Hypertension self-control with a portable feedback unit or meditation-relaxation

Thirty borderline essential hypertensives were randomly assigned to a portable constant-cuff blood pressure feedback technique or meditation-relaxation. Each technique was taught in the laboratory, then practiced twice daily at home for four weeks. Subjects mailed daily records of their progress. Seven feedback and ten meditation-relaxation subjects completed the program. Both techniques produced significant systolic and diastolic reductions within practice sessions and diastolic reductions over weeks of training. Neither technique improved reductions nor reduced initial systolic pressure levels over the four weeks. Differences between biofeedback and meditation-relaxation in within-session pressure reductions were not significant.This study was supported by NIMH grant MH27214 to Joanne L. Hager, NIMH grant MH8880-2 to Elliot Mishler, and NIMH grant MH25104 to Richard S. Surwit. The authors are grateful to the Parke-Davis Instrument Co. who provided the instrumentation for this study.     

Chronopharmacology of Captopril plus Hydrochlorothiazide in Hypertension: Morning Versus Evening Dosing

Blood pressure follows a strong circadian rhythm in normotensive people and in patients with primary hypertension. This may have several implications for antihypertensive therapy, including the time of dosing. For this reason we studied the influence of different dosing times on the antihypertensive effect over 24 h using ambulatory blood pressure monitoring (ABPM). We studied 13 male patients with moderate hypertension with controlled blood pressure over 12 months under a fixed combination of captopril and hydrochlorothiazide. The dosage of the combination therapy was then halved and given as one evening and then as one morning dose, each for 3 weeks. The combination therapy given twice daily showed a good 24-h antihypertensive effect after 12 months of treatment. During the following 6 weeks the mean 24-h blood pressure did not increase under half dosage, irrespective of whether under evening or morning dosing. However, mean daytime values (systolic and diastolic) of ABPM were significantly higher with evening dosing when compared both with full dosage and with half dosage given in the morning. The mean arterial blood pressure over 24 h showed the same differences as systolic and diastolic blood pressure, whereas heart rate was not significantly different between the three therapeutic regimens. ABPM seems to be an ideal method for chronopharmacological investigations under everyday conditions. Our study demonstrated significant differences in daytime blood pressure but not in 24-h blood pressure between morning and evening dosing of a fixed antihypertensive combination therapy.     

Chronopharmacology of Captopril plus Hydrochlorothiazide in Hypertension: Morning Versus Evening Dosing

Blood pressure follows a strong circadian rhythm in normotensive people and in patients with primary hypertension. This may have several implications for antihypertensive therapy, including the time of dosing. For this reason we studied the influence of different dosing times on the antihypertensive effect over 24 h using ambulatory blood pressure monitoring (ABPM). We studied 13 male patients with moderate hypertension with controlled blood pressure over 12 months under a fixed combination of captopril and hydrochlorothiazide. The dosage of the combination therapy was then halved and given as one evening and then as one morning dose, each for 3 weeks. The combination therapy given twice daily showed a good 24-h antihypertensive effect after 12 months of treatment. During the following 6 weeks the mean 24-h blood pressure did not increase under half dosage, irrespective of whether under evening or morning dosing. However, mean daytime values (systolic and diastolic) of ABPM were significantly higher with evening dosing when compared both with full dosage and with half dosage given in the morning. The mean arterial blood pressure over 24 h showed the same differences as systolic and diastolic blood pressure, whereas heart rate was not significantly different between the three therapeutic regimens. ABPM seems to be an ideal method for chronopharmacological investigations under everyday conditions. Our study demonstrated significant differences in daytime blood pressure but not in 24-h blood pressure between morning and evening dosing of a fixed antihypertensive combination therapy.     

A Preliminary Clinical Study on an Antihypertensive Agent,Troxonium Tosylate

The effects of a new antihypertensive agent, troxonium tosylate, were studied in a group of 22 patients whose ages ranged from 48 to 88 years. Fourteen of these were classified as hypertensive because of a diastolic pressure over 95 mm. Hg. Eight were normotensive. This was a double-blind study. A dose of 600 mg. daily produced a significant fall in systolic and diastolic pressure relative to control levels in the hypertensives, while in the normotensives a dose of 600 mg. produced no significant effect. A dosage of 1000 mg. daily produced a significant fall in diastolic pressure from control levels in both these groups.Blood counts, urinalyses, blood urea nitrogen and cholesterol levels remained unchanged throughout the study, and no side effects were experienced by the patients.     

Blood pressure reduction in “borderline” hypertensives following physical training

One hundred and sixty-five middle-aged, apparently normal men were submitted to a six-month conditioning program. On the basis of a casual blood pressure measurement during the pre-training evaluation, 37 individuals (23%) were classified as “borderline” hypertensive. The remaining subjects (n = 128) were normotensive. At the conclusion of the program both groups exhibited significant reductions in systolic and diastolic blood pressures at rest and after submaximal work. Moreover, the reductions of the resting systolic and diastolic and of the exercise (300 kg.m./min.) systolic blood pressures were significantly greater for the hypertensives.     

Central Pressure Appraisal: Clinical Validation of a Subject-Specific Mathematical Model

IntroductionCurrent evidence suggests that aortic blood pressure has a superior prognostic value with respect to brachial pressure for cardiovascular events, but direct measurement is not feasible in daily clinical practice.AimThe aim of the present study is the clinical validation of a multiscale mathematical model for non-invasive appraisal of central blood pressure from subject-specific characteristics.MethodsA total of 51 young male were selected for the present study. Aortic systolic and diastolic pressure were estimated with a mathematical model and were compared to the most-used non-invasive validated technique (SphygmoCor device, AtCor Medical, Australia). SphygmoCor was calibrated through diastolic and systolic brachial pressure obtained with a sphygmomanometer, while model inputs consist of brachial pressure, height, weight, age, left-ventricular end-systolic and end-diastolic volumes, and data from a pulse wave velocity study.ResultsModel-estimated systolic and diastolic central blood pressures resulted to be significantly related to SphygmoCor-assessed central systolic (r = 0.65 p <0.0001) and diastolic (r = 0.84 p<0.0001) blood pressures. The model showed a significant overestimation of systolic pressure (+7.8 (-2.2;14) mmHg, p = 0.0003) and a significant underestimation of diastolic values (-3.2(-7.5;1.6), p = 0.004), which imply a significant overestimation of central pulse pressure. Interestingly, model prediction errors mirror the mean errors reported in large meta-analysis characterizing the use of the SphygmoCor when non-invasive calibration is performed.ConclusionIn conclusion, multi-scale mathematical model predictions result to be significantly related to SphygmoCor ones. Model-predicted systolic and diastolic aortic pressure resulted in difference of less than 10 mmHg in the 51% and 84% of the subjects, respectively, when compared with SphygmoCor-obtained pressures.     

Biofeedback of R-wave-to-pulse interval normalizes blood pressure

We investigated whether biofeedback of the R-wave-to-pulse interval, a measure related to the pulse wave velocity, enables participants with either high or low arterial blood pressure to modify their blood pressure. Twelve participants with high blood pressure (mean systolic blood pressure = 142.6 ± 13.5 mmHg; mean diastolic blood pressure = 99.9 ± 12.3 mmHg) and 10 participants with low blood pressure (mean systolic blood pressure = 104.8 ± 6.6 mmHg; mean diastolic blood pressure = 73.2 ± 4.2 mmHg) received 3 individual sessions of RPI biofeedback within a 2-week period. Participants with high blood pressure were rewarded for decreasing and participants with low blood pressure for increasing their blood pressure. Standard arm-cuff blood pressure measurements across the sessions served as dependent variables. Participants with high blood pressure achieved significant reductions of systolic (15.3 mmHg) and diastolic (17.8 mmHg) blood pressure levels from the beginning of the first to the end of the last training session. In contrast, participants with low blood pressure achieved significant increases in systolic (12.3 mmHg) and diastolic (8.4 mmHg) blood pressure levels. The degree of blood pressure changes in this study might be of clinical relevance. With prolonged and refined training regimens, even larger effects seem to be likely.     

Nifedipine and atenolol singly and combined for treatment of essential hypertension: comparative multicentre study in general practice in the United Kingdom

A randomised double blind parallel group study was performed to compare the efficacy and acceptability of slow release nifedipine (maximum dose 40 mg twice a day) with those of atenolol (maximum dose 100 mg once a day) as single agents for the treatment of essential hypertension. Of 410 patients recruited almost exclusively from general practices in 22 centres in the United Kingdom 210 received nifedipine and 200 atenolol. Both drugs significantly reduced blood pressure, and control—a reduction of the diastolic pressure to less than 95 mm Hg—was obtained in about 65% of patients. Those who received nifedipine had more pronounced reductions in systolic pressure than those who received atenolol. One hundred and forty nine patients who failed to respond adequately to either atenolol or nifedipine in low doses were given both drugs once daily for eight weeks in a fixed combination capsule that contained atenolol 50 mg and nifedipine 20 mg. All patients showed further reductions in blood pressure, although those who were taking β atenolol before the combination capsule had more pronounced reductions in systolic pressures. Twenty six patients (12%) were withdrawn because of adverse effects while taking nifedipine compared with 19 (10%) taking atenolol. Flushing and oedema were more common after the calcium antagonist, whereas diarrhoea and dyspepsia were more common after atenolol. The frequencies of headaches, dizziness, fatigue, and dyspnoea were equally distributed between the two groups. When the fixed combination capsule was taken side effects such as flushing and oedema continued.Nifedipine was more effective than atenolol in lowering systolic blood pressure, although neither drug used alone controlled the pressure of more than two thirds of the patients studied. When used in a fixed combination slightly better control of blood pressure was achieved with a lower dose of each drug.     

Effects of chronic insulin treatment on blood pressure in rats

There is an evident epidemiological association between plasma insulin levels and blood pressure. The mechanism that relates insulin to blood pressure and the role of insulin in the pathogenesis of arterial hypertension have not been clearly defined. The present study was designed to examine the effects of chronic hyperinsulinism on blood pressure and to determine different related morphological variables. WistarKyoto rats were subcutaneously injected with insulin (25 UI/Kg of weight) daily during the eight weeks of the experiment. Data were collected on systolic and diastolic arterial pressures and heart rate by plethysmography and direct recording (in the last week), and on morphological variables. A statistically significant elevation of systolic arterial pressure was produced after the sixth week of hyperinsulinaemia. At the end of the treatment, the systolic arterial pressure was 173.7 +/- 26.1 in the hyperinsulinaemic rats versus 153.09 +/- 21.7 in the control group. The values obtained by direct recording and by plethysmography did not differ. These results indicate that chronic hyperinsulinism produces a significant elevation in systolic blood pressure levels in the rats studied.     

Device-Guided Paced Respiration as an Adjunctive Therapy for Hypertension in Obstructive Sleep Apnea: A Pilot Feasibility Study

Data suggest that device-guided paced respiration (<10 breaths/min) may reduce blood pressure in hypertensive patients. We hypothesized that daily device-guided slow breathing may lower blood pressure in patients with hypertension and obstructive sleep apnea (OSA). In this one-arm pilot study, we enrolled 25 subjects with hypertension and OSA. Subjects were asked to perform device-guided paced respiration 30 min a day for 8 weeks. Our primary outcome was change in office systolic and diastolic blood pressures from baseline to 8 weeks. Twenty-four subjects completed the study. Mean baseline blood pressure was 140.0 ± 10.2 mmHg systolic and 82.7 ± 8.9 mmHg diastolic. Complete device data were available for 17 subjects. Mean device adherence was 81 ± 24% and 51% achieved a mean breath rate ≤10 breaths/min over 8 weeks. Three subjects had changes in their anti-hypertensive medications during the study. Among the remaining 21 subjects, mean difference in office blood pressure from baseline to 8 weeks was −9.6 ± 11.8 mmHg systolic (p ≤ 0.01) and −2.52 ± 8.9 mmHg diastolic (p = 0.21). Device-guided paced respiration may lower systolic blood pressure in patients with hypertension and OSA; however, our findings need to be confirmed with larger randomized controlled trials.     

Hypotensive effectiveness and metabolic effects of indapamide in patients with primary arterial hypertension

Indapamide--a non-thiazide diuretic agent--was given to 28 patients with mild and moderate hypertension in a daily dose of 2.5 mg for 12 weeks. Statistically significant decrease in both systolic and diastolic blood pressure and complete normalization of the arterial blood pressure were achieved in 82% of the treated patients. Adverse reactions were mild and transient. However, low but statistically significant decrease in blood serum potassium and changes in the carbohydrate metabolism were seen. No significant effect of the-drug on lipid metabolism was found except the low but statistically significant increase in total cholesterol. Indapamide is an efficient and well tolerated hypotensive agent. However, biochemical indices should be checked up during the treatment due to the potential adverse reactions.     

Maintenance of relaxation-induced blood pressure reductions: the importance of continued relaxation practice

This study examined the long-term importance of continued relaxation practice in the maintenance of relaxation-induced blood pressure reductions. An ABAB withdrawal-reinstatement design was employed with two hypertensive subjects. An objective, unobtrusive measure of home relaxation practice was used to monitor compliance. Subject 1 showed substantial reductions in systolic and diastolic blood pressure during 3 months of relaxation practice, followed by a 60% return to baseline during withdrawal, and a subsequent decrease with reinstatement of relaxation. Subject 2 showed a pattern similar to that of Subject 1 for systolic blood pressure, though the trend for diastolic pressure was unclear owing to a marginal treatment response. These preliminary data suggest that continued relaxation practice may be an important factor in the maintenance of relaxation-induced blood pressure reductions.     

Influence of pulsing electromagnetic field therapy on resting blood pressure in aging adults

This double-blind study tested the effects of pulsating electromagnetic field (PEMF) therapy sessions on the changes in peripheral cardiovascular function in a group of aging adults after 12 weeks of treatment. Each therapy session involved 15 min of exposure to low-frequency PEMF with asymmetrical waveforms emitted by the Impulser? Pro mattress. The treatment was provided 5 days per week for a total of 60 sessions. Resting blood pressure and arterial stiffness index were determined for peripheral cardiovascular function. Fifty-four older men and women (mean age 59.8 ± 3.5 yrs) completed the entire protocol involving either the PEMF or a sham treatment. The results include statistically significant reductions in systolic and pulse blood pressure, while no significant difference in diastolic pressure or the index of arterial stiffness was observed. These findings suggest that the PEMF treatment might be linked to improvements in peripheral resistance or circulation.     

Sodium restriction and blood pressure in hypertensive type II diabetics: randomised blind controlled and crossover studies of moderate sodium restriction and sodium supplementation.

OBJECTIVE--To determine the effect of moderate dietary sodium restriction on the hypertension of non-insulin-dependent (type II) diabetes. DESIGN--Randomised parallel controlled study of moderate sodium restriction for three months compared with usual diabetic diet, followed by randomised double blind crossover trial of sustained release preparation of sodium for one month versus placebo for one month in patients continuing with sodium restriction. SETTING--Patients attending diabetic outpatient clinic of city hospital. PATIENTS--Thirty four patients with established type II diabetes complicated by mild hypertension (systolic blood pressure greater than 160 mm Hg or diastolic pressure greater than 95 mm Hg on three consecutive occasions). Patients already taking antihypertensive agents (but not diuretics) not barred from study provided that criteria for mild hypertension still met. Conditions precluding patients from study were diabetic or hypertensive nephropathy, cardiac failure, and pregnancy. INTERVENTIONS--After run in phase with recordings at seven weeks, three weeks, and time zero patients were allocated at random to receive moderate dietary sodium restriction for three months (n = 17) or to continue with usual diabetic diet. Subsequently nine patients in sodium restriction group continued with regimen for a further two months, during which they completed a randomised double blind crossover trial of sustained release preparation of sodium (Slow Sodium 80 mmol daily) for one month versus matching placebo for one month. END POINT--Reduction in blood pressure in type II diabetics with mild hypertension. MEASUREMENTS AND MAIN RESULTS--Supine and erect blood pressure, body weight, and 24 hour urinary sodium and potassium excretion measured monthly during parallel group and double blind crossover studies. After parallel group study sodium restriction group showed significant reduction in systolic blood pressure (supine 19.2 mm Hg, erect 21.4 mm Hg; p less than 0.001) and mean daily urinary sodium excretion (mean reduction 60 mmol/24 h). There were no appreciable changes in weight, diabetic control, or diastolic pressure. No significant changes occurred in controls. In double blind crossover study mean supine systolic blood pressure rose significantly (p less than 0.005) during sodium supplementation (to 171 mm Hg) compared with value after three months of sodium restriction alone (159.9 mm Hg) and after one month of placebo (161.8 mm Hg). CONCLUSIONS--Moderate dietary restriction of sodium has a definite hypotensive effect, which may be useful in mild hypertension of type II diabetes.     

Psychological Changes Accompanying and Mediating Stress-Management Training for Essential Hypertension

In a previous controlled study, 21 participants with essential hypertension were treated with a program based on education, relaxation and D'Zurilla problem-solving training, and another 21 participants were assigned to a waiting list control condition (García-Vera, Labrador, & Sanz, 1997). In this report, the pre-post-treatment psychological changes accompanying those conditions were examined with the Jenkins Activity Survey, the Rosenbaum Self-Control Schedule, the Spielberger State-Trait Anxiety Inventory, and the D'Zurilla-Nezu Social Problem-Solving Inventory. Treatment yielded significant psychological changes that included an increase of problem-solving abilities. Moreover, correlation and multiple regression analyses revealed that, when clinic blood pressure (BP) values were considered, increases in problem-solving abilities were correlated with systolic and diastolic BP reductions for participants in the stress-management condition, and they mediated partially the antihypertensive effects of stress-management training on BP. No significant correlations were found between psychological changes and self-measured systolic or diastolic BP reductions.     

松龄血脉康胶囊联合低剂量厄贝沙坦治疗65岁以上高血压患者疗效观察

目的观察松龄血脉康胶囊联合低剂量厄贝沙坦治疗65岁以上老年高血压病患者的临床疗效。方法将90例65岁以上高血压患者随机分为松龄血脉康胶囊联合低剂量厄贝沙坦治疗组和高剂量厄贝沙坦对照组。治疗组给予松龄血脉康胶囊1.5g,每天3次,同时加厄贝沙坦75mg/d;对照组单纯给予厄贝沙坦150mg/d治疗。两组治疗周期为1个月进行比较血压控制情况及不良反应等指标水平。结果治疗后,两组患者收缩压和舒张压均较治疗前下降,差异有统计学意义(P0.05);治疗后两组患者的收缩压、舒张压比较,差异无统计学意义(P0.05)。结论松龄血脉康联合低剂量厄贝沙坦治疗高血压疗效确切,无明显不良反应,值得临床应用。     

Maintenance of relaxation-induced blood pressure reductions: The importance of continued relaxation practice

This study examined the long-term importance of continued relaxation practice in the maintenance of relaxation-induced blood pressure reductions. An ABAB withdrawal-reinstatement design was employed with two hypertensive subjects. An objective, unobtusive measure of home relaxation practice was used to monitor compliance. Subject I showed substantial reductions in systolic and diastolic blood pressure during 3 months of relaxation practice, followed by a 60% return to baseline during withdrawal, and a subsequent decrease with reinstatement of relaxation. Subject 2 showed a pattern similar to that of Subject 1 for systolic blood pressure, though the trend for diastolic pressure was unclear owing to a marginal treatment response. These preliminary data suggest that continued relaxation practice may be an important factor in the maintenance of relaxation-induced blood pressure reductions.This research was supported, in part, by grant AG00029 from the National Institute of Aging.     

Effectiveness of multiple muscle-site EMG biofeedback and relaxation training in reducing the aversiveness of cancer chemotherapy

A 44-year-old female cancer patient was given progressive muscle relaxation training and multiple muscle-site EMG biofeedback to reduce the conditioned negative responses she had apparently developed to her chemotherapy treatments. Following three baseline chemotherapy sessions, the patient was given relaxation training and biofeedback during four consecutive chemotherapy treatments and was asked to practice her relaxation skills daily in the hospital or at home. After the patient felt able to relax on her own, relaxation training and biofeedback were terminated and three follow-up sessions were held. Results indicated that during the chemotherapy sessions in which the patient received relaxation training and biofeedback, she showed reductions in physiological arousal (EMG, pulse rate, systolic blood pressure, and diastolic blood pressure) and reported feeling less anxious and nauseated. Moreover, these changes were maintained during the follow-up sessions. These results suggest that relaxation training plus multiple muscle-site biofeedback may be an effective adjunctive procedure for reducing some of the adverse side effects of cancer chemotherapy.     

Angiotensin receptor blockade and angiotensin-converting-enzyme inhibition limit adverse remodeling of infarct zone collagens and global diastolic dysfunction during healing after reperfused ST-elevation myocardial infarction

To determine whether therapy with the angiotensin II type 1 receptor blocker (ARB) candesartan and the comparator angiotensin-converting-enzyme inhibitor (ACEI) enalapril during healing after reperfused ST-elevation myocardial infarction (RSTEMI) limit adverse remodeling of infarct zone (IZ) collagens and left ventricular (LV) diastolic dysfunction, we randomized 24 dogs surviving anterior RSTEMI (90-min coronary occlusion) to placebo, candesartan, and enalapril therapy between day 2 and 42. Six other dogs were sham. We measured regional IZ and non-infarct zone (NIZ) collagens (hydroxyproline; types I/III; cross-linking), transforming growth factor-β (TGF-β) and topography at 6 weeks, and hemodynamics, LV diastolic and systolic function, and remodeling over 6 weeks. Compared to sham, placebo-RSTEMI differentially altered regional collagens, with more pronounced increase in TGF-β, hydroxyproline, and type I, insoluble, and cross-linked collagens in the IZ than NIZ, and increased IZ soluble and type III collagens at 6 weeks, and induced persistent LV filling pressure elevation, diastolic and systolic dysfunction, and LV remodeling over 6 weeks. Compared to placebo-RSTEMI, candesartan and enalapril limited adverse regional collagen remodeling, with normalization of type III, soluble and insoluble collagens and decrease in pyridinoline cross-linking in the IZ at 6 weeks, and attenuation of LV filling pressure, diastolic dysfunction, and remodeling over 6 weeks. The results suggest that candesartan and enalapril during healing after RSTEMI prevent rather than worsen adverse remodeling of IZ collagens and LV diastolic dysfunction, supporting the clinical use of ARBs and ACEIs during subacute RSTEMI.     

不同周龄自发性高血压大鼠的动态血压变化与心脏的组织学改变

目的测量不同周龄自发性高血压(SHR)的收缩压、舒张压、平均压、心率、血流量及血流速,为SHR及有关高血压方面的实验研究提供基础数据参考。方法采用CODATM无创血压仪,测量34只8～15周龄SHR的收缩压、舒张压、平均压、心率、血流量及血流速。在最后一周测量完血压值后,采用45mg/kg的戊巴比妥钠,腹腔注射麻醉动物,进行处死。采取胸主动脉、肺、肾、心脏和大脑,经10%的福尔马林溶液固定常规脱水,包埋,切片,进行HE染色。结果8～15周龄SHR的收缩压和心率值在各周之间均无统计学差异(P0.05)。舒张压的比较中,第8周与第15周之间存在显著差异(P0.05)。平均压的比较中,第8周与第15周之间存在显著差异(P0.05)。在组织学观察中,40%的心肌细胞变性。结论SHR的舒张压、收缩压及平均压随周龄的增加均有上升的趋势。而心率、血流速及血流量均有下降的趋势,但是在各周存在一定的波动。