Long-term use of probiotics for the management of office and ambulatory blood pressure: A systematic review and meta-analysis of randomized, controlled trials.

Previous studies showed a controversial result on the relationship between probiotics treatment duration and blood pressure (BP). The present meta-analysis is performed to summarize the effects of long-term (≥8 weeks) use of probiotics on office and ambulatory BP using combined evidence from randomized, controlled trials. We searched PubMed, Embase, Cochrane library, and the ClinicalTrials.gov till January, 2021 to identify eligible articles. Primary outcomes were changes in office BP. In the presence of heterogeneity, a random-effects model was used to calculate the combined treatment effect. Begg's funnel plots and Egger's regression test were used to assess the publication bias. Meta-analysis of 26 trials in 1624 participants demonstrated that probiotic consumption significantly decreased office systolic BP by 2.18 mmHg (95% confidence interval [CI], -3.41 to -0.94 mmHg) and diastolic BP by 1.07 mmHg (95% CI, -1.72 to -0.41 mmHg). The analysis on ambulatory BP from three trials showed a similar reduction by -2.35/-1.61 mmHg (p ≤ .052). Subgroup analysis in hypertensive and diabetic patients showed a significant reduction in systolic and diastolic BP (p ≤ .02). The reductions in diabetic and hypertensive patients were comparatively larger than nondiabetic and normotensive patients (p ≥ .052). With the increase of age, baseline body mass index (BMI), treatment duration, and systolic BP, the effects of probiotics on BP did not increase significantly (p trend ≥ .18). The present meta-analysis suggests a beneficial effect of probiotics on BP by a modest degree, especially in the diabetes mellitus and hypertension. Prolonging the treatment duration could not improve the antihypertensive effect.

The Weighted Combination of the Epworth Sleepiness Scale and the STOP-Bang Questionnaire Improved the Predictive Value of for OSAHS in Hypertensive Patients.

Purpose: Hypertension interrelated with obstructive sleep apnea hypopnea syndrome (OSAHS), worsening morbidity and mortality. It is urgent to screening OSAHS from hypertensive patients. An ideal effective questionnaire screening approach for OSAHS is lacking. In this study, we aimed to explore a new OSAHS screening method via weighted combining the current used Epworth sleepiness scale (ESS) and STOP-Bang questionnaire (SBQ) upon calculation. Patients and Methods: Three hundred and sixteen hypertensive patients with suspicion of the OSAHS were enrolled and randomized in the study into ESS, SBQ and portable respiratory polysomnography (RP) tests. The predictive value of ESS, SBQ and weighted combination were evaluated by calculating the area under curve (AUC), sensitivity and specificity, positive and negative likelihood ratio. Results: Both the two scales alone and weighted combination were closely related with apnea hypopnea index (AHI), minimum oxygen saturation and average oxygen saturation at night (P < 0.05). The AUC, sensitivity and specificity, positive predictive value (PPV) and negative predictive value (NPV) of ESS in predicting OSAHS were 79.0%, 74.8%, 75.6%, 80.1% and 57.5%, respectively. For SBQ, they were 73.6%, 67.0%, 68.6%, 65.1% and 75.2%, respectively. In contrast, the AUC, sensitivity, and specificity of the combined approach were 82.5%, 73.9% and 82.6%. Conclusion: The weighted combination of ESS and SBQ could improve the diagnostic ability of OSAHS in patients with hypertension, not only in the accuracy and sensitivity, but also for its easy procedure and accessibility and in hospital. Therefore, the weighted combination approach of ESS and SBQ is promising for OSAHS screening.

Alcohol consumption in relation to the incidence of atrial fibrillation in an elderly Chinese population.

BACKGROUND: Alcohol consumption is a known modifiable risk factor for atrial fibrillation. The association, however, might differ according to gender. We investigated gender-specific associations between alcohol consumption and incident atrial fibrillation in an elderly Chinese population. METHODS: Our study participants were elderly residents (≥ 65 years) recruited from five community health centers in the urban area of Shanghai (n = 6,618). Alcohol intake was classified as never drinkers and current light-to-moderate (< 40 g/day) and heavy drinkers (≥ 40 g/day). Atrial fibrillation was detected by a 30-s single-lead electrocardiography (ECG, AliveCor® Heart Monitor) and further evaluated with a regular 12-lead ECG. RESULTS: During a median of 2.1 years (interquartile range: 2.0-2.2) follow-up, the incidence rate of atrial fibrillation was 1.10% in all study participants. It was slightly but non-significantly higher in men (n = 2849) than women (n = 3769, 1.30% vs. 0.96%, P = 0.19) and in current drinkers (n = 793) than never drinkers (n = 5825, 1.64% vs. 1.03%,P = 0.12). In both unadjusted and adjusted analyses, there was interaction between sex and current alcohol intake in relation to the incidence of atrial fibrillation (P < 0.0001). After adjustment for confounding factors, current drinkers had a significantly higher incidence rate of atrial fibrillation than never drinkers in women (12.96% [7/54] vs. 0.78% [29/3715], adjusted odds ratio [OR] = 10.25, 95% confidence interval [CI]: 3.54-29.67,P < 0.0001), but not in men (0.81% [6/739] vs. 1.47% [31/2110], OR = 0.62, 95% CI: 0.25-1.51,P = 0.29). CONCLUSIONS: Our study showed a significant association between alcohol intake and the incidence of atrial fibrillation in elderly Chinese women, but not men.

Comparison of the mean of the first two blood pressure readings with the overall mean of three readings on a single occasion.

OBJECTIVE: Guidelines differed on the required number of blood pressure (BP) readings for accurate BP assessment. We, therefore, compared the mean of the first two BP readings with the overall mean of three readings in the diagnosis of hypertension. METHODS: BP was measured three times consecutively with a 1 min interval using a validated automated electronic BP monitor in volunteers aged at least 18 years. The mean of the first and second BP readings was compared with the mean of the three blood pressure readings for the diagnostic accuracy of hypertension. RESULTS: Of the 77 520 study participants, 65.2 and 25.2% had a SBP or DBP difference at least 5 mmHg and at least 10 mmHg between the first and second BP readings, respectively. Regardless whether the BP difference between the first two BP readings was at least 5 mmHg or at least 10 mmHg for systolic and diastolic alone or both, significant (P < 0.0001) SBP/DBP differences between the mean of the first two BP readings and the overall mean of three readings were observed with an absolute value up to 1.28/1.11 mmHg. However, the mean of the first two BP readings exhibited good reliability and sufficient agreement in the diagnosis of hypertension with a kappa statistic at least 0.88, except that the difference between the first and second BP readings was at least 10 mmHg for both systolic and diastolic (κ=0.79). The diagnostic accuracy was similar across age quartile, sex, and BP category. CONCLUSION: Two BP readings may be sufficient, unless the BP difference between the two readings was at least 10 mmHg for both systolic and diastolic.

Effects of the valsartan/amlodipine combination and nifedipine gastrointestinal therapeutic system monotherapy on brachial pulse pressure and radial augmentation index in hypertensive patients.

OBJECTIVE: In a substudy of a randomized controlled trial, we investigated the effects of the valsartan/amlodipine single-pill combination and nifedipine gastrointestinal therapeutic system (GITS) monotherapy on brachial pulse pressure (bPP) and radial augmentation index (rAI) in patients with previously uncontrolled hypertension. METHODS: We performed measurements of clinic blood pressure (BP) and pulse rate and rAI (n = 63) and ambulatory BP monitoring (n = 42) at baseline and 12-week of follow-up. Analysis of covariance was performed to calculate the least square mean change from baseline and between-group differences [95% confidence interval (CI)]. Correlation analysis was performed to study the interrelationship between the changes in bPP and rAI and in pulse rate. RESULTS: After 12-week treatment, clinic and ambulatory SBP/DBP and pulse rate were not differently changed between the valsartan/amlodipine (n = 29) and nifedipine GITS groups (n = 34, P ≥ 0.06) except daytime SBP (P = 0.01). The reductions in 24-h and daytime ambulatory bPP were significantly greater in the former than the latter group (P ≤ 0.04). rAI increased slightly by 3.5% (P = 0.20) and 5.2% (P = 0.06) in the valsartan/amlodipine and nifedipine groups, respectively, with a between-group difference of -1.7% (95% CI -9.6 to 6.1%, P = 0.66). In the two groups combined, the changes in clinic and ambulatory bPP were not or weakly associated with that in clinic or ambulatory pulse rate (r = -0.14 to 0.36, P = 0.02-0.95), while the changes in rAI were more strongly or significantly associated with that in clinic or ambulatory pulse rate (r = -0.39 to -0.23, P = 0.02-0.16). CONCLUSIONS: Antihypertensive drug-induced changes in rAI but not bPP were dependent on pulse rate.

Quarterly versus annual ECG screening for atrial fibrillation in older Chinese individuals (AF-CATCH): a prospective, randomised controlled trial.

BACKGROUND: Screening for atrial fibrillation before onset of symptoms and the subsequent initiation of oral anticoagulants could prevent stroke and death. The most cost-effective strategy to screen for atrial fibrillation in a population at high risk aged 65 years and older is unknown. Therefore, we aimed to investigate whether more frequent electrocardiography (ECG) recordings would significantly improve the detection of atrial fibrillation compared with annual ECG screenings. METHODS: We did a randomised controlled trial that compared different screening frequencies of 30 s single-lead ECG (AliveCor Heart Monitor) in the detection of atrial fibrillation in Chinese residents (≥65 years) in five community health centres in Shanghai, China. Only participants without history of atrial fibrillation and without atrial fibrillation rhythm at baseline were eligible for inclusion in the trial. Random assignment was done with the use of a random number table and stratified for study site. Participants were randomly assigned in a 1:1 ratio to annual or quarterly screening groups. The quarterly screening group was further randomly assigned in a 3:1 ratio to subgroups of quarterly screening and quarterly screening plus (which involved ECG screening once per week for the first month of follow-up, then quarterly for the remainder of follow-up). The primary outcome was the detection rate of atrial fibrillation. The intention-to-treat analysis was done for all randomly assigned patients who had at least one ECG recording during follow-up. This trial was registered at ClinicalTrials.gov, NCT02990741, and terminated on Oct 31, 2020. FINDINGS: Between April 17, 2017, and June 26, 2018, 8240 participants were randomly assigned to annual screening (n=4120), quarterly screening (n=3090), and quarterly screening plus (n=1030), with a mean number of ECG recordings of 1·6 (SD 0·5) for annual screening, 3·5 (1·5) for quarterly screening, and 5·2 (2·9) for quarterly screening plus during a median of 2·1 years follow-up (13 284 person-years). 73 incident cases of atrial fibrillation occurred: 26 in the annual screening group (4·1 per 1000 person-years) and 47 in the quarterly screening group (6·7 per 1000 person-years. Quarterly screening was associated with a significant increase in the detection rate of atrial fibrillation, compared with annual screening (hazard ratio [HR] 1·71; 95% CI 1·06-2·76; p=0·029). 40 incident cases were detected in quarterly screening (7·2 per 1000 person-years; HR compared to annual screening, 1·83; 95% CI 1·12-3·00; p=0·017) and seven in the quarterly screening plus group (4·8 per 1000 person-years; HR compared with annual screening, 1·24; 0·54-2·86; p=0·61). No significant difference was noted between quarterly screening and the quarterly screening plus group (HR of quarterly screening plus compared with quarterly screening, 0·68; 0·30-1·52; p=0·35). INTERPRETATION: Quarterly 30 s single-lead ECG screening was associated with a significantly higher detection rate of incident atrial fibrillation compared with annual screening, but additional once per week screenings in the first month did not yield an added predictive value. Quarterly screening might be considered in a general population at a high risk of atrial fibrillation, such as those aged 65 years and older. FUNDING: Bayer Healthcare Company.

Barriers to blood pressure control in China in a large opportunistic screening.

We investigated the prevalence, awareness, treatment, and control of hypertension in a large opportunistic screening study in China. Our study participants had to be ≥18 years of age and had ideally not taken blood pressure (BP) for ≥1 year. BP was measured three times consecutively in the sitting position with a 1-minute interval, using a validated electronic BP monitor or mercury sphygmomanometer. Trained volunteer investigators administered a questionnaire to collect information on medical history, lifestyle, and use of medications. The 364 000 participants (52.6% women, and mean age 53.4 years) had a mean systolic/diastolic BP of 124.2/76.4 mm Hg. The proportion of hypertension was 24.7%. In all hypertensive subjects (n = 89 925), the awareness, treatment, and control rates of hypertension were 60.1%, 42.5%, and 25.4%, respectively. In multiple stepwise logistic regression analyses, the odds for unawareness vs awareness of hypertension was higher in men and lower with age advancing, current smoking, and the presence of diabetes mellitus, coronary heart disease, and stroke or transient ischemic attack (P < .0001). The odds for uncontrolled vs controlled hypertension was higher with age advancing and current smoking, and lower with the presence of diabetes mellitus and coronary heart disease (P ≤ .03) in 38 207 treated hypertensive patients, and it was also higher with the use of antihypertensive monotherapy (odds ratio 1.13, P = .0003) in 19 523 treated hypertensive patients with specific antihypertensive drugs. Our study identified several factors as barriers to BP control in China, such as male gender, younger age, current smoking, and the under-use of combination therapy.

May Measurement Month 2017: an analysis of blood pressure screening results in China-East Asia.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. In China, several hypertension screening programmes are undertaken in the elderly in the community and in youths at university entrance and graduation. However, most people, especially the middle-aged working population, do not often have their BP measured. The current awareness (46.9%), treatment (40.7%), and control rates (15.3%) of hypertension remain low, while the proportion of screenees with hypertension is high in adult Chinese (23.2%). An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. About 125 236 individuals were screened. After multiple imputation, with 124 623 as denominator, 32 089 (25.7%) had hypertension. Of the 103 981 individuals not on antihypertensive medication, 11 447 (11.0%) were hypertensive. Of the 20 547 individuals on antihypertensive medication, 7392 (36.0%) had uncontrolled BP (≥140/90 mmHg). An opportunistic screening may effectively identify those with high BP regardless of the use of antihypertensive medication and shows similar information on BP as a survey in a randomly selected population sample.

A randomized cross-over study on the blood pressure lowering effect of the combined passive head-up and -down movement with Device-Guided slow breathing.

Purpose: Baroreflex emerges as a therapeutic target of hypertension. We investigated blood pressure (BP) lowering effect of the combined passive head-up and -down movement with device-guided slow breathing in untreated mild hypertension or high-normal BP. Methods: In a randomized, cross-over trial, untreated subjects with an ambulatory systolic/diastolic BP of 125-140/80-90 mmHg and a clinic BP of 130-150/80-90 mmHg were randomized to intervention treatment with head movement and slow breathing or sham control, and then crossed over. Both treatments consisted of 1-week preparation, 2-week treatment, and 1-week recovery. During the 2-week treatment, subjects were treated for a session of 20 min/day. BP, pulse rate and respiration were measured before and after each treatment session. Ambulatory BP monitoring was performed at baseline and the end of the 2-week treatments' period, and home BP monitoring in the morning and evening for the whole 8-week follow-up period. Results: 14 subjects completed the study. The intervention treatment, compared to control, reduced respiration rate by -2.1 breaths/min (95% CI -2.9 to -1.2, p = .0001), but not clinic BP and pulse rate (p ≥ .67). The intervention treatment, compared to control, significantly reduced nighttime systolic/diastolic blood pressure by -5.63/-3.82 mm Hg (p ≤ .01) but not 24-h or daytime ambulatory blood pressure (p ≥ .69). Home BP decreased with the intervention treatment, but the between-treatment difference was not statistically significant (p ≥ .27). Conclusions: The combined head movement with slow breathing did not influence 24-h BP, but reduced nighttime BP in untreated mild hypertension or high-normal BP.

Cross-sectional Association Between Blood Pressure Status and Atrial Fibrillation in an Elderly Chinese Population.

OBJECTIVE: Atrial fibrillation (AF) and hypertension are prevalent chronic disease conditions in the elderly population. In the present cross-sectional study, we investigated the association between blood pressure (BP) and AF in an elderly Chinese population. METHOD: Our elderly (≥65 years) subjects were residents recruited from 6 communities in Shanghai from 2006 to 2017. Atrial fibrillation was systematically screened by rest 12-lead electrocardiogram (ECG) or by a handheld single-lead ECG. BP status was defined according to the European hypertension guidelines as optimal, normal, or high-normal BP, and stage 1, 2, or 3 hypertension. RESULT: In the 6,966 participants (women 56.0%, mean age: 72.3 years), the prevalence of AF was 3.3%, and the prevalence of hypertension was 58.7% (83.7% treated). In all participants, the association with prevalent AF was negative for systolic BP (odds ratio [OR] per 10-mm Hg increase 0.79, 95% confidence interval [CI]: 0.71-0.88, P < 0.0001) but positive for diastolic BP (OR per 5-mm Hg increase 1.11, 95% CI: 1.02-1.22, P = 0.02). In untreated participants (n = 3,544), the association with prevalent AF was U-shaped for both systolic and diastolic BP, with the nadir at high-normal BP and a significantly higher risk of prevalent AF in optimal systolic BP (OR: 3.11, 95% CI: 1.65-5.85, P = 0.004) and stage 2 or 3 diastolic hypertension relative to the nadir (OR: 8.04, 95% CI: 2.28-28.3, P = 0.001). CONCLUSION: In the elderly population, BP shows a complicated relationship with prevalent AF, with high-normal BP at the lowest risk and optimal systolic BP and stage 2 or 3 diastolic hypertension at increased risks.

A randomized multicenter study on ambulatory blood pressure and arterial stiffness in patients treated with valsartan/amlodipine or nifedipine GITS.

In a pre-specified subgroup analysis of a 12-week randomized multicenter study, we investigated effects of valsartan/amlodipine 80/5 mg single-pill combination (n = 75) and nifedipine GITS 30 mg (n = 75) on ambulatory blood pressure (BP) and arterial stiffness assessed by brachial-ankle pulse wave velocity (PWV) in patients with uncontrolled hypertension. At week 12, the between-treatment mean differences in systolic/diastolic BP were smaller for 24-hour and daytime (-2.1/-1.7 and -2.0/-1.5 mm Hg, respectively, P ≥ 0.22) but greater (P < 0.01) for nighttime (-4.0/-2.8 mm Hg, P ≤ 0.09), especially in sustained uncontrolled hypertension (-5.0/-4.1 mm Hg, P ≤ 0.04) and non-dippers (-6.5/-3.7 mm Hg, P ≤ 0.07), in favor of valsartan/amlodipine. At week 12, PWV was significantly reduced from baseline by valsartan/amlodipine (n = 59, P < 0.0001) but not nifedipine (n = 59, P = 0.06). The changes in PWV were significantly associated with that in ambulatory systolic BP and pulse pressure in the nifedipine (P ≤ 0.0008) but not valsartan/amlodipine group (P ≥ 0.57), with a significant interaction (P ≤ 0.045). The valsartan/amlodipine combination was more efficacious than nifedipine GITS in lowering nighttime BP in sustained uncontrolled hypertension and non-dippers, and in lowering arterial stiffness independent of BP lowering.

Validation of a Piezoelectric Sensor Array-Based Device for Measurement of Carotid-Femoral Pulse Wave Velocity: The Philips Prototype.

BACKGROUND: Multiple piezoelectric pressure mechanotransducers topologized into an array might improve efficiency and accuracy in collecting arterial pressure waveforms for measurement of pulse wave velocity (PWV). OBJECTIVE: In the present study, we validated a piezoelectric sensor array-based prototype (Philips) against the validated and clinically widely used Complior device (Alam Medical). METHODS: We recruited 33 subjects with a wide distribution of PWV. For the validation, PWV was measured sequentially with the Complior device (four times) and the Philips prototype (three times). With the 99 paired PWV values, we investigated the agreement between the Philips prototype and the Complior device using Pearson correlation analysis and Bland-Altman plot. We also performed analysis on the determinants and reproducibility of PWV measured with both devices. RESULTS: The correlation coefficient for PWV measured with the two devices was 0.92 (p < 0.0001). Compared with the Complior device, the Philips prototype slightly overestimated PWV by 0.24 (± 2 standard deviations, ± 1.91) m/s, especially when PWV was high. The correlation coefficient between the difference and the average of the Philips and Complior measurements was 0.21 (p = 0.035). Nonetheless, they had similar determinants. Age, mean arterial pressure, and sex altogether explained 81.6 and 83.9% of the variance of PWV values measured with the Philips prototype and Complior device, respectively. When the two extremes of the three PWV values measured with the Philips prototype and the Complior device were investigated, the coefficients of variation were 8.26 and 3.26%, respectively. CONCLUSIONS: Compared with the Complior device, the Philips prototype had similar accuracy, determinants, and reproducibility in measuring PWV.

Ambulatory blood pressure in relation to oxygen desaturation index as simultaneously assessed by nighttime finger pulse oximetry at home.

We investigated the relationship between ambulatory blood pressure (BP) and oxygen desaturation index (ODI), while accounting for pulse rate and age. ODI was assessed by overnight finger pulse oximetry in 2342 participants on the day of ambulatory BP monitoring, and calculated as the number of desaturation episodes per sleeping hour. Both BP and pulse rate increased significantly (P ≤ .006) from normal (< 5 events/h) to mildly (5-14), moderately (15-30), and severely (≥ 30 events/h) elevated ODI. The association for BP was substantially attenuated by accounting for pulse rate (partial r² from .003-.012 to .002-.006). In adjusted analysis, the associations of 24-hour diastolic BP and 24-hour pulse rate with ODI were dependent on age (P ≤ .0001) and only significant in younger subjects (< 60 years, P ≤ .0001). In conclusion, the association between ambulatory BP and ODI was partially mediated by pulse rate, a measure of sympathetic activity, and was more prominent in younger subjects.

Efficacy and tolerability of initial high vs low doses of S-(-)-amlodipine in hypertension.

In an 8-week randomized trial of patients with mild or moderate hypertension, the authors investigated the efficacy and tolerability of initial high (5.0 mg/d) vs low (2.5 mg/d) doses of S-(-)-amlodipine (equivalent to 5 and 10 mg of racemic amlodipine, respectively). In the S-(-)-amlodipine 2.5-mg group (n=263), 24-hour ambulatory systolic/diastolic blood pressure (±standard deviation) decreased from 131.5±15.0/82.1±10.7 mm Hg at baseline to 126.0±13.5/78.5±9.5 mm Hg at 8 weeks of follow-up by a least square mean (±standard error) change of 6.0±0.6/3.8±0.4 mm Hg. In the S-(-)-amlodipine 5-mg group (n=260), the corresponding changes were from 133.6±13.7/83.1±9.9 mm Hg to 125.0±12.0/78.2±8.9 mm Hg by 8.1±0.6/4.7±0.4 mm Hg, respectively. The between-group differences in changes in 24-hour systolic/diastolic blood pressure were 2.1/0.9 (P=.02/.17) mm Hg. Similar trends were observed for daytime and nighttime ambulatory and clinic blood pressure. The incidence rate was similar for all adverse events. An initial high dose of S-(-)-amlodipine improved ambulatory blood pressure control with similar tolerability as an initial low dose in hypertension.