38 research outputs found
Nebivolol Reduces Central Blood Pressure In Stage I Hypertensive Patients: Experimental Single Cohort Study.
Assessment of central blood pressure (BP) has grown substantially over recent years because evidence has shown that central BP is more relevant to cardiovascular outcomes than peripheral BP. Thus, different classes of antihypertensive drugs have different effects on central BP despite similar reductions in brachial BP. The aim of this study was to investigate the effect of nebivolol, a ÎČ-blocker with vasodilator properties, on the biochemical and hemodynamic parameters of hypertensive patients. Experimental single cohort study conducted in the outpatient clinic of a university hospital. Twenty-six patients were recruited. All of them underwent biochemical and hemodynamic evaluation (BP, heart rate (HR), central BP and augmentation index) before and after 3 months of using nebivolol. 88.5% of the patients were male; their mean age was 49.7 ± 9.3 years and most of them were overweight (29.6 ± 3.1 kg/m2) with large abdominal waist (102.1 ± 7.2 cm). There were significant decreases in peripheral systolic BP (P = 0.0020), diastolic BP (P = 0.0049), HR (P < 0.0001) and central BP (129.9 ± 12.3 versus 122.3 ± 10.3 mmHg; P = 0.0083) after treatment, in comparison with the baseline values. There was no statistical difference in the augmentation index or in the biochemical parameters, from before to after the treatment. Nebivolol use seems to be associated with significant reduction of central BP in stage I hypertensive patients, in addition to reductions in brachial systolic and diastolic BP.132290-
Effects of transcutaneous electrical nerve stimulation (TENS) on arterial stiffness and blood pressure in resistant hypertensive individuals: study protocol for a randomized controlled trial
Background: Resistant hypertension (RH) treatment requires an adequate and intense therapeutic approach. However, the results are not always satisfactory despite intensive treatment. Of the different pathophysiological mechanisms involved in the pathogenesis of RH, sympathetic overstimulation and therapies that block the sympathetic system have been widely studied. These approaches, however, are invasive and expensive. Another possible approach is by transcutaneous electrical nerve stimulation (TENS), a noninvasive method that modulates activity by using low-frequency transcutaneous electrical stimulation to inhibit primary afferent pathways. Thus, the current study will evaluate the effect of applying TENS in the cervicothoracic region of subjects with RH and will seek to develop a new low-cost and readily available therapy to treat this group of hypertensive individuals.
Methods/design: This is a randomized, single blind (subject), parallel-assignment study controlled with a sham group and including participants aged 40 to 70 years with resistant hypertension. The trial has two arms: the treatment and control (sham group). The treatment group will be submitted to the stimulation procedure (TENS). The sham group will not be submitted to stimulation. The primary outcomes will be a reduction in the peripheral blood pressure and adverse events. The secondary outcomes will be a reduction the central blood pressure. The study will last 30 days. The sample size was calculated assuming an alpha error of 5 % to reject the null hypothesis with a statistical power of 80 %, thereby resulting in 28 participants per group (intervention versus sham).
Discussion: In recent decades, RH has become very common and costly. Adequate control requires several drugs, and in many cases, treatment is not successful. Sympathetic nervous system inhibition by renal denervation and central inhibition have significant effects in reducing BP; however, these treatments are costly and invasive. Another type of sympathetic nervous system inhibition can also be noninvasively achieved by electric current. Therefore, the application of TENS may be a new therapeutic option for treating resistant hypertensive individuals.
Trial Registration: Clinical Trials NCT0236597
Factors associated with increased radial augmentation index in hypertensive individuals
BACKGROUND: Arterial stiffness is a variable predictor of morbidity and mortality and a possible marker of vascular injury. Its non-invasive assessment by radial tonometry and analysis of the augmentation index (r-AI) allows identifying patients exposed to higher cardiovascular risk. OBJECTIVE: To analyze the influence of r-AI on clinical-biochemical variables and its influence on the prevalence of target-organ damage in hypertensive patients. METHODS: 140 consecutive hypertensive patients, followed-up in an outpatient clinic, were analyzed in a cross-sectional study. Blood pressure (BP) levels and r-AI were obtained by applanation tonometry of the radial artery (HEM-9000AI, Onrom). The patients were allocated into r-AI tertiles (r-AI < 85%; 85< r-AI < 97%; r-AI > 97%). RESULTS: The sample was predominantly composed of women (56.4%), mean age of 61.7 ± 11.7 years and body mass index 29.6 ± 6.1 Kg/mÂČ. The highest tertile showed higher proportion of women (p = 0.001), higher systolic BP (p = 0.001) and pulse pressure (p = 0.014), and lower weight (p = 0.044), height (p < 0.001) and heart rate (p < 0.001). Multivariate analysis demonstrated that weight (β = -0.001, p = 0.017), heart rate (β = -0.001, p = 0.007) and central pressure (β = 0.015, p < 0.001) correlated independently with r-AI. In logistic regression analyses, the 3rd r-AI tertile was associated to lower levels of diabetes (DM) (OR = 0.41; 95% CI 0.17-0.97; p = 0.042). CONCLUSION: This study demonstrated that weight, heart rate and central BP were independently related to r-AI.FUNDAMENTO: A rigidez arterial Ă© uma variĂĄvel preditora de morbimortalidade e um possĂvel marcador de lesĂŁo vascular. Sua avaliação nĂŁo invasiva por tonometria radial e anĂĄlise do Ăndice de incremento (r-AI) permite identificar os pacientes expostos a um maior risco cardiovascular. OBJETIVO: Analisar a influĂȘncia do r-AI em variĂĄveis clĂnico-bioquĂmicas e sua influĂȘncia na prevalĂȘncia de dano em ĂłrgĂŁo-alvo em pacientes hipertensos. MĂTODOS: Cento e quarenta pacientes hipertensos consecutivos, em seguimento clĂnico ambulatorial, foram submetidos Ă anĂĄlise transversal. Os nĂveis de pressĂŁo arterial (PA) e o r-AI foram obtidos por tonometria de aplanação da artĂ©ria radial (HEM-9000AI, Onrom). Os pacientes foram alocados em tercis r-AI (r-AI < 85%; 85 < r-AI < 97%; r-AI > 97%). RESULTADOS: A amostra era predominantemente composta por mulheres (56,4%), com idade mĂ©dia de 61,7 ± 11,7 anos e Ăndice de massa corporal de 29,6 ± 6,1 Kg/mÂČ. O maior tercil apresentou uma proporção maior de mulheres (p = 0,001), maior PA sistĂłlica (p = 0,001) e pressĂŁo de pulso (p = 0,014), e menor peso (p = 0,044), altura (p < 0,001) e frequĂȘncia cardĂaca (p < 0,001). A anĂĄlise multivariada demonstrou que o peso (β = -0,001, p = 0,017), frequĂȘncia cardĂaca (β = -0,001, p = 0,007) e pressĂŁo central (β = 0,015, p < 0,001) se correlacionam com o r-AI de maneira independente. Em anĂĄlises de regressĂŁo logĂstica, o 3Âș tercil r-AI foi associado a uma diminuição do diabete (DM) (OR = 0,41; 95% CI 0,17-0,97; p = 0,042). CONCLUSĂO: Este estudo demonstrou que peso, frequĂȘncia cardĂaca e PA central se relacionam com o r-AI de maneira independente.24124