Hypertension
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Randomized Controlled Trial
Lower treatment blood pressure is associated with greatest reduction in hematoma growth after acute intracerebral hemorrhage.
The pilot phase of the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT) showed that rapid blood pressure (BP) lowering can attenuate hematoma growth in acute intracerebral hemorrhage. We sought to define the systolic BP level associated with greatest attenuation of hematoma growth. INTERACT included 404 patients with computed tomographic-confirmed intracerebral hemorrhage, elevated systolic BP (150 to 220 mm Hg), and capacity to commence BP lowering treatment within 6 hours of onset. ⋯ By contrast, achieved on-treatment systolic BP levels in the first 24 hours were clearly associated with both absolute and proportional hematoma growth (both P trend=0.03). Maximum reduction in hematoma growth occurred in the one third of participants with the lowest on-treatment systolic BP levels (median: 135 mm Hg). Intensive BP reduction to systolic levels between 130 and 140 mm Hg is likely to provide the maximum protection against hematoma growth after intracerebral hemorrhage.
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Previous studies show that exercise training and caloric restriction improve cardiac function in obesity. However, the molecular mechanisms underlying this effect on cardiac function remain unknown. Thus, we studied the effect of exercise training and/or caloric restriction on cardiac function and Ca(2+) handling protein expression in obese rats. ⋯ Exercise training and/or caloric restriction prevented reduction in left ventricular fractional shortening and in phosphorylation of the Ser(2808)-ryanodine receptor and Thr(17)-phospholamban. These findings show that exercise training and/or caloric restriction prevent cardiac dysfunction in high-fat and sucrose diet rats, which seems to be attributed to decreased circulating neurohormone levels. In addition, this nonpharmacological paradigm prevents a reduction in the Ser(2808)-ryanodine receptor and Thr(17)-phospholamban phosphorylation and redox status.
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Randomized Controlled Trial
Interactive hemodynamic effects of dipeptidyl peptidase-IV inhibition and angiotensin-converting enzyme inhibition in humans.
Dipeptidyl peptidase-IV inhibitors improve glucose homeostasis in type 2 diabetics by inhibiting degradation of the incretin hormones. Dipeptidyl peptidase-IV inhibition also prevents the breakdown of the vasoconstrictor neuropeptide Y and, when angiotensin-converting enzyme (ACE) is inhibited, substance P. This study tested the hypothesis that dipeptidyl peptidase-IV inhibition would enhance the blood pressure response to acute ACE inhibition. ⋯ Sitagliptin enhanced the dose-dependent effect of enalapril on renal blood flow. In summary, sitagliptin lowers blood pressure during placebo or submaximal ACE inhibition; sitagliptin activates the sympathetic nervous system to diminish hypotension when ACE is maximally inhibited. This study provides the first evidence for an interactive hemodynamic effect of dipeptidyl peptidase-IV and ACE inhibition in humans.
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Comparative Study
Orthostatic hypotension is a more robust predictor of cardiovascular events than nighttime reverse dipping in elderly.
Aims of the study were to assess in an elderly population the prevalences of orthostatic hypotension at different times after standing and of nighttime reverse dipping on ambulatory blood pressure monitoring, as well as their interrelationships and relative prognostic power for incident cardiovascular events. The study population consisted of 374 patients (225 women), aged 70.2+/-8.5 years, registered in 1 primary care practice and without major cardiovascular events or other comorbidities at baseline. They experienced 76 first cardiovascular events (death, myocardial infarction, or stroke) during 3406 years of follow-up. ⋯ The independent predictive power of diastolic orthostatic hypotension was only significant soon after standing (P<0.05). Systolic and diastolic reverse dipping carried prognostic significance in univariable analyses (P<0.001) but not after adjustment for confounders, including 24-hour blood pressure. We conclude that orthostatic hypotension contributes to the phenomenon of reverse dipping but is a more robust predictor of cardiovascular events than reverse dipping in the elderly of the current study.