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Treatment options for hypertension have been evolving over time. However, prevalence rates keep increasing and perpetuate hypertension as a major cardiovascular risk factor. Exercise training is effective in reducing blood pressure, cardiovascular disease risk factors and mortality, besides improving quality of life. However, participation rates for hypertensive patients remain shockingly low and adherence to exercise training tends to decline following exercise programs. These trends emphasize the need to deepen our knowledge of modifiable intrapersonal, interpersonal, and socioeconomic and environmental factors that help explain exercise adherence among people with hypertension. The present review focuses on the determinants of adherence and long-term maintenance of a physically active lifestyle in hypertensive individuals.
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Terapia por Ejercicio , Hipertensión , Cooperación del Paciente , Calidad de Vida , Ejercicio Físico , Estilo de Vida Saludable , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/terapiaRESUMEN
BACKGROUND: Physical activity is associated with reduced arterial stiffness, although such a relationship has not been reported in those with resistant hypertension. Therefore, this study aimed to determine the association between daily physical activity and arterial stiffness in patients with resistant hypertension. METHODS: Fifty-seven (57) patients with resistant hypertension (50.9% men), aged 58.8±9.4 years, were consecutively recruited. Arterial stiffness was evaluated using carotid-femoral pulse wave velocity (cf-PWV). Daily physical activity was objectively assessed with accelerometers during 7 consecutive days. RESULTS: Patients had a body mass index of 29.0±4.0 kg/m2 (84.3% overweight/obese) and were taking an average 4.5 antihypertensive medications. Overall, the cf-PWV was 9.2±2.4 m/s and the majority of participants (n=41, 71.9%) presented a cf-PWV <10 m/s. The cf-PWV showed an inverse correlation with light-intensity physical activity (r = -0.290, p=0.029) and total daily physical activity (r = -0.287, p=0.030). The correlation between light physical activity and cf-PWV remained significant after adjustment for systolic and diastolic blood pressure, but lost significance when further adjusted for age. CONCLUSIONS: Higher daily levels of light-intensity and total physical activity were associated with lower arterial stiffness. Nonetheless, this association is weak and attenuated or abolished when adjusted for blood pressure and age. These results suggest that physical activity may play an important role as a lifestyle intervention for patients with resistant hypertension. Future studies with larger samples sizes are necessary to confirm this preliminary data.
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Hipertensión , Rigidez Vascular , Presión Sanguínea , Ejercicio Físico , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Análisis de la Onda del PulsoRESUMEN
Heart failure (HF) is a clinical entity included in cardiovascular diseases affecting millions of people worldwide, being a leading cause of hospitalization of older adults, and therefore imposing a substantial economic burden on healthcare systems. HF is characterized by dyspnea, fatigue, and edema associated with elevated blood levels of natriuretic peptides, such as N Terminal pro-B-type Natriuretic Peptide (NT-proBNP), for which there is a high demand for point of care testing (POCT) devices. Optical fiber (OF) biosensors offer a promising solution, capable of real-time detection, quantification, and monitoring of NT-proBNP concentrations in serum, saliva, or urine. In this study, immunosensors based on plasmonic uncladded OF tips were developed using OF with different core diameters (200 and 600 µm). The tips were characterized to bulk refractive index (RI), anddetection tests were conducted with NT-proBNP concentrations varying from 0.01 to 100 ng/mL. The 200 µm sensors showed an average total variation of 3.6 ± 2.5 mRIU, an average sensitivity of 50.5 mRIU/ng·mL-1, and a limit of detection (LOD) of 0.15 ng/mL, while the 600 µm sensors had a response of 6.1 ± 4.2 mRIU, a sensitivity of 102.8 mRIU/ng·mL-1, and an LOD of 0.11 ng/mL. Control tests were performed using interferents such as uric acid, glucose, and creatinine. The results show the potential of these sensors for their use in biological fluids.
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Técnicas Biosensibles , Péptido Natriurético Encefálico , Fibras Ópticas , Fragmentos de Péptidos , Péptido Natriurético Encefálico/sangre , Humanos , Fragmentos de Péptidos/sangre , Fragmentos de Péptidos/análisis , Insuficiencia Cardíaca/diagnóstico , Límite de DetecciónRESUMEN
Central blood pressure (BP) and BP variability are associated with cardiovascular disease risk. However, the influence of exercise on these hemodynamic parameters is unknown among patients with resistant hypertension. The EnRicH (The Exercise Training in the Treatment of Resistant Hypertension) was a prospective, single-blinded randomized clinical trial (NCT03090529). Sixty patients were randomized to a 12-week aerobic exercise program or usual care. The outcome measures include central BP, BP variability, heart rate variability, carotid-femoral pulse wave velocity, and circulating cardiovascular disease risk biomarkers including high-sensitivity C-reactive protein, angiotensin II, superoxide dismutase, interferon gamma, nitric oxide, and endothelial progenitor cells. Central systolic BP decreased by 12.22 mm Hg (95% CI, -1.88 to -22.57, P = 0.022) as did BP variability by 2.85 mm Hg (95% CI, -4.91 to -0.78, P = 0.008), in the exercise (n = 26) compared to the control group (n = 27). Interferon gamma -4.3 pg/mL (95%CI, -7.1 to -1.5, P = 0.003), angiotensin II -157.0 pg/mL (95%CI, -288.1 to -25.9, P = 0.020), and superoxide dismutase 0.4 pg/mL (95%CI, 0.1-0.6, P = 0.009) improved in the exercise compared to the control group. Carotid-femoral pulse wave velocity, heart rate variability, high-sensitivity C-reactive protein, nitric oxide, and endothelial progenitor cells were not different between groups (P > 0.05). In conclusion, a 12-week exercise training program improved central BP and BP variability, and cardiovascular disease risk biomarkers in patients with resistant hypertension. These markers are clinically relevant as they are associated with target organ damage and increased cardiovascular disease risk and mortality.
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Enfermedades Cardiovasculares , Hipertensión , Rigidez Vascular , Humanos , Presión Sanguínea/fisiología , Proteína C-Reactiva , Análisis de la Onda del Pulso , Óxido Nítrico , Angiotensina II , Interferón gamma , Estudios Prospectivos , Hipertensión/terapia , Ejercicio Físico/fisiología , Biomarcadores , Superóxido Dismutasa , Rigidez Vascular/fisiologíaRESUMEN
Purpose: Aerobic exercise training programs decrease blood pressure in individuals with resistant hypertension. However, participants' experiences regarding exercise training participation are unknown and often undervalued. Therefore, participant's experiences and program acceptability of the exercise arm of the EnRicH trial, a randomized clinical trial investigating the effect of a 12-week aerobic exercise training program in individuals with resistant hypertension were analysed.Methods: An exploratory qualitative study was conducted with twenty individuals with resistant hypertension (11 males, mean age 58.9 ± 8.9 years), after the exercise program. Four focus group interviews were performed to explore participants' perspectives. The interviews were digitally audio-recorded, transcribed verbatim, and subjected to thematic analysis.Results: Five themes emerged from the data analyses: 1) main impacts of participating in the exercise program; 2) facilitators of adherence; 3) perceived barriers; 4) perception of the program structure; and 5) global satisfaction with the program. Positive physical and emotional changes were reported, associated with reduced perceived stress and irritability, and decreased blood pressure. Adherence to the exercise program was facilitated by personalized supervision and feedback, the personal commitment to attend the training sessions, and different schedule options. Lack of motivation, peer support, physical health limitations, and difficulty in conciliating schedules were identified as barriers to the maintenance of exercise training after the program.Conclusion: The qualitative analysis demonstrates the acceptability of the program. Peer and health professional's support, commitment to health professionals, and boosting individual-perceived advantages are key-points to promote participants adherence.Implications for RehabilitationExercising in small groups seems to provide peer support, facilitating maintenance of exercise trainingProviding feedback on the health gains achieved by participants is important to increase adherence to exerciseEstablishing good and empathic communication between health professionals and participants facilitates adherence to exercise trainingProviding personal nutritional counselling may improve patient satisfactionIndividually tailored exercise programs may facilitate exercising for participants with physical limitationsProviding different training schedules may increase adherence and maintenance of exercise training.
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Reports suggest that the blood pressure (BP) response to an acute bout of exercise is associated with the BP response to aerobic training in participants with elevated BP. These associations have not been tested among patients with resistant hypertension. This study aimed to determine whether the BP response to acute exercise predicts the 24-h ambulatory BP response to a 12-week exercise training program in patients with resistant hypertension (n = 26, aged 59.3 ± 8.2 years, 24-h ambulatory BP 127.4 ± 12.2/75.6 ± 7.8 mm Hg) who completed the exercise arm of the EnRicH trial. Ambulatory BP measurements were obtained before and after the exercise program to assess the chronic BP response. To assess acute BP changes, resting BP was measured before and 10 min after three exercise sessions in the third week of training and averaged. The resting systolic (9.4 ± 6.7, p < 0.001) and diastolic BP (1.9 ± 3.2, p = 0.005) were reduced after acute exercise. The 24-h systolic (6.2 ± 12.2, p = 0.015) and diastolic BP (4.4 ± 6.1, p = 0.001) were decreased after exercise training. The reductions in systolic BP after acute exercise were associated with the reductions in 24-h systolic BP after exercise training (ß = 0.538, adjusted r2 = 0.260, P = 0.005). The reductions in diastolic BP after acute exercise (ß = 0.453, adjusted r2 = 0.187) and baseline 24-h diastolic BP (ß = -0.459, adjusted r2 = 0. 199) accounted for 38.6% (p = 0.008) of the 24-h diastolic BP response to exercise training. In conclusion, the magnitude of the BP response to acute exercise appears to predict the ambulatory BP response to exercise training among patients with resistant hypertension.
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Monitoreo Ambulatorio de la Presión Arterial , Hipertensión , Presión Sanguínea/fisiología , Ejercicio Físico/fisiología , Humanos , Hipertensión/terapia , SístoleRESUMEN
OBJECTIVE: Arterial stiffness, namely pulse wave velocity (PWV), is an emerging biomarker in the assessment of vascular health. This meta-analysis aims to determine the effects of exercise training on PWV in patients with hypertension, and to identify the possible moderator variables (e.g. type of exercise) of the effect of exercise on PWV. METHODS: MEDLINE, EMBASE, Cochrane and Web of Science were searched up until July 2019 for randomized controlled trials assessing the effect of exercise interventions lasting 4 or more weeks on PWV in adults with hypertension. Random-effects modelling was used to compare changes from pre to postintervention in PWV between exercise and control groups. Data were reported as weighted mean difference (WMD) and 95% confidence interval (95% CI). Protocol registration: PROSPERO registration number CRD42019138658. RESULTS: We included 14 trials (15 interventions), involving five aerobic, two dynamic resistance, six combined and two isometric resistance groups, totalling 642 participants with hypertension. PWV was significantly reduced by exercise training [(WMD (95% CI)â=â-0.76âm/s (-1.05 to -0.47)]. Analysis of moderator variables showed that aerobic exercise [WMD (95% CI)â=â-0.70âm/s (-1.20 to -0.19)], combined exercise [WMD (95% CI)â=â-0.74âm/s (-1.41 to -0.08)] and isometric resistance exercise [WMD (95% CI)â=â-0.98âm/s (-1.24 to -0.73)] reduced PWV. There was no significant reduction in PWV in participants undertaking dynamic resistance training [WMD (95% CI)â=â-0.58 (-1.58 to 0.42)]. CONCLUSION: This meta-analysis supports that exercise interventions based on aerobic, combined or isometric exercise are suitable to improve PWV in adults with hypertension.
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Hipertensión , Entrenamiento de Fuerza , Rigidez Vascular , Adulto , Ejercicio Físico , Humanos , Hipertensión/terapia , Análisis de la Onda del PulsoRESUMEN
Importance: Limited evidence suggests exercise reduces blood pressure (BP) in individuals with resistant hypertension, a clinical population with low responsiveness to drug therapy. Objective: To determine whether an aerobic exercise training intervention reduces ambulatory BP among patients with resistant hypertension. Design, Settings, and Participants: The Exercise Training in the Treatment of Resistant Hypertension (EnRicH) trial is a prospective, 2-center, single-blinded randomized clinical trial performed at 2 hospital centers in Portugal from March 2017 to December 2019. A total of 60 patients with a diagnosis of resistant hypertension aged 40 to 75 years were prospectively enrolled and observed at the hospitals' hypertension outpatient clinic. Interventions: Patients were randomly assigned in a 1:1 ratio to a 12-week moderate-intensity aerobic exercise training program (exercise group) or a usual care control group. The exercise group performed three 40-minute supervised sessions per week in addition to usual care. Main Outcomes and Measures: The powered primary efficacy measure was 24-hour ambulatory systolic BP change from baseline. Secondary outcomes included daytime and nighttime ambulatory BP, office BP, and cardiorespiratory fitness. Results: A total of 53 patients completed the study, including 26 in the exercise group and 27 in the control group. Of these, 24 (45%) were women, and the mean (SD) age was 60.1 (8.7) years. Compared with the control group, among those in the exercise group, 24-hour ambulatory systolic BP was reduced by 7.1 mm Hg (95% CI, -12.8 to -1.4; P = .02). Additionally, 24-hour ambulatory diastolic BP (-5.1 mm Hg; 95% CI, -7.9 to -2.3; P = .001), daytime systolic BP (-8.4 mm Hg; 95% CI, -14.3 to -2.5; P = .006), and daytime diastolic BP (-5.7 mm Hg; 95% CI, -9.0 to -2.4; P = .001) were reduced in the exercise group compared with the control group. Office systolic BP (-10.0 mm Hg; 95% CI, -17.6 to -2.5; P = .01) and cardiorespiratory fitness (5.05 mL/kg per minute of oxygen consumption; 95% CI, 3.5 to 6.6; P < .001) also improved in the exercise group compared with the control group. Conclusions and Relevance: A 12-week aerobic exercise program reduced 24-hour and daytime ambulatory BP as well as office systolic BP in patients with resistant hypertension. These findings provide clinicians with evidence to embrace moderate-intensity aerobic exercise as a standard coadjutant therapy targeting this patient population. Trial Registration: ClinicalTrials.gov Identifier: NCT03090529.
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Monitoreo Ambulatorio de la Presión Arterial/métodos , Presión Sanguínea/fisiología , Capacidad Cardiovascular/fisiología , Ejercicio Físico/fisiología , Hipertensión/rehabilitación , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Consumo de Oxígeno/fisiología , Estudios Prospectivos , Método Simple CiegoRESUMEN
BACKGROUND: The long-term prognosis and transition towards sustained ambulatory hypertension (SHT) of white-coat hypertension (WCHT) remain uncertain particularly in those with both normal nighttime and daytime blood pressure (BP) values. Different classification criteria and the use of antihypertensive drugs may contribute to conflicting results. Patients and Methods. We prospectively evaluated for a 7.1 year transition to SHT in 899 nondiabetic subjects free from cardiovascular (CV) events: normotensive (NT) (n = 344; 52, 9% female; ageing 48 ± 14 years); untreated WCHT (UnWCHT n = 399; 50, 1% female; ageing 51 ± 14 years); and treated WCHT with antihypertensive drugs after baseline (TxWCHT n = 156; 54, 4% female; ageing 51 ± 15 years). All underwent 24 h ambulatory BP monitoring (24 h-ABPM) at baseline, at 30 to 60 months, and at 70 to 120 months thereafter. WCHT was at baseline (with no treatment) as office BP ≥ 140/or 90 mm·Hg, daytime BP < 135/85 mm·Hg, and nighttime BP < 120/70 mm·Hg. Development of SHT was considered if daytime BP ≥ 135/or 85 mm Hg and/or nighttime BP ≥ 120/or 70 mm·Hg. RESULTS: Baseline metabolic parameters did not differ among groups. At 30-60 months and at the end of follow-up, development of SHT occurred, respectively, in NT (3.8% (n = 13) and 9.6% (n = 33)) and in UnWCHT (10.1% (n = 40) and 16.5% (n = 66)) (p < 0.009). The mean annual increase of average 24 h-systolic BP was 0.48 + 0.93 in NT and 0.73 + 1.06 in UnWCHT, whereas annual SBP in office increased in NT by 1.2 + 0.95 but decreased in UnWCHT by 1.36 + 1.35 mm Hg (p < 0.01). CONCLUSION: Untreated WCHT patients exhibit a faster and a higher risk of developing SHT compared to NT with TxWCHT assuming an intermediate position between them.
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BACKGROUND: The prognostic impact of white-coat hypertension (WCHT) is still a matter of debate and controversy. Night-time blood pressure (NBP) is related strongly to cardiovascular (CV) prognosis, but this has not been considered currently in the definition of WCHT. PATIENTS AND METHODS: We investigated the long-term CV prognosis of 2659 patients submitted at admission to 24 h-ambulatory blood pressure (BP) monitoring divided into three groups: normotension (NT) (n=812; 59% female; ageing 49±13 years), sustained hypertension (SHT) (n=1230; 56% female; ageing 51±13 years) and WCHT (n=617; 55% female; ageing 50±3 years) defined as office BP of at least 140/90 mmHg, daytime BP less than 135/85 mmHg and NBP less than 120/70 mmHg. RESULTS: The median follow-up was 7.6 years (range: 0.4-24.4), during which a total of 257 CV events (36 fatal) occurred (46% strokes, 32% coronary and 22% others), 38 in NT, 31 in WCHT and 188 in SHT. The event rate per 100 patient-years was 0.60 in the WCHT group, 0.66 in the NT group and 2.09 in the SHT group. Cox's regression analysis adjusted for covariables showed a higher risk of CV events in patients with SHT than WCHT [hazard ratio (HR)=2.230, 95% confidence interval: 1.339-3.716, P=0.002], whereas there was no difference between WCHT and NT groups. Event-free survival was significantly different from SH versus WCHT and NT groups. Within the group of WCHT, 29% of patients received sustained antihypertensive medication during the follow-up, but the HR of CV events between WCHT either treated or not treated did not differ: HR=0.76 (95% confidence interval: 0.37-1.51, P=0.42). CONCLUSION: In patients with WCHT defined by normal daytime and NBP values, the risk of CV events was significantly lower than that of SHT and similar to that of NT patients, suggesting that NBP should be included in the WCHT definition and in its prognostic stratification.
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Presión Sanguínea , Enfermedad Coronaria , Accidente Cerebrovascular , Hipertensión de la Bata Blanca , Adulto , Enfermedad Coronaria/etiología , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/fisiopatología , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Tasa de Supervivencia , Hipertensión de la Bata Blanca/complicaciones , Hipertensión de la Bata Blanca/mortalidad , Hipertensión de la Bata Blanca/fisiopatologíaRESUMEN
Although there has been an observed progress in the treatment of hypertension, its prevalence remains elevated and constitutes a leading cause of cardiovascular disease development. Resistant hypertension is a challenge for clinicians, as the available treatment options have reduced success. Physical activity and exercise training play an important role in the management of blood pressure. The importance of physical activity and exercise training as part of a comprehensive lifestyle intervention is acknowledged by several professional organizations in their recommendations/guidelines for the management of arterial hypertension. Aerobic exercise, dynamic resistance exercise, and concurrent training - the combination of dynamic resistance and aerobic exercise training in the same exercise session or on separate days - has been demonstrated to reduce blood pressure and help in the management of hypertension. The present review draws attention to the importance of exercise training in the management of blood pressure in both hypertension and resistant hypertension individuals.
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OBJECTIVE: To assess ambulatory blood pressure monitoring (ABPM) circadian patterns and their determinants in a large sample of normotensive and hypertensive patients. METHODS: A total of 26170 individual ABPM recordings from 1995 to 2015 were analyzed. Mean office blood pressure (OBP), 24-hour blood pressure (BP), daytime BP and nocturnal BP were measured. Circadian patterns were classified by nocturnal systolic BP fall as extreme dipper (ED, ≥20%), dipper (D, 10%-19.9%), non-dipper (ND, 0%-9.9%), and reverse dipper (RD, <0%). RESULTS: The population were 52% female, aged 58±15 years, mean body mass index (BMI) 27±5 kg/m2. Using ABPM criteria of normalcy, 22.8% were normotensives (NT), 19.1% were untreated hypertensives, 29.7% were controlled hypertensives and 28.4% were treated but uncontrolled hypertensives. Among NT, 60.7% were white-coat hypertensive. In controlled hypertensives 62.4% had OBP ≥140/90 mmHg. In treated but uncontrolled hypertensives 8.2% had masked uncontrolled hypertension. ABPM values were lower than OBP in all cases. In all subgroups the most common pattern was D (42-50%), followed by ND (35-41%), ED (7-11%) and RD (4-11%). Age and BMI were determinants of attenuation of nocturnal BP fall and ND+RD. The proportion of ND+RD was higher in patients with BMI >30 kg/m2 vs. others (46.5 vs. 42.9%, p<0.01) and in those aged ≥65 vs. <65 years (54.9. vs. 33.1%, p<0.00). Nocturnal BP fall was greater in NT than in hypertensives (11.3±6.7 vs. 9.9±7.9%, p<0.000). CONCLUSIONS: There was a marked discrepancy between office and ABPM values. The rates of control on ABPM were more than double those on OBP. Non-dipping occurred in >43%, including in NT. Age and BMI predicted non-dipping.
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Monitoreo Ambulatorio de la Presión Arterial , Hipertensión/diagnóstico , Adulto , Anciano , Presión Sanguínea/fisiología , Ritmo Circadiano , Estudios Cruzados , Estudios Transversales , Bases de Datos Factuales , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND AND PURPOSE: A single bout of aerobic exercise acutely decreases blood pressure, even in older adults with hypertension. Nonetheless, blood pressure responses to aerobic exercise in very old adults with hypertension have not yet been documented. Therefore, this study aimed to assess the effect of a single session of aerobic exercise on postexercise blood pressure in very old adults with hypertension. METHODS: Eighteen older adults with essential hypertension were randomized into exercise (N = 9, age: 83.4 ± 3.2 years old) or control (N = 9, age: 82.7 ± 2.5 years old) groups. The exercise group performed a session of aerobic exercise constituting 2 periods of 10 minutes of walking at an intensity of 40% to 60% of the heart rate reserve. The control group rested for the same period of time. Anthropometric variables and medication status were evaluated at baseline. Heart rate and systolic and diastolic blood pressures were measured at baseline, after exercise, and at 20 and 40 minutes postexercise. RESULTS: Systolic blood pressure showed a significant interaction for group × time (F3,24 = 6.698; P = .002; ηp(2) = 0.153). In the exercise group, the systolic blood pressure at 20 (127.3 ± 20.9 mm Hg) and 40 minutes (123.7 ± 21.0 mm Hg) postexercise was significantly lower in comparison with baseline (135.6 ± 20.6 mm Hg). Diastolic blood pressure did not change. Heart rate was significantly higher after the exercise session. In the control group, no significant differences were observed. CONCLUSIONS: A single session of aerobic exercise acutely reduces blood pressure in very old adults with hypertension and may be considered an important nonpharmacological strategy to control hypertension in this age group.
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Presión Sanguínea/fisiología , Ejercicio Físico/fisiología , Frecuencia Cardíaca/fisiología , Hipertensión/fisiopatología , Anciano de 80 o más Años , Femenino , Humanos , MasculinoRESUMEN
Hypertension is a very prevalent risk factor for cardiovascular disease. The prevalence of resistant hypertension, i.e., uncontrolled hypertension with 3 or more antihypertensive agents including 1 diuretic, is between 5% and 30% in the hypertensive population. The causes of resistant hypertension are multifactorial and include behavioral and biological factors, such as non-adherence to pharmacological treatment. All current treatment guidelines highlight the positive role of physical exercise as a non-pharmacological tool in the treatment of hypertension. This paper draws attention to the possible role of physical exercise as an adjunct non-pharmacological tool in the management of resistant hypertension. A few studies have investigated it, employing different methodologies, and taken together they have shown promising results. In summary, the available evidence suggests that aerobic physical exercise could be a valuable addition to the optimal pharmacological treatment of patients with resistant hypertension.
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OBJECTIVE: To evaluate in untreated subjects the reproducibility of mean values and four circadian patterns between two ambulatory blood pressure monitoring (ABPM) recordings separated by 1-11 months. METHODS: We performed a retrospective analysis of 481 individuals (59% women) evaluated by ABPM on two occasions, visit 1 (V1) and 2 (V2), separated by 5.5+0.2 months. Four circadian patterns were defined by night/day systolic blood pressure (SBP) ratios: reverse dippers (RD), ratio >1.0; non-dippers (ND), ratio 0.9-1.0; dippers (D), ratio 0.8-<0.9; and extreme dippers (ED), ratio <0.8. Coefficients of correlation and concordance between the ABPM values at V1 and V2 and the reproducibility of the RD, ND, D and ED patterns were calculated by the percentage of the same profile from V1 to V2. RESULTS: Mean 24-h blood pressure (BP) at V1 and V2 was 126.8/75.9±0.5/0.5 vs. 126.5/75.7±0.5/0.4 mmHg (NS). Nighttime SBP fall was 9.8±0.4 (V1) and 9.6±0.3% (V2) (NS). The correlation coefficient of ABPM data at V1 vs. at V2 was 0.41-0.69 (p<0.001) and the concordance coefficient was 0.34-0.57 (p<0.01). At V1, 38 subjects were classified as ED (7.9%); D, n=216 (44.9%), 187 as ND (38.9%) and 40 as RD (8.3%). At V2 only 26.3% of ED, 44.9% of D, 54.5% of ND and 40% of RD maintained the same profile as at V1. CONCLUSION: In untreated subjects ABPM has high reproducibility for mean values but only modest reproducibility for circadian profiles, thereby challenging the prognostic value of BP dipping patterns.
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Monitoreo Ambulatorio de la Presión Arterial , Ritmo Circadiano , Adulto , Presión Sanguínea , Femenino , Humanos , Hipertensión , Masculino , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
INTRODUCTION: The association of the Mediterranean diet and exercise appears to have a protective role, reducing cardiovascular risk. This study investigated the effects of education sessions on the Mediterranean diet and an exercise program in modifying eating behaviors, body composition and abdominal fat. METHODS: An experimental study was performed on 20 subjects with known coronary heart disease randomly assigned to experimental (n=10) and control (n=10) groups. Both groups received education sessions on the Mediterranean diet, but the experimental group also followed an eight-week program of specific exercises. A semiquantitative food frequency questionnaire was administered to analyze food intake, bioimpedance was used to measure weight, fat mass and lean mass, and waist circumference was measured to calculate waist-to-height ratio. RESULTS: After eight weeks, protein (p<0.05) and cholesterol (p<0.05) intake in the experimental group had decreased significantly compared with the control group. Between the beginning and end of the study, there were significant decreases in the control group in carbohydrate (p<0.05) and saturated fat intake (p<0.05). In both groups the percentage of total fat (p<0.05) and fat mass (p<0.05) was significantly decreased. In the experimental group the waist-to-height ratio was significantly reduced (p<0.05). CONCLUSION: The Mediterranean diet reduced carbohydrate and saturated fat intake, reflected in reduced fat mass. The association of the exercise program showed additional benefits in reduction of protein and cholesterol intake and abdominal fat.
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Enfermedad de la Arteria Coronaria/dietoterapia , Dieta Mediterránea , Terapia por Ejercicio , Adulto , Anciano , Enfermedades Cardiovasculares , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad , Factores de RiesgoAsunto(s)
Antihipertensivos , Hipertensión , Presión Sanguínea , Humanos , Estilo de Vida , PortugalRESUMEN
INTRODUCTION: The aim of this study was to compare the 24-h ambulatory blood pressure (ABP) profile in never-treated black hypertensive patients living in Africa, Mozambique (20-80 years), versus never-treated white hypertensive patients living in Europe. PATIENTS AND METHODS: ABP recordings of untreated black hypertensive patients and white hypertensive patients with 24-h ABP of 130/80 mmHg or more were retrospectively selected from two computerized database records of ABP and matched for age by decades, sex, and BMI. RESULTS: Black hypertensive patients were n=548, 47 ± 12 years, 52% women, BMI=28.0 ± 8.2 kg/m(2), 7% smokers, 7% diabetics; white hypertensive patients were n=604, 47 ± 15 years, 52% women, BMI=27.4 ± 5.1 kg/m(2), 8.4% diabetics, and 18% smokers (P<0.02). Black hypertensive patients versus white hypertensive patients showed higher casual blood pressure (BP) 160/104 ± 19/14 versus 149/97 ± 18/12 mmHg, 24-h ABP 146/92 ± 16/13 versus 139/85 ± 11/10 mmHg, daytime ABP 150/95 ± 16/13 versus 143/88 ± 13/11 mmHg, night-time BP 139/84 ± 17/13 versus 130/78 ± 13/10 mmHg (all P<0.001) and lower night-time BP fall 8.3 ± 6.9 versus 10.1 ± 8.7% (P<0.02) and higher BP variability. Differences were still significant in all decades above 30 years of age and when calculations were carried out separately for both men and women. The average 24-h heart rate did not differ between groups. CONCLUSION: Our data suggest that untreated black hypertensive patients systematically present higher clinic and ABP values and a lower night-time BP fall than untreated white hypertensive patients for all spectra of age distribution. This might be the reason for the worse cardiovascular prognosis described in black hypertensive patients compared with white hypertensive patients.