) and HR by 5 bpm (95 % CI: -4, -6), all p<0.05. These results are consistent with slow breathing training modifying central mechanisms regulating cardiovascular function. PMID:25804100
Background Nearly one-third of the United States adult population suffers from hypertension. Hydrochlorothiazide (HCTZ), one of the most commonly used medications to treat hypertension, has variable efficacy. The renal epithelial sodium channel (ENaC) provides a mechanism for fine-tuning sodium excretion, and is a major regulator of blood pressure homeostasis. DOT1L, MLLT3, SIRT1, and SGK1 encode genes in a pathway that controls methylation of the histone H3 globular domain at lysine 79 (H3K79), thereby modulating expression of the ENaCα subunit. This study aimed to determine the role of variation in these regulatory genes on blood pressure response to HCTZ, and secondarily, untreated blood pressure. Methods We investigated associations between genetic variations in this candidate pathway and HCTZ blood pressure response in two separate hypertensive cohorts (clinicaltrials.gov NCT00246519 and NCT00005520). In a secondary, exploratory analysis, we measured associations between these same genetic variations and untreated blood pressure. Associations were measured by linear regression, with only associations with P ≤ 0.01 in one cohort and replication by P ≤ 0.05 in the other cohort considered significant. Results In one cohort, a polymorphism in DOT1L (rs2269879) was strongly associated with greater systolic (P = 0.0002) and diastolic (P = 0.0016) blood pressure response to hydrochlorothiazide in Caucasians. However, this association was not replicated in the other cohort. When untreated blood pressure levels were analyzed, we found directionally similar associations between a polymorphism in MLLT3 (rs12350051) and greater untreated systolic (P < 0.01 in both cohorts) and diastolic (P < 0.05 in both cohorts) blood pressure levels in both cohorts. However, when further replication was attempted in a third hypertensive cohort and in smaller, normotensive samples, significant associations were not observed. Conclusions Our data suggest polymorphisms in DOT1L, MLLT3
de la Sierra, Alejandro; Segura, Julián; Banegas, José R; Gorostidi, Manuel; de la Cruz, Juan J; Armario, Pedro; Oliveras, Anna; Ruilope, Luis M
We aimed to estimate the prevalence of resistant hypertension through both office and ambulatory blood pressure monitoring in a large cohort of treated hypertensive patients from the Spanish Ambulatory Blood Pressure Monitoring Registry. In addition, we also compared clinical features of patients with true or white-coat-resistant hypertension. In December 2009, we identified 68 045 treated patients with complete information for this analysis. Among them, 8295 (12.2% of the database) had resistant hypertension (office blood pressure ≥140 and/or 90 mm Hg while being treated with ≥3 antihypertensive drugs, 1 of them being a diuretic). After ambulatory blood pressure monitoring, 62.5% of patients were classified as true resistant hypertensives, the remaining 37.5% having white-coat resistance. The former group was younger, more frequently men, with a longer duration of hypertension and a worse cardiovascular risk profile. The group included larger proportions of smokers, diabetics, target organ damage (including left ventricular hypertrophy, impaired renal function, and microalbuminuria), and documented cardiovascular disease. Moreover, true resistant hypertensives exhibited in a greater proportion a riser pattern (22% versus 18%; P<0.001). In conclusion, this study first reports the prevalence of resistant hypertension in a large cohort of patients in usual daily practice. Resistant hypertension is present in 12% of the treated hypertensive population, but among them more than one third have normal ambulatory blood pressure. A worse risk profile is associated with true resistant hypertension, but this association is weak, thus making it necessary to assess ambulatory blood pressure monitoring for a correct diagnosis and management.