Apoptosis is increased and cell proliferation is decreased in out-of-phase endometria from infertile and recurrent abortion patients

Various endometrial abnormalities have been associated with luteal phase deficiency: a significant dyssynchrony in the maturation of the glandular epithelium and the stroma and a prevalence of out-of-phase endometrial biopsy specimens. Out-of phase endometrium is a controversial disorder related to failed implantation, infertility and early pregnancy loss. Given that the regulation of the apoptotic process in endometrium of luteal phase deficiency is still unknown, the aim of this study was to evaluate cell proliferation, apoptosis and the levels of the main effector caspase, caspase-3 in the luteal in-phase and out-of-phase endometrium.Fil: Meresman, Gabriela Fabiana. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Olivares, Carla Noemi. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Vighi, Susana. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Alfie, Margarita. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Irigoyen, Marcela. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Etchepareborda, Juan J.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentin

Determinants of the Morning-Evening Home Blood Pressure Difference in Treated Hypertensives: The HIBA-Home Study

Background. The morning home blood pressure (BP) rise is a significant asymptomatic target organ damage predictor in hypertensives. Our aim was to evaluate determinants of home-based morning-evening difference (MEdiff) in Argentine patients. Methods. Treated hypertensive patients aged ≥18 years participated in a cross-sectional study, after performing home morning and evening BP measurement. MEdiff was morning minus evening home average results. Variables identified as relevant predictors were entered into a multivariable linear regression analysis model. Results. Three hundred sixty-seven medicated hypertensives were included. Mean age was 66.2 (14.5), BMI 28.1 (4.5), total cholesterol 4.89 (1.0) mmol/L, 65.9% women, 11.7% smokers, and 10.6% diabetics. Mean MEdiff was 1.1 (12.5) mmHg systolic and 2.3 (6.1) mmHg diastolic, respectively. Mean self-recorded BP was 131.5 (14.1) mmHg systolic and 73.8 (7.6) mmHg diastolic, respectively. Mean morning and evening home BPs were 133.1 (16.5) versus 132 (15.7) systolic and 75.8 (8.4) versus 73.5 (8.2) diastolic, respectively. Significant beta-coefficient values were found in systolic MEdiff for age and smoking and in diastolic MEdiff for age, smoking, total cholesterol, and calcium-channel blockers. Conclusions. In a cohort of Argentine medicated patients, older age, smoking, total cholesterol, and use of calcium channel blockers were independent determinants of home-based MEdiff

Uncontrolled Hypertension is Associated with Postprandial Hypotension

Background: In a previous study that incorporated post-lunch measurements to the conventional scheme of home-based bloodpressure monitoring, we detected postprandial hypotension in about a quarter of hypertensive patients. The coexistence ofhypertension with hypotension poses a therapeutic dilemma, suggesting that the control of hypertension might attenuatepostprandial hypotension.Objectives: The aim of this study was to compare the postprandial change of systolic blood pressure, and the correspondingchronotropic response, associated to the control of hypertension.Methods: We prospectively evaluated 140 treated hypertensive patients, aged over 40 years, with home-based blood pressuremonitoring. The control of hypertension was based on the average morning and evening blood pressure, considering 135/85mmHg as cutoff value. Postprandial hypotension was defined as a drop in systolic blood pressure equal to or greater than 20mmHg with respect to the preprandial value in at least one of three lunches.Results: Postprandial hypotension was found in 13.2% (n=10) of patients with controlled hypertension and in 42.2% (n=27)with uncontrolled hypertension (p<0.001). After lunch, the average decrease of systolic blood pressure was 9.5±10.5 mmHg(6.4%±7.8%) in patients with uncontrolled hypertension and 3.2±7.8 mmHg (2.6%±6.5%) in those with controlled hypertension(p<0.001), with no significant difference in the chronotropic response. After stratifying the patients by hypertension control, the postprandial response of heart rate and systolic blood pressure showed a significant inverse correlation in controlledhypertensive patients (r=-0.24; p=0.035), and a not significant correlation in uncontrolled patients. On the multiplelinear regression analysis, lack of blood pressure control (beta=0.26, p=0.002) and female gender (beta=0.22; p<0.001) weresignificant predictors of a postprandial drop in systolic blood pressure, without a significant influence of age or number ofantihypertensive drugs.Conclusion: Lack of blood pressure control was associated with an abnormal postprandial circulatory response that predisposesto hypotension.Resumen Introducción En un estudio previo que incorporó mediciones post almuerzo al esquema convencional  de monitoreo domiciliario de presión arterial, hemos detectado hipotensión postprandial  en » ¼ de nuestros pacientes hipertensos. Objetivos En el presente estudio comparamos el cambio postprandial de la presión arterial sistólica, y la correspondiente respuesta cronotrópica, en relación al control de la hipertensión. Material y métodos Evaluamos prospectivamente con monitoreo domiciliario de presión arterial a 140 hipertensos tratados mayores de 40 años. El control de la hipertensión se basó en el promedio de presión arterial matinal y vespertina, tomando como valor de corte 135/85 mmHg. Se consideró hipotensión postprandial cuando la presión arterial sistólica disminuyó 20 mmHg ó más respecto del valor preprandial en al menos 1 de 3 almuerzos. Resultados Detectamos hipotensión postprandial, en el 13,2% (n = 10) de los hipertensos controlados y en el 42,2% (n = 27) de los no controlados (P< 0,001). Después de los almuerzos la presión arterial sistólica disminuyó en promedio 9,5±10,5 mmHg (6,4±7,8%) en los hipertensos no controlados y 3,2±7,8 mmHg (2,6±6,5 %) en los controlados (p < 0,001), sin diferencia significativa en la respuesta crontrópica.  El análisis de regresión lineal múltiple, confirmó que el delta postprandial de presión arterial sistólica se asoció significativamente con el control de la hipertensión (Beta = -0,26; P = 0,002) pero no con la edad. Al estratificar a los pacientes por el control de la hipertensión, se observó que la respuesta postprandial de la frecuencia cardíaca y de la presión arterial sistólica correlacionaron entre sí de manera inversa en los controlados (r = -0,42; P < 0,001), sin relación significativa en los no controlados. Conclusión La falta de control de la hipertensión se asoció a una anormal respuesta circulatoria postprandial que predispone a la hipotensión

Determinants of the Morning-Evening Home Blood Pressure Difference in Treated Hypertensives: The HIBA-Home Study

Background. The morning home blood pressure (BP) rise is a significant asymptomatic target organ damage predictor in hypertensives. Our aim was to evaluate determinants of home-based morning-evening difference (MEdiff) in Argentine patients. Methods. Treated hypertensive patients aged ≥18 years participated in a cross-sectional study, after performing home morning and evening BP measurement. MEdiff was morning minus evening home average results. Variables identified as relevant predictors were entered into a multivariable linear regression analysis model. Results. Three hundred sixty-seven medicated hypertensives were included. Mean age was 66.2 (14.5), BMI 28.1 (4.5), total cholesterol 4.89 (1.0) mmol/L, 65.9% women, 11.7% smokers, and 10.6% diabetics. Mean MEdiff was 1.1 (12.5) mmHg systolic and 2.3 (6.1) mmHg diastolic, respectively. Mean self-recorded BP was 131.5 (14.1) mmHg systolic and 73.8 (7.6) mmHg diastolic, respectively. Mean morning and evening home BPs were 133.1 (16.5) versus 132 (15.7) systolic and 75.8 (8.4) versus 73.5 (8.2) diastolic, respectively. Significant beta-coefficient values were found in systolic MEdiff for age and smoking and in diastolic MEdiff for age, smoking, total cholesterol, and calcium-channel blockers. Conclusions. In a cohort of Argentine medicated patients, older age, smoking, total cholesterol, and use of calcium channel blockers were independent determinants of home-based MEdiff

Hemodynamic characterization of hypertensive patients with an exaggerated orthostatic blood pressure variation

Exaggerated orthostatic blood pressure variation (EOV) is a poorly understood phenomenon related to high cardiovascular risk. We aimed to determine whether hypertensive patients with EOV have a distinct hemodynamic pattern, assessed through impedance cardiography. Methods: In treated hypertensive patients, we measured the cardiac index (CI), systemic vascular resistance index (SVRI), blood pressure (BP), and heart rate (HR) in the supine and standing (after 3 minutes) positions, defining three groups according to BP variation: 1) Normal orthostatic BP variation (NOV): standing systolic BP (stSBP)-supine systolic BP (suSBP) between −20 and 20 mmHg and standing diastolic BP (stDBP)-supine diastolic BP (suDBP) between −10 and 10 mmHg; 2) orthostatic hypotension (OHypo): stSBP-suSBP≤-20 or stDBP-suDBP≤-10 mmHg; 3) orthostatic hypertension (OHyper): stSBP-suSBP≥20 or stDBP-suDBP≥10 mmHg. We performed multivariable analyses to determine the association of hemodynamic variables with EOV. Results: We included 186 patients. Those with OHyper had lower suDBP and higher orthostatic SVRI variation compared to NOV. In multivariable analyses, orthostatic HR variation (OR = 1.06 (95%CI 1.01–1.13), p = 0.03) and orthostatic SVRI variation (OR = 1.16 (95%CI 1.06–1.28), p = 0.002) were independently related to OHyper. No variables were independently associated with OHypo. Conclusion: Patients with OHyper have a distinct hemodynamic pattern, with an exaggerated increase in SVRI and HR when standing