Effects of Intensive Antihypertensive Treatment on Chinese Hypertensive Patients Older Than 70 Years

This study was performed to investigate whether intensive antihypertensive treatment with achieved blood pressure (BP) ≤140/90 mm Hg, as compared with standard treatment with achieved BP ≤150/90 mm Hg, could further improve cardiovascular outcomes in Chinese hypertensive patients older than 70 years. A total of 724 participants were randomly assigned to intensive or standard antihypertensive treatment. After a mean follow‐up of 4 years, the mean achieved BP was 135.7/76.2 mm Hg in the intensive treatment group and 149.7/82.1 mm Hg in the standard treatment group. The visit‐to‐visit variability in systolic BP and diastolic BP was lower in the intensive group than that in the standard group. Intensive antihypertensive treatment, compared with the standard treatment, decreased total and cardiovascular mortality by 41.7% and 50.3%, respectively, and reduced fatal/nonfatal stroke by 42.0% and heart failure death by 62.7%. Cox regression analysis indicated that the mean systolic BP (P=.020; 95% confidence interval, 1.006–1.069) and the standard deviation of systolic BP (P=.033; 95% confidence interval, 1.006–1.151) were risk factors for cardiovascular endpoint events. Intensive antihypertensive treatment with achieved 136/76 mm Hg was beneficial for Chinese hypertensive patients older than 70 years. Long‐term visit‐to‐visit variability in systolic BP was positively associated with the incidence of cardiovascular events.     

Risk of Methylphenidate‐Induced Prehypertension in Normotensive Adult Smokers With Attention Deficit Hyperactivity Disorder

The authors studied predictors of methylphenidate‐induced increases in blood pressure (BP). In this secondary analysis of a randomized, double‐blind, placebo‐controlled smoking cessation trial, nonhypertensive adult smokers with attention deficit hyperactivity disorder randomized to osmotic‐release oral system methylphenidate (OROS‐MPH) (n=115) were matched one‐to‐one on baseline systolic BP (SBP) (±5 mm Hg) with participants randomized to placebo (n=115) and followed for 10 weeks. In adjusted mixed linear models of SBP and diastolic BP (DBP), baseline normal SBP (P<.0001) and DBP (P<.0001) were associated with significant OROS‐MPH–induced increases compared with placebo, whereas significant increases were not observed in participants with baseline prehypertensive SBP (P=.27) and DBP (P=.79). Participants randomized to OROS‐MPH with baseline normal BP had increased odds of developing either systolic (odds ratio [OR], 3.32; 95% confidence interval [CI], 1.41–8.37; P=.006) or diastolic prehypertension (OR, 4.32; 95% CI, 1.56–14.0; P=.004) compared with placebo using simple logistic regression. The authors demonstrated an augmented OROS‐MPH–induced BP elevation and risk of prehypertension in adults with baseline normal BP. Significantly increased BP was not observed in adults with baseline prehypertension. J Clin Hypertens (Greenwich). 2012; 00:00–00. ©2012 Wiley Periodicals, Inc.     

Prognostic impact of baseline low blood pressure in hypertensive patients with stable coronary artery disease of daily clinical practice

J Clin Hypertens (Greenwich). 2012;00:00–00 ©2012 Wiley Periodicals, Inc. The authors’ aim was to investigate the prognostic value of first‐visit systolic and diastolic blood pressure (SBP/DBP) in hypertensive patients with stable coronary artery disease (sCAD) in conditions of contemporary daily clinical practice. From February 1, 2000, to January 31, 2004, 690 consecutive hypertensive patients with sCAD (mean age 68±10 years, 65% male) were prospectively followed in the outpatient cardiology clinic for major events (acute coronary syndrome, revascularization, stroke, heart failure, or death) and associations with baseline SBP/DBP were investigated. At first visit, median SBP/SDP were 130/75 mm Hg (interquartile range, 25–75; 120–140/70–80 mm Hg). After 25 months of follow‐up (median), 19 patients died (2.8%); 10 from cardiovascular causes (1.5%), 87 patients experienced a coronary event (13%), and 130 patients (19%) a major event. After adjusting for baseline variables, DBP <75 mm Hg or SBP <130 mm Hg resulted in independent predictors of major events (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.07–2.16, P=.02; HR, 1.68; 95% CI, 1.18–2.40, P=.004, respectively), coronary events (HR, 1.78; 95% CI, 1.15–2.75, P=.009; HR, 1.84; 95% CI, 1.20–2.83, P=.005, respectively), and cardiovascular mortality (HR, 7.02; 95% CI, 1.26–39.04, P=.03; HR, 9.26; 95% CI, 1.33–64.32, P=.02, respectively). In this study, a low first‐visit SBP or DBP was associated with an adverse prognosis in hypertensive patients with sCAD of contemporary daily clinical practice.     

A Hypertensive Response to Exercise Is Prominent in Patients With Obstructive Sleep Apnea and Hypertension: A Controlled Study

Blood pressure (BP) behavior during exercise is not clear in hypertensive patients with obstructive sleep apnea (OSA). The authors studied 57 men with newly diagnosed essential hypertension and untreated OSA (apnea‐hypopnea index [AHI] ≥5) but without daytime sleepiness (Epworth Sleepiness Scale score ≤10), and an equal number of hypertensive controls without OSA matched for age, body mass index, and office systolic BP. All patients underwent ambulatory BP measurements, transthoracic echocardiography, and exercise treadmill testing according to the Bruce protocol. A hypertensive response to exercise (HRE) was defined as peak systolic BP ≥210 mm Hg. Patients with OSA and control patients had similar ambulatory and resting BP, ejection fraction, and left ventricular mass. Peak systolic BP was significantly higher in patients with OSA (197.6±25.6 mm Hg vs 187.8±23.6 mm Hg; P=.03), while peak diastolic BP and heart rate did not differ between groups. Furthermore, an HRE was more prevalent in patients with OSA (44% vs 19%; P=.009). Multiple logistic regression revealed that an HRE is independently predicted by both the logAHI and minimum oxygen saturation during sleep (odds ratio, 3.94; confidence interval, 1.69–9.18; P=.001 and odds ratio, 0.94; confidence interval, 0.89–0.99; P=.02, respectively). Exaggerated BP response is more prevalent in nonsleepy hypertensives with OSA compared with their nonapneic counterparts. This finding may have distinct diagnostic and prognostic implications.     

Effects of reduced sodium intake on hypertension control in older individuals: results from the Trial of Nonpharmacologic Interventions in the Elderly (TONE)

BACKGROUND: Few trials have evaluated the effects of reduced sodium intake in older individuals, and no trial has examined the effects in relevant subgroups such as African Americans. PATIENTS AND METHODS: The effects of sodium reduction on blood pressure (BP) and hypertension control were evaluated in 681 patients with hypertension, aged 60 to 80 years, randomly assigned to a reduced sodium intervention or control group. Participants (47% women, 23% African Americans) had systolic BP less than 145 mm Hg and diastolic BP less than 85 mm Hg while taking 1 antihypertensive medication. Three months after the start of intervention, medication was withdrawn. The primary end point was occurrence of an average systolic BP of 150 mm Hg or more, an average diastolic BP of 90 mm Hg or more, the resumption of medication, or a cardiovascular event during follow-up (mean, 27.8 months). RESULTS: Compared with control, mean urinary sodium excretion was 40 mmol/d less in the reduced sodium intervention group (P<.001); significant reductions in sodium excretion occurred in subgroups defined by sex, race, age, and obesity. Prior to medication withdrawal, mean reductions in systolic and diastolic BPs from the reduced sodium intervention, net of control, were 4.3 mm Hg (P<.001) and 2.0 mm Hg (P =.001). During follow-up, an end point occurred in 59% of reduced sodium and 73% of control group participants (relative hazard ratio = 0.68, P<.001). In African Americans, the corresponding relative hazard ratio was 0.56 (P =.005); results were similar in other subgroups. In dose-response analyses, end points were progressively less frequent with greater sodium reduction (P for trend =.002). CONCLUSION: A reduced sodium intake is a broadly effective, nonpharmacologic therapy that can lower BP and control hypertension in older individuals.     

Angiotensin System Blockade Combined With Calcium Channel Blockers Is Superior to Other Combinations in Cardiovascular Protection With Similar Blood Pressure Reduction: A Meta‐Analysis in 20,451 Hypertensive Patients

The authors aimed to investigate the superiority of angiotensin system blockade (angiotensin‐converting enzyme [ACE] inhibitor/angiotensin receptor blocker [ARB]) plus a calcium channel blocker (CCB) (A+C) over other combination therapies in antihypertensive treatment. A meta‐analysis in 20,451 hypertensive patients from eight randomized controlled trials was conducted to compare the A+C treatment with other combination therapies in terms of blood pressure (BP) reduction, clinical outcomes, and adverse events. The results showed that BP reduction did not differ significantly among the A+C therapy and other combination therapies in systolic and diastolic BP (P=.87 and P=.56, respectively). However, A+C therapy, compared with other combination therapies, achieved a significantly lower incidence of cardiovascular composite endpoints, including cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke (risk ratio [RR], 0.80; 95% confidence interval [CI], 0.70–0.91; P<.001), but similar all‐cause mortality (RR, 0.90; 95% CI, 0.77–1.04; P=.15) and stroke rates (RR, 0.90; 95% CI, 0.77–1.04; P=.09). Moreover, A+C therapy yielded a 4.21 mL/min/1.73 m² lower estimated glomerular filtration rate reduction than other combinations (P<.001). Finally, A+C therapy showed a similar incidence of adverse events as other combination therapies (P=.34) but presented a significantly lower incidence of serious adverse events (RR, 0.85; 95% CI, 0.73–0.98; P=.03). In conclusion, A+C therapy is superior to other combinations of antihypertensive treatment as it shows a lower incidence of cardiovascular events and adverse events, while it has similar effects in lowering BP and preserving renal function.     

Effects of isoflavonoids on blood pressure in subjects with high-normal ambulatory blood pressure levels: A randomized controlled trial

Vegetarian diets lower blood pressure (BP), but attempts to identify dietary components responsible have been unsuccessful. Isoflavonoids are commonly consumed as part of vegetarian diets. The objective of this study was to assess the effect of isoflavonoid supplementation on BP. Fifty-nine subjects with high-normal range systolic BP completed a randomized, double blind, placebo-controlled trial of two-way parallel design and 8 weeks duration. One tablet containing 55 mg of isoflavonoids, including 30 mg of genistein, 16 mg of biochanin A (a genistein precursor), 1 mg of daidzein, and 8 mg of formononetin (a daidzein precursor), or one placebo tablet, was taken daily with the evening meal. Significant increases in urinary excretion of genistein (5.22 mg/day, 95% CI: 3.72, 6.72) and daidzein (2.53 mg/day, 95% CI: 1.66, 3.40) were observed in the group taking the isoflavonoid supplement. There were no significant changes in isoflavonoid excretion in the placebo group. Clinic BP was measured at two visits, and ambulatory BP monitoring was performed over one 24-h period, at baseline and postintervention. There was no significant difference between groups, after adjustment for baseline values, in postintervention clinic supine BP (systolic 1.2 mm Hg, 95% CI: −2.3, 4.7; diastolic 0.6 mm Hg, 95% CI: −1.9, 2.5), clinic erect BP (systolic 1.7 mm Hg, 95% CI: −4.0, 8.4; diastolic 0.4 mm Hg, 95% CI: −2.4, 3.2), or 24-h ambulatory BP (systolic −1.4 mm Hg, 95% CI: −4.4, 1.6; diastolic −0.8 mm Hg, 95% CI: −2.3, 0.7). Adjustment for age, gender, and weight change did not alter the result. Therefore, these results do not support the hypothesis that isoflavonoids, and genistein in particular, are major contributors to the BP lowering effect of vegetarian diets.     

Impact of Achieved Blood Pressures on Mortality Risk and End-Stage Renal Disease Among a Large,Diverse Hypertension Population

Background

Medical data or clinical guidelines have not adequately addressed the ideal blood pressure (BP) treatment targets for survival and renal outcome.

Objectives

This study sought to evaluate ranges of treated BP in a large hypertension population and compare risk of mortality and end-stage renal disease (ESRD).

Methods

A retrospective cohort study within the Kaiser Permanente Southern California health system was performed from January 1, 2006, to December 31, 2010. Treated hypertensive subjects ≥18 years of age were studied. Cox proportional hazards regression models were used to evaluate the risks (hazard ratios) for mortality and/or ESRD among different BP categories with and without stratification for diabetes mellitus and older age.

Results

Among 398,419 treated hypertensive subjects (30% with diabetes mellitus), mortality occurred in 25,182 (6.3%) and ESRD in 4,957 (1.2%). Adjusted hazard ratios (95% confidence intervals [CI]) for composite mortality/ESRD in systolic BP <110, 110 to 119, 120 to 129, 140 to 149, 150 to 159, 160 to 169, and ≥170 compared with 130 to 139 mm Hg were 4.1 (95% CI: 3.8 to 1.3), 1.8 (95% CI: 1.7 to 1.9), 1.1 (95% CI: 1.1 to 1.1), 1.4 (95% CI: 1.4 to 1.5), 2.3 (95% CI: 2.2 to 2.5), 3.3 (95% CI: 3.0 to 3.6), and 4.9 (95% CI: 4.4 to 5.5) respectively. Diastolic BP 60 to 79 mm Hg were associated with the lowest risk. The nadir systolic and diastolic BP for the lowest risk was 137 and 71 mm Hg, respectively. Stratified analyses revealed that the diabetes mellitus population had a similar hazard ratio curve but a lower nadir at 131 and 69 mm Hg but age ≥70 had a higher nadir (140 and 70 mm Hg).

Conclusions

Both higher and lower treated BP compared with 130 to 139 mm Hg systolic and 60 to 79 mm Hg diastolic ranges had worsened outcomes. Our study adds to the growing uncertainty about BP treatment targets.     

Creatine Kinase as Predictor of Blood Pressure and Hypertension. Is It All About Body Mass Index? A Follow‐Up Study of 250 Patients

The correlation between creatine kinase (CK) and blood pressure (BP) was examined prospectively in 120 patients with persistent high CK and 130 individuals with normal CK. Hypertension was defined as systolic BP (SBP) ≥140 mm Hg or diastolic BP (DBP) ≥90 mm Hg or current use of antihypertensive medication. Baseline CK was weakly correlated with SBP (r=0.11, P=.07) and DBP (r=0.16, P=.01) at follow‐up. Persons with persistent high CK had higher SBP (140.8 mm Hg vs 138.2 mm Hg) and DBP (83.2 mm Hg vs 81.0 mm Hg, P=.06) values and were more likely to have hypertension (66.7% vs 55.5%, P=.05) than individuals with normal CK. In age‐ and sex‐adjusted analysis, a 1‐unit change in logCK was associated with a 4.9‐mm Hg higher SBP, a 3.3‐mm Hg higher DBP, and a 2.2‐higher odds for having hypertension at follow‐up (P=.1, .07, and .06, respectively). When including body mass index (BMI) to the model, BMI was a strong and independent predictor for SBP, DBP, and hypertension at follow‐up and the CK effect on blood pressure was substantially attenuated. This study showed that the CK effect on blood pressure is clearly modified by BMI.     

Significance of white-coat hypertension in older persons with isolated systolic hypertension: a meta-analysis using the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes population

The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (≥90 mm Hg) or by daytime ABP (≥85 mm Hg), a history of cardiovascular disease, and persons <18 years of age, the present analysis totaled 7295 persons, of whom 1593 had isolated systolic hypertension. During a median follow-up of 10.6 years, there was a total of 655 fatal and nonfatal cardiovascular events. The analyses were stratified by treatment status. In untreated subjects, those with white-coat hypertension (CBP ≥140/<90 mm Hg and ABP <135/<85 mm Hg) and subjects with normal BP (CBP <140/<90 mm Hg and ABP <135/<85 mm Hg) were at similar risk (adjusted hazard rate: 1.17 [95% CI: 0.87-1.57]; P=0.29). Furthermore, in treated subjects with isolated systolic hypertension, the cardiovascular risk was similar in elevated conventional and normal daytime systolic BP as compared with those with normal conventional and normal daytime BPs (adjusted hazard rate: 1.10 [95% CI: 0.79-1.53]; P=0.57). However, both treated isolated systolic hypertension subjects with white-coat hypertension (adjusted hazard rate: 2.00; [95% CI: 1.43-2.79]; P<0.0001) and treated subjects with normal BP (adjusted hazard rate: 1.98 [95% CI: 1.49-2.62]; P<0.0001) were at higher risk as compared with untreated normotensive subjects. In conclusion, subjects with sustained hypertension who have their ABP normalized on antihypertensive therapy but with residual white-coat effect by CBP measurement have an entity that we have termed, "treated normalized hypertension." Therefore, one should be cautious in applying the term "white-coat hypertension" to persons receiving antihypertensive treatment.     

Optimal blood pressure for patients with end‐stage renal disease following coronary interventions

Hypertension is a frequent manifestation of chronic kidney disease but the ideal blood pressure (BP) target in patients with coronary artery disease (CAD) with end‐stage renal disease (ESRD) (eGFR < 15 ml/min/1.73m²) still unclear. The authors aimed to investigate the ideal achieved BP in ESRD patients with CAD after coronary intervention. Five hundred and seventy‐five ESRD patients who had undergone percutaneous coronary interventions (PCIs) were enrolled and their clinical outcomes were analyzed according to the category of systolic BP (SBP) and diastolic BP (DBP) achieved. The clinical outcomes included major cardiovascular events (MACE) and MACE plus hospitalization for congestive heart failure (total cardiovascular (CV) event).The mean systolic BP was 135.0 ± 24.7 mm Hg and the mean diastolic BP was 70.7 ± 13.1 mm Hg. Systolic BP 140–149 mm Hg and diastolic BP 80–89 mm Hg had the lowest MACE (11.0%; 13.2%) and total CV event (23.3%; 21.1%). Patients with systolic BP < 120 mm Hg had a higher risk of MACE (HR: 2.01; 95% CI: 1.17–3.46, p = .008) than those with systolic BP 140–149 mm Hg. Patients with systolic BP ≥ 160 mm Hg (HR: 1.84; 95% CI, 3.27–1.04, p = .04) and diastolic blood BP ≥ 90 mm Hg (HR: 2.19; 95% CI: 1.15–4.16, p = .02) had a higher risk of total CV event rate when compared to those with systolic BP 140–149 mm Hg and diastolic BP 80–89 mm Hg. A J‐shaped association between systolic (140–149 mm Hg) and diastolic (80–89 mm Hg) BP and decreased cardiovascular events for CAD was found in patients with ESRD after undergoing PCI in non‐Western population.     

Pulse pressure and mortality in older people

BACKGROUND: In older people, observational data are unclear concerning the relationships of systolic and diastolic blood pressure with cardiovascular and total mortality. We examined which combinations of systolic, diastolic, pulse, and mean arterial pressure best predict total and cardiovascular mortality in older adults. METHODS: In 1981, the National Institute on Aging initiated its population-based Established Populations for Epidemiologic Studies of the Elderly in 3 communities. At baseline, 9431 participants, aged 65 to 102 years, had blood pressure measurements, along with measures of medical history, use of medications, disability, and physical function. During an average follow-up of 10. 6 years among survivors, 4528 participants died, 2304 of cardiovascular causes. RESULTS: In age- and sex-adjusted survival analyses, the lowest overall death rate occurred among those with systolic pressure less than 130 mm Hg and diastolic pressure 80 to 89 mm Hg; relative to this group, the highest death rate occurred in those with systolic pressure of 160 mm Hg or more and diastolic pressure less than 70 mm Hg (relative risk, 1.90; 95% confidence interval, 1.47-2.46). Both low diastolic pressure and elevated systolic pressure independently predicted increases in cardiovascular (P<.001) and total (P<.001) mortality. Pulse pressure correlated strongly with systolic pressure (R = 0.82) but was a slightly stronger predictor of both cardiovascular and total mortality. In a model containing pulse pressure and other potentially confounding variables, diastolic pressure (P =.88) and mean arterial pressure (P =.11) had no significant association with mortality. CONCLUSIONS: Pulse pressure appears to be the best single measure of blood pressure in predicting mortality in older people and helps explain apparently discrepant results for low diastolic blood pressure.     

Add‐On Use of Eplerenone Is Effective for Lowering Home and Ambulatory Blood Pressure in Drug‐Resistant Hypertension

The authors aimed to investigate the blood pressure (BP)–lowering ability of eplerenone in drug‐resistant hypertensive patients. A total of 57 drug‐resistant hypertensive patients whose home BP was ≥135/85 mm Hg were investigated. The patients were randomized to either an eplerenone group or a control group and followed for 12 weeks. The efficacy was evaluated by clinic, home, and ambulatory BP monitoring. Urinary albumin, pulse wave velocity, and flow‐mediated vasodilation (FMD) were also evaluated. Home morning systolic BP (148±15 vs 140±15 mm Hg) and evening systolic BP (137±16 vs 130±16 mm Hg) were significantly lowered in the eplerenone group (n=35) compared with baseline (both P<.05), while unchanged in the control group (n=22). BP reductions in the eplerenone group were most pronounced for ambulatory awake systolic BP (P=.04), awake diastolic BP (P=.004), and 24‐hour diastolic BP (P=.02). FMD was significantly improved in the eplerenone group. In patients with drug‐resistant hypertension, add‐on use of eplerenone was effective in lowering BP, especially home and ambulatory awake BP.     

A cluster randomized trial to evaluate physician/pharmacist collaboration to improve blood pressure control

This was a prospective, cluster randomized controlled trial in patients with uncontrolled hypertension aged 21 to 85 years (mean, 61 years). Pharmacists made recommendations to physicians for patients in the intervention clinics (n=101) but not patients in the control clinics (n=78). The mean adjusted difference in systolic blood pressure (BP) between the control and intervention groups was 8.7 mm Hg (95% confidence interval [CI], 4.4-12.9), while the difference in diastolic BP was 5.4 mm Hg (CI, 2.8-8.0) at 9 months. The 24-hour BP levels showed similar effects, with a mean systolic BP level that was 8.8 mm Hg lower (CI, 5.0-12.6) and a mean diastolic BP level that was 4.6 mm Hg (CI, 2.4-6.8) lower in the intervention group. BP was controlled in 89.1% of patients in the intervention group and 52.9% in the control group (adjusted odds ratio, 8.9; CI, 3.8-20.7; P<.001). Physician/pharmacist collaboration achieved significantly better mean BP values and overall BP control rates, primarily by intensification of medication therapy and improving patient adherence.     

White‐Coat Effect Among Older Adults: Data From the Jackson Heart Study

Many adults with elevated clinic blood pressure (BP) have lower BP when measured outside the clinic. This phenomenon, the “white‐coat effect,” may be larger among older adults, a population more susceptible to the adverse effects of low BP. The authors analyzed data from 257 participants in the Jackson Heart Study with elevated clinic BP (systolic/diastolic BP [SBP/DBP] ≥140/90 mm Hg) who underwent ambulatory BP monitoring (ABPM). The white‐coat effect for SBP was larger for participants 60 years and older vs those younger than 60 years in the overall population (12.2 mm Hg, 95% confidence interval [CI], 9.2–15.1 mm Hg and 8.4 mm Hg, 95% CI, 5.7–11.1, respectively; P=.06) and among those without diabetes or chronic kidney disease (15.2 mm Hg, 95% CI, 10.1–20.2 and 8.6 mm Hg, 95% CI, 5.0–12.3, respectively; P=.04). After multivariable adjustment, clinic SBP ≥150 mm Hg vs <150 mm Hg was associated with a larger white‐coat effect. Studies are needed to investigate the role of ABPM in guiding the initiation and titration of antihypertensive treatment, especially among older adults.     

Interarm blood pressure differences in the women's interagency HIV study

Hypertension has been reported in 8-32% of HIV-infected individuals. Large interarm blood pressure differences (IABPD) may cause misclassification of blood pressure (BP) status. The objectives of this study were to determine the magnitude and factors associated with IABPD in HIV-infected women and uninfected controls. Using automated devices, two BP recordings were measured and averaged from each arm in Brooklyn enrollees of the Women's Interagency HIV Study. Absolute IABPD was calculated for each patient. Among 335 subjects, 238 were HIV infected and 97 were uninfected. Mean systolic and diastolic IABPD were 6 +/- 5 mm Hg and 4 +/- 3 mm Hg, respectively. Twenty-six percent of subjects had systolic IABPD >10 mm Hg and 6% had systolic IABPD >20 mm Hg. Fifteen percent of subjects had diastolic IABPD >10 mm Hg. Interarm BP differences were not associated with HIV serostatus, CD4(+) cell count, and use of highly active antiretroviral therapy. Systolic IABPD >20 mm Hg was associated with obesity (ORadj 5.37, 95% CI 1.47, 19.65), and LDL cholesterol above 160 (ORadj 9.12, 95% CI 2.53, 32.88). Right arm BP measurement resulted in 10% of subjects with high/uncontrolled BP. Bilateral arm BP measurement increased the yield to 15% (p < 0.001). In conclusion, systolic and diastolic IABPD are common and appear to be of clinically important magnitude. Systolic IABPD are related to cardiovascular risk factors but not to HIV-related factors. Bilateral BP determination is important to detect and manage hypertension as well as for accurate cardiovascular risk assessment.     

Predictors of the Short-Term Effect of Isoleucine–Proline–Proline/Valine–Proline–Proline Lactotripeptides from Casein on Office and Ambulatory Blood Pressure in Subjects with Pharmacologically Untreated High-Normal Blood Pressure or First-Degree Hypertension

Our aim was to evaluate the predictors of Isoleucine–Proline–Proline/Valine–Proline–Proline (IPP–VPP) lactotripeptides (LTPs) antihypertensive effect in the context of a short-term large double-blind randomized clinical trial involving 164 pharmacologically untreated subjects in primary prevention for cardiovascular disease. When compared with the baseline, office systolic blood pressure (SBP) (?3.42 mm Hg, P < .001) and diastolic blood pressure (DBP) (?2.35 mm Hg, P < .001) significantly decreased, in the LTP-treated patients only. No significant change in predictors during the study of ambulatory blood pressure measurement (ABPM) parameters was observed. A short-term supplementation with LTPs significantly improves the office SBP and DBP, especially in male subjects. The main predictor of LTP antihypertensive effect was the baseline BP.     

Central hemodynamics and cardiovascular risk in nondippers

J Clin Hypertens (Greenwich). 2011;13:557–562. ©2011 Wiley Periodicals, Inc. Failure of blood pressure (BP) to decline appropriately overnight (nondipping) is associated with increased risk. This may be due to inappropriately raised supine central BP and this study’s first aim was to examine this hypothesis. Secondly, aortic stiffness, central hemodynamics, and left ventricular (LV) mass were measured as other possible mechanisms of higher risk. Brachial and central BP (supine and seated), aortic stiffness, central hemodynamics, and LV dimensions were measured in 95 patients with hypertension (mean age 62±8 standard deviation). Central hemodynamics were recorded by combined radial tonometry and 3‐dimensional echocardiography. Seated brachial and central systolic BP (SBP) were similar between dippers (n=52) and nondippers (n=43). However, nondippers had higher supine brachial (132±14 mm Hg vs 126±11 mm Hg; P=.029) and central (121±15 mm Hg vs 115±11 mm Hg; P=.024) SBP. Aortic stiffness was not different between groups (P=.76), but LV mass index (33.0±6.2 vs 29.4±7.2 g/m^2.7; P=.019), stroke volume index (30.2±6.2 mL/m² vs 27.4±6.0 mL/m²; P=.040), and LV stroke work (3246±815 mm Hg/mL/m² vs 2778±615 mm Hg/mL/m²; P=.005) were all higher in nondippers. Dipper status independently predicted LV mass index (β=3.61; P=.001). Nondippers have higher supine brachial and central SBP, significantly different central hemodynamics, and elevated LV mass index compared with dippers. These cardiovascular anomalies possibly contribute to increased mortality risk.     

Prognostic Significance of Visit‐to‐Visit Systolic Blood Pressure Variability: A Meta‐Analysis of 77,299 Patients

In recent clinical investigations, visit‐to‐visit systolic blood pressure (SBP) variability was proven as a predictor of cardiovascular events and all‐cause mortality. However, inconsistent results exist in this association. A meta‐analysis of 13 prospective studies was conducted to evaluate the prognostic value of visit‐to‐visit SBP variability by different parameters in 77,299 patients with a mean follow‐up of 6.3 years. The pooled age‐ and mean SBP‐adjusted hazard ratios (HRs) for all‐cause mortality were 1.03 (95% confidence interval [CI], 1.02–1.04; P<.001) per 1‐mm Hg increase in SBP standard deviation (SD) and 1.04 (1.02–1.06, P<.001) per 1% in SBP coefficient of variation, and the corresponding values of cardiovascular mortality were 1.10 (1.02–1.17, P<.001) and 1.01 (0.99–1.03, P=.32), respectively. Moreover, a 1‐mm Hg increase in SD was significantly associated with stroke, with an HR of 1.02 (1.01–1.03, P<.001). Visit‐to‐visit SBP variability, independent of age and mean SBP, is a predictor of cardiovascular and all‐cause mortality and stroke.     

Prediction of Blood Pressure and Blood Pressure Change With a Genetic Risk Score

The authors investigated whether a genetic risk score (GRS) constructed of 32 single nucleotide polymorphisms would predict incident hypertension and blood pressure (BP) change over time in a population cohort during an 11‐year follow‐up (n=5402 at baseline, 3266 at follow‐up). In multivariable models, GRS was associated with higher systolic/diastolic BP values at baseline (β±standard error [SE], 1.04±0.14/1.11±0.13 mm Hg; P<.0001 for both) and at reinvestigation (β±SE, 0.84±0.18/0.79±0.16 mm Hg; P<.0001 for both). Among participants who were normotensive at baseline (n=2045), GRS was not independently associated with systolic/diastolic BP change over time (β±SE, 0.16±0.18/0.20±0.18 mm Hg; P≥.28 for both). In participants in the top tertile of the GRS, as compared with the bottom tertile, the predicted increase in systolic/diastolic BP was 1.18±0.78/0.70±0.49 mm Hg (P=.046/.15) greater and the odds ratio for incident hypertension was 33% higher (P=.03). These data show that GRS is strongly associated with BP but weakly associated with BP increase and incident hypertension in a late middle‐aged population.