Relationship between blood pressure repeatedly measured by a wrist-cuff oscillometric wearable blood pressure monitoring device and left ventricular mass index in working hypertensive patients

This study sought to evaluate the relationship between blood pressure (BP) taken by a new wrist-cuff oscillometric wearable BP monitoring device and left ventricular mass index measured by cardiac magnetic resonance imaging (cMRI-LVMI) in 50 hypertensive patients (mean age 60.5 ± 8.9 years, 92.0% men, 96% treated for hypertension) with regular employment. Participants were asked to self-measure their wearable BPs twice in the morning and evening under a guideline-recommended standardized home BP measurement, and once each at five predetermined times and any additional time points under an ambulatory condition for a maximum of 7 days. In total, 2105 wearable BP measurements (home BP: 747 [morning: 409, evening: 338], ambulatory condition: 1358 [worksite: 942]) were collected over 5.5 ± 1.2 days. The average of all wearable systolic BP (SBP) readings (129.8 ± 11.0 mmHg) was weakly correlated with cMRI-LVMI (r = 0.265, p = 0.063). Morning home wearable SBP average (128.5 ± 13.8 mmHg) was significantly correlated with cMRI-LVMI (r = 0.378, p = 0.013), but ambulatory wearable SBP average (132.5 ± 12.7 mmHg) was not (r = 0.215, p = 0.135). The averages of the highest three values of all wearable SBPs (153.3 ± 13.9 mmHg) and ambulatory wearable SBPs (152.9 ± 13.9 mmHg) were 16 mmHg higher than that of the morning home wearable SBPs (137.0 ± 15.9 mmHg). Those peak values were significantly correlated with cMRI-LVMI (r = 0.320, p = 0.023; r = 0.310, p = 0.029; r = 0.451, p = 0.002, respectively). In conclusion, an increased number of wearable BP measurements, which could detect individual peak BP, might add to the clinical value of these measurements as a complement to the guideline-recommended home BP measurements, but further studies are needed to confirm these findings

Application of non-invasive central aortic pressure assessment in clinical trials: Clinical experience and value

Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular (CV) events. However, recent clinical evidence suggests that central aortic pressure (CAP) provides additional information for assessing CV risk than brachial blood pressure (BrBP). Central hemodynamics can now be non-invasively assessed with a number of devices, however, the methodology employed to measure CAP, in order to better identify the patients at higher CV risk in clinical practice, is still controversial. The purpose of this article is to review the technology behind the non-invasive measurement of CAP via the effects of different classes of antihypertensive drugs on CAP and the data supporting the predictive value of assessing CAP on clinical outcomes, and to foster the transfer of methodological knowledge from clinical trials into routine clinical practice

Rationale and study design of the Prospective comparison of Angiotensin Receptor neprilysin inhibitor with Angiotensin receptor blocker MEasuring arterial sTiffness in the eldERly (PARAMETER) study.

Hypertension in elderly people is characterised by elevated systolic blood pressure (SBP) and increased pulse pressure (PP), which indicate large artery ageing and stiffness. LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), is being developed to treat hypertension and heart failure. The Prospective comparison of Angiotensin Receptor neprilysin inhibitor with Angiotensin receptor blocker MEasuring arterial sTiffness in the eldERly (PARAMETER) study will assess the efficacy of LCZ696 versus olmesartan on aortic stiffness and central aortic haemodynamics

When Blood Pressure Increases with Standing: Consensus Definition for Diagnosing Orthostatic Hypertension

When changing from the supine to the standing position approximately 500–1000 ml blood is pooled below the diaphragm and hydrostatic pressure forces fluids from the intravascular to the interstitial compartment. These changes impose a major hemodynamic burden on the cardiovascular system. Baroreflex-mediated withdrawal of cardiac parasympathetic activity and sympathetic activation maintain standing blood pressure in healthy persons. Orthostatic hypotension occurs when these counterregulatory mechanisms fail. Conversely, some patients have a paradoxical increase in upright blood pressure to hypertensive levels, presumably due to sympathetic activation overshoot. This orthostatic hypertension is not a benign condition because it is associated with increased cardiovascular morbidity and mortality independently of traditional risk factors.Citation1,Citation2 Yet, there has not been a uniform definition of orthostatic hypertension and the entity is not covered in current hypertension guidelines. Because diagnostic criteria vary profoundly between studies, data on epidemiology, associated health risks, and management of orthostatic hypertension in the existing literature is difficult to interpret

Effect Modification by Age on the Benefit or Harm of Antihypertensive Treatment for Elderly Hypertensives: A Systematic Review and Meta-analysis

BACKGROUND: The influence of age on balance of benefit versus potential harm of blood pressure (BP)-lowering therapy for elderly hypertensives is unclear. We evaluated the modifying effects of age on BP lowering for various adverse outcomes in hypertensive patients older than 60 years without specified comorbidities. METHODS: All relevant randomized controlled trials (RCTs) were systematically identified. Coronary heart disease, stroke, heart failure (HF), cardiovascular death, major adverse cardiovascular events (MACE), renal failure (RF), and all-cause death were assessed. Meta-regression analysis was used to explore the relationship between achieved systolic BP (SBP) and the risk of adverse events. Random-effects meta-analysis was used to pool the estimates. RESULTS: Our study included eighteen RCTs (n=53993). Meta-regression analysis showed a lower achieved SBP related with a lower risk of stroke and cardiovascular death, but an increased risk of RF. The regression slopes were comparable between populations stratifying by age 75 years. In subgroup analysis, the relative risks of a more aggressive BP lowering strategy were similar between patients aged older or less than 75 years for all outcomes except for RF (P for interaction=0.02). Compared to treatment with final achieved SBP 140-150 mmHg, a lower achieved SBP (<140 mmHg) was significantly associated with decreased risk of stroke (relative risk, 0.68; 95% confidence interval, 0.55-0.85), HF (0.77; 0.60-0.99), cardiovascular death (0.68; 0.52-0.89), and MACE (0.83; 0.69-0.99). CONCLUSIONS: To treat hypertension in the elderly, age had trivial effect modification on most outcomes, except for renal failure. Close monitoring of renal function may be warranted in the management of elderly hypertension

Central Glucagon-like Peptide-1 Receptor Signaling via Brainstem Catecholamine Neurons Counteracts Hypertension in Spontaneously Hypertensive Rats

Glucagon-like peptide-1 receptor (GLP-1R) agonists, widely used to treat type 2 diabetes, reduce blood pressure (BP) in hypertensive patients. Whether this action involves central mechanisms is unknown. We here report that repeated lateral ventricular (LV) injection of GLP-1R agonist, liraglutide, once daily for 15 days counteracted the development of hypertension in spontaneously hypertensive rats (SHR). In parallel, it suppressed urinary norepinephrine excretion, and induced c-Fos expressions in the area postrema (AP) and nucleus tractus solitarius (NTS) of brainstem including the NTS neurons immunoreactive to dopamine beta-hydroxylase (DBH). Acute administration of liraglutide into fourth ventricle, the area with easy access to the AP and NTS, transiently decreased BP in SHR and this effect was attenuated after lesion of NTS DBH neurons with anti-DBH conjugated to saporin (anti-DBH-SAP). In anti-DBH-SAP injected SHR, the antihypertensive effect of repeated LV injection of liraglutide for 14 days was also attenuated. These findings demonstrate that the central GLP-1R signaling via NTS DBH neurons counteracts the development of hypertension in SHR, accompanied by attenuated sympathetic nerve activity

Effects of Sacubitril/Valsartan Versus Olmesartan on Central Hemodynamics in the Elderly With Systolic Hypertension: The PARAMETER Study.

Effective treatment of systolic hypertension in elderly patients remains a major therapeutic challenge. A multicenter, double-blind, randomized controlled trial with sacubitril/valsartan (LCZ696), a first-in-class angiotensin receptor neprilysin inhibitor, was conducted to determine its effects versus olmesartan (angiotensin receptor blocker) on central aortic pressures, in elderly patients (aged ≥60 years) with systolic hypertension and pulse pressure >60 mm Hg, indicative of arterial stiffness. Patients (n=454; mean age, 67.7 years; mean seated systolic blood pressure, 158.6 mm Hg; mean seated pulse pressure, 69.7 mm Hg) were randomized to receive once-daily sacubitril/valsartan 200 mg or olmesartan 20 mg, force titrated to double the initial doses after 4 weeks, before primary assessment at 12 weeks. The study extended double-blind treatment for 12 to 52 weeks, during which amlodipine (2.5-5 mg) and subsequently hydrochlorothiazide (6.25-25 mg) were added-on for patients not achieving blood pressure target (<140/90). At week 12, sacubitril/valsartan reduced central aortic systolic pressure (primary assessment) greater than olmesartan by -3.7 mm Hg (P=0.010), further corroborated by secondary assessments at week 12 (central aortic pulse pressure, -2.4 mm Hg, P<0.012; mean 24-hour ambulatory brachial systolic blood pressure and central aortic systolic pressure, -4.1 mm Hg and -3.6 mm Hg, respectively, both P<0.001). Differences in 24-hour ambulatory pressures were pronounced during sleep. After 52 weeks, blood pressure parameters were similar between treatments (P<0.002); however, more patients required add-on antihypertensive therapy with olmesartan (47%) versus sacubitril/valsartan (32%; P<0.002). Both treatments were equally well tolerated. The PARAMETER study (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Measuring Arterial Stiffness in the Elderly), for the first time, demonstrated superiority of sacubitril/valsartan versus olmesartan in reducing clinic and ambulatory central aortic and brachial pressures in elderly patients with systolic hypertension and stiff arteries

Occupational and leisure time physical activity in contrasting relation to ambulatory blood pressure

Background: While moderate and vigorous leisure time physical activities are well documented to decrease the risk for cardiovascular disease, several studies have demonstrated an increased risk for cardiovascular disease in workers with high occupational activity. Research on the underlying causes to the contrasting effects of occupational and leisure time physical activity on cardiovascular health is lacking. The aim of this study was to examine the relation of objective and self-report measures of occupational and leisure time physical activity with 24-h ambulatory systolic blood pressure (BP). Methods: Results for self-reported physical activity are based on observations in 182 workers (60% male, mean age 51 years), while valid objective physical activity data were available in 151 participants. The usual level of physical activity was assessed by 5 items from the Job Content Questionnaire (high physical effort, lifting heavy loads, rapid physical activity, awkward body positions and awkward positions of head or arms at work) and one item asking about the general level of physical activity during non-working time. On a regular working day, participants wore an ambulatory BP monitor and an accelerometer physical activity monitor during 24 h. Associations were examined by means of Analysis of Covariance. Results: Workers with an overall high level of self-reported occupational physical activity as well as those who reported to often lift heavy loads at work had a higher mean systolic BP at work, at home and during sleep. However, no associations were observed between objectively measured occupational physical activity and BP. In contrast, those with objectively measured high proportion of moderate and vigorous leisure time physical activity had a significantly lower mean systolic BP during daytime, while no differences were observed according to self-reported level of leisure time physical activity. Conclusions: These findings suggest that workers reporting static occupational physical activities, unlike general physically demanding tasks characterized by dynamic movements of large muscle groups, are related to a higher daily systolic BP, while high objective levels of moderate and vigorous leisure time physical activity are related to lower daytime systolic BP. Ambulatory systolic BP may be a physiological explanatory factor for the contrasting effects of occupational and leisure time physical activity