Effect of repeated measurements of blood pressure on blood pressure in essential hypertension: Role of anxiety

Over the past years, we repeatedly observed that of the hypertensive population entered into our behavioral treatment programs, more than half were actually false hypertensives. With repeated measurements of blood pressure (BP), only one-third remained hypertensive, while two-thirds showed a significant decrease in BP. The purpose of this study was to determine which factors correlate with the decrease in BP and could be useful in distinguishing the true and the false hypertensives. Of the 24 patients in this study, 15 decreased their mean arterial pressure by at least 5 mm Hg during a 6-week period of home and clinic BP measurement, while 9 did not. The 9 patients with BPs that did not change had lower State Anxiety, Trait Anxiety scores, lower diastolic BP, and lower heart rates compared to the group whose BPs decreased. These results suggest that under certain conditions a relationship exists between anxiety and elevated blood pressure. In a segment of the hypertensive population, anxious patients may be placed on inappropriate anti-hypertensive medication if a BP measurement period is not conducted before intervention.     

穴位敷贴联合抗抑郁药对抑郁症患者失眠症状的疗效

目的:观察穴位敷贴联合药物治疗对抑郁症的疗效和安全性,尤其是对患者失眠症状的改善程度.方法:将162例抑郁症患者随机分成研究组(n=86)和对照组(n=76),研究组接受穴位敷贴治疗联合抗抑郁药物治疗,对照组接受抗抑郁药物治疗,治疗持续6周,基线及治疗第1,2,6周末用同时用汉密尔顿抑郁量表(Hamilton Depression scales,HAMD-17)以及汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)评定患者的抑郁和焦虑严重程度,用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)评定患者的失眠严重程度,同时用副反应量表(Treatment Emergent Symptom Scale,TESS)和实验室检查评估治疗安全性.结果:治疗6周末研究组和对照组的HAMD评分分别为8.62±2.90,10.14±3.38,均较治疗前显著下降,研究组显著低于对照组,差异有统计学意义(t=3.0805,P=0.0024);同样治疗6周末研究组和对照组的HAMA评分分别为6.93±2.19,10.30±3.55,均较治疗前显著下降,研究组显著低于对照组,差异有统计学意义(t=7.3614,P<0.001);治疗6周末研究组和对照组的PSQI评分分别为5.23±1.90,8.14±3.11,均较治疗前显著下降,且研究组显著低于对照组,差异有统计学意义(t=7.2771,P<0.001).研究组皮肤瘙痒显著多于对照组,失眠显著少于对照组,其他方面没有显著差异.结论:穴位敷贴联合抗抑郁药治疗对抑郁症安全有效,同时可以显著改善患者的失眠症状.     

Clinical study on treating anxiety,depression and insomnia by pulsed light stimulation

ＩＮＴＲＯＤＵＣＴＩＯＮ　　Ｉｎｔｈｅｍｏｄｅｒｎｓｏｃｉｅｔｙ,ｔｈｅｅｖｅｒｉｎｃｒｅａｓｉｎｇｌｙｆａｓｔｓｔｅｐｓｏｆｌｉｆｅｍａｋｅａｎｘｉｅｔｙ,ｄｅｐｒｅｓｓｉｏｎａｎｄｉｎｓｏｍｎｉａｂｅｃｏｍｅｍｏｒｅａｎｄｍｏｒｅｃｏｍｍｏｎｉｎｐｅｏｐｌｅ．Ａｃｃｏｒｄｉｎｇｔｏｔｈｅｓｔａｔｉｓｔｉｃｓ〔１〕,１５．１～２２．５ｐｅｒｃｅｎｔｏｆｎｏｒｍａｌｐｅｏｐｌｅｓｕｆｆｅｒｆｒｏｍｄｅｐｒｅｓｓｉｏｎ．Ａｍｏｎｇｐｅｏｐｌｅｗｉｔｈｄｉｓａｂｉｌｉｔｉｅｓ,ｔｈｅｓｔａｔｉｓｔ…     

The relationship between media use in the bedroom, sleep habits and symptoms of insomnia

This postal questionnaire study investigated the use of media in the bedroom and its relationships with sleep habits and symptoms of insomnia. The sample comprised 2500 individuals aged 16-40 years drawn randomly from the Norwegian national register. A total of 816 (34.0%) completed and returned the questionnaire. Respondents were asked how often they used computers, television sets, DVD players, game consoles and mobile telephones and listened to music/radio in their bedrooms. They also reported sleep habits on weekdays and at weekends/days off and symptoms of insomnia. After controlling for gender, age, anxiety and depression, the respondents who used a computer in the bedroom 'often' compared to 'rarely' rose later on weekdays and at weekends/days off, turned off the lights to go to sleep later at weekends/days off, slept more hours at weekends/days off and had a greater discrepancy between turning off the lights to go to sleep on weekdays and at weekends/days off. Respondents who used a mobile telephone in their bedrooms at night 'often' compared to 'rarely' turned off the lights to go to sleep later on weekdays and at weekends/days off, and rose later at weekends/days off. No such differences were found with the use of the other media. There were also no significant differences in symptoms of insomnia. This study indicates that the use of computers and mobile telephones in the bedroom are related to poor sleep habits, but that media use in the bedroom seems to be unrelated to symptoms of insomnia.     

Prevalence and correlates of clinical insomnia co-occurring with chronic back pain

Given the suggestion of a reciprocal relationship between sleep and pain and the recognition of sleep as an important parameter in determining quality of life, there is increasing research interest in sleep disturbance linked to chronic pain. The present study aimed to provide an estimate of the prevalence of 'clinical insomnia' in patients attending a specialist pain clinic and identify factors associated with it. Seventy chronic back pain patients and 70 gender- and age-matched pain-free controls completed a set of questionnaires measuring sleep (Insomnia Severity Index; ISI), pain (Short-Form McGill Pain Questionnaire) and a selection of general and specific psychological variables (Hospital Anxiety and Depression Scale, Short Health Anxiety Inventory). Scores suggestive of clinical insomnia (ISI > or = 15) were noted in 53% of chronic pain patients, when compared with only 3% in pain-free controls. Significant positive correlations with insomnia severity were detected for all six variables of interest (pain intensity, sensory pain ratings, affective pain ratings, general anxiety, general depression and health anxiety). Affective pain ratings and health anxiety were the best predictors of insomnia severity in this sample, accounting for 30% of the total variance, even when present pain intensity was controlled for. Affective pain remained as a significant predictor of insomnia severity when both the effect of pain intensity and the effects of anxiety and depression were controlled for. Future research should consider investigating the role of pain appraisal and health anxiety in the development and manifestation of insomnia concomitant to chronic pain.     

Meta-analysis of sleep changes in control groups of insomnia treatment trials

A meta-analysis assessing the magnitude of sleep changes from baseline in placebo-treated (psychological and pharmacological placebo) and untreated groups issued from independent trials was conducted. Comparisons were then performed to assess if the magnitude of sleep changes in the placebo control groups were significantly different than those of the untreated group. Medline, PsychInfo and Current Contents databases (1990-2004) were searched for primary insomnia treatment studies using a randomized controlled parallel-group design. Effect sizes were computed for each end-point variable based on subjective (patient-reported) and polysomnographic measures. Thirty-four studies (n = 1392 subjects) met inclusion criteria; twenty-three used a pharmacological placebo (n = 1163), four used a psychological placebo (n = 81), and seven used a waitlist condition (n = 148). Between-group comparisons were performed using a random effects model analysis. Significant pre-post changes were observed in the pharmacological placebo condition on several sleep parameters, both on objectively and subjectively measured outcomes [objective and subjective sleep onset latency (SOL) and total sleep time (TST) and subjective wake after sleep onset]. Although a tendency was observed for objective SOL, only the changes on subjective SOL and TST in the pharmacological placebo condition were significantly different from the corresponding changes in the untreated group. No differences were significant for the psychological placebo groups. Although the present findings suggest that sleep may significantly change in response to a pharmacological placebo, conclusions remain tentative because of possible confounds that may arise when comparing groups issued from different trials. Further research directly comparing placebo groups and untreated groups from the same randomized trials remains necessary.     

Effect of satisfaction with social support on blood pressure in normotensive and borderline hypertensive men and women

The relation between blood pressure (BP) and two aspects of social support, perceived satisfaction and structural social support network characteristics, were examined in adults classified as having normal BP or borderline hypertension. Casual BP_s were taken by a trained technician on 3 separate visits, each approximately 1 week apart. Participants were categorized as borderline hypertensive if screening systolic blood pressure (SBP) fell in the range 130-160 mmHg and/ordiastolic blood pressure (DBP) fell in the range 85-100 mmHg; BP_s below these ranges were considered normotensive. Participants underwent ambulatory BP monitoring, Individuals classified as normotensive reported significantly greater support satisfaction than individuals with borderline hypertension. Social network characteristics were not associated with BP. During 24 hr of ambulatory BP monitoring, high perceived support satisfaction was associated with lower SBP and DBP at work, home, and during sleep. These data suggest that perceived satisfaction with social support is associated with lower BP. The presence of social support also may reduce BP levels during daily life. This study was supported by National Institutes of Health (NIH) Grants HL49427, HL49572. HL53724, and MOI-RR-30, National Center far Research Resources, Clinical Research Centers Program, National Institutes of Health.     

抗焦虑和抗抑郁治疗对2型糖尿病患者血糖水平的影响

目的 探讨抗焦虑和抗抑郁治疗对2型糖尿病患者血糖水平的影响.方法 将60例应用Zung抑郁自评量表(SDS)及焦虑自评量表(SAS)评定合并焦虑抑郁倾向的2型糖尿病患者随机分为对照组及治疗组,对照组单纯降糖治疗,治疗组降糖联合抗焦虑抑郁治疗,比较治疗前后焦虑抑郁指数SAS、SDS以及血糖的变化.结果 与治疗前比较,对照...     

Caffeine, extended stress, and blood pressure in borderline hypertensive men

Caffeine increases blood pressure (BP), and its pressor effects are larger in borderline hypertensive (BH) men than in controls. This article extends findings of larger caffeine effects on BP at rest and to brief mental stress in BH to a new analysis of caffeine and prolonged mental stress in BH. In a double-blind, crossover study, 24 male BH (140/90 mmHg < BP < 160/95 mmHg) and 23 normotensive controls who were habitual caffeine consumers (NT; BP < 135/85 mmHg; negative parental history) worked on alternating mental stressors for 35 min after placebo or caffeine (3.3 mg/kg). Caffeine raised systolic blood pressure (SBP) and diastolic blood pressure (DBP) alone and during the extended tasks (all ps < .00001/.00001). BH had larger SBP and DBP increases over all postcaffeine periods (ps < .04/04) and larger DBP rises to the extended tasks after caffeine (p = .007). These combined effects led to undesirably high BPs (> 140/82 mmHg) relative to controls (< 130/75) during the 100 min after caffeine intake. Caffeine taken by BH at times of extended behavioral stress may elevate BP to a clinically meaningful degree. This research was supported by the Medical Research Service of the Department of Veterans Affairs and the National Heart Lung and Blood Institute of the National Institutes of Health, grant numbers HL32050 and HL07640. We thank Barbara McKey and Judith Silverstein for their efforts in data collection and Terrie Thomas for her valuable comments on an earlier version of this article.     

个体化出院指导应用于高血压病患者的效果分析

目的：探讨个体化出院指导对高血压患者依从性的影响。方法：将80例患者随机分为实验组和对照组,分别给予个体化出院指导联合一般性出院指导和单用一般性出院指导,出院三个月和六个月时跟踪随访。结果：实验组的依从性明显好于对照组,出院后随访病情复发率明显降低（P〈0.05〉。结论：个体化出院指导可提高高血压患者依从性,改善患者的社会适应能力,降低复发率。     

The impact of negative mood state on sleep‐related attentional bias in insomnia

Sleep‐related attentional bias is thought to play a role in the maintenance of insomnia. However, this concept has been questioned by several studies that did not show the presence of sleep‐related attentional bias in clinical insomnia or poor sleepers. Our goal in the present study was to test whether the mood state of individuals with insomnia affects the presence of sleep‐related attentional bias. To this end, 31 individuals with insomnia and 34 good sleepers were randomly assigned to a negative mood‐inducing condition or a control condition. They then completed a visual probe task with three types of pictorial stimuli (general threat, sleep‐related negative pictures and sleep‐related positive pictures). Vigilance, maintenance and the overall bias indexes were calculated based on the reaction time. We found individuals with insomnia only showed a greater overall bias compared with good sleepers following a negative mood induction, regardless of the pictures presented. In addition, we found that a negative mood state was significantly correlated with the overall attentional bias in good sleepers but not in individuals with insomnia. These findings suggest that sleep‐related attentional bias in insomnia can be modulated by mood state. This effect may reflect the dysregulation of top‐down attentional control in individuals with insomnia.     

Dynamic features of placebo effects addressing persistent insomnia disorder: A meta‐analysis of placebo‐controlled randomized clinical trials

It has been accepted knowledge that placebo effects have been significant in insomnia clinical trials. However, the dynamic features of placebo effects have not been clarified. Our aim was therefore to conduct a meta‐analysis of placebo‐controlled randomized clinical trials to characterize the dynamic features of placebo effects addressing persistent insomnia disorder. We performed a comprehensive literature search for randomized, placebo‐controlled, double‐blind clinical trials evaluating the efficacy of therapeutic regimens addressing persistent insomnia disorder. We pooled separate effect size estimates (Hedge's g) of placebo and regimen conditions across trials for outcome measures, and multilevel mixed‐effects models were used to explore potential sources of heterogeneity. The placebo effects were significant and robust to improve the symptoms of insomnia, and subjective measures were significantly smaller than objective measures (p < .001), but placebo response rates were nearly identical between subjective and objective measures. The overall placebo effects were influenced by publication year (p = .015), treatment duration (p = .010), sample size (p < .001) and therapeutic regimen (p < .001). Placebo effects showed a diphasic feature within treatment duration: initially a decrease and subsequently being stable; a sustained decline trend after withdrawals; and a steady‐to‐upward trend for a mixed therapeutic regimens in a large‐scale period over decades. The dynamic features of placebo effects addressing persistent insomnia disorder may lead to the development and validation of dosing strategies that require less medication exposure to maintain clinical effects.     

Prevalence of pre-high blood pressure and high blood pressure among non-overweight children and adolescents using international blood pressure references in developed regions in China

Background: There is a lack of data on the prevalence of pre-high blood pressure (PreHBP) and high blood pressure (HBP), based on recent international blood pressure references, in non-overweight children and adolescents.

Aim: To describe the prevalence of PreHBP and HBP in non-overweight children and adolescents in developed regions of China.

Subjects and methods: In total, 588?097 non-overweight children and adolescents aged 6–17?years from the National Surveys on Chinese Students’ Constitution and Health in 2015 were included.

Results: The prevalence of PreHBP was 13.41% and subjects in urban areas had a higher prevalence of PreHBP (14.14%) than those in rural areas (12.92%). Subjects in regions with a high (13.56%) or moderate (13.61%) socioeconomic status showed a higher prevalence of PreHBP than those in regions with a relatively low socioeconomic status (12.76%). A similar pattern was found for the prevalence of HBP, and the prevalence of HBP was 18.25% for all participants, 20.55% for subjects in urban areas, 16.71% in rural areas, 18.76% in high socioeconomic areas, 18.62% in moderate socioeconomic areas and 16.70% in relatively low socioeconomic areas.

Conclusion: A large proportion of non-overweight children and adolescents had elevated blood pressure and there were urban–rural and socioeconomic disparities in the prevalence of elevated blood pressure.     

Blood pressure measurements taken by patients are similar to home and ambulatory blood pressure measurements

OBJECTIVE: To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement. METHODS: A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed. RESULTS: Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to "office measurement." CONCLUSION: This study showed that the measurement most similar to home blood pressure measurement and ambulatory blood pressure monitoring was blood pressure measured by the patient, and that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic value relative to "office measurements".     

Relationship between plasma homocysteine and blood pressure in hypertensive Northern-Nigerians

AimThe study sought to determine whether there is any relationship between plasma homocysteine and blood pressure levels in Nigerians with essential hypertension.MethodIt was a cross-sectional analytical study done on 120 randomly selected hypertensive patients and 120 normal healthy controls seen at the large Conference hall of the Ahmadu Bello University (ABU) Medical Centre, Zaria as well as the ABU Teaching Hospital, Zaria, Northern-Nigeria. Pearson''s Correlation and Binary Logistic Regression analysis determined the relationship between homocysteine and hypertension.ResultsHyperhomocysteinaemia found in the hypertensive patients (22.8 ± 6.6 µmol/L) differed significantly (p<0.001) from controls (10.9 ± 2.8 µmol/L) with significant (p<0.001), blood pressure difference between both groups. Homocysteine significantly positively correlated with systolic (r = 0.51, p<0.001) and diastolic (r = 0.47, p<0.001) blood pressures in hypertensive subjects. The relation of plasma hcy to hypertension was statistically significant for SBP; OR: 1.08 (95% CI, 1.05–1.11) and DBP; OR: 1.08 (95% CI, 1.03–1.13) in the unadjusted model. When adjusted for confounding variables, hcy was significantly related to SBP; OR: 1.1 (95% CI, 1.04–1.18) but not DBP (p=0.25; OR: 1.06 (95 % CI, 0.96–1.18). The mean plasma folate level was high (115.2 ± 48.0 ng/mL) in the hypertensive subjects. The hyperhomocysteinaemic subjects showed a 2.8 times Odds of developing hypertension.ConclusionThis study showed higher mean plasma homocysteine levels in hypertensives than controls not accounted for by sub-optimal folate levels. Hyperhomocysteinaemia showed a positive relationship to systolic hypertension after adjusting for confounders.     

Peripheral and brachial blood pressure during standardized occupation-related tests in normotensive and mild hypertensive men and women

We investigated the usefulness of peripheral blood pressure (BP) measurement in the assessment of strain in occupational physiology. Our hypothesis was that the brachial and peripheral BP reflect physiologically different events under various occupation-related demands in normotensive (NT) and hypertensive (HT) people. A group of 20 female and 20 male subjects with unmedicated mild hypertension that had been diagnosed by ambulatory blood pressure monitoring [awake time systolic/diastolic BP (BP_s/BP_d) 142.9 (SD 11.3)/86.4 (SD 6.2) mmHg] and 40 NT matched by age and sex [BP_s/BP_d 120.0 (SD 9.8)/75.6 (SD 5.9) mmHg] attended a laboratory session to undertake mental arithmetic tasks, a fingergrip test and submaximal cycle ergometry. Brachial and peripheral BP as well as heart rate were measured using a sphygmomanometer and an continuously automatic blood pressure measuring device on the finger, respectively. The peripheral BP_s was higher than brachial BP_s, BP_d was similar for peripheral and brachial BP except during cycle ergometry. Associations between the levels of brachial and peripheral BP depended on demands and did not explain more than 42% of the common variance. The highest correlations between the two BP methods were observed during habituation, recovery and mental demands, and weak correlations during cycle ergometry. For peripheral BP_s and BP_d we found significant correlations in all phases of the test (r=0.58 to 0.86, P < 0.001), also in ergometry (NT r=0.62, P < 0.001, HT r=0.53, P < 0.001), in contrast to the brachial BP. Peripheral BP differentiated the two BP groups (57.5%–72.5% correctly classified) which had been grouped by daily measurement of brachial BP, but brachial BP was superior in this respect with 65.0%–87.5% being correctly classified. These results supported the suggestion that the combined measurement of peripheral and brachial BP provides complementary information regarding physiological changes in NT and HT in different situations. Accepted: 30 August 1999     

A randomized controlled trial of bedtime music for insomnia disorder

Music is often used as a self‐help tool to alleviate insomnia. To evaluate the effect of bedtime music listening as a strategy for improving insomnia, we conducted an assessor‐blinded randomized controlled trial. Fifty‐seven persons with insomnia disorder were included and randomized to music intervention (n = 19), audiobook control (n = 19) or a waitlist control group (n = 19). The primary outcome measure was the Insomnia Severity Index. In addition, we used polysomnography and actigraphy to evaluate objective measures of sleep, and assessed sleep quality and quality of life. The results showed no clear effect of music on insomnia symptoms as the group × time interaction only approached significance (effect size = 0.71, p = .06), though there was a significant improvement in insomnia severity within the music group. With regard to the secondary outcomes, we found a significant effect of the music intervention on perceived sleep improvement and quality of life, but no changes in the objective measures of sleep. In conclusion, music listening at bedtime appears to have a positive impact on sleep perception and quality of life, but no clear effect on insomnia severity. Music is safe and easy to administer, but further research is needed to assess the effect of music on different insomnia subtypes, and as an adjunctive or preventive intervention.     

The natural history of insomnia: predisposing,precipitating, coping,and perpetuating factors over the early developmental course of insomnia

While there is an extensive literature on predisposing, precipitating, coping, and perpetuating factors in those with chronic insomnia, very little work has been undertaken to evaluate these factors over the early developmental course of insomnia. The present aim was to determine whether several hypothesized factors in each domain (predisposing, precipitating, coping, and perpetuating), assessed during an episode of acute insomnia (AI), are related to its persistence or remission to normal sleep. Participants comprised n = 140 people with AI and n = 737 normal sleepers (NS) recruited from the general public. Participants completed measures assessing predisposing characteristics (personality traits, arousal predisposition, and insomnia vulnerability), precipitating events and outcomes (life events, perceived stress, anxiety, and depression), coping styles (thought control strategies and coping styles), and perpetuating factors (sleep preoccupation, pre-sleep arousal, dysfunctional beliefs, and fatigue). Additionally, insomnia status (from AI at baseline to its persistence or natural remission [NR]) was assessed 1 month later (n = 129). Baseline differences between NS and individuals with AI were observed in each domain with increasing age, lower openness to experience and conscientiousness, higher insomnia severity, levels of anxiety, and affective sleep preoccupation significantly predicting AI status. Further, a previous episode of insomnia, higher depression scores, and affective sleep preoccupation scores significantly predicted its persistence, as opposed to its NR. Results are discussed with reference to the conceptualization of insomnia and how the findings may influence the design of preventative interventions to circumvent the transition from acute to chronic insomnia.