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1.
J Hypertens ; 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32004208

RESUMO

OBJECTIVE: Twenty-four-hour ambulatory pulse pressure (PP) is a powerful predictor of outcome. We attempted to apply the recently described PP components, an elastic (elPP), and systolic stiffening (stPP) components from 24-h ambulatory blood pressure (BP) monitoring (AMBP), and examine their influence on outcome in the Ohasama study population. DESIGN AND METHODS: Included were participants of the Ohasama study without history of cardiovascular disease (CVD), who were followed-up for total and CVD mortality, and for stroke morbidity. The PP components were derived from 24-h SBP and DBP using a model based on the nonlinear pressure--volume relationship in arteries expressing pressure stiffness relationship. Outcome predictive power was estimated by Cox regression models; hazard ratio with 95% confidence interval (CI), applied to elPP, and stPP, adjusted for age, sex, BMI, smoking, alcohol drinking, diabetes mellitus, total cholesterol, antihypertensive treatment, and mean arterial pressure (MAP), whenever appropriate. RESULTS: Of 1745 participants (age 61.4 ±â€Š11.6, 65% women), 580 died, 212 of CVD, and 290 experienced a stroke during 17 follow-up years. PP was strongly correlated with elPP (r = 0.89) and less so with stPP (r = 0.58), and the correlation between the two components was weak (r = 0.15). After the adjustment, hazard ratio of PP per 1 SD increment for total mortality, CVD mortality, and stroke morbidity were 1.095 (95% CI 0.973-1.232), 1.207 (1.000-1.456), and 0.983 (0.829-1.166), respectively. Corresponding hazard ratios and 95% CIs were nonsignificant for elPP, and stPP. However, among participants with median pulse rate 68.5 bpm or less (median, n = 872), total (327 deaths) and CVD (131 deaths) mortality were predicted by elPP (per 1 SD increment), hazard ratio 1.231 (95% CI, 1.082-1.401), and 1.294 (95% CI, 1.069-1.566), respectively. In the subgroup of treated participants with hypertension and pulse rate 68.5 or less bpm (n = 309), total (177 deaths) and CVD (77 deaths) mortality were predicted by elPP, hazard ratio of 1.357 (95% CI, 1.131-1.628), and 1.417 (95% CI, 1.092-1.839), respectively. Stroke morbidity was not predicted by either PP or the PP components. CONCLUSION: In a rural Japanese population, elPP but not stPP was predictive of total and CVD mortality even when adjusted for MAP and conventional risk factors in the subpopulation with slower pulse rate. This was mostly among the treated hypertensive patients.

2.
J Hum Hypertens ; 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31965013

RESUMO

In this review I try to summarize concisely available information on common effectors on blood pressure, occupational, and environmental ones, which are sometimes overlooked, so that clinicians involved in caring for patients with hypertension may have somewhat better vision of what our patients are exposed to.

3.
Hypertension ; : HYPERTENSIONAHA11914508, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-31983311

RESUMO

The prognostic relevance of short-term blood pressure (BP) variability in hypertension is not clearly established. We aimed to evaluate the association of short-term BP variability, assessed through ambulatory BP monitoring, with total and cardiovascular mortality in a large cohort of patients with hypertension. We selected 63 910 subjects from the Spanish ABPM Registry from 2004 to 2014, with a median follow-up of 4.7 years. Systolic and diastolic BP SD from 24 hours, daytime, and nighttime, weighted SD (mean of daytime and nighttime SD weighted for period duration), average real variability (mean of differences between consecutive readings), variation independent of the mean, and BP variability ratio (ratio between systolic and diastolic 24-hour SD) were calculated through 24-hour ambulatory BP monitoring performed at baseline. Association with total and cardiovascular mortality (obtained through death certificates) were assessed by Cox regression models adjusted for clinical confounders and BP. Patients who died during follow-up had higher values of BP variability compared with those remaining alive. In fully adjusted models, daytime, nighttime, and weighted SD, systolic and diastolic, as well as diastolic average real variability, were all significantly associated with total and cardiovascular mortality. Hazard ratios for 1 SD increase ranged from 1.05 to 1.09 for total mortality and from 1.07 to 1.12 for cardiovascular mortality. A nighttime systolic SD ≥12 mm Hg was independently associated with total (hazard ratio: 1.13 [95% CI, 1.06-1.21]) and cardiovascular mortality (hazard ratio: 1.21 [95% CI, 1.09-1.36]). We conclude that short-term BP variability is independently associated with total and cardiovascular mortality in patients with hypertension.

7.
J Hum Hypertens ; 33(10): 701-702, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31350534
9.
Am J Hypertens ; 32(7): e1, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-30976778
10.
J Hypertens ; 37(4): 765-774, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30817458

RESUMO

BACKGROUND: Ambulatory pulse pressure (PP) a well known predictor of mortality, is widely believed to be a marker for arterial stiffness. However stiffness itself is pressure-dependent. OBJECTIVES: Developing a model-based method for splitting PP into two components expressing the contribution of a pressure-independent stiffness ('elastic', elPP) and the pressure-dependence of stiffness ('stiffening', stPP), and investigating their predictive power for all-cause mortality. METHODS: Deriving quantitative expressions for elPP and stPP assuming an exponential pressure-volume relationship in arteries, calculated from ambulatory blood pressure (BP) data and estimate standardized hazard ratios with Cox proportional hazards regression in selected patient groups. RESULTS: Ambulatory BP records of 1999 consecutive hypertensive patients, of whom 103 died from all causes within 5 years, were analyzed. PP, elPP, stPP and stPP/elPP (PP variables) (mean ±â€ŠSD) were 60 ±â€Š14, 50 ±â€Š10, 10 ±â€Š8 and 0.20 ±â€Š0.14 mmHg, respectively. elPP and stPP were weakly correlated (r = 0.21). Predictive power was found for patients with heart rate less than 70: mean [95% confidence interval] (P value) hazard ratio of PP, stPP and stPP/elPP (adjusted) were 1.48 [1.13-1.95] (P = 0.005), 1.58 [1.20-2.09] (P = 0.001) and 1.78 [1.25-2.52] (P = 0.001), respectively. The elPP (83% of PP) did not show predictive power. None of the PP variables displayed predictive power for the higher-heart-rate subgroup. CONCLUSION: Ambulatory PP components provide a novel and clinically valuable tool bridging between PP and arterial properties. Replacing PP by its components, taken as independent variables, may improve predictive power. The prognostic significance of the PP for all-cause mortality in elderly hypertensive patients with lower heart rates is dominated by its smaller component that quantifies arterial stiffening with pressure.

12.
J Hypertens ; 2018 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-30169389

RESUMO

BACKGROUND: Ambulatory pulse pressure (PP) a well known predictor of mortality, is widely believed to be a marker for arterial stiffness. However stiffness itself is pressure-dependent. OBJECTIVES: Developing a model-based method for splitting PP into two components expressing the contribution of a pressure-independent stiffness ('elastic', elPP) and the pressure-dependence of stiffness ('stiffening', stPP), and investigating their predictive power for all-cause mortality. METHODS: Deriving quantitative expressions for elPP and stPP assuming an exponential pressure-volume relationship in arteries, calculated from ambulatory blood pressure (BP) data and estimate standardized hazard ratios with Cox proportional hazards regression in selected patient groups. RESULTS: Ambulatory BP records of 1999 consecutive hypertensive patients, of whom 103 died from all causes within 5 years, were analyzed. PP, elPP, stPP and stPP/elPP (PP variables) (mean ±â€ŠSD) were 60 ±â€Š14, 50 ±â€Š10, 10 ±â€Š8 and 0.20 ±â€Š0.14 mmHg, respectively. elPP and stPP were weakly correlated (r = 0.21). Predictive power was found for patients with heart rate less than 70: mean [95% confidence interval] (P value) hazard ratio of PP, stPP and stPP/elPP (adjusted) were 1.48 [1.13-1.95] (P = 0.005), 1.58 [1.20-2.09] (P = 0.001) and 1.78 [1.25-2.52] (P = 0.001), respectively. The elPP (83% of PP) did not show predictive power. None of the PP variables displayed predictive power for the higher-heart-rate subgroup. CONCLUSION: Ambulatory PP components provide a novel and clinically valuable tool bridging between PP and arterial properties. Replacing PP by its components, taken as independent variables, may improve predictive power. The prognostic significance of the PP for all-cause mortality in elderly hypertensive patients with lower heart rates is dominated by its smaller component that quantifies arterial stiffening with pressure.

15.
Int J Hypertens ; 2018: 8637101, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29623220

RESUMO

Objectives: Prevalence of hypertension has not been studied in the Ethiopian HIV-infected population, which represents 60% of the patients in our AIDS unit. Our aim was to identify risk factors and characterize the prevalence of hypertension in the population monitored at our unit. Methods: A retrospective chart review categorized subjects according to their blood pressure levels. Hypertension prevalence was determined and stratified according to variables perceived to contribute to elevated blood pressure. Results: The prevalence of hypertension in our study population was significantly higher compared to the general population (53% versus 20%, P < 0.0001) and was associated with known risk factors and not with patients' viral load and CD4 levels. Ethiopian HIV-infected adults had a prominently higher rate of blood pressure rise over time as compared to non-Ethiopians (P = 0.016). Conclusions: The high prevalence of hypertension in this cohort and the rapid increase in blood pressure in Ethiopians are alarming. We could not attribute high prevalence to HIV-related factors and we presume it is part of the metabolic syndrome. The lifelong cardiovascular risk associated with HIV infection mandates hypertension screening and close monitoring in this population.

18.
Hypertension ; 71(4): 540-547, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29483231
20.
Am J Hypertens ; 30(12): 1177-1188, 2017 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-28992192

RESUMO

BACKGROUND: Blood pressure variability ratio (BPVR)(derived from within-subject SD of 24-hour ambulatory blood pressure [BP]) predicts all-cause mortality independent of BP and has a similar prognostic ability to ambulatory arterial stiffness (AASI). Whether BPVR, and AASI, offer prognostic information beyond measurements of arterial stiffness at a given pressure, as indexed by pulse wave velocity (PWV), is not known. METHODS: We assessed whether BPVR and AASI were associated with indices of subclinical organ damage (TOD) [estimated glomerular filtration rate (eGFR), left ventricular mass index, early-to-late transmitral velocity (E/A), carotid intima-media thickness (IMT)] independent of BP, and whether BPVR-TOD and AASI-TOD relations were independent of PWV (applanation tonometry) in 772 randomly selected participants from an urban, developing community. AASI was derived from 24-hour diastolic BP vs. systolic BP standard linear regression. RESULTS: On bivariate analyses, BPVR, AASI, and PWV were correlated with all indices of TOD (P < 0.0005). However, after adjustments for potential confounders including age and 24-hour mean BP, BPVR, and PWV (P < 0.005 to P < 0.0001), but not AASI (P > 0.25), were independently associated with eGFR, but not other indices of TOD. Importantly, the BPVR-eGFR relation was independent of BP variability (P < 0.005) and PWV (P < 0.001). CONCLUSIONS: BPVR was negatively associated with eGFR independent of mean BP, BP variability, and PWV. Therefore, in the prediction of cardiovascular risk, measurements of arterial stiffening (BPVR) may provide information beyond the impact of arterial stiffness.


Assuntos
Pressão Sanguínea/fisiologia , Taxa de Filtração Glomerular/fisiologia , Adulto , Grupo com Ancestrais do Continente Africano , Fatores Etários , Idoso , Velocidade do Fluxo Sanguíneo , Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Espessura Intima-Media Carotídea , Ecocardiografia , Feminino , Frequência Cardíaca , Humanos , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Análise de Onda de Pulso , Fatores Socioeconômicos , África do Sul/epidemiologia , Rigidez Vascular
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