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1.
Effects of intraduodenal administration of the artificial sweetener sucralose on blood pressure and superior mesenteric artery blood flow in healthy older subjects.
Pham, HT, Stevens, JE, Rigda, RS, Phillips, LK, Wu, T, Hausken, T, Soenen, S, Visvanathan, R, Rayner, CK, Horowitz, M, et al
The American journal of clinical nutrition. 2018;(1):156-162
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Abstract
BACKGROUND Postprandial hypotension (PPH) occurs frequently, particularly in older people and those with type 2 diabetes, and is associated with increased morbidity and mortality. The magnitude of the decrease in blood pressure (BP) induced by carbohydrate, fat, and protein appears to be comparable and results from the interaction of macronutrients with the small intestine, including an observed stimulation of mesenteric blood flow. It is not known whether artificial sweeteners, such as sucralose, which are widely used, affect BP. OBJECTIVE The aim of this study was to evaluate the effects of intraduodenal sucralose on BP and superior mesenteric artery (SMA) blood flow, compared with intraduodenal glucose and saline (control), in healthy older subjects. DESIGN Twelve healthy subjects (6 men, 6 women; aged 66-79 y) were studied on 3 separate occasions in a randomized, double-blind, crossover design. After an overnight fast, subjects had concurrent measurements of BP and heart rate (HR; automated device), SMA blood flow (Doppler ultrasound), and blood glucose (glucometer) during intraduodenal infusion of 1) glucose (25% wt:vol, ∼1400 mOsmol/L), 2) sucralose (4 mmol/L, ∼300 mOsmol/L), or 3) saline (0.9% wt:vol, ∼300 mOsmol/L) at a rate of 3 mL/min for 60 min followed by intraduodenal saline for a further 60 min. RESULTS There was a decrease in mean arterial BP (P < 0.001) during intraduodenal glucose [baseline (mean ± SEM): 91.7 ± 2.6 mm Hg compared with t = 60 min: 85.9 ± 2.8 mm Hg] but not during intraduodenal saline or intraduodenal sucralose. The HR (P < 0.0001) and SMA blood flow (P < 0.0001) also increased during intraduodenal glucose but not during intraduodenal saline or intraduodenal sucralose. As expected, blood glucose concentrations increased in response to glucose (P < 0.0001) but not saline or sucralose. CONCLUSIONS In healthy older subjects, intraduodenal administration of the artificial sweetener sucralose was not associated with changes in BP or SMA blood flow. Further studies are therefore warranted to determine the potential role for artificial sweeteners as a therapy for PPH. This trial was registered at http://www.ANZCTR.org.au as ACTRN12617001249347.
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Acute effects of salt on blood pressure are mediated by serum osmolality.
Kanbay, M, Aslan, G, Afsar, B, Dagel, T, Siriopol, D, Kuwabara, M, Incir, S, Camkiran, V, Rodriguez-Iturbe, B, Lanaspa, MA, et al
Journal of clinical hypertension (Greenwich, Conn.). 2018;(10):1447-1454
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Abstract
It is classically thought that it is the amount of salt that is critical for driving acute blood pressure responses. However, recent studies suggest that blood pressure responses, at least acutely, may relate to changes in serum osmolality. Here, we test the hypothesis that acute blood pressure responses to salt can be altered by concomitant water loading. Ten healthy patients free of any disease and medication underwent 4 interventions each a week apart in which they took 300 mL of lentil soup with no salt (visit 1), lentil soup with 3 g salt (visit 2), or lentil soup with 3 g salt and 500 mL water (visit 3) or 750 mL water (visit 4). At each visit, hourly blood measurements and blood pressure measurements (baseline, 1st, 2nd, 3rd, and 4th hour) were performed and plasma osmolarity, sodium and copeptin levels were measured. Patients receiving the 3 g salt showed a 6 mOsm/L change in osmolality with a 2.5 mmol/L change in plasma sodium and 10 mm Hg rise in systolic blood pressure at 2 hours. When the same patients drank salty soup with water, the changes in plasma osmolarity, plasma sodium, and blood pressure were prevented. The ability to raise blood pressure acutely with salt appears dependent on changes in plasma osmolality rather than the amount of salt. Our findings suggest that concurrent intake of water must be considered when evaluating the role of salt in blood pressure.
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Low Diastolic Blood Pressure Is Associated With Angina in Patients With Chronic Coronary Artery Disease.
Peri-Okonny, PA, Patel, KK, Jones, PG, Breeding, T, Gosch, KL, Spertus, JA, Arnold, SV
Journal of the American College of Cardiology. 2018;(11):1227-1232
Abstract
BACKGROUND In patients with coronary artery disease (CAD), low diastolic blood pressure (DBP) is associated with increased risk of myocardial infarction, but its association with angina is unknown. OBJECTIVES The goal of this study was to examine the association of low DBP and angina in patients with CAD. METHODS The study assessed the frequency of angina (measured by using the Seattle Angina Questionnaire-Angina Frequency score) according to DBP in patients with known CAD from 25 U.S. cardiology clinics. Hierarchical logistic regression was used to test the association between DBP and angina, with a spline term for DBP to assess nonlinearity. RESULTS Among 1,259 outpatients with CAD, 411 (33%) reported angina in the prior month, with higher rates in the lowest DBP quartile (40 to 64 mm Hg: 37%). In the unadjusted model, DBP was associated with angina with a J-shaped relationship (p = 0.017, p for nonlinearity = 0.027), with a progressive increase in odds of angina as DBP decreased below ∼70 to 80 mm Hg. This association remained significant after sequential adjustment for demographic characteristics (p = 0.002), comorbidities (p = 0.002), heart rate (p = 0.002), systolic blood pressure (p = 0.046), and antihypertensive antianginal medications (p = 0.045). CONCLUSIONS In patients with chronic CAD, there seemed to be an association between lower DBP and increased odds of angina. If validated, these findings suggest that clinicians should consider less aggressive blood pressure control in patients with CAD and angina.
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Global association between ambient air pollution and blood pressure: A systematic review and meta-analysis.
Yang, BY, Qian, Z, Howard, SW, Vaughn, MG, Fan, SJ, Liu, KK, Dong, GH
Environmental pollution (Barking, Essex : 1987). 2018;:576-588
Abstract
Although numerous studies have investigated the association of ambient air pollution with hypertension and blood pressure (BP), the results were inconsistent. We performed a comprehensive systematic review and meta-analysis of these studies. Seven international and Chinese databases were searched for studies examining the associations of particulate (diameter<2.5 μm (PM2.5), 2.5-10 μm (PM2.5-10) or >10 μm (PM10)) and gaseous (sulfur dioxide (SO2), nitrogen dioxide (NO2), nitrogen oxides (NOx), ozone (O3), carbon monoxide (CO)) air pollutants with hypertension or BP. Odds ratios (OR), regression coefficients (β) and their 95% confidence intervals were calculated to evaluate the strength of the associations. Subgroup analysis, sensitivity analysis, and meta-regression analysis were also conducted. The overall meta-analysis showed significant associations of long-term exposures to PM2.5 with hypertension (OR = 1.05), and of PM10, PM2.5, and NO2 with DBP (β values: 0.47-0.86 mmHg). In addition, short-term exposures to four (PM10, PM2.5, SO2, NO2), two (PM2.5 and SO2), and four air pollutants (PM10, PM2.5, SO2, and NO2), were significantly associated with hypertension (ORs: 1.05-1.10), SBP (β values: 0.53-0.75 mmHg) and DBP (β values: 0.15-0.64 mmHg), respectively. Stratified analyses showed a generally stronger relationship among studies of men, Asians, North Americans, and areas with higher air pollutant levels. In conclusion, our study indicates a positive association between ambient air pollution and increased BP and hypertension. Geographical and socio-demographic factors may modify the pro-hypertensive effects of air pollutants.
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Dietary Modifications and Lipid Accumulation Product Are Associated with Systolic and Diastolic Blood Pressures in the Women's Health Trial: Feasibility Study in Minority Populations.
Bhargava, A
Current hypertension reports. 2018;(6):50
Abstract
PURPOSE OF REVIEW Approximately 65% of adults over 60 years in the USA are hypertensive. Poor dietary habits and sedentary lifestyles are fueling the hypertension epidemic. The effects of higher intakes of fruits and vegetables and whole-grain products on systolic and diastolic blood pressures were analyzed using data at baseline, 6 months, and 12 months on 349 and 573 subjects, respectively, in the control and intervention groups of the Women's Health Trial: Feasibility Study in Minority Populations. RECENT FINDINGS Models for systolic and diastolic blood pressures have been estimated using cross-sectional and longitudinal data in different settings. However, it is important to estimate comprehensive dynamic random effects models that take into account inter-relationships between systolic and diastolic blood pressures as well as the effects of dietary intakes and biomarkers for making robust inferences. There were significantly greater reductions (P < 0.05) between baseline and 12 months in systolic and diastolic blood pressures in the intervention group. Second, ratios of α-tocopherol to energy intakes were negatively and significantly associated with systolic and diastolic blood pressures in the intervention group. Third, the lipid accumulation product was positively associated with systolic and diastolic blood pressures in the control and intervention groups. The estimated coefficients of diastolic and systolic blood pressure variables in the respective models for systolic and diastolic blood pressures showed that combining the two measures as pulse pressure can lead to misleading inferences. Overall, dietary interventions promoting higher consumption of fruits and vegetables and whole-grain products can help lower blood pressures of women in the USA.
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Twenty-four-hour systolic blood pressure variability and renal function decline in elderly male hypertensive patients with well-controlled blood pressure.
Wang, X, Wang, F, Chen, M, Wang, X, Zheng, J, Qin, A
Clinical interventions in aging. 2018;:533-540
Abstract
PURPOSE Increased variability in blood pressure (BP) is known to be closely associated with the development, progression and severity of renal damage in patients with chronic kidney disease. However, little is known about the association of BP variability (BPV) with the decline of renal function in elderly hypertensive patients with well-controlled BP. We, therefore, aimed to investigate the association between BPV and glomerular filtration rate in hypertensive elderly (age >60 years) and very elderly (age >80 years) male patients with BP controlled within the normal range by antihypertensive therapy. PATIENTS AND METHODS This study involved 484 hospitalized elderly male hypertensive patients with BP controlled within the normal range by antihypertensive therapy. BPV was defined as the SD from mean BP over a 24 h period. Renal function was estimated by estimated glomerular filtration rate (eGFR) which was calculated by the Chinese modified Modification of Diet in Renal Disease Equation. Participants were divided into three groups according to their eGFR data. Multivariate linear regression was then used to analyze the correlation between eGFR and BPV. RESULTS The 24 h systolic BP (SBP) variability increased as eGFR decreased. There was no significant difference in 24 h SBP variability when compared between elderly and very elderly hypertensive patients. Multivariate linear regression analysis showed that SBP variability demonstrated a negative linear relationship with eGFR (P<0.05) after adjustment for potential confounding factors. CONCLUSION Among the parameters of 24 h ambulatory BP monitoring, 24 h SBP variability is the only independent risk factor for a decline in renal function in elderly and very elderly male hypertensive patients with well-controlled BP.
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Orthostatic Hypotension in the Hypertensive Patient.
Biaggioni, I
American journal of hypertension. 2018;(12):1255-1259
Abstract
Orthostatic hypotension (OH) is an important and common medical problem, particularly in the frail elderly with multiple comorbidities and polypharmacy. OH is an independent risk factor for falls and overall mortality. Hypertension is among the most common comorbidities associated with OH, and its presence complicates the management of these patients because treatment of one can worsen the other. However, there is evidence that uncontrolled hypertension worsens OH so that both should be managed. The limited data available suggest that angiotensin receptor blockers and calcium channel blockers are preferable antihypertensives for these patients. Patients with isolated supine hypertension can be treated with bedtime doses of short-acting antihypertensives. Treatment of OH in the hypertensive patients should focus foremost on the removal of drugs that can worsen OH, including ones that are easily overlooked, such as tamsulosin, tizanidine, sildenafil, trazodone, and carvedilol. OH and postprandial hypotension can be prevented with abdominal binders and acarbose, respectively, without the need to increase baseline blood pressure. Upright blood pressure can be improved by harnessing residual sympathetic tone with atomoxetine, which blocks norepinephrine reuptake in nerve terminals, and pyridostigmine, which facilitates cholinergic neurotransmission in autonomic ganglia. Oral water bolus acutely but transiently increases blood pressure in autonomic failure patients. If traditional pressor agents are needed, midodrine and droxidopa can be used, administered at the lowest dose and frequency that improves symptoms. Management of OH in the hypertensive patient is challenging, but a management strategy based on understanding the underlying pathophysiology can be effective in most patients.
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Beneficial Effects of High Potassium: Contribution of Renal Basolateral K+ Channels.
Staruschenko, A
Hypertension (Dallas, Tex. : 1979). 2018;(6):1015-1022
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Effects of salt substitute on home blood pressure differs according to age and degree of blood pressure in hypertensive patients and their families.
Hu, J, Zhao, L, Thompson, B, Zhang, Y, Wu, Y
Clinical and experimental hypertension (New York, N.Y. : 1993). 2018;(7):664-672
Abstract
BACKGROUND It is known that home blood pressure (HBP) is a more reliable assessment of hypertension treatments than clinical blood pressure (BP). Despite this, HBP response to a salt substitute has only been evaluated by one study which, did not look at the salt substitute's effect on family members and did not analyze by age, gender, or BP degree. The aim of this current study was to assess the effects of a low-sodium and high-potassium salt substitute on HBP among hypertensive patients and their family members. METHODS A total of 220 households (including 220 hypertensive patients and 380 their families) were randomly assigned to the regular salt or salt substitute groups. HBP was measured at the beginning, 3rd, 6th, and 12th months. Among the patients (n = 220), only home systolic blood pressure (HSBP) was significantly reduced, by an adjusted baseline BP of 4.2 mm Hg (95% CI: 1.3-7.0 mm Hg), in the salt substitute group compared with those in the regular salt group at each visit (all P < 0.05). There were no detectable differences between groups for home diastolic blood pressure (HDBP) at any visit. Among the family members, HSBP and HDBP were not significantly different between the groups. Furthermore, Individuals ≥60 years old, hypertensive patients with stage-2 hypertension, family members with hypertension, and women experienced greater HSBP reduction. CONCLUSIONS Older subjects, those with higher blood pressure, and women experienced greater home blood pressure reduction from the salt substitute compared to regular salt.
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Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults.
Martens, CR, Denman, BA, Mazzo, MR, Armstrong, ML, Reisdorph, N, McQueen, MB, Chonchol, M, Seals, DR
Nature communications. 2018;(1):1286
Abstract
Nicotinamide adenine dinucleotide (NAD+) has emerged as a critical co-substrate for enzymes involved in the beneficial effects of regular calorie restriction on healthspan. As such, the use of NAD+ precursors to augment NAD+ bioavailability has been proposed as a strategy for improving cardiovascular and other physiological functions with aging in humans. Here we provide the evidence in a 2 × 6-week randomized, double-blind, placebo-controlled, crossover clinical trial that chronic supplementation with the NAD+ precursor vitamin, nicotinamide riboside (NR), is well tolerated and effectively stimulates NAD+ metabolism in healthy middle-aged and older adults. Our results also provide initial insight into the effects of chronic NR supplementation on physiological function in humans, and suggest that, in particular, future clinical trials should further assess the potential benefits of NR for reducing blood pressure and arterial stiffness in this group.