The Effects of Acute Aerobic Exercise on Blood Pressure, Arterial Function, and Heart Rate Variability in Men Living With HIV.

PURPOSE: This study aims to investigate the effects of acute cycling on blood pressure (BP), arterial function, and heart rate variability (HRV) in men living with HIV (MLHIV) using combined antiretroviral therapy (cART). METHODS: Twelve MLHIV (48.7 ± 9.2 years; 25.2 ± 2.8 kg m-2) and 13 healthy controls (41.2 ± 9.9 years; 26.3 ± 2.9 kg m-2) performed a cycling bout (ES) (intensity: 50% oxygen uptake reserve; duration: time to achieve 150 kcal-MLHIV: 24.1 ± 5.5 vs. controls: 23.1 ± 3.0 min; p = 0.45), and a 20-min non-exercise session (NES). RESULTS: At rest (p < 0.05), MLHIV presented higher brachial systolic/diastolic BP (SBP/DBP: 123.2 ± 14.2/76.8 ± 6.3 vs. 114.3 ± 5.1/71.6 ± 2.6 mmHg) and central BP (cSBP/cDBP: 108.3 ± 9.3/76.5 ± 6.5 vs. 101.6 ± 4.9/71.3 ± 4.4 mmHg) vs. controls but lower absolute maximal oxygen uptake (2.1 ± 0.5 vs. 2.5 ± 0.3 L min-1) and HRV indices reflecting overall/vagal modulation (SDNN: 24.8 ± 7.1 vs. 42.9 ± 21.3 ms; rMSSD: 20.5 ± 8.5 vs. 38.1 ± 22.8 ms; pNN50: 3.6 ± 4.2 vs. 13.6 ± 11.3%). DBP postexercise lowered in controls vs. MLHIV (∼4 mmHg, p < 0.001; ES: 0.6). Moreover, controls vs. MLHIV had greater reductions (p < 0.05) in augmentation index (-13.6 ± 13.7 vs. -3.1 ± 7.2% min-1; ES: 2.4), and HRV indices up to 5 min (rMSSD: -111.8 ± 32.1 vs. -75.9 ± 22.2 ms min-1; ES: 3.8; pNN50: -76.3 ± 28.3 vs. -19.0 ± 13.7% min-1; ES: 4.4). Within-group (ES vs. NES; p < 0.05) reductions occurred in controls for SBP (∼10 mmHg, 2 h), DBP (∼6 mmHg, 20, 30, and 70 min), cSBP (∼9 mmHg, 30 min), cDBP (∼7 mmHg, 30 and 70 min), augmentation index (∼10%, 30 min), and pNN50 (∼20%; up to 2 h), while in MLHIV only cSBP (∼6 mmHg, 70 min) and cDBP (∼4 mmHg, 30 min) decreased. Similar increases (up to 5 min) in heart rate (∼22 bpm) and decreases in SDNN (∼18 ms) and rMSSD (∼20 ms) occurred in both groups. CONCLUSION: MLHIV under cART exhibited attenuated postexercise hypotension vs. healthy controls, which seemed to relate with impairments in vascular function.

Significado clínico da hipertensão durante o sono / Clinical meaning of hypertension during sleep

A anormalidade da pressão arterial durante o período de sono identificada como médias ≥ 120 x 70 mm Hg, por meio de registros da Monitorização Ambulatorial da Pressão Arterial de 24 horas (MAPA), está relacionada a pior prognóstico e maior risco de eventos. Essa alteração pode ser decorrência de vários fatores, mas, geralmente, independentemente da causa está fortemente relacionada a maior probabilidade de eventos e mortalidade cardiovasculares. Ainda restam dúvidas, embora evidências começam a ser oferecidas, se o tratamento medicamentoso desse estado de comportamento peculiar da pressão arterial nas 24 horas deva ser instituído. Nessa revisão esses aspectos são amplamente discutidos com base nas melhores evidências disponíveis

The abnormality of blood pressure during the sleep period identified as means ≥ 120 x 70 mm Hg, through 24-hour Ambulatory Blood Pressure Monitoring (ABPM) records, is related to a worse prognosis and greater risk of events. This change can be due to several factors, but, generally, regardless of the cause, it is strongly related to a higher probability of cardiovascular events and mortality. Doubts remain, although evidence is beginning to be offered, whether drug treatment of this peculiar behavioral state of blood pressure within 24 hours should be instituted. In this review, these aspects are widely discussed based on the best available evidence

Identifying patterns of diurnal blood pressure variation among ELSA-Brasil participants.

Ambulatory blood pressure monitoring (ABPM) is the gold standard method for the diagnosis of hypertension. ABPM provides a set of repeated measurements for blood pressure (BP), usually over 24 h. Traditional approaches characterize diurnal BP variation by single ABPM parameters such as average and standard deviation, regardless of the temporal nature of the data. In this way, information about the pattern of diurnal BP variation and relationship between parameters is lost. The objective of this study was to identify and characterize daily BP patterns considering the set of repeated measures from 24-h ABPM. A total of 859 adult participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) performed a 24-h ABPM record. Hypertension, sex, age, race/color, education, marital status, smoking, alcohol, physical activity, and BMI were the covariables analyzed. Techniques for longitudinal clustering, multinomial models, and models with mixed effects were used. Three daily BP patterns were identified. Daily BP patterns with high BP presented higher standard deviation and morning surge and lower nocturnal dipping. They showed greater systolic BP variability and faster rise than fall in diastolic BP during sleep. Hypertensive, "pardos," and men had greater odds to present these patterns. Daily BP patterns with high BP presented the worst profile concerning ABPM parameters associated with cardiovascular risk. The daily BP patterns identified contribute to the characterization of diurnal BP variation.

High frequency of nocturnal hypertension in lupus nephritis: should ABPM be implemented in usual practice?

INTRODUCTION/OBJECTIVES: Hypertension management in lupus nephritis (LN) is guided by in-office blood pressure (BP); however, recent studies demonstrate that lupus patients frequently have nocturnal hypertension and reduced BP dipping. The aim of the study was to evaluate 24-h blood pressure in patients with active LN and after response to treatment. METHODS: Seventy active LN patients were evaluated during a LN flare by ambulatory blood pressure monitoring (ABPM). Later, 10 patients with complete response were re-evaluated after 12 months along with 20 matched controls. Overall, daytime and nightime BP, day-to-night dipping, BP load and variability, and the incidence of abnormal BP patterns were assessed. Blood pressure levels were correlated with clinical and histologic parameters and independent associations evaluated by linear regression. RESULTS: Overall systolic hypertension occurred in 25 (36%) patients and diastolic hypertension in 28 (40%). Nighttime systolic and diastolic hypertension occurred in 35 (50%) and 44 (63%) of patients, respectively. Nocturnal systolic day-to-night BP decrease was abnormal in 59 (84%) patients. Only 18 (26%) were diagnosed with HT by in-office evaluation while 29 (41%) had masked hypertension (MH)/masked uncontrolled hypertension (MUCH), and 3 (4%) had white coat hypertension. Patients with MH had lower eGFR, complement C3, hemoglobin, and higher systolic variability compared with patients with normal BP. Systolic and diastolic BP levels were associated with the years under corticosteroid treatment, activity biomarkers (proteinuria, complement C3), and the degree of interstitial inflammation in the kidney biopsy. A re-evaluation at 12 months showed that although 9 out of 10 patients had normal in-office BP and BP loads improved, still 5 patients remained with MH due to nocturnal hypertension, and 7 remained with abnormal day-to-night dipping. These numbers were higher than those of matched controls. CONCLUSIONS: Due to the high frequency of nocturnal hypertension and abnormal day-to-night dipping, office BP measurements alone may not be sufficient to guide hypertension management in patients with LN.Key Points• Nocturnal hypertension and abnormal BP patterns are frequent and not detectable by the standard in-office BP evaluation in LN patients.• BP abnormalities may not be fully corrected after a complete clinical response to treatment in lupus nephritis and are only detectable by ABPM.• The degree of interstitial inflammation in the kidney biopsy in LN patients is associated to BP levels. This supports the hypotheses underlining the role of interstitial inflammation in salt sensitivity and hypertension.

Monitorización ambulatoria de presión arterial (MAPA): recomendaciones de la rama de nefrología pediátrica / Ambulatory blood pressure monitoring (ABPM): statement from chilean pediatric nephrology committee

Resumen: La monitorización ambulatoria de la presión arterial (MAPA) es una herramienta clínica útil para el diagnóstico y confirmación de hipertensión arterial en pediatría y permite igualmente el diagnóstico de condiciones especiales como la hipertensión de delantal blanco e hipertensión enmascarada. Exis ten recomendaciones internacionales para su realización e interpretación, sin embargo, aún quedan interrogantes por resolver. En esta guía se resume la bibliografía disponible y se intenta estandarizar, a través de consenso de especialistas nacionales, la aplicación de esta técnica. Se necesitan más estudios de investigación en niños que aporten nuevos valores de referencia y que determinen la relación de alteraciones en MAPA con resultados clínicos a largo plazo.

Abstract: Ambulatory blood pressure monitoring (ABPM) is a useful clinical tool for the diagnosis and confir mation of arterial hypertension in pediatrics, and also allows the diagnosis of special conditions such as white coat hypertension and masked hypertension. There are international recommendations for its implementation and interpretation, however, there are still unresolved questions. This guide summarizes the available literature and attempts to standardize, through consensus of national specia lists, the application of this technique. More research studies are needed that provide new reference values and determine the relationship of alterations in ABPM with long-term clinical results.

Hipertensión arterial en la infancia: recomendaciones para su diagnóstico y tratamiento. Parte 1. Rama de Nefrología Infantil, Sociedad Chilena de Pediatría / Blood hypertension in childrens: guideliness for diagnosis and treatment. Part 1. Pediatric Nephrology Branch, Chilean Pediatric Society

Resumen: La hipertensión arterial (HTA) en niños y adolescentes es una patología importante, asociada a fac tores modificables y no modificables. En la edad pediátrica, la prevalencia de la HTA es de alrededor de un 3,5%, y va aumentando progresivamente con la edad. El método ideal para su diagnóstico es la medición de la presión arterial (PA) con instrumentos auscultatorios. Según lo publicado por la Academia Americana de Pediatría (AAP) la PA debe ser medida en niños mayores de 3 años una vez al año, y en niños menores de 3 años, si presenta factores de riesgo. Una vez confirmada la HTA, la evaluación debe dirigirse hacia la detección de una enfermedad causal y a la búsqueda de factores de riesgo asociados a una HTA primaria. El objetivo del tratamiento de la HTA primaria y secundaria en pediatría es lograr un nivel de PA que disminuya el riesgo de daño de órgano blanco. Las opcio nes terapéuticas incluyen: tratamiento según etiología específica, no farmacológico y farmacológico. Este documento es producto de un esfuerzo colaborativo de la Rama de Nefrología de la Sociedad Chilena de Pediatría con el objetivo de ayudar a los pediatras y nefrólogos infantiles en el diagnóstico y tratamiento de la HTA en la infancia. En esta primera parte, se presentan las recomendaciones del diagnóstico y estudio.

Abstract: Hypertension (HT) in children and adolescents is an important pathology, associated with modi fiable and non-modifiable factors. In the pediatric, the prevalence of HT is around 3.5%, and it in creases progressively with age. The ideal method for diagnosis is the measurement of blood pressure (BP) with auscultatory instruments. As published by the American Academy of Pediatrics (AAP), BP should be measured in children over 3 years of age once a year, and in children under 3 years of age, if it presents risk factors. Once HT has been confirmed, the evaluation should be directed towards the detection of a causative disease and the search for risk factors associated with primary HTN. The goal of treating primary and secondary HTN in pediatrics is to achieve a level of BP that decreases the risk of target organ damage. The therapeutic options include: treatment according to specific etiology, non-pharmacological and pharmacological. This document is the product of a collaborative effort of the Nephrology Branch of the Chilean Society of Pediatrics with the aim of helping pediatricians and pediatric nephrologists in the diagnosis and treatment of hypertension in childhood. In this first part, the recommendations of the diagnosis and study are presented.

Papel da monitorização ambulatorial da pressão arterial na HAS de difícil controle / Role of ambulatory blood pressure monitoring in hard-to-control hypertension

Hipertensão permanece não controlada na maioria dos pacientes que utilizam tratamento antihipertensivo. Pacientes tratados com hipertensão não controlada freqüentemente têm múltiplos fatores de risco cardiovascular. Além disso, vários estudos observacionais têm demonstrado que a maioria dos pacientes com hipertensão não controlada não recebem terapia tríplice incluindo um diurético. A hipertensão resistente tem sido diferenciada em hipertensão verdadeiramente resistente e hipertensão do avental branco através do uso da monitorização ambulatorial da pressão arterial (MAPA). A MAPA, dessa forma, apresenta um papel importante no diagnóstico preciso de hipertensão resistentes auxiliando na utilização racional do tratamento medicamentoso.

Hypertension remains uncontrolled in most of the patients treated with antihypertensive drugs. Treated patients with uncontrolled hypertension often have multiple risk factors of cardiovascular risk. Moreover, many observational studies have shown that most of the patients with uncontrolled hypertension do not receive triple therapy including an antidiuretic. Resistant hypertension has been distinguished from truly resistant hypertension and white coat hypertension through ambulatory blood pressure monitoring (ABPM). Thus, ABMP has an important role in the accurate diagnosis of resistant hypertension and in supporting the rational use of drug therapy.

Avaliação da pressão arterial em indivíduos normais e hiper-reatores. Um estudo comparativo dos métodos de medidas casual e da MAPA / Blood Pressure Response in Normorreactive and Hyperreactive Patients. A Comparative Study Between Casual and Ambulatory Blood Pressure Monitoring

PURPOSE: To evaluate the levels of blood pressure when measured by casual and ambulatory blood pressure monitoring. METHODS: We studied 16 sedentary and normotensive subjects (mean 43 +/- 3 years old) showing an exaggerated blood pressure response (SBP > 220 mmHg) during a cycloergometric test, hyperreactive group (HG). This group was compared to 15 others with SBP < or = 220 mmHg during exercise, normoreactive group (NG). Casual blood pressure was obtained by the conventional method and the ambulatory blood pressure monitoring (ABPM) was obtained with SpaceLabs 90207 monitor. This procedure (test 1) was repeated after four months (test 2). RESULTS: Both groups showed statistically higher levels of blood pressure when measured by ABPM device, compared to casual measurements. Systolic blood pressure was significantly higher in HG in casual measurement, in test 1 but not in test 2. Diastolic blood pressure was significantly higher in HG only through the ABPM device. The ambulatory blood pressure average values for two or 24 hours was similar in both groups. No significant differences were observed in left ventricular morphology at the echocardiogram. CONCLUSION: These findings indicate that hyperreactive subjects have an exaggerated stress-induced cardiovascular response during the installation of the device.

Objetivo - Avaliar a pressão arterial de indivíduos normais e hiper-reatores antes e após a colocação do aperelho de monitorização ambulatorial da pressão arterial (MAPA), bem como as médias de 2h, 24h e subperíodos de monitorização. Métodos - Estudaram-se 16 indivíduos (43±3 anos), sedentários, assintomáticos, normotensos e que apresentaram elevação exagerada da pressão sistólica (PAS >220mmHg) durante o teste ergométrico, constituindo o grupo hiper-reator (GH). Este grupo foi comparado com outros 15 indivíduos normotensos em repouso e que apresentaram durante o esforço PAS <220mmHg (GN). A pressão casual foi determinada pelo método auscultatório convencional e os valores de monitorização foram obtidos com o monitor SpaceLabs 90207. Este procedimento (teste 1) foi repetido após período de quatro meses (teste 2). Resultados - Em ambos os grupos observou-se elevação estatisticamente significante das cifras pressóricas após a instalação do monitor, em relação à medida casual. A PAS casual e a pressão diastólica da 1ª medida da MAPA foram maiores (p<0,05) em GH, cujas significâncias desapareceram após quatro meses. A média das duas primeiras horas de monitorização e dos valores da MAPA de 24h foram semelhantes em ambos os grupos. O estudo ecocardiográfico não apresentou diferenças estruturais cardíacas entre GN e GH. Conclusão - Esses dados indicam que indivíduos hiper-reatores podem apresentar resposta cardiovascular exagerada estresse-induzida durante a instalação do monitor

Estudo multicêntrico brasileiro de avaliaçäo de eficácia clínica e tolerabilidade da isradipina SRO através da monitorizaçäo ambulatorial da pressäo arterial no tratamento da hipertensäo arterial leve e moderada / Tolerability and Antihypertensive Effects of Isradipine SRO on Clinical and Ambulatorial Blood Pressure Monitoring in Essential Hypertensives. A Brazilian Multicenter Study

PURPOSE--To evaluate clinical efficacy and tolerability of isradipine SRO (I.SRO), 5 mg O.D. in essential hypertensives. METHODS--Eighty-three of 87 selected outpatients with a mean age of 51.3 years (ranging from 25 to 65), 33 male, 48 white, 29 black and others of different races, who had clinical supine and orthostatic diastolic blood pressure (DBP) > or = 95 mmHg and < or = 115 mmHg underwent the study. After a three-week wash-out period, patients received I.SRO 5 mg O.D. at 8:00 am for a six-week period (phase I). After this phase, patients received I.SRO 5 mg O.D. at 8:00 pm for a six-week period (phase II). The patients had a follow-up with an interval of three weeks and the ambulatorial blood pressure monitoring (ABPM) for 24 hours was performed with a SpaceLabs 90207 or Del Mar Avionics devices after the wash-out period and at the end of phases I and II. Measurements were performed at 15-min intervals during the day (6 am to 10 pm) and at 30-min intervals during the night (10 pm to 6 am). RESULTS--a) Heart rate did not show significant changes during the treatment period (phases I and II) when compared with the wash-out period; b) causal blood pressure: at the end of both treatment periods (phases I and II) there were statistically significant decreases (p < 0.001) in supine SBP and DBP compared with wash-out values. The mean SBP decreased from 161.6 +/- 14 to 144.3 +/- 13 mmHg (phase I) and to 141.8 +/- 13 mmHg (phase II). The mean DBP decreased from 103.4 +/- 6 to 91.2 +/- 7 (phase I) and to 89.1 +/- 8 (phase II); c) ABPM: the mean systolic 24-h ambulatory blood pressure was significantly reduced (p < 0.001) from 148.8 +/- 17 to 137.2 +/- 15 mmHg (phase I) and to 133.4 +/- 13 mmHg (phase II). The mean diastolic 24-h ambulatory blood pressure was significantly decreased (p < 0.001) from 94.3 +/- 9 to 87.0 +/- 9 (phase I) and to 85.8 +/- 8 mmHg (phase II). The mean daytime and nighttime, systolic and diastolic 24-h ambulatory blood pressure were: wash-out--152.3 +/- 17, 140.2 +/- 21, 97.4 +/- 9, 86.8 +/- 13; phase I--139.9 +/- 15, 130.0 +/- 17, 89.3 +/- 9, 81.3 +/- 10; phase II--136.7 +/- 13, 125.3 +/- 15, 88.5 +/- 8, 79.1 +/- 10, respectively. Blood pressure load (percentage of systolic blood pressure values > 140 mmHg or of diastolic blood pressure values > 90 mmHg) was significantly reduced from 62.2/62 per cent (SBP/DBP), on the was-out, to 37.9/39.9 per cent (SBP/DBP) on phase I and to 32.3/34.3 per cent (SBP/DBP) on phase II; d) side effects: most frequently related were palpitations (2.3 per cent ), headache (1.1 per cent ), flush (1 per cent ) and ankle oedema (1 per cent ). They were in general, mild-to-moderate and disappeared after the first 3 weeks of treatment. Only two patients were withdrawn because of headache (one of them with previous diagnosis of migraine). CONCLUSION--I.SRO, given by oral route, in the dosage of 5 mg O.D. as monotherapy, was effective and well tolerated, promoted significant reduction on 24-h ambulatory blood pressure attenuating the early morning rise and did not interfere with the circadian rhythm of blood pressure. No significant differences were detected in the BP lowering effect when I.SRO was given during the morning or evening. These results may indicate that the drug is as suitable as one of the first choice for treating mild and moderate hypertensive patients