[Effect of strontium in drinking water on blood pressure and inflammatory function in hypertension mice].

OBJECTIVE: To explore the effect of strontium in drinking water on blood pressure in hypertensive mice and its possible mechanism. METHODS: Establishment of mouse model of high blood pressure by drinking 2 mg/mL N'nitro-L-arginine methyl eater hydrochloride(L-NAME) for 4 weeks. One hundred ICR mice were randomly divided into normal control group(n=20) and model group(n=80) according to systolic blood pressure. Eighty hypertensive mice were randomly divided into model control group(n=20), 2.5 mg/L strontium water group(n=20), 5.0 mg/L strontium water group(n=20) and 10.0 mg/L strontium water group(n=20). The body weight and blood pressure of mice were measured every week. After 10 weeks, serum sodium(Na), potassium(K), calcium(Ca), magnesium(Mg), Chlorine(Cl), nitric oxide(NO), renin, angiotensin II(Ang II), aldosterone(ALD), endothelial nitric oxide synthase(eNOS), intercellular cell adhesion molecule-1(ICAM-1), heart interleukin-6(IL-6), interleukin-1 beta(IL-1ß) and tumor necrosis factor-α(TNF-α) were determined. RESULTS: After 10 weeks of intervention, the systolic blood pressure in the low, medium and high strontium water groups(129.60±4.90 mmHg vs.127.33±6.35 mmHg vs.124.70±3.91 mmHg) was significantly lower than that of the model control group(141.84±5.34 mmHg)(P<0.05). The diastolic blood pressure in the high strontium water group(84.74±5.49 mmHg) was significantly lower than that of the model control group(92.21±10.08 mmHg). The contents of serum potassium, calcium and magnesium in medium strontium gourp(8.06±0.80 mmol/L vs.2.34±0.13 mmol/L vs.0.57±0.12 mmol/L) and high strontium group(9.59±0.58 mmol/L vs. 2.37±0.17 mmol/L vs.0.58±0.09 mmol/L) were significantly higher than those in normal control group(6.64±0.57 mmol/L vs.2.07±0.15 mmol/L vs.0.46±0.10 mmol/L) and model control group(6.62±0.53 mmol/L vs.2.09±0.11 mmol/L vs.0.48±0.09 mmol/L)(P<0.05). Compared with model control group, the contents of renin(24.08±6.65 ng/mL vs.15.24±3.88 ng/mL), AngII(263.30±61.66 pg/mL vs.203.31±54.95 pg/mL), ALD(102.41±22.39 pg/mL vs. 60.31±10.83 pg/mL), ICAM-1(367.17±120.08 ng/mL vs.224.45±46.86 ng/mL), IL-6(5.90±0.66 ng/mL vs.3.88±1.08 ng/mL), IL-1ß(6.37±1.83 ng/mL vs.3.44±1.28 ng/mL) and TNF-α(9.35±1.41 ng/mL vs.5.68±2.11 ng/mL) in high strontium group were significantly decreased(P<0.05). CONCLUSION: Strontium can reduce the blood pressure of hypertensive mice by regulating the eNOS/NO pathway and reducing the production of inflammatory factors.

Digital hypertension towards to the anticipation medicine.

"Digital Hypertension" is a new research field proposed by the Japanese Society of Hypertension that integrates digital technology into hypertension management and proactively promotes research activities. This novel approach includes the development of new technologies for better BP management, such as sensors for detecting environmental factors that affect BP, information processing, and machine learning. To facilitate "Digital Hypertension," a more sophisticated BP monitoring system capable of measuring an individual's BP more frequently in various situations would be required. With the use of these technologies, hypertension management could shift from the current "dots" management based on office BP readings during clinic visits to a "line" management system based on seamless home BP or individual BP data taken by a wearable BP monitoring device. DTx is the innovation to change hypertension management from "dots" to "line", completely achieved by wearable BP.

Clinical Validation of a Wearable Piezoelectric Blood-Pressure Sensor for Continuous Health Monitoring.

Wearable blood-pressure sensors have recently attracted attention as healthcare devices for continuous non-invasive arterial pressure (CNAP) monitoring. However, the accuracy of wearable blood-pressure (BP) monitoring devices has been controversial due to the low signal quality of sensors, the absence of an accurate transfer function to convert the sensor signals into BP values, and the lack of clinical validation regarding measurement precision. Here, a wearable piezoelectric blood-pressure sensor (WPBPS) is reported, which achieves a high normalized sensitivity (0.062 kPa-1 ), and fast response time (23 ms) for CNAP monitoring. The transfer function of a linear regression model is designed, offering a simple solution to convert the flexible piezoelectric sensor signals into BP values. In order to verify the measurement accuracy of WPBPS, clinical trials are performed on 35 subjects aged from 20 to 80 s after screening. The mean difference between the WPBPS and a commercial sphygmomanometer of 175 BP data pairs is -0.89 ± 6.19 and -0.32 ± 5.28 mmHg for systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively. By building a WPBPS-embedded wristwatch, the potentially promising use of a convenient, portable, continuous BP monitoring system for cardiovascular disease diagnosis is demonstrated.

Economic evaluation of new blood pressure target for hypertensive patients in Taiwan according to the 2022 hypertension clinical practice guidelines of the Taiwan society of cardiology: a simulation modeling study.

With the promising cardiovascular benefits in the STEP and SPRINT trials, the 2022 Taiwan's hypertension guidelines redefined the hypertension threshold as 130/80 mmHg and a universal blood-pressure target of <130/80 mmHg. This study's objective was to examine the cost-effectiveness of the intensive blood-pressure target for hypertensive patients using estimated lifetime medical costs and quality-adjusted life years (QALY) from the Taiwan national payer's perspective. We developed a lifetime Markov model comparing the intensive and conservative blood-pressure targets. Incremental cost-effectiveness ratio (ICER) against the willing-to-pay thresholds at the one-time [US$34,000(NT$1,020,000)] and three-time [US$100,000(NT$3,000,000)] gross domestic product per capita were defined as very cost-effect and only cost-effective. The cost-effectiveness in different age stratifications and cardiovascular risks treated with a more intensive target (120 mmHg) were examined in the subgroup analyses. The new blood-pressure treatment target produced more lifetime medical costs [US$31,589(NT$947,670) versus US$26,788(NT$803,640)] and QALYs (12.54 versus 12.25), and the ICER was US$16,589(NT$497,670), which was 99.1% and 100% probability of a very cost-effective and cost-effective strategy. The ICERs in all age stratifications had more than a 90% probability of being very cost-effective, and ICERs decreased with age. More intensive control in patients with high cardiovascular risks produced a lower ICER [US$14,547(NT$436,410)]. In conclusion, Taiwan's new blood-pressure treatment target can prevent more cardiovascular events with acceptable costs per QALY below the willing-to-pay thresholds. The cost-effectiveness of intensive control is consistent across different ages and more pronounced with the increase in age and cardiovascular risk.

Diagnosing hypertension in primary care: a retrospective cohort study to investigate the importance of night-time blood pressure assessment.

BACKGROUND: Ambulatory blood-pressure monitoring (ABPM) has become less frequent in primary care since the COVID-19 pandemic, with home blood-pressure monitoring (HBPM) often the preferred alternative; however, HBPM cannot measure night-time blood pressure (BP), and patients whose night-time BP does not dip, or rises (reverse dipping), have poorer cardiovascular outcomes. AIM: To investigate the importance of measuring night-time BP when assessing individuals for hypertension. DESIGN AND SETTING: Retrospective cohort study of two patient populations - namely, hospital patients admitted to four UK acute hospitals located in Oxfordshire, and participants of the BP in different ethnic groups (BP-Eth) study, who were recruited from 28 UK general practices in the West Midlands. METHOD: Using BP data collected for the two cohorts, three systolic BP phenotypes (dipper, non-dipper, and reverse dipper) were studied. RESULTS: Among the hospital cohort, 48.9% (n = 10 610/21 716) patients were 'reverse dippers', with an average day-night systolic BP difference of +8.0 mmHg. Among the community (BP-Eth) cohort, 10.8% (n = 63/585) of patients were reverse dippers, with an average day-night systolic BP difference of +8.5 mmHg. Non-dipper and reverse-dipper phenotypes both had lower daytime systolic BP and higher night-time systolic BP than the dipper phenotype. Average daytime systolic BP was lowest in the reverse-dipping phenotype (this was 6.5 mmHg and 6.8 mmHg lower than for the dipper phenotype in the hospital and community cohorts, respectively), thereby placing them at risk of undiagnosed, or masked, hypertension. CONCLUSION: Not measuring night-time BP puts all groups, other than dippers, at risk of failure to identify hypertension. As a result of this study, it is recommended that GPs should offer ABPM to all patients aged ≥60 years as a minimum when assessing for hypertension.

Establishing nomogram of blood pressure for late adolescents in India: Secondary analysis of NFHS-4 data.

Background: Hypertension among adolescents is a public health problem, which is going to become more severe given the current obesity epidemic. There is a scarcity of information on the reference range value for blood pressure (BP) cut-off for adolescents. Aim: We aimed to establish BP distribution in adolescents aged 15-19 years by using the nationally representative National Family Health Survey-4 (NFHS-4) data. Materials and Methods: We analyzed the data of 15,936 boys and 1,04,132 girls aged 15-19 years in the NFHS-4 survey. We took the mean of systolic and diastolic BPs. Height for age z scores for each individual was calculated using the WHO Anthro plus. The sampling weight was taken as provided by the demographic and health surveys (DHS) website. Nomograms of systolic and diastolic BPs were made by calculating their 50th, 90th, and 95th percentiles for each age (in months), gender, and height percentile for age categories. Results: Both systolic and diastolic BPs increased with age and height centiles. The BP was higher in boys than girls. The average annual increase in systolic and diastolic BPs was 2.52 and 1.20 mmHg in boys and 0.50 and 0.46 mmHg in girls, respectively, when adjusted for height centiles. Conclusion: This study provides a BP nomogram that can be generalized to all the Indian population. Research is required for the diagnostic performance of this nomogram for the diagnosis of adolescent hypertension.

Physical Activity in Renal Disease and the Effect on Hypertension: A Randomized Controlled Trial.

INTRODUCTION: Exercise is an effective strategy for blood pressure (BP) reduction in the general population, but its efficacy for the management of hypertension in chronic kidney disease (CKD) is not known. We evaluated the difference in 24-h ambulatory systolic BP (SBP) with exercise training in people with moderate to severe CKD. METHODS: Participants with an estimated glomerular filtration rate (eGFR) of 15-44 mL/min per 1.73 m2 and SBP >120 mm Hg were randomized to receive thrice-weekly moderate-intensity aerobic-based exercise over 24 weeks, or usual care. Phase 1 included supervised in-center and home-based sessions for 8 weeks. Phase 2 was 16 weeks of home-based sessions. BP, arterial stiffness, cardiorespiratory fitness, and markers of cardiovascular (CV) risk were analyzed using mixed linear regression. RESULTS: We randomized 44 people; 36% were female, the median age was 69 years, 55% had diabetes, and the median eGFR was 28 mL/min per 1.73 m2. Compared with usual care, there was no significant change in 24-ambulatory SBP at 8 weeks (2.96 mm Hg; 95% confidence interval (CI): -2.56, 8.49) or 24 weeks. Peak oxygen uptake improved by 1.9 mL/kg/min in the exercise group (95% CI: 0.03, 3.79) at 8 weeks with a trend toward higher body mass index 1.84 kg/m2 (95% CI: -0.10, 3.78) and fat free mass, but this was not sustained at 24 weeks. Markers of CV risk were unchanged. CONCLUSIONS: Despite an improvement in peak aerobic capacity and body composition, we did not detect a change in 24-h ambulatory SBP in people with moderate-to-severe CKD.

Association between Height and Blood Pressure in Middle Age and Older Adults in Southeast Nigeria.

BACKGROUND: This study was carried out in Abia State, Southeast Nigeria, to determine the association between height and blood pressure in middle age and elderly adults. MATERIALS AND METHODS: This was a cross-sectional study carried out in Abia State, Southeast Nigeria, between August 2011 and March 2012. The participants were residents in the state and were recruited from the three senatorial zones of the state. The total number of participants that took part in the study was 2,487 adults. The World Health Organisation STEPwise approach to surveillance of chronic disease risk factors was used. Information collected included blood pressure and anthropometric measurements. The association between height and blood pressure was determined. RESULTS: A total of 1,363 participants that took part in the study were >40 years old. Six hundred and fifty-five participants (48.1%) were males and 708 participants (51.9%) were females. There was no significant inverse relationship between height and blood pressure components ( Systolic Blood Pressure Diastolic Blood Pressure, and Pulse Pressure ) among the males. Among the females there was a high inverse relationship between height and blood pressure components. However, this relationship was not statistically significant. In addition, among the males there was no relationship between height and hypertension. Among the females, there was some degree of inverse relationship between height and hypertension, although multivariate regression analysis showed that this was not significant. CONCLUSION: There was an inverse but non-significant relationship between height and blood pressure components/ hypertension among males and females in Southeast Nigeria in this study.

CONTEXTE: Cette étude a été menée dans l'État d'Abia, au sud-est du Nigeria, pour déterminer, pour déterminer l'association entre la taille et la pression artérielle chez les adultes d'âge moyen et les personnes âgées. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude transversale réalisée dans l'État d'Abia, au sud-est du Nigeria, entre août 2011 et mars 2012. Les participants étaient des résidents de l'État et ont été recrutés dans les trois zones sénatoriales de l'État. Le nombre total de participants ayant pris part à l'étude était de 2 487 adultes. L'approche STEPwise de l'Organisation mondiale de la santé pour la surveillance des facteurs de risque des maladies chroniques a été utilisée. Les informations recueillies comprenaient la pression artérielle et les mesures anthropométriques. L'association entre la taille et la pression artérielle a été déterminée. RÉSULTATS: Au total, 1 363 participants à l'étude étaient âgés de plus de 40 ans. Six cent cinquante-cinq participants (48,1%) étaient des hommes et 708 participants (51,9 %) étaient des femmes. Il n'y avait pas de relation inverse significative entre la taille et les composantes de la pression artérielle (pression artérielle systolique, pression artérielle diastolique et pression du pouls) chez les hommes. Chez les femmes, on a constaté une forte relation inverse entre la taille et les composantes de la pression artérielle. Cependant, cette relation n'était pas statistiquement significative. En outre, Chez les hommes, il n'y a pas de relation entre la taille et l'hypertension. Chez les femmes, on a constaté un certain degré de relation inverse entre la taille et l'hypertension, bien que l'analyse de régression multivariée a montré qu'elle n'était pas significative. CONCLUSION: Il existe une relation inverse, mais non significative, entre la taille et les composantes de la pression artérielle/ hypertension chez les hommes et les femmes du sud-est du Nigeria. Mots clés: Taille, Hypertension, Pression artérielle, Pression artérielle systolique.

Comparability of a Blood-Pressure-Monitoring Smartphone Application with Conventional Measurements-A Pilot Study.

(1) Background: New cuffless technologies attempting blood-pressure measurements (BPM) offer possibilities to improve hypertension awareness and control. The aim of this study was to compare a smartphone application (app)-based algorithm with office BPM (OBPM). (2) Methods: We included consecutive patients with an indication for ambulatory BPM. The smartphone app (RIVA digital) acquired the pulse wave in the fingers' arterial bed using the phone's camera and estimated BP based on photoplethysmographic (PPG) waveforms. Measurements were alternatingly taken with an oscillometric cuff-based device and smartphone BPM (AppBP) on two consecutive days. AppBP were calibrated to the first OBPM. Each AppBP was compared to its CuffBP (mean of the previous/following OBPM). (3) Results: 50 participants were included, resulting in 50 AppBP values on Day 1 and 33 on Day 2 after exclusion of 225 AppBP due to insufficient quality. The mean ± SD of the differences between AppBP and CuffBP was 0.7 ± 9.4/1.0 ± 4.5 mmHg (p-value 0.739/0.201) on Day 1 and 2.6 ± 8.2/1.3 ± 4.1 mmHg (p-value 0.106/0.091) on Day 2 for systolic/diastolic values, respectively. There were no significant differences between the deviations on Day 1 and Day 2 (p-value 0.297/0.533 for systolic/diastolic values). Overall, there were 10 (12%) systolic measurement pairs differing by >15 mmHg. (4) Conclusions: In this pilot evaluation, the RIVA Digital app shows promising results when compared to oscillometric cuff-based measurements, especially regarding diastolic values. Its differences between AppBP−CuffBP have a good stability one day after calibration. Before clinical use, signal acquisition needs improvement and the algorithm needs to undergo formal validation against a gold-standard BPM method.

Implementing Single-Pill Combination Therapy for Hypertension: A Scoping Review of Key Health System Requirements in 30 Low- and Middle-Income Countries.

Objective: The World Health Organization (WHO) included single-pill combination (SPC) antihypertensive medications on their 2019 essential medicines list (EML) to encourage uptake and improved hypertension control. We documented key national-level facilitators (SPCs on national EMLs, recommendation for SPCs in national hypertension guidelines and availability of SPCs on the market) supporting uptake of SPCs in the 30 most populous low- and middle-income countries (LMICs). Methods: A hierarchical information gathering strategy was used including literature and web searches, the use of organisational databases and personal communications with colleagues to obtain information on (1) whether SPC antihypertensives are on national EMLs, (2) whether SPC antihypertensives are recommended in national hypertension guidelines and (3) whether SPCs are available on the market. Results: Eleven of 30 LMICs had all facilitators in place being Egypt, Kenya, Nigeria, Sudan, China, the Philippines, Thailand, Iran, Argentina, Colombia and Mexico. Twenty-six countries had national hypertension guidelines (or similar) in place with SPCs being recommended in 18 of these. Apart from Afghanistan, SPCs were available on the market in all countries. The facilitator least present was the inclusion of SPC antihypertensives on national EMLs at 12 of 29 (Turkey does not have an EML). Conclusion: This study demonstrated that many LMICs have made significant progress in their uptake of SPC antihypertensives and several had included SPCs on their EMLs and guidelines prior to their inclusion on the WHO EML. Despite this progress, the uptake of SPC antihypertensives in LMICs could be improved including through their further inclusion on EMLs.

Changes in ophthalmic artery Doppler during acute blood-pressure control in hypertensive pregnant women.

OBJECTIVE: To examine the changes in ophthalmic artery Doppler indices and their association with changes in mean arterial blood pressure (MAP) and systolic (SBP) and diastolic (DBP) blood pressure, following acute antihypertensive treatment in women with hypertensive disorders of pregnancy presenting with high blood pressure. METHODS: This was a prospective cohort study of 31 pregnant women presenting at 30 + 0 to 39 + 6 weeks' gestation for management of their hypertension. Paired maternal blood-pressure and ophthalmic-artery-Doppler measurements were performed prior to and at 30 min and 60 min after starting antihypertensive medication. In patients who did not achieve blood-pressure control (i.e. when blood pressure was < 140/90 mmHg) by 60 min, paired readings were continued up to 120 min. If blood-pressure control was still not achieved at that point, patients were admitted to hospital. Univariate linear regression was performed to determine the association of ophthalmic artery peak systolic velocity (PSV) ratio with SBP, DBP and MAP before treatment and after blood-pressure control. The longitudinal changes in MAP, SBP, DBP and PSV ratio from pretreatment to 30 min and 60 min after commencement of antihypertensives were examined by repeated measure, multilevel, linear mixed-effects analysis. RESULTS: Antihypertensive treatment was associated with a decrease in SBP, DBP, MAP and PSV ratio. At 60 min following antihypertensive treatment, the decrease in SBP, DBP, MAP and PSV ratio was 12.1 mmHg (95% CI, 9.0-15.1 mmHg; P < 0.0001), 9.1 mmHg (95% CI, 6.5-11.5 mmHg; P < 0.0001), 10.0 mmHg (95% CI, 7.6-12.4 mmHg; P < 0.0001) and 0.07 (95% CI, 0.03-0.11 mmHg; P < 0.001), respectively. From the total cohort, 20 (64.5%) women had achieved blood-pressure control at 60 min and another seven (22.6%) by 120 min from commencement of antihypertensive treatment. Four (12.9%) women did not achieve blood-pressure control during this period and were admitted to hospital. The relationship between PSV ratio and SBP, DBP and MAP was assessed before treatment (n = 31) and at the point of blood-pressure control in women in whom this was achieved by 120 min (n = 27). Prior to treatment, there was a significant association between PSV ratio and MAP (P < 0.0001, R2 = 0.39). This was primarily due to the association of PSV ratio with DBP (P < 0.0001, R2 = 0.39) and less so due to its association with SBP (P = 0.02, R2 = 0.16). At the point of achieving blood-pressure control, there was no significant association between PSV ratio and MAP (P = 0.7), DBP (P = 0.5) or SBP (P = 0.7). CONCLUSIONS: Acute blood-pressure control in pregnancy is associated with a concomitant reduction in blood pressure and ophthalmic artery PSV ratio. In hypertensive pregnant women, there is a significant association of PSV ratio with MAP, SBP and DBP, which disappears after blood pressure is reduced to < 140/90 mmHg following antihypertensive treatment. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Plasma metabolomic profiles associated with hypertension and blood pressure in response to thiazide diuretics.

This study aimed to identify the metabolomic alterations associated with hypertension (HTN) and the response of blood pressure (BP) to thiazide diuretics. A total of 50 participants previously untreated for HTN were prospectively recruited. After a 2-week lifestyle adjustment, 30 participants with systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg were classified into the HTN group and prescribed hydrochlorothiazide (HCTZ) at 50 mg per day for 2 weeks. The remaining 20 participants, who had relatively normal BP, were assigned to the normotension group. Metabolomic profiles related to the response of BP to thiazide diuretics were analyzed. A total of 73 differential metabolites were found to be associated with HTN, and 27 metabolites were significantly changed upon HCTZ treatment (HCTZ-sensitive metabolites). Among the identified metabolites, 7 (aspartate, histidine, C5-DC, C5-M-DC, C14:1, phosphatidylcholine ae C34:1, and phosphatidylcholine ae C34:3) were positively associated with HTN and decreased in abundance upon HCTZ treatment (HCTZ-reduced/HTN-associated metabolites). Moreover, multivariate analysis of 20 metabolites whose baseline levels were associated with the response of BP revealed that aspartate, glutamate, lysophosphatidylcholine C16:0, lysophosphatidylcholine C20:3, and sphingomyelin C24:1 were independently related to systolic BP reduction, and lysophosphatidylcholine C20:3 was independently associated with diastolic BP reduction. In conclusion, we identified 5 metabolites independently related to BP changes with HCTZ treatment. An advanced biomarker profile of thiazide-induced metabolomic changes may provide a clue with which to further explore the complex and mixed effects of thiazide treatment in a clinical setting.

Diabetic Kidney Disease versus Primary Glomerular Disease: A Propensity Score-Matched Analysis of Association between Ambulatory Blood-Pressure Monitoring and Target-Organ Damage.

Diabetic kidney disease (DKD) and primary glomerular disease (PGD) are the main causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD). This study was conducted to compare the characteristics of ambulatory blood-pressure monitoring (ABPM) and its relationship with target-organ damage (TOD) in patients with DKD and PGD matched by propensity score. The assessment of TOD included macroalbuminuria, left ventricular hypertrophy (LVH) and macrovascular disease. Propensity-score weighting (PSW) was used in stratified analysis. Results: Patients with DKD had a higher prevalence of abnormal blood-pressure patterns such as reversed dipper pattern, nocturnal hypertension, and sustained hypertension and had a higher prevalence of TOD than did patients with PGD. Logistic regression indicated that patients with DKD were more related to TOD than to PGD. The stratified analysis indicated that DKD patients with white-coat hypertension, masked hypertension and sustained hypertension had closer relationships with TOD compared with PGD patients. Conclusion: Patients with type 2 diabetic kidney disease had more abnormal blood-pressure patterns and were more closely related to target organ damage than were patients with primary glomerular disease.

Blood-pressure variability is associated with left-ventricular mechanics in patients with gestational hypertension and preeclampsia.

We aimed to investigate short- and long-term blood-pressure (BP) variability and left-ventricular (LV) structure, function, and mechanics in women with gestational hypertension and preeclampsia, as well as the relationship between BP variability and LV mechanics. This cross-sectional study included 140 pregnant women (45 normotensive controls, 50 patients with gestational hypertension and, 45 patients with preeclampsia) after 20 weeks of gestation. All participants underwent 24-h ambulatory BP monitoring and echocardiographic examination, as well as regular clinical BP measurements during each visit. Our results show that 24-h, daytime and nighttime systolic and diastolic BP, as well as visit-to-visit systolic and diastolic BPs, gradually increased from controls across patients with preeclampsia to those with gestational hypertension. Similar changes were observed for 24-h systolic BP-variability indices. LV longitudinal and circumferential strains gradually decreased from controls across women with gestational hypertension to patients with preeclampsia. Radial strain was significantly lower in women with preeclampsia than in controls. Indices of short- and long-term BP variability were independent of BP and demographic and echocardiographic parameters associated with LV longitudinal and circumferential strain. In conclusion, LV mechanics are impaired in women with gestational hypertension and preeclampsia compared with LV mechanics in normotensive controls. Short- and long-term BP variability was higher in patients with hypertensive disorders and was significantly associated with longitudinal and circumferential strains.

Sustained Elevated Blood Pressure Accelerates Atherosclerosis Development in a Preclinical Model of Disease.

The continuous relationship between blood pressure (BP) and cardiovascular events makes the distinction between elevated BP and hypertension based on arbitrary cut-off values for BP. Even mild BP elevations manifesting as high-normal BP have been associated with cardiovascular risk. We hypothesize that persistent elevated BP increases atherosclerotic plaque development. To evaluate this causal link, we developed a new mouse model of elevated BP based on adeno-associated virus (AAV) gene transfer. We constructed AAV vectors to support transfer of the hRenin and hAngiotensinogen genes. A single injection of AAV-Ren/Ang (1011 total viral particles) induced sustained systolic BP increase (130 ± 20 mmHg, vs. 110 ± 15 mmHg in controls; p = 0.05). In ApoE-/- mice, AAV-induced mild BP elevation caused larger atherosclerotic lesions evaluated by histology (10-fold increase vs. normotensive controls). In this preclinical model, atheroma plaques development was attenuated by BP control with a calcium channel blocker, indicating that a small increase in BP within a physiological range has a substantial impact on plaque development in a preclinical model of atherosclerosis. These data support that non-optimal BP represents a risk for atherosclerosis development. Earlier intervention in elevated BP may prevent or delay morbidity and mortality associated with atherosclerosis.

High Versus Normal Blood Pressure Targets in Relation to Right Ventricular Dysfunction After Cardiac Surgery: A Randomized Controlled Trial.

OBJECTIVE: Management of right ventricular (RV) dysfunction is challenging. Current practice predominantly is based on data from experimental and small uncontrolled studies and includes augmentation of blood pressure. However, whether such intervention is effective in the clinical setting of cardiac surgery is unknown. DESIGN: Randomized controlled trial. SETTING: Single-center study in a tertiary teaching hospital. PARTICIPANTS: The study comprised 78 patients equipped with a pulmonary artery catheter (PAC), classified according to PAC-derived RV ejection fraction (RVEF); 44 patients had an RVEF of <20%, and 34 patients had an RVEF between ≥20% and <30%. INTERVENTIONS: Patients randomly were assigned to either a normal target group (mean arterial pressure 65 mmHg) or a high target group [mean arterial pressure 85 mmHg]). The primary end- point was the change in RVEF over a one-hour study period. MEASUREMENTS AND MAIN RESULTS: There was no significant between-group difference in change of RVEF <20% (-1% [-3.3 to 1.8] in the normal-target group v 0.5% [-1 to 4] in the high-target group; p = 0.159). There was no significant between-group difference in change in RVEF 20%-to-30% (-1% [-3 to 0] in the normal-target group v 1% [-1 to 3] in the high-target group; p = 0.074). These results were in line with the simultaneous observation that echocardiographic variables of RV and left ventricular function also remained unaltered over time, irrespective of either baseline RVEF or treatment protocol. CONCLUSION: In a mixed cardiac surgery population with RV dysfunction, norepinephrine-mediated high blood pressure targets did not result in an increase in PAC-derived RVEF compared with normal blood pressure targets.

Studies in Zebrafish Demonstrate That CNNM2 and NT5C2 Are Most Likely the Causal Genes at the Blood Pressure-Associated Locus on Human Chromosome 10q24.32.

Background: Globally, high blood pressure (BP) is the most important risk factor for cardiovascular disease. Several genome-wide association studies (GWAS) have identified variants associated with BP traits at more than 535 chromosomal loci with genome-wide significance. The post-GWAS challenge is to annotate the most likely causal gene(s) at each locus. Chromosome 10q24.32 is a locus associated with BP that encompasses five genes: CYP17A1, BORCS7, AS3MT, CNNM2, and NT5C2 and warrants investigation to determine the specific gene or genes responsible for the phenotype. Aim: To identify the most likely causal gene(s) associated with BP at the 10q24.32 locus using zebrafish as an animal model. Results: We report significantly higher blood flow, increased arterial pulse, and elevated linear velocity in zebrafish larvae with cnnm2 and nt5c2 knocked down using gene-specific splice modification transcriptional morpholinos, compared with controls. No differences in blood-flow parameters were observed after as3mt, borcs7, or cyp17a1 knockdown. There was no effect on vessel diameter in animals with any of the four genes knocked down. At the molecular level, expression of hypertension markers (crp and ace) was significantly increased in cnnm2 and nt5c2 knockdown larvae. Further, the results obtained by morpholino knockdown were validated using zebrafish knockout (KO) lines with cnnm2 and nt5c2 deficiency, again resulting in higher blood flow, increased arterial pulse, and elevated linear velocity. Analysis of nt5c2a KO larvae demonstrated that lack of this gene resulted in reduced expression of cnnm2a, with reciprocal downregulation of nt5c2a in cnnm2a KO larvae. Staining of whole-blood smears from nt5c2 mutants revealed that KO of this gene might be associated with an acute lymphoblastic leukemia phenotype, consistent with literature reports. Additional experiments were designed based on previous literature on cnnm2a mutant zebrafish revealed impaired renal function, high levels of renin, and significantly increased expression of the ren gene, leading us to hypothesize that the observed elevated blood-flow parameters may be attributable to triggering of the renin-angiotensin-aldosterone signaling pathway. Conclusion: Our zebrafish data establish CNNM2 and NT5C2 as the most likely causal genes at the 10q24.32 BP locus and indicate that they trigger separate downstream mechanistic pathways.

Patrones geométricos del ventrículo izquierdo en pacientes con y sin hipertensión arterial nocturna: Hospital Calixto García - 2016-2017 / Left ventricle geometric patterns in patients with or without nocturnal hypertension: Hospital Calixto García - 2016-2017

RESUMEN Introducción: En los cambios de la geometría ventricular en hipertensos influyen el control de la presión arterial durante las 24 horas del día, así como su descenso adecuado en el período nocturno. Objetivo: Describir los patrones geométricos del ventrículo izquierdo en pacientes con y sin hipertensión arterial nocturna. Método: Se realizó monitoreo ambulatorio de la presión arterial (MAPA) y ecocardiograma a 54 pacientes con hipertensión arterial del 2016 al 2017. Se calcularon las variables de MAPA: promedio y cargas de presión diurno, nocturno y 24 horas, y el patrón circadiano. En el ecocardiograma se midieron los diámetros, el tabique interventricular y la pared posterior del ventrículo izquierdo, se calculó su masa e índice de masa, y se determinó su patrón geométrico y de función diastólica. Resultados: La edad promedio fue 55,4±14,1 años y predominaron el sexo femenino (57,4%) y el color de la piel blanco (59,3%). La hipertensión arterial al despertar y nocturna se halló en el 38,9% y 51,9%, respectivamente, y el fenómeno dipper alterado en 68,5% de los pacientes, asociado significativamente al incremento de la presión arterial nocturna (p=0,001). El tabique interventricular fue significativamente mayor en pacientes con hipertensión arterial nocturna en comparación con el grupo que no la presentaba (11,1±2,2 vs. 9,6±1,4 mm; p=0,006). Predominó la geometría alterada (53,7%) a expensas de mayor remodelado concéntrico (40,7%), sin asociación con la hipertensión arterial nocturna. Conclusiones: Los patrones geométricos del ventrículo izquierdo se comportaron de forma similar en pacientes con y sin hipertensión arterial nocturna.

ABSTRACT Introduction: Changes in ventricular geometry in hypertensive patients are influenced by 24-hour control of blood pressure, as well as its adequate decrease during nighttime. Objective: To describe the left ventricle geometric patterns in patients with or without nocturnal hypertension. Method: An ambulatory blood pressure monitoring (ABPM) and an echocardiogram were performed on 54 patients with high blood pressure, from 2016 to 2017. The following ABPM variables were calculated: average and pressure loads of daytime, nighttime, and 24-hour, as well as circadian pattern. In the echocardiogram, the diameters, the interventricular septum and the left ventricular posterior wall were measured; its mass and mass index were calculated, as well as determined its geometric and diastolic function patterns. Results: The average age was 57.4%±14.1 years old. Females (57.4%) and white skin color (59.3%) predominated. Waking and nocturnal hypertension were found in 38.9% and 51.9% respectively, and the altered dipper phenomenon was found in 68.5% of the patients, significantly associated with increased nocturnal blood pressure (p=0.001). The interventricular septum was considerably higher in patients with nocturnal hypertension when compared to the group without it (11.1±2.2 vs. 9.6±1.4 mm; p=0.006). Altered geometry predominated (53.7%) at the expense of higher concentric remodeling (40.7%), without any association with nocturnal hypertension. Conclusions: Left ventricle geometric patterns behaved similarly in patients with and without nocturnal hypertension.

Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study): a cross-sectional, observational study in central England.

BACKGROUND: Home blood-pressure (BP) monitoring is recommended in guidelines and is increasingly popular with patients and health professionals, but the accuracy of patients' own monitors in real-world use is not known. AIM: To assess the accuracy of home BP monitors used by people with hypertension, and to investigate factors affecting accuracy. DESIGN AND SETTING: Cross-sectional, observational study in urban and suburban settings in central England. METHOD: Patients (n = 6891) on the hypertension register at seven practices in the West Midlands, England, were surveyed to ascertain whether they owned a BP monitor and wanted it tested. Monitor accuracy was compared with a calibrated reference device at 50 mmHg intervals between 0-280/300 mmHg (static pressure test); a difference from the reference monitor of +/-3 mmHg at any interval was considered a failure. Cuff performance was also assessed. Results were analysed by frequency of use, length of time in service, make and model, monitor validation status, purchase price, and any previous testing. RESULTS: In total, 251 (76%, 95% confidence interval [95% CI] = 71 to 80%) of 331 tested devices passed all tests (monitors and cuffs), and 86% (CI] = 82 to 90%) passed the static pressure test; deficiencies were, primarily, because of monitors overestimating BP. A total of 40% of testable monitors were not validated. The pass rate on the static pressure test was greater in validated monitors (96%, 95% CI = 94 to 98%) versus unvalidated monitors (64%, 95% CI = 58 to 69%), those retailing for >£10 (90%, 95% CI = 86 to 94%), those retailing for ≤£10 (66%, 95% CI = 51 to 80%), those in use for ≤4 years (95%, 95% CI = 91 to 98%), and those in use for >4 years (74%, 95% CI = 67 to 82%). All in all, 12% of cuffs failed. CONCLUSION: Patients' own BP monitor failure rate was similar to that demonstrated in studies performed in professional settings, although cuff failure was more frequent. Clinicians can be confident of the accuracy of patients' own BP monitors if the devices are validated and ≤4 years old.

A Highly Sensitive Pressure-Sensing Array for Blood Pressure Estimation Assisted by Machine-Learning Techniques.

This work describes the development of a pressure-sensing array for noninvasive continuous blood pulse-wave monitoring. The sensing elements comprise a conductive polymer film and interdigital electrodes patterned on a flexible Parylene C substrate. The polymer film was patterned with microdome structures to enhance the acuteness of pressure sensing. The proposed device uses three pressure-sensing elements in a linear array, which greatly facilitates the blood pulse-wave measurement. The device exhibits high sensitivity (-0.533 kPa-1) and a fast dynamic response. Furthermore, various machine-learning algorithms, including random forest regression (RFR), gradient-boosting regression (GBR), and adaptive boosting regression (ABR), were employed for estimating systolic blood pressure (SBP) and diastolic blood pressure (DBP) from the measured pulse-wave signals. Among these algorithms, the RFR-based method gave the best performance, with the coefficients of determination for the reference and estimated blood pressures being R² = 0.871 for SBP and R² = 0.794 for DBP, respectively.