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PubMed1997

Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study.

BACKGROUND: We attempted to characterize age-related changes in blood pressure in both normotensive and untreated hypertensive subjects in a population-based cohort from the original Framingham Heart Study and to infer underlying hemodynamic mechanisms. METHODS AND RESULTS: A total of 2036 participants were divided into four groups according to their systolic blood pressure (SBP) at biennial examination 10, 11, or 12. After excluding subjects receiving antihypertensive drug therapy, up to 30 years of data on normotensive and untreated hypertensive subjects from biennial examinations 2 through 16 were used. Regressions of blood pressure versus age within individual subjects produced slope and curvature estimates that were compared with the use of ANOVA among the four SBP groups. There was a linear rise in SBP from age 30 through 84 years and concurrent increases in diastolic blood pressure (DBP) and mean arterial pressure (MAP); after age 50 to 60 years, DBP declined, pulse pressure (PP) rose steeply, and MAP reached an asymptote. Neither the fall in DBP nor the rise in PP was influenced significantly by removal of subsequent deaths and subjects with nonfatal myocardial infarction or heart failure. Age-related linear increases in SBP, PP, and MAP, as well as the early rise and late fall in DBP, were greatest for subjects with the highest baseline SBP; this represents a divergent rather than parallel tracking pattern. CONCLUSIONS: The late fall in DBP after age 60 years, associated with a continual rise in SBP, cannot be explained by "burned out" diastolic hypertension or by "selective survivorship" but is consistent with increased large artery stiffness. Higher SBP, left untreated, may accelerate large artery stiffness and thus perpetuate a vicious cycle.

Adult↗
PubMed2003

Blood pressure indices and cardiovascular disease in the Asia Pacific region: a pooled analysis.

This article aims to compare the importance of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) as risk factors for stroke and ischemic heart disease and to assess whether the patterns are consistent by age and gender. Cox proportional-hazards regression, adjusted for cholesterol and smoking, was used to assess the associations of the 4 BP indices with stroke and ischemic heart disease by age and gender. The relative importance of individual indices was assessed with a hazard ratios for a 1-SD change in BP and by likelihood-ratio chi2 tests. The influence of >1 BP index in the Cox model was also estimated. The analyses demonstrated similar associations of SBP, DBP, and MAP with both fatal stroke and ischemic heart diseases, which were stronger than those of PP. Both SBP and MAP tended to be more important in the regression model than DBP or PP. In Cox models including DBP, addition of SBP improved the goodness of fit at all ages and for both genders. However, in Cox models including SBP, addition of DBP typically resulted in little incremental benefit over and above that of SBP alone. These data suggest that if time or resources are highly constrained, such as in much-needed epidemiologic surveys in developing countries, very little is lost from only measuring SBP.

Adult↗
PubMed2003

Association between physical activity and blood pressure is modified by variants in the G-protein coupled receptor 10.

Hypertension is strongly related to cardiovascular disease and all-cause mortality. Exercise reduces blood pressure but the response varies between individuals. The mechanisms by which physical activity energy expenditure (PAEE) modifies blood pressure are not fully defined but include modulation of sympathetic tone. Novel polymorphisms in the G-protein coupled receptor (GPR10) have been linked with high blood pressure. GPR10 may mediate the relationship between PAEE and blood pressure via central nervous mechanisms. We examined whether two GPR10 polymorphisms (G-62A and C914T) modify the association between PAEE and blood pressure in the MRC Ely study (N=687). When stratified by the C914T genotype, there were between-group differences for body mass index (BMI) (P=0.05), diastolic blood pressure (DBP) (P=0.006), and systolic blood pressure (SBP) (P=0.005). No differences were found between G-62A genotypes. The previously reported inverse relationship between PAEE and blood pressure was not observed in minor allele carriers for either polymorphism (A62 carriers: DBP beta-1.11, P=0.52; SBP beta-1.66, P=0.52. T914 carriers: SBP beta=3.27; P=0.60) but was in common allele homozygotes (G62G: DBP beta-6.18 P=0.00001; SBP beta-8.54 P=0.0001. C914C: SBP beta-7.07; P=0.00001). This corresponded to a significant interaction between PAEE and GPR10 polymorphisms on DBP (G-62A: P=0.006) and SBP (G-62A: P=0.008. C914T: P=0.068). Significant interactions were observed between haplotype (derived from G-62A and C914T), PAEE, and blood pressure (DBP: P=0.08; SBP: P=0.023). The effect of physical activity on blood pressure is highly variable at population level. Knowledge of GPR10 genotype may define those who are least likely to benefit from physical activity. These findings may have relevance in the targeted treatment of hypertensive disease.

Blood Pressure↗
PubMed2004

Comparison of four blood pressure indexes for the prediction of 10-year stroke risk in middle-aged and older Asians.

Information has been sparse on the comparison of 4 blood pressure (BP) indexes (systolic BP [SBP], diastolic BP [DBP], pulse pressure [PP], and mean BP [MBP]) in relation to long-term stroke incidence, especially in middle-aged and older Asian people. A prospective cohort study was performed in 4989 Japanese (1523 men and 3466 women) aged 35 to 79 at baseline with 10 years of follow-up. End points included stroke incidence (total, ischemic, and hemorrhagic). Multivariate-adjusted hazard ratios with a 1-SD higher value for each BP index were determined by Cox proportional hazard analyses; Wald chi2 tests were used to compare the strength of relationships. Analyses were also done for each of 4 age-gender groups consisting of men and women aged 35 to 64 and 65 to 79 years. During follow-up, 132 participants developed stroke. Adjusted hazard ratios for all strokes were 1.68 for SBP, 1.72 for DBP, and 1.80 for MBP, which were higher than that for PP (1.34). SBP and DBP were related positively to stroke risk after adjustment of each other. PP was not the strongest predictor in any age-gender groups among 4 BP indexes. In men aged 65 to 79 years, SBP showed the strongest relationship to all stoke risk (hazard ratio 1.62) among 4 BP indexes. In women aged 65 to 79 years, hazard ratios for all strokes were 2.48 for MBP, 2.46 for DBP, 2.25 for SBP, and 1.57 for PP. The long-term incident stroke risk of high BP in Asians should be assessed by SBP and DBP together, or by MBP, not by PP.

Adult↗
PubMed1991

Blood pressure and high blood pressure. Aspects of risk.

This report deals with three aspects of risk related to blood pressure and high blood pressure. The first aspect of risk concerns distributions of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the adult population and their relation to long-term risk of morbidity and mortality. By middle age, only a minority (about 20%) of Americans have optimal SBP and DBP levels, less than 120 mm Hg and less than 80 mm Hg, respectively. For the majority with higher levels, risks of major clinical events, including death from cardiovascular diseases and from all causes, are markedly increased. The relations of SBP and DBP with risk are strong, continuous, and graded. Risk is sizable not only for persons with high blood pressure by usual clinical criteria (SBP greater than or equal to 140 mm Hg or DBP greater than or equal to 90 mm Hg), but also for those with "high-normal" blood pressure (e.g., SBP 130-139 mm Hg or DBP 80-89 mm Hg). Thus, the blood pressure problem is a population-wide one and requires for its control a combined population-wide and high-risk strategy. A major component of this strategy must be nutritional-hygienic measures for the primary prevention of the rise in blood pressure during adulthood and of high blood pressure (i.e., primary prevention not only of the complications of high blood pressure but also of high blood pressure itself) through improved lifestyles having the potential to shift downward the blood pressure distribution of the whole population. The second aspect of risk concerns the known risk factors (i.e., aspects of modern lifestyle) leading to the mass occurrence of blood pressure rise during adulthood and of high blood pressure. These risk factors are high salt intake, high dietary sodium/potassium ratio, calorie imbalance and resultant obesity, and high alcohol intake. The extensive data base establishing the role of these common traits in the etiology of the blood pressure/high blood pressure problem is the scientific foundation for efforts to achieve the primary prevention of high blood pressure. The third aspect of risk relates to the combined impact of other risk factors along with blood pressure-high blood pressure in markedly increasing the probabilities of morbidity and mortality (e.g., "rich" diet, diet-dependent serum cholesterol and uric acid, smoking, diabetes, and target-organ damage). Prevention and control of lifestyle-related traits are essential components of the strategy for dealing with the blood pressure-high blood pressure problem.

Blood Pressure↗
PubMed1996

Blood pressure level and variability in the prediction of blood pressure after 5-year follow-up.

We compared mean intra-arterial ambulatory blood pressure (IAMB), blood pressure (BP) diurnal profiles are variability, and postural measurements with casual sphygmomanometric measurements for the prediction of future BP. We studied 97 healthy, ummedicated men classified as normotensive (NT, n = 34), borderline hypertensive (BHT, n = 29), or mildly hypertensive (HT, n = 34) by repeated casual measurements during the 2 months before IAMB. Five years later, we reassessed 79 subjects (81%) using casual BP measurements and noninvasive ambulatory 24-hour BP monitoring (NAMB). IAMB level generally correlated well with follow-up BP and slightly better with NAMB level than with casual measurements (24-hour IAMB versus follow-up NAMB systolic BP [SBP], r = .64, P < .001; versus diastolic' BP [DBP], r = .52, P < .001). NT and BHT subgroup correlations were of similar strength, but the relationship in the HT subgroup was not significant. Similarly, when we examined daytime and nighttime BP levels, nighttime BP correlated better with follow-up BP in NT and BHT but not in HT. The only measures that were significantly related to follow-up BP in HT were two BP variability measures, SD and the range of variability (RV80: 90th minus 10th percentile), (initial 24-hour IAMB SD and follow-up BP, r = .42 to r = .52, P < .05 to P < .01; RV80 versus follow-up BP, r = .43 to r = .52, P < .05 to P < .01). Correlations of follow-up BP with postural BP were generally weaker than with casual BP or IAMB level. Linear stepwise regressions for SBP and DBP separately (including all IAMB variables) demonstrated that the best single predictor for follow-up BP was 24-hour IAMB SBP level, which explained 41% of follow-up NAMB SBP level variance (F = 52.6, P < .001). However, in a second analysis including casual values, casual SBP alone explained 44% of follow-up NAMB SBP variance (F = 62.5, P < .001), whereas IAMB SBP added only 4% (F = 5.5, P < .05). Predictions of follow-up DBP were always poorer. After 5 years, 70% of NT and 86% of HT were still in their initial classification group, but 67% of BHT had become hypertensive. In these new HT (n = 16), initial IAMB level correlated most strongly with follow-up NAMB level (24-hour SBP, r = .70, P < .01; 24-hour DBP, r = .55, P < .05). The only other significant demographic variable predicting future BP was change in weight over 5 years, which added 10% to the explanation of future casual SBP variance (F = 12.5, P = .0007) and 15% to casual DBP variance (F = 18.0, P = .0001); for NAMB, the percentages were lower. In logistic regression, those NT and BHT who became hypertensive (n = 22) had a 75% probability of becoming hypertensive if they gained 11.7 kg or more during 5 years (X2 = 4.5, P = .03). To conclude, BP tended to increase in all groups, especially in BHT, during follow-up. Nominal differences were observed between casual measurements and BP level measures in the prediction of future BP, and their explanatory value for future BP was generally less than 50%. However, for BHT who became hypertensive, BP level and variability measurements somewhat improved the prediction of follow-up BP. Weight gain was an important additional predictor for future hypertension in both NT and BHT.

Adult↗
PubMed1997

Diastolic pressure underestimates age-related hemodynamic impairment.

It has been hypothesized that as large arteries become more rigid with age, the pattern of hypertension changes from diastolic to systolic. Thus, diastolic blood pressure (DBP) may lose its ability to reflect the increase in vascular resistance with age. To assess this, we studied the age-related changes in blood pressure pattern and its steady-state and pulsatile determinants. We performed an epidemiological analysis based on a national survey of 10,462 subjects from Argentina. A hemodynamic analysis (impedance cardiography) was then carried out in 636 consecutive hypertensive patients (age, 25 to 74 years). Whereas the rate of increment in the prevalence of mild to moderate hypertension (MMH) reached a plateau after the sixth decade, isolated and borderline systolic forms of hypertension began a steep and sustained rise. Among patients with MMH, DBP remained stable from the third to the seventh decade, whereas SBP maintained a sustained increase. Despite similar DBP, the systemic vascular resistance index increased 47% (P<.01) and the cardiac index decreased 27% (P<.01), whereas the ratio of stroke volume to pulse pressure, an index of arterial compliance, decreased 45% (P<.01). However, there were no significant differences between older patients with MMH and those with isolated systolic hypertension in the level of SBP, vascular resistance, stroke volume, and cardiac index. Compared with age-matched normotensive control subjects, the ratio of stroke volume to pulse pressure was much more reduced in isolated systolic hypertension (48%) than in MMH (30%). In summary, the present study, carried out in a large sample of hypertensive subjects with a wide age range, showed a simultaneous impairment in vascular resistance and arterial compliance associated with aging in different patterns of hypertension. The magnitude of these changes, with opposite effects on DBP but additive effects on SBP, suggests that a hemodynamic mechanism could determine the transition in the prevalence of diastolic hypertension toward a systolic pattern of hypertension with aging. Also, the results suggest that SBP, but not DBP, is a reliable indicator of the underlying hemodynamic abnormalities (high resistance and low arterial compliance) in the elderly.

Adolescent↗
PubMed2000

Systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure as predictors of cardiovascular disease risk in Men.

We compared systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP) in predicting the risk of cardiovascular disease (CVD), stratifying results at age 60 years, when DBP decreases while SBP continues to increase. We prospectively followed 11 150 male physicians with no history of CVD or antihypertensive treatment through the 2-year questionnaire, after which follow-up began. Reported blood pressure was averaged from both the baseline and 2-year questionnaires. During a median follow-up of 10.8 years, there were 905 cases of incident CVD. For men aged <60 years (n=8743), those in the highest versus lowest quartiles of average SBP (>/=130 versus <116 mm Hg), DBP (>/=81 versus <73 mm Hg), and MAP (>/=97 versus <88 mm Hg) had relative risks (RRs) of CVD of 2.16, 2.23, and 2.52, respectively. Models with average MAP and PP did not add information compared with models with MAP alone (P>0.05). For men aged >/=60 years (n=2407), those in the highest versus lowest quartiles of average SBP (>/=135 versus <120 mm Hg), PP (>/=55 versus <44 mm Hg), and MAP (>/=99 versus <91 mm Hg) had RRs of CVD of 1.69, 1.83, and 1.43, respectively. The addition of other blood pressure measures did not add information compared with average SBP or PP alone (all P>0.05). These data suggest that average SBP, DBP, and MAP strongly predict CVD among younger men, whereas either average SBP or PP predicts CVD among older men. More research should distinguish whether MAP, highly correlated with SBP and DBP, better predicts CVD.

Adult↗
PubMedDate not supplied

Blood pressure, heart rate, and plasma catecholamines in normal and hypertensive children and their siblings at rest and after standing.

Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), plasma norepinephrine (NE), and epinephrine (E) levels at rest and in response to orthostatic stress of quiet standing were compared in 19 subjects with borderline hypertension (BH) (SBP-135 mm Hg, DBP-80 mm Hg), nine with significant hypertension (SH) (SBP-150 mm Hg, DBP-95 mm Hg), 14 normotensive siblings (NS) of hypertensives (SBP-113 mm Hg, DBP-64 mm Hg), and 21 age-matched normotensive controls (NC) (SBP-116 mm Hg, DBP-61 mm Hg). Group resting plasma NE levels were significantly higher in BH (454 pg/ml, p less than 0.001 pg/ml) and SH (384 pg/ml, p less than 0.01 pg/ml) than in NC (281 pg/ml) or NS (309 pg/ml), and more than 2 SD above the NC mean value in 50% of BH, 28% of SH, and 7% of NS. Plasma E levels were similar. On standing, mean arterial pressure (MAP) rose 13.7 mm Hg in NC, 3.9 mm Hg in BH, and 2.8 mm Hg in NS, and fell 7.3 mm Hg in SH. These differences reflect the frequent occurrence of hypotensive responses in study group subjects, which were not observed in NC. The mean rise in plasma NE with standing was blunted in hypertensives, increasing 40% to 50% compared with 95% in NC. In BH and NS, SBP was positively correlated with plasma NE levels at rest and with standing. These observations offer support for the hypothesis that altered adrenergic sympathetic nervous system (SNS) activity is present in a subgroup of young hypertensives and can be a contributing factor to their hypertension. Findings of similar SNS activity in some normotensive siblings suggest that genetic factors might be involved.

Adolescent↗
PubMedDate not supplied

Low-dose captopril for the treatment of mild to moderate hypertension.

Short-term results of this double-blind control trial (previously reported) in patients with initial diastolic blood pressures (DBP) in the range of 92-109 mm Hg indicated that doses of 12.5 or 25 mg captopril (C) three times daily (t.i.d.) and 37.5 mg twice daily (b.i.d.) had similar antihypertensive effectiveness as 50 mg t.i.d. After 7 weeks of C, the addition of hydrochlorothiazide (H) to two-thirds of the patients enhanced the antihypertensive response. This report presents the results of unchanged and uninterrupted treatment for 9.5 months in 46 patients taking C alone, and for 7.8 months in 94 patients taking C plus H or H alone. With C alone, reductions in DBP averaged 8.3, 11.0, 15.1, and 17.5 mm Hg with the 12.5, 25, 37.5, and 50 mg doses respectively. The response to the 12.5 mg dose only was significantly less than the 50 mg dose. With H alone, the reduction in DBP averaged 10.6 mm Hg and with C plus H reductions averaged 15.6, 18.1, 16.8, and 18.7 mm Hg with the 12.5, 25, 37.5, and 50 mg doses of C, respectively. Reductions in DBP with C plus H regimens were significantly different from H alone. There was no waning of effectiveness from short to long term except for the 12.5 mg dose of C alone. During the long-term phase, two patients developed rash and one lost the sense of taste. Neutropenia in one patient probably was not drug-related. There were no terminations for elevated DBP greater than 104 mm Hg on two successive visits.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMedDate not supplied

Orthostatic hypertension. Pathogenetic studies.

Among 1800 referred hypertensive patients, 181 had recumbent diastolic blood pressures (DBP) below 90 mm Hg and standing DBP above 90 mm Hg. Orthostatic increments in DBP were greater in these orthostatic hypertensive patients than in 181 persistently hypertensive patients and 134 normotensive subjects. In 12 patients with orthostatic hypertension, the orthostatic fall in cardiac output (27.3 +/- 2.9%, measured by a respiratory method) was double that in 8 normotensive subjects (13.3 +/- 3.7%, p less than 0.01). An inflated pressure suit over the pelvis and lower limbs prevented the excessive fall in cardiac output and significantly reduced (p less than 0.02) the excessive rise in standing DBP in orthostatic hypertensive patients. Gravitational pooling of blood in the legs and reduction of blood in the head was measured by external gamma counting of autologous erythrocytes labeled with sodium pertechnetate Tc 99m through ports in fixed positions over the leg and the temple. Orthostatic intravascular pooling was significantly greater (p less than 0.01) in orthostatic hypertensive subjects than in normotensive subjects, and the magnitudes of orthostatic pooling and orthostatic increases in DBP were closely correlated (r = +0.85). Plasma norepinephrine concentrations were similar in recumbency and after sustained handgrip exercise, but significantly greater (p less than 0.01) after 5 to 60 mins of standing in orthostatic hypertensive subjects than in normotensive subjects. Our results indicate that orthostatic hypertension is common and that its mechanism in representative patients involves excessive orthostatic blood pooling, which results in decreased venous return, decreased cardiac output, increased sympathetic stimulation (presumably through low-pressure cardiopulmonary receptors), and excessive arteriolar, but not venular, constriction.

Adolescent↗
PubMed2005

Characteristics of blood pressure profiles as predictors of long-term outcome after acute ischemic stroke.

BACKGROUND AND PURPOSE: Most patients have elevated blood pressure (BP) in the early phase after an acute ischemic stroke. Mechanism and effects of this BP elevation are not well understood. The benefits of intervention by lowering the initial BP or waiting for spontaneous return to normal values remain debated. We studied the hypothesis that increased BP level and profile variability will adversely affect long-term outcome after stroke with and without thrombolytic treatment. METHODS: We studied the 615 patients with acute ischemic hemispheric stroke in the first European Cooperative Acute Stroke Study (ECASS). BP was measured at 2-hour intervals during the first 20 hours after randomization, and then every 4 hours, up to 72 hours after admission. Studied features of individual 0- to 72-hour BP profiles were: baseline BP, maximum and minimum BP, mean level, and successive variation in the BP profile. The end point was good functional recovery (modified Rankin Scale [mRS] score of 0 to 1) at 90 days. Logistic regression was used to adjust for known prognostic factors, demographic, initial stroke severity, disease and medication histories, and computed tomography signs. RESULTS: Higher systolic BP or diastolic BP at baseline were associated with favorable outcome assessed on modified mRS at 90 days (adjusted odds ratio [OR], 1.22; 95% CI, 1.01 to 1.49; and OR, 1.22; 95% CI, 1.01 to 1.49 per 10 mm Hg), lower within-patient 0- to 72-hour average systolic BP (SBP), or DBP implied favorable outcome (OR, 0.74; 95% CI, 0.61 to 0.90; and OR, 0.61; 95% CI, 0.41 to 0.90 per 10 mm Hg). Reduced variability of 0- to 72-hour DBP profile was an independent predictor of favorable outcome (OR, 0.58; 95% CI, 0.39 to 0.85 per 5 mm Hg). CONCLUSIONS: Higher baseline SBP or DBP was associated with favorable outcome after stroke. Other characteristics of first 72-hour BP profiles: lower mean level of SBP or DBP and reduced successive variability of DBP profile were independent predictors of favorable outcome at 90 days.

Aged↗
PubMed2025

Associations Between Polygenic Risk Score for Blood Pressure and Risk of Hypertension in Northeast Asian Individuals.

BACKGROUND: Data on associations between genetic predisposition to high blood pressure (BP) and hypertension and its complications in non-European populations are limited. The current study investigated associations between polygenic risk scores (PRSs) for BP and risks of hypertension, cardiovascular disease, and chronic kidney disease in Northeast Asian populations. METHODS: A genome-wide association study of systolic BP (SBP) and diastolic BP (DBP) was conducted using data from the KoGES (Korean Genome and Epidemiology Study). Results were meta-analyzed using summary statistics from Biobank Japan to construct PRSs. RESULTS: Compared with a PRS in the lowest 5 percentiles, a PRS in the highest 5 percentiles was associated with an increased risk of hypertension (hazard ratio [HR], 2.44 [95% CI, 1.67-3.56] for PRS for SBP; and HR, 1.77 [95% CI, 1.20-2.62] for PRS for DBP) and earlier onset of hypertension (by a median of 8.5&#x2009;years for PRS for SBP and 8.0&#x2009;years for PRS for DBP). These associations remained significant when continuous PRS was analyzed. The genetic risk of hypertension incidence was attenuated by moderate to vigorous physical activity. Adding the PRS for BP to the clinical risk factors improved the predictive value for hypertension (both area under the curve values, 0.787&#xa0;[95% CI, 0.771-0.803]; P=0.063 for PRS for SBP and [95% CI, 0.771-0.804]; P=0.031 for PRS for DBP). However, neither PRS for SBP nor PRS for DBP was associated with the incidence of cardiovascular or chronic kidney disease. CONCLUSIONS: The PRS for BP was associated with a higher risk of incident hypertension and earlier-onset hypertension in a Northeast Asian population. PRS may facilitate early identification and targeted management of individuals at high risk of developing hypertension.

Adult↗
PubMed1999

Inappropriate sympathetic activation at onset of septic shock: a spectral analysis approach.

The autonomic cardiovascular control was investigated in 10 patients with septic shock, 10 patients with sepsis syndrome, and six tilted healthy subjects. Overall variability, high- and low-frequency components (AUC, HF, and LF, beats/min(2)/Hz or mm Hg(2)/Hz) from heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressures spectra were obtained from 5-min recordings. LF(HR)/HF(HR) and the square root of LF(SBP)/LF(HR) (alpha) were used as indices of sympathovagal interaction and baroreflex control of the heart, respectively. Compared with tilted control subjects and patients with sepsis syndrome, septic shock is characterized by reduction in: (1) HR variability, i.e., decreased AUC(HR) (p = 0.007), LF(HR) (p = 0.002), and LF(HR)/HF(HR) (p = 0.0002); (2) DBP variability, i.e., decreased AUC(DBP) (p = 0.003) and LF(DBP) (p = 0.001), (3) alpha (p = 0.003). In septic shock, LF(HR)/HF(HR), alpha, and LF(DBP) correlated with mean blood pressure (r = 0.67, p = 0.04, r = 0.64, p = 0.03, and r = 0.88, p = 0.0008, respectively), and with plasma norepinephrine levels (r = -0.65, p = 0.03, r = -0.79, p = 0.006, and r = -0.69, p = 0.03, respectively). In conclusion, onset of septic shock is characterized by high concentrations of circulating catecholamines but impaired sympathetic modulation on heart and vessels, suggesting that central autonomic regulatory impairment contributes to circulatory failure.

Adult↗
PubMed1986

Role of plasma gelsolin and the vitamin D-binding protein in clearing actin from the circulation.

We determined the plasma kinetics of both actin and complexes of actin with the two high affinity actin-binding proteins of plasma, gelsolin, and vitamin D-binding protein (DBP). Actin is cleared rapidly from the plasma by the liver (half-disappearance time, 0.5 h). Using radiolabeled actin-binding proteins, we found that actin accelerated the clearance of both plasma gelsolin and the vitamin D-binding protein. In separate experiments we found that DBP-actin complexes were cleared more quickly than gelsolin-actin complexes, at a rate comparable to the clearance of actin from the blood. A low affinity interaction (dissociation constant, 2.9 X 10(-4) M) between actin and fibronectin was found, suggesting that little actin will bind to fibronectin in plasma. We conclude that while plasma gelsolin and DBP may both clear actin from the circulation, DBP appears to play a more important role. By so doing, DBP may conserve the filament-severing activity of plasma gelsolin.

Actins↗
PubMed1991

Single-dose sublingual nifedipine as the only treatment in hypertensive urgencies and emergencies.

One hundred and eighteen patients with hypertensive urgencies and emergencies and diastolic blood pressure (DBP) at least 120 mm Hg by the cuff method were seen at the Emergency Care Department; none had received calcium channel blockers during the previous twelve hours. Patients with DBP of 120 to 139 mm Hg received 10 mg of sublingual nifedipine; patients with left ventricular hypertrophy or failure, renal disease, hypertensive encephalopathy, angina, papilledema, or a DBP over 140 mm Hg received 20 mg of the drug. The criterion for control was the achievement of a DBP of 100 mm Hg or less within sixty minutes of receiving sublingual nifedipine and maintenance of the effect until discharge. Control was achieved in all patients; a sixty-three-year-old man died of a brain hemorrhage after pulmonary edema and a DBP of 210 had been controlled; the other 117 were discharged to their attending physicians, either as outpatients or to a hospital ward. No patient developed hypotension, clinical or electrocardiographic signs of myocardial ischemia, or clinical signs of neurologic dysfunction. Practical, fast, safe, and dependable control of hypertensive urgencies and emergencies has made sublingual nifedipine the treatment of choice of such patients in the Emergency Care Department.

Administration, Sublingual↗
PubMed1996

Ambulatory-determined 24-hour blood pressure in mild hypertensives and in normotensives.

Noninvasive ambulatory twenty-four-hour blood pressure (BP) monitoring was carried out in 30 normotensive subjects (16 women, 14 men), aged twenty-five to sixty years (mean thirty-eight) and in 29 mild essential hypertensive patients without target organ damage (14 women, 15 men), aged twenty-three to sixty-one years (mean thirty-nine). Hypertensive patients were not treated, and they discontinued any antihypertensive treatment at least four weeks before the study. During the daytime period (6 AM-10 PM) BP was monitored every fifteen minutes, and during the night (10 PM-6 AM), every thirty minutes. Obviously, mean twenty-four-hour systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in hypertensive patients (P < 0.001). There was a persistent correlation in the group of mild hypertensives between successive BP hourly mean readings (r ranged from 0.61 to 0.93 for SBP and from 0.45 to 0.82 for DBP). In normotensive subjects these correlations failed in particular periods: 8 AM-9 AM, r = 0.30 for SBP and 0.45 for DBP; 1 PM-3 PM, r = 0.17-0.49 for SBP and 0.28-0.37 for DBP; 9 PM to midnight, r = 0.21-0.57 for SBP and 0.23-0.38 for DBP.

Adult↗
PubMed1997

Cardiovascular response to cognitive stress in subjects with menstrually related disorders.

We measured reactivity to a stress paradigm during the premenstrual period in 19 women affected by Menstrually Related Disorders (MRD) and in 11 normal controls. Eight had premenstrual syndrome diagnosed by the Menstrual Distress Questionnaire and 11 suffered menstrual migraine, diagnosed according to International Headache Society criteria. Subjects were observed during two menstrual cycles and submitted to a psychocognitive test (Stroop Color Word) during the luteal phase. In both groups the stimulation by Stroop C-W was present for systolic blood pressure (SBP) (F = 18.14, p = 0.000), diastolic blood pressure (DBP) (F = 9.56, p = 0.000), and heart rate (F = 12.80, p = 0.000). Moreover, an interaction of response by group was present for DBP (2.58, p = 0.04); DBP values were higher in MRD subjects. Also baseline DBP values were higher in MRD with respect to controls. Area under the curve (AUC) subtracted from baseline for the SBP, DBP and heart rate did not differ between groups. In conclusion, MRD subjects facing a cognitive stress had normal cardiovascular response. However, patients had increased arousal of cardiovascular measures before and after testing. The significant differences during stress of testing were dissociated from those of experimental stress stimulation. MRD subjects may have less ability to cope with novelty than healthy volunteers.

Adult↗