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Obesity Increases Blood Pressure Variability during the Night.

Hong Ju AN ; Wan KIM ; Chung KANG ; Dong In NAM ; Il Hyung JUNG ; Hoon KANG ; Sang Sun LEE ; Ho Yeong SONG ; Sang Cheol CHO ; Won Yu KANG ; Sun Ho HWANG

Journal of the Korean Society of Hypertension.2014;20(1):1-7. doi:10.5646/jksh.2014.20.1.1

BACKGROUND: Previous studies have reported that obesity increases heart rate variability. Body mass index (BMI) has been reported to affect blood pressure variability (BPV) over 24 hours. However, the diurnal variation in the effect of BMI on BPV has not been evaluated. This study aimed to clarify the diurnal variation in the effect of BMI on BPV. METHODS: A total of 2,044 patients were consecutively enrolled in this study, and the data were analyzed retrospectively. All patients underwent 24-hour ambulatory blood pressure monitoring. We divided patients into two groups according to BMI (non-obese group: n = 1,145, BMI < 25; obese group: n = 899, BMI > or = 25). We compared BPV during daytime and nighttime between the non-obese and obese groups. We also evaluated the impact of BMI on BPV by multivariate regression analysis. RESULTS: On univariate regression analysis, there was no significant difference in BPV during daytime (systolic BP [SBP] variability: 20.7 vs. 21.7, p = 0.511; diastolic BP [DBP] variability: 16.8 vs. 17.5, p = 0.539). However, both SBP variability (13.8 vs. 17.6, p = 0.009) and DBP variability (11.7 vs. 14.3, p = 0.042) during nighttime were affected significantly by BMI. After adjusting other compounding variables (age > 60 years, current smoking habit, hypertension, diabetes mellitus, and use of calcium channel blockers and renin-angiotensin-aldosterone system blockers), multivariate analysis showed that BMI was an independent factor associated with increase in BPV during the night (SBP variability: p = 0.039; DBP variability: p = 0.034). CONCLUSIONS: Obesity increased BPV during nighttime.
Blood Pressure Monitoring, Ambulatory ; Blood Pressure* ; Body Mass Index ; Calcium Channel Blockers ; Diabetes Mellitus ; Heart Rate ; Humans ; Hypertension ; Multivariate Analysis ; Obesity* ; Renin-Angiotensin System ; Retrospective Studies ; Smoke ; Smoking

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Effects of Bosentan Treatment on Angiotensin Converting Enzyme in Monocrotaline Induced Pulmonary Hypertension Rats.

Sung Jin KIM ; Ji Hae CHA ; Hae Ryun LEE ; Young Mi HONG

Journal of the Korean Society of Hypertension.2011;17(1):28-36. doi:10.5646/jksh.2011.17.1.28

BACKGROUND: Pulmonary artery hypertension is characterized by persistent increase of vascular resistance, and is associated with right ventricle failure. We investigated changes of plasma renin, serum aldosterone, angiotensin converting enzyme (ACE) concentrations, ACE gene expressions and protein contents after bosentan treatment. METHODS: Six-week-old male Sprague-Dawley rats were divided into three groups: control (C) group, monocrotaline (M) group, and bosentan (B) group. Groups M and B were subcutaneously administered with 60 mg/kg of monocrotaline. In group B, 20 mg/kg/day of bosentan was administered by gavage twice a day. The rats were sacrificed after 1, 5, 7, 14, and 28 days. Changes of ACE gene expressions were analyzed by reverse transcription-polymerase chain reaction. Also, plasma renin, serum aldosterone, and ACE levels were measured. RESULTS: Serum aldosterone levels were significantly increased in group M compared with group C and significantly decreased after bosentan treatment on day 28. Serum ACE concentrations were significantly decreased compared with group M after bosentan treatment on day 28. Gene expressions of ACE were significantly increased in group M compared with group C on day 5 and significantly decreased after bosentan treatment on day 7 and 14. ACE protein contents significantly increased in group M compared with group C in week 2 and 4. It significantly decreased after bosentan treatment in week 2. CONCLUSIONS: The renin-angiotensin system is associated with pulmonary artery hypertension. To investigate the effects of bosentan on the renin-angiotensin system in pulmonary artery hypertension, further studies on the effects of bosentan according to different doses are required in the future.
Aldosterone ; Angiotensins ; Animals ; Gene Expression ; Heart Ventricles ; Humans ; Hypertension ; Hypertension, Pulmonary ; Male ; Monocrotaline ; Peptidyl-Dipeptidase A ; Plasma ; Pulmonary Artery ; Rats ; Rats, Sprague-Dawley ; Renin ; Renin-Angiotensin System ; Sulfonamides ; Vascular Resistance

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Effects of Angiotensin II and Shear Stress Interaction on Vascular Inflammation.

Sung Hyun CHOI ; Eun Hye PARK ; Yujin OH ; Sang Hong BAEK

Journal of the Korean Society of Hypertension.2011;17(1):17-27. doi:10.5646/jksh.2011.17.1.17

BACKGROUND: Angiotensin II (AngII) and abnormal oscillatory shear stress are highly associated with vascular inflammation including atherosclerosis. However, it is poorly understood how interactions between AngII and shear stress in human aortic endothelial cells (HAEC) are involved in mechanisms by which cellular adhesion molecules are expressed. The purpose of this study was to improve that understanding. METHODS: AngII (10(-7)M for 6 hr) and two-types of shear stress treatments were used: laminar shear stress (LS: unidirectional, 12 dynes/cm2) and oscillatory shear stress (OS: bi-directional, 5 dynes/cm2, 1 Hz) in HAEC. Immunoblotting was used to detect expression of cellular adhesion molecules markers such as vascular cell adhesion molecule 1 (VCAM1) and intercellular adhesion molecule 1 (ICAM1). RESULTS: AngII significantly increased VCAM1 and ICAM1 expression in HAEC that had been reduced due to pretreatment with telmisartan. AngII-LS co-stimulation and AngII-OS co-stimulation significantly increased VCAM1 and ICAM1 expression in HAEC. The expression levels of VCAM1 and ICAM1 were also, significantly reduced when pretreated with telmisartan. However, VCAM1 and ICAM1 expression were significantly reduced under LS and OS stimulation. CONCLUSIONS: Telmisartan may modulate the expressions of VCAM1 and ICAM1 via different types of shear stress in HAEC that are activated by AngII.
Angiotensin II ; Angiotensins ; Atherosclerosis ; Benzimidazoles ; Benzoates ; Endothelial Cells ; Humans ; Immunoblotting ; Inflammation ; Intercellular Adhesion Molecule-1 ; Vascular Cell Adhesion Molecule-1

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How Much Do We Lower the Blood Pressure in Hypertensive Patients with Diabetes?.

Dong Kyu JIN ; Seung Jin LEE

Journal of the Korean Society of Hypertension.2011;17(1):10-16. doi:10.5646/jksh.2011.17.1.10

Hypertension is an independent risk factor of atherosclerotic cardiovascular disease. Diabetes multiplies the risk when combined. Therefore, it is crucial for the doctors to control the blood pressure (BP) properly in hypertensive patients with diabetes. And then, how much do we lower the BP? Several guidelines recommend target BP levels to minimize the risk under the basis of so many experimental and observational studies. But, we must consider several factors to properly apply the guidelines in the clinical fields. First, diabetes is not a uniform but a diverse disease. From asymptomatic microvascular disease to macrovascular cardiovascular disease, diabetic clinical findings are so different. So we must define where the patients stand in long diabetic road, and what the patients want to us. Second, because more people are becoming health-conscious, more people take the aspirin, lipid-lowering agents and other medications. It's means that interpretation of the results of recent studies is more difficult than previous, old studies. Third, measuring the BP in the hospital is really reflect the ambulatory BP? Now, it's too early to conclude that the one is more better than the other. From the next study, we can consider the use of ambulatory, home BP monitoring combined with hospital BP measuring. Finally, although BP lowering-effects are similar, all anti-hypertensives do not have same effect in diabetic patients. For example, angiotensin converting enzyme-inhibitor is more superior than calcium channel blocker in patients with heart failure. So, we must consider what type of drug used in the study.
Angiotensins ; Antihypertensive Agents ; Aspirin ; Blood Pressure ; Calcium Channels ; Cardiovascular Diseases ; Heart Failure ; Humans ; Hypertension ; Risk Factors

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The Appropriate Interpretation of Recent Clinical Trials: How to Read RCT in the Era of Advertizing-based Medicine.

Iwao KUWAJIMA

Journal of the Korean Society of Hypertension.2011;17(1):1-9. doi:10.5646/jksh.2011.17.1.1

Although evidence-based medicine (EBM) has changed medical therapy from experience- or experiment-based medicine to the modern science-based medicine, nowadays it seems to be used as a tool of advertizing strategy of industries. Clinical trial is a fundamental component of EBM and it costs very much and are mostly conducted by the financial support of pharmaceutical industries at a tremendous expense. If anticipated results for the sponsor were not shown in the trial, a "spin" has been used to mislead readers as if positive results for test drugs or devices were obtained by emphasizing subgroup analysis, or searching favorable endpoint by post-hoc analysis. Clinical trials on angiotensin receptor blocker (ARB) are continuing succession of defeat all over world except two Japanese clinical trials, JIKEI HEART and KYOTO HEART studies. However, in both trials, subjective soft endpoints, such as angina pectoris or congestive heart failure were used despite of prospective randomized, open labeled, blinded endpoint design. In the era of advertizing-based medicine, It is important to read clinical trial data with critical view points.
Angina Pectoris ; Angiotensins ; Asian Continental Ancestry Group ; Drug Industry ; Evidence-Based Medicine ; Financial Support ; Heart ; Heart Failure ; Humans

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A Case of Renovascular Hypertension Controlled by Renal Autotransplantation.

Eunyoung LEE ; Youn Kyung KEE ; Jungyoen LEE ; In Mee HAN ; Jae Il SHIN ; Myoung Soo KIM ; Sungha PARK

Journal of the Korean Society of Hypertension.2013;19(2):63-69. doi:10.5646/jksh.2013.19.2.63

Renovascular hypertension caused by renal artery stenosis is an uncommon but curative cause of hypertension in children. We report a case of recurrent severe hypertension caused by renovascular hypertension. After recurrence of hypertension after redo percutaneous transluminal renal angioplasty, the blood pressure was finally controlled by renal autotransplantation. This case demonstrates the importance of considering renovascular hypertension as a cause of severe hypertension in children. Also, renal autotransplantation should be considered as a viable treatment option for treatment of renovascular hypertension that is recurrent after renal angioplasty.
Angioplasty ; Blood Pressure ; Child ; Humans ; Hypertension ; Hypertension, Renovascular* ; Recurrence ; Renal Artery ; Renal Artery Obstruction ; Transplantation*

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The Changes of Noninvasive Hemodynamic Parameters after Device-Guided Slow Breathing Exercise in Hypertensive Patients.

Jang Young KIM ; Byung Su YOO ; Seung Hwan LEE ; Junghan YOON ; Kyung Hoon CHOE

Journal of the Korean Society of Hypertension.2013;19(2):55-62. doi:10.5646/jksh.2013.19.2.55

BACKGROUND: The device-guided breathing (DGB) exercise is a non-pharmacological treatment of high blood pressure (BP). Changes in hemodynamic variables after DGB remain to be defined. This study evaluated the hemodynamic effects of DGB in hypertensive patients. METHODS: Fifty-nine hypertensive individuals (male, 56%; age, 44 +/- 10 years) with systolic BP (SBP) in the range of 140 to169 mm Hg and diastolic BP (DBP) < 105 mm Hg were divided into two group: control group (n = 17) vs. DGB group (n = 42) who slowed respiratory rate by using 15 minutes daily DBG (RESPeRATE) over 8 weeks. Heart rate, BP and hemodynamic parameters including cardiac index (CI), thoracic fluid content (TFC), systemic vascular resistance index (SVRI) and total arterial compliance index (TACI) were measured using the ICG Monitor (CardioDynamics) at baseline and study end. RESULTS: Baseline characteristics were not different between the two groups. Office BP (SBP/DBP) was reduced from baseline to end value by 13.2 +/- 11.1/6.9 +/- 7.5 mm Hg in DGB group and 2.2 +/- 6.9/0.5 +/- 6.6 mm Hg in control group (p = 0.001, p = 0.004, respectively). Heart rate, CI, stroke index, and TFC were not changed in both groups. However, the SVRI was lower and the TACI was higher in DGB group than control group (SVRI: 2,728 +/- 599 vs. 3,141 +/- 714 dyne sec m2/cm5, p = 0.002; TACI: 0.845 +/- 0.194 vs. 0.761 +/- 0.184 mm Hg/mL/m2, p = 0.041). CONCLUSIONS: Daily device-guided breathing exercise for 8 weeks lowers the BP mediated by reducing the systemic vascular resistance and increasing the total arterial compliance without changes in heart rate and CI.
Breathing Exercises ; Cardiography, Impedance ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Respiratory Rate ; Vascular Resistance

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Association of Blood Pressure and Heart Rate Response to Graded Exercise Test with Left Atrial Volume Index and Pulse Wave Velocity.

Jae Ho PARK ; Seon Ah JIN ; Young Dal LEE ; Seok Woo SEONG ; Hyeon Seok LEE ; Mi Joo KIM ; Kwang In PARK ; Jin Kyung OH ; Kye Taek AHN ; Soo Jin PARK ; Jun Hyung KIM ; Jae Hyeong PARK ; Jae Hwan LEE ; Si Wan CHOI ; In Whan SEONG ; Jin Ok JEONG

Journal of the Korean Society of Hypertension.2013;19(2):45-54. doi:10.5646/jksh.2013.19.2.45

BACKGROUND: Exaggerated blood pressure (BP) response to exercise can be an independent risk factor for cardiovascular mortality and morbidity. The purpose of this study was to define the factor that effect on early systolic BP response to exercise. METHODS: We examined echocardiographic data, BP, heart rate from graded exercise test and brachial ankle pulse wave velocity (PWV) of 205 patients (137 men and 68 women; mean age 58 +/- 11 years; range, 19 to 83 years). Graded exercise test was conducted in BRUCE protocol. We define delta systolic blood pressure (SBP) as systolic BRUCE stage "n" BP minus baseline BP. RESULTS: Resting BP (127 +/- 16 mm Hg) was elevated to 171 +/- 26 mm Hg after peak graded exercise test. Resting heart rate (80 +/- 15 bpm) was increased to 146 +/- 27 bpm after peak graded exercise test. Stepwise regression test between baseline SBP, delta SBP, maximal SBP and left atrial volume index (LAVI) was done. Supine SBP, delta SBP, maximal SBP was not associated with LAVI (p > 0.5). But increased LAVI was significantly associated with delta SBP1 in woman (R2 = 0.192, p = 0.002). PWV was significantly associated with base line (R2 = 0.311, p < 0.01) and maximal SBP (R2 = 0.051, p < 0.01). However, PWV was not associated with delta SBP. CONCLUSIONS: LAVI and PWV were not associated with early SBP response to exercise. But in women, elevation of early SBP during exercise is associated with LAVI.
Blood Pressure* ; Exercise Test* ; Female ; Heart Rate* ; Heart ; Humans ; Male ; Pulse Wave Analysis* ; Risk Factors

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Influences of Dry Weight Adjustment Based on Bioimpedance Analysis on Ambulatory Blood Pressure in Hemodialysis Patients.

Jung Ho SHIN ; Chae Rim KIM ; Moonki HONG ; Su Hyun KIM ; Suk Hee YU

Journal of the Korean Society of Hypertension.2012;18(4):166-175. doi:10.5646/jksh.2012.18.4.166

BACKGROUND: Hypertension is a common problem for hemodialysis patients and is associated with an increased cardiovascular mortality. We analyzed ambulatory blood pressure (ABP) in hemodialysis patients and investigated if an adjustment of dry weight can be used to control blood pressure. METHODS: ABP was measured for twenty-four hours after hemodialysis. A bioimpedance Analysis (BIA) was conducted. Patients were divided into two groups by the edema index. A normohydration (NH) group included patients with the edema index less than 0.40, and an overhydration (OH) group included patients with the edema index 0.40 or more. We accordingly adjusted the dry weight based on BIA results. RESULTS: Thirty-six patients were recruited, comprising twenty-two men and fourteen women. In regard to the ABP, 24-hour systolic and diastolic blood pressures were 140.2 +/- 19.7 mm Hg and 79.0 +/- 10.6 mm Hg, respectively. There was a significant association between 24-hour systolic blood pressure and the edema index (r = 0.501, p = 0.002). Twenty four-hour systolic blood pressure was significantly different between the NH and OH groups (median value, 132.0 vs. 150.5 mm Hg; p = 0.008). In OH group, after adjustment of the dry weight, the edema index was decreased from 0.411 +/- 0.009 to 0.389 +/- 0.047 and office systolic blood pressure was also decreased from 144.7 +/- 32.7 mm Hg to 125.3 +/- 15.4 mm Hg in OH group (p = 0.028 and p = 0.018, respectively). CONCLUSIONS: The edema index obtained by the bioimpedance analysis is significantly correlated with 24-hour systolic blood pressure in hemodialysis patients. Also, an adjustment of dry weight can be used to control blood pressure in hemodialysis patients.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Edema ; Female ; Humans ; Hypertension ; Male ; Renal Dialysis

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Determinants of Follow-up Changes of Brachial Ankle Pulse Wave Velocity in Korean Women.

Dae Young KIM ; Sung Yeol KONG ; Sung Ja LEE ; Ha Do SONG ; Eun Jin HAN ; Ji Hoon YANG ; Ji Yeon KIM ; Dong Hyun LEE ; Hyun Ho SHIN

Journal of the Korean Society of Hypertension.2012;18(4):154-165. doi:10.5646/jksh.2012.18.4.154

BACKGROUND: Pulse Wave Velocity (PWV) correlates well with arterial distensibility and stiffness and is a useful approach for evaluating the severity of systemic arteriosclerosis in adults. In addition, measurement of brachial-ankle PWV (baPWV) has been commonly reported as a simple, noninvasive, and practicable method. Arterial stiffness assessed by PWV could predict cardiovascular morbidity and mortality. In this study, we investigated the association between the changes of baPWV and cardiovascular risk factors in Korean women using data from follow-up evaluations. METHODS: The subjects were 626 women (age, 47.2 +/- 8.2) in whom we measured baPWV and cardiovascular risk factors at baseline and about one year later. Arterial stiffness was evaluated by baPWV and biological parameters were evaluated on the same day. We retrospectively analyzed the relationships between changes of baPWV and those other factors. All analyses were performed with SPSS ver. 20.0 and p-values < 0.05 were considered significant. RESULTS: In correlation analysis, changes of baPWV were affected by changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure, total cholesterol, high density lipoprotein-cholesterol, and low density lipoprotein-cholesterol. Multiple regression analysis of relationship between changes of baPWV and other associated variables shows that improvement of baPWV was significantly positively associated with changes of SBP and hemoglobin A1c (HbA1c), and worsening of baPWV was significantly negatively associated with changes of DBP, age, and SBP in sequence. CONCLUSIONS: In improvement of baPWV, decreases of SBP and HbA1c and in worsening of baPWV, increases of DBP, age, and SBP were significant factors in Korean women.
Adult ; Animals ; Ankle ; Arteriosclerosis ; Blood Pressure ; Cholesterol ; Female ; Follow-Up Studies ; Hemoglobins ; Humans ; Pulse Wave Analysis ; Retrospective Studies ; Risk Factors ; Vascular Stiffness

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