The Cardiovascular Risk of White-Coat Hypertension Franklin, Stanley S., MD; Thijs, Lutgarde, MSc; Asayama, Kei, MD, PhD ...
Journal of the American College of Cardiology,
11/2016, Volume:
68, Issue:
19
Journal Article
Peer reviewed
Open access
Abstract Background The role of white-coat hypertension (WCH) and the white-coat-effect (WCE) in development of cardiovascular disease (CVD) risk remains poorly understood. Objectives Using data from ...the population-based, 11-cohort IDACO (International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes), this study compared daytime ambulatory blood pressure monitoring with conventional blood pressure measurements in 653 untreated subjects with WCH and 653 normotensive control subjects. Methods European Society Hypertension guidelines were used as a 5-stage risk score. Low risk was defined as 0 to 2 risk factors, and high risk was defined as ≥3 to 5 risk factors, diabetes, and/or history of prior CVD events. Age- and cohort-matching was done between 653 untreated subjects with WCH and 653 normotensive control subjects. Results In a stepwise linear regression model, systolic WCE increased by 3.8 mm Hg (95% confidence interval CI: 3.1 to 4.6 mm Hg) per 10-year increase in age, and was similar in low- and high-risk subjects with or without prior CVD events. Over a median 10.6-year follow-up, incidence of new CVD events was higher in 159 high-risk subjects with WCH compared with 159 cohort- and age-matched high-risk normotensive subjects (adjusted hazard ratio HR: 2.06; 95% CI: 1.10 to 3.84; p = 0.023). The HR was not significant for 494 participants with low-risk WCH and age-matched low-risk normotensive subjects. Subgroup analysis by age showed that an association between WCH and incident CVD events is limited to older (age ≥60 years) high-risk WCH subjects; the adjusted HR was 2.19 (95% CI: 1.09 to 4.37; p = 0.027) in the older high-risk group and 0.88 (95% CI: 0.51 to 1.53; p = 0.66) in the older low-risk group (p for interaction = 0.044). Conclusions WCE size is related to aging, not to CVD risk. CVD risk in most persons with WCH is comparable to age- and risk-adjusted normotensive control subjects.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The northernmost part of continental Yakutia in the Dmitry Laptev Strait region developed under non-glacial conditions during the Quaternary period. During cooling periods, ice-rich deposits with ...syngenetic ice wedges, called the Ice Complex, formed here. During periods of warming, they partially thawed under thermokarst lakes and a peculiar complex of lacustrine-boggy deposits (the Alas Complex) was formed. The article presents a description of ice-rich deposit sequences in several Ice Complex horizons and their transformation in lake taliks from the Middle Pleistocene to the Holocene (MIS 7—MIS 1). The Oyogos Yar section structure is considered as an example using additional geological data from the southern coast of Bol’shoy Lyakhovsky Island. Specific examples show the results of changes in the structure of sections via cryogenic processes—ice wedge formation and thawing. We confirm that cryogenic processes are important factors, along with accumulation and erosion processes, which change the geological and cryolithological structure of the sections. It is shown that to clearly understand the stratigraphic subdivision of Quarternary deposits in areas of Ice Complex development, geological and analytical studies of the sections are insufficient; an elucidation of the sequence of sediment freezing and thawing and the resulting cryolithogical phenomena is necessary.
In previous studies, of which several were underpowered, the relation between cardiovascular outcome and blood pressure (BP) variability was inconsistent. We followed health outcomes in 8938 subjects ...(mean age53.0 years; 46.8% women) randomly recruited from 11 populations. At baseline, we assessed BP variability from the SD and average real variability in 24-hour ambulatory BP recordings. We computed standardized hazard ratios (HRs) while stratifying by cohort and adjusting for 24-hour BP and other risk factors. Over 11.3 years (median), 1242 deaths (487 cardiovascular) occurred, and 1049, 577, 421, and 457 participants experienced a fatal or nonfatal cardiovascular, cardiac, or coronary event or a stroke. Higher diastolic average real variability in 24-hour ambulatory BP recordings predicted (P≤0.03) total (HR1.14) and cardiovascular (HR1.21) mortality and all types of fatal combined with nonfatal end points (HR≥1.07) with the exception of cardiac and coronary events (HR≤1.02; P≥0.58). Higher systolic average real variability in 24-hour ambulatory BP recordings predicted (P<0.05) total (HR1.11) and cardiovascular (HR1.16) mortality and all fatal combined with nonfatal end points (HR≥1.07), with the exception of cardiac and coronary events (HR≤1.03; P≥0.54). SD predicted only total and cardiovascular mortality. While accounting for the 24-hour BP level, average real variability in 24-hour ambulatory BP recordings added <1% to the prediction of a cardiovascular event. Sensitivity analyses considering ethnicity, sex, age, previous cardiovascular disease, antihypertensive treatment, number of BP readings per recording, or the night:day BP ratio were confirmatory. In conclusion, in a large population cohort, which provided sufficient statistical power, BP variability assessed from 24-hour ambulatory recordings did not contribute much to risk stratification over and beyond 24-hour BP.
Seaweed metabolites (fucoidans, carrageenans, ulvans, lectins, and polyphenols) are biologically active compounds that target proteins or genes of the influenza virus and host components that are ...necessary for replication and reproduction of the virus.
This review gathers the information available in the literature regarding to the useful properties of seaweeds metabolites as potential agents for the prevention and therapy of influenza infection.
The sources of scientific literature were found in various electronic databases (i.e., PubMed, Web of Science, and ScienceDirect) and library search. The retrospective search depth is 25 years.
Influenza is a serious medical and social problem for humanity. Recently developed drugs are quite effective against currently circulating influenza virus strains, but their use can lead to the selection of resistant viral strains. In this regard, new therapeutic approaches and drugs with a broad spectrum of activity are needed. Metabolites of seaweeds fulfill these requirements. This review presents the results of in vitro and in vivo experimental and clinical studies about the effectiveness of these compounds in combating influenza infection and explains the necessity of their use as a potential basis for the creation of new drugs with a broad spectrum of activity.
Abstract Objectives We assessed to what extent arterial properties measured at baseline and follow-up predict longitudinal alterations in echocardiographic indexes reflecting left ventricular (LV) ...structure and function. Background Serial imaging studies are needed to clarify the relation of changes in LV structure and function to arterial stiffness. Methods In 607 participants (50.7% women; mean age 50.7 years), using echocardiography and Doppler imaging, we measured LV dimensions, transmitral blood flow, and mitral annular tissue velocities at baseline and after 4.7 years. Using applanation tonometry, we assessed central pulse pressure (cPP) and carotid-femoral pulse wave velocity (PWV) at baseline. We regressed longitudinal changes in LV indexes on the arterial stiffness parameters and reported standardized effect sizes as a fraction of SD of LV change. Results After full adjustment, longitudinal increase in LV septal (standardized effect size: +14.4%; p = 0.0018) and posterior wall (+12.6%; p = 0.0027) thickness was associated with higher baseline PWV, whereas LV internal diameter (-12.4%; p = 0.012) decreased during follow-up with PWV. Consequently, greater increase in relative wall thickness was associated with higher baseline PWV (+17.2%; p <0.0001). Participants with higher baseline PWV had a greater risk to develop or retain LV concentric remodeling during follow-up (odds ratio 1.35; p = 0.028). In addition, in women, baseline cPP predicted a greater increase in LV mass (+22.8%; p = 0.0009) and E/e′ ratio (+36.1%; p <0.0001). Conclusions Progression to LV concentric remodeling pattern was associated with higher baseline PWV. In women, cPP predicted worsening of LV diastolic function. Our study highlights the importance of arterial properties as mediator of LV concentric remodeling in men and women, and diastolic dysfunction in women.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
We and other investigators previously reported that isolated nocturnal hypertension on ambulatory measurement (INH) clustered with cardiovascular risk factors and was associated with intermediate ...target organ damage. We investigated whether INH might also predict hard cardiovascular endpoints.
We monitored blood pressure (BP) throughout the day and followed health outcomes in 8711 individuals randomly recruited from 10 populations (mean age 54.8 years, 47.0% women). Of these, 577 untreated individuals had INH (daytime BP <135/85 mmHg and night-time BP ≥120/70 mmHg) and 994 untreated individuals had isolated daytime hypertension on ambulatory measurement (IDH; daytime BP ≥135/85 mmHg and night-time BP <120/70 mmHg). During follow-up (median 10.7 years), 1284 deaths (501 cardiovascular) occurred and 1109 participants experienced a fatal or nonfatal cardiovascular event. In multivariable-adjusted analyses, compared with normotension (n = 3837), INH was associated with a higher risk of total mortality (hazard ratio 1.29, P = 0.045) and all cardiovascular events (hazard ratio 1.38, P = 0.037). IDH was associated with increases in all cardiovascular events (hazard ratio 1.46, P = 0.0019) and cardiac endpoints (hazard ratio 1.53, P = 0.0061). Of 577 patients with INH, 457 were normotensive (<140/90 mmHg) on office BP measurement. Hazard ratios associated with INH with additional adjustment for office BP were 1.31 (P = 0.039) and 1.38 (P = 0.044) for total mortality and all cardiovascular events, respectively. After exclusion of patients with office hypertension, these hazard ratios were 1.17 (P = 0.31) and 1.48 (P = 0.034).
INH predicts cardiovascular outcome in patients who are normotensive on office or on ambulatory daytime BP measurement.
The aim of this research was to study the features of clinical and laboratory parameters of acute otitis media (AOM), taking into account the value of the leukocyte shift index (LSI) in pediatric ...patients with the demonstration of clinical cases. Methods and Results: This study included 100 children (55 boys and 45 girls) with AOM. The mean age of all patients was 4.32±0.31 years. Group 1 included 50 patients (30 boys and 20 girls) with acute suppurative otitis media (SupAOM) . Group 2 included 50 patients (25 boys and 25 girls)with acute serous otitis media (SerAOM). As a marker for determining the activity of the inflammatory process and the disorders of the immunological reactivity of the body, we chose LSI, calculated taking into account the parameters of the general blood test. Our results show the diagnostic significance of LSI in predicting the clinical course of AOM in patients in the age group of 2-16 years. The development of SerAOM is predicted when the LSI is 1.05±0.08; SupAOM - 2.08±0.23 The results obtained can be useful in providing specialized medical care for children of this age group, for optimizing the algorithms for preventive examinations and therapeutic interventions, and for offering the possibility of predicting the severity of the disease and timely treatment of SupAOM requiring a surgical intervention followed by systemic antibiotic therapy in order to prevent otogenic complications and hearing.
Background: The noninvasive assessment of renal hemodynamics is currently possible by assessing the renal resistive index (RRI) derived from intrarenal Doppler arterial waveforms as (peak systolic ...velocity - end-diastolic velocity)/peak systolic velocity. In this review, we outline the important determinants of the RRI to clarify the true identity of the RRI and highlight its potential diagnostic and prognostic value in renal and cardiovascular pathology. Summary: Although the RRI was initially considered to reflect intrarenal vascular pathological processes, this index is actually a product of a complex interaction between renal and systemic vascular wall properties and hemodynamic factors. Indeed, studies in patients and general populations consistently demonstrated a significant and direct association between the RRI and central or peripheral pulse pressure independent of other covariables. Moreover, studies in renal transplant patients also showed that the RRI mainly reflects characteristics of the recipient but not those of the graft. Thus, the major influence of the systemic hemodynamics on the intrarenal arterial waveforms excludes RRI as a specific marker of renal vascular pathology. On the other hand, because the RRI reflects pulsatility in renal arteries, it might be useful for the early detection of renal microvascular damage. Future longitudinal studies are still needed to clarify whether the detection of Doppler changes in intrarenal arteries might yield an improvement in the adverse cardiovascular and renal outcome. Conclusion: Published studies on RRI imply that the interaction between the systemic hemodynamics and peripheral circulation in the kidney is a complex physiological phenomenon. In addition to renal vascular properties, the central hemodynamic factors significantly influence the intrarenal arterial Doppler waveform patterns. Previous research also suggested an important role of the RRI for the evaluation of renal target organ damage, particularly in patients with increased pulsatility of the intrarenal blood flow.
The amount of energy in the form of natural gas hydrates is huge and likely substantially more than twice the amount of worldwide conventional fossil fuel. Various ways to produce these hydrates have ...been proposed over the latest five decades. Most of these hydrate production methods have been based on evaluation of hydrate stability limits rather than thermodynamic consideration and calculations. Typical examples are pressure reduction and thermal stimulation. In this work we discuss some of these proposed methods and use residual thermodynamics for all phases, including the hydrate phase, to evaluate free energy changes related to the changes in independent thermodynamic variables. Pressures, temperatures and composition of all relevant phases which participate in hydrate phase transitions are independent thermodynamic variables. Chemical potential and free energies are thermodynamic responses that determine whether the desired phase transitions are feasible or not. The associated heat needed is related to the first law of thermodynamics and enthalpies. It is argued that the pressure reduction method may not be feasible since the possible thermal gradients from the surroundings are basically low temperature heat that is unable to break water hydrogen bonds in the hydrate–water interface efficiently. Injecting carbon dioxide, on the other hand, leads to formation of new hydrate which generates excess heat compared to the enthalpy needed to dissociate the in situ CH4 hydrate. But the rapid formation of new CO2 hydrate that can block the pores, and also the low permeability of pure CO2 in aquifers, are motivations for adding N2. Optimum mole fractions of N2 based on thermodynamic considerations are discussed. On average, less than 30 mole% N2 can be efficient and feasible. Thermal stimulation using steam or hot water is not economically feasible. Adding massive amounts of methanol or other thermodynamic inhibitors is also technically efficient but far from economically feasible.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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