Hypertension research : official journal of the Japanese Society of Hypertension
-
Hypertensive disorders of pregnancy (HDP) is a common disease and is believed to be a multifactorial genetic disease. Stromal interaction molecule 1 (STIM1) was previously reported to regulate the concentration of Ca2+ and vascular contraction. The aim of the present study was to assess the association between HDP and single-nucleotide polymorphisms (SNPs) or haplotypes in the human STIM1 gene via case-control studies. ⋯ In the logistic regression analysis, the AA genotype of rs7945554 was significantly more predominant in the HDP group than in the control group. We found HDP-sensitive SNPs and haplotypes, and the STIM1 gene was identified as a possible susceptibility gene for HDP. By providing guidance to patients with genetic factors for HDP, we may be able to help them avoid environmental factors that could increase the risk of HDP before or during pregnancy and thus prevent or delay the onset of the disease.
-
The second derivative of the digital photoplethysmogram (SDPTG) is an indicator of arterial stiffness. The ratio of the height of the d wave to the a wave of the SDPTG (d/a) is associated with functional peripheral vascular tension and represents aortic-blood pressure (BP) augmented by reflection waves from the periphery. This longitudinal study aimed to investigate the relationship between SDPTG and cardiovascular mortality in middle-aged and elderly Japanese women. ⋯ In multivariate analysis, the hazard ratio was 2.30 for Q3 (95% confidence interval (CI): 1.06-4.99, P<0.05) and 2.60 for Q4 (95% CI: 1.21-5.60, P<0.05), after adjustment for age, height, body mass index, BP levels, heart rate and other atherosclerosis-related factors. The hazard ratios of cardiovascular mortality for Q3 and Q4 were significantly higher compared with the reference (Q1). Thus, the SDPTG d/a is an independent predictor of cardiovascular mortality in middle-aged and elderly Japanese women.
-
Correlation between blood pressure (BP) and target organ damage, vascular risk and long-term patient prognosis is greater for measurements derived from around-the-clock ambulatory BP monitoring than in-clinic daytime ones. Numerous studies consistently substantiate the asleep BP mean is both an independent and a much better predictor of cardiovascular disease (CVD) risk than either the awake or 24 h means. Sleep-time hypertension is much more prevalent than suspected, not only in patients with sleep disorders, but also among those who are elderly or have type 2 diabetes, chronic kidney disease or resistant hypertension. ⋯ For example, because the high-amplitude circadian rhythm of the renin-angiotensin-aldosterone system activates during nighttime sleep, bedtime vs. morning ingestion of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers better reduces the asleep BP mean, with additional benefit, independent of medication terminal half-life, of converting the 24 h BP profile into more normal dipper patterning. The MAPEC (Monitorización Ambulatoria para Predicción de Eventos Cardiovasculares) study, first prospective randomized treatment-time investigation designed to test the worthiness of bedtime chronotherapy with ⩾1 conventional hypertension medications so as to specifically target attenuation of asleep BP, demonstrated, relative to conventional morning therapy, 61% reduction of total CVD events and 67% decrease of major CVD events, that is, CVD death, myocardial infarction, and ischemic and hemorrhagic stroke. The MAPEC study, along with other earlier conducted less refined trials, documents the asleep BP mean is the most significant prognostic marker of CVD morbidity and mortality; moreover, it substantiates attenuation of the asleep BP mean by a bedtime hypertension treatment strategy entailing the entire daily dose of ⩾1 hypertension medications significantly reduces CVD risk in both general and more vulnerable hypertensive patients, that is, those diagnosed with chronic kidney disease, diabetes and resistant hypertension.