China Stroke Primary Prevention Trial: Visit‐to‐Visit Systolic Blood Pressure Variability Is an Independent Predictor of Primary Stroke in Hypertensive Patients

Men, Xi; Sun, Wei; Fan, Fangfang; Zhao, Min; Huang, Xiao; Wang, Yu; Liu, Lishun; Liu, Ran; Sun, Weiping; Peng, Qing; Qin, Xianhui; Tang, Genfu; Li, Jianping; Zhang, Yan; Cai, Yefeng; Hou, Fan Fan; Zhang, Yuanyuan; Xu, Xiping; Cheng, Xiaoshu; Sun, Ning; Huang, Yining; Huo, Yong

doi:10.1161/jaha.116.004350

Cited by 24 publications

(20 citation statements)

References 32 publications

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“…Longitudinal studies such as the Minnesota Heart Survey, the National Health and Nutrition Examination Survey and the China Stroke Primary Prevention trial proved that the excess body fat is one of the main factors responsible for the development of hypertension. 10–12…”

Section: Discussionmentioning

confidence: 99%

Use of atypical antipsychotics and risk of hypertension: A case report and review literature

Alves

Oliveira

Neto

et al. 2019

SAGE Open Medical Case Reports

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Atypical antipsychotics is being considered in the treatment of “negative” symptoms of psychoses, such as schizophrenia. In this case report, we presented a case of a patient with psychiatric disorder who developed hypertension soon after starting using atypical antipsychotic. A 53-year-old woman had reported having episodes of tachycardia, nausea, headache and high blood pressure. At the time of the doctor’s appointment, the blood pressure was 210/110 mmHg. According to the patient, she made use of simvastatin for dyslipidemia and started taking aripiprazole, an antipsychotic for approximately 40 days before the symptoms. The initial treatment was 20 mg of olmesartan, and examinations were requested. After 2 months, the patient returned with the examinations: altered serum lipids and the other results were normal. Ambulatory blood pressure monitoring showed an average of 24 h of 150/100 mmHg. Blood pressure was measured at the doctor’s office; in regular use of 20 mg of olmesartan, it was 156/92 mmHg. The dosage of olmesartan was increased to 40 mg and 1.5 mg of indapamide was initiated. The patient returned after 20 days with a blood pressure of 146/90 mmHg. After approval from the psychiatrist, the Aripiprazole was stopped, and the patient returned 15 days later with blood pressure of 120/80 mmHg. The ambulatory blood pressure monitoring control showed an average of 24 h of 130/78 mmHg. The Dopamine receptors play a role in the regulation of the blood pressure and the alterations in this system can lead to hypertension. D1, D3 and D4 receptors interact with the renin-angiotensin-aldosterone system, while D2 and D5 interact with the sympathetic nervous system in the regulation of PA. The case reported and the literature review bring to light the discussion of the use of atypical antipsychotics and its adverse events. If necessary, the use of these drugs should be followed by careful monitoring of blood pressure.

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Section: Discussionmentioning

confidence: 99%

Use of atypical antipsychotics and risk of hypertension: A case report and review literature

Alves

Oliveira

Neto

et al. 2019

SAGE Open Medical Case Reports

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“…Hypertension is a pandemic disease worldwide, particularly affecting 65–75% of individuals older than 65 years. Disruptions in neurovascular coupling are considered to be related to hypertension, which can cause diseases including cognitive decline, stroke, and certain microvascular diseases ( Gianaros et al, 2009 ; Wright and Harding, 2010 ; Li et al, 2013a , 2014 , 2015 ; Queiroz et al, 2013 ; Fang et al, 2016 ; Norris, 2016 ; Men et al, 2017 ). Patients with hypertension exhibit poor performance in language, processing speed, visuospatial abilities, attention, executive functioning, and memory ( Harrison et al, 2012 ; Muela et al, 2017 ; Ticcinelli et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Alteration in Brain Functional and Effective Connectivity in Subjects With Hypertension

Huo

et al. 2018

Front. Physiol.

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To reveal the physiological mechanism of the cognitive decline in subjects with hypertension, the functional connectivity (FC) was assessed by using the wavelet phase coherence (WPCO), and effective connectivity (EC) was assessed by using the coupling strength (CS) of near-infrared spectroscopy (NIRS) signals. NIRS signals were continuously recorded from the prefrontal cortex, sensorimotor cortex, and occipital lobes of 13 hypertensive patients (hypertension group, 70 ± 6.5 years old) and 16 elderly healthy subjects (control group, 71 ± 5.5 years old) in resting and standing periods. WPCO and CS were calculated in four frequency intervals: I, 0.6–2; II, 0.145–0.6; III, 0.052–0.145; and IV, 0.021–0.052 Hz. CS quantifies coupling amplitude. In comparison with the control group, the hypertension group showed significantly decreased (p < 0.05) WPCO and CS in intervals III and IV and in the resting and standing states. WPCO and CS were significantly decreased in the resting state compared with those in the standing state in the hypertension group (p < 0.05). Decreased WPCO and CS indicated a reduced network interaction, suggesting disturbed neurovascular coupling in subjects with hypertension. Compared with the control group, the hypertension group showed significantly lower Mini-Mental State Examination (MMSE) (p = 0.028) and Montreal Cognitive Assessment (MoCA) scores (p = 0.011). In the hypertension group, correlation analysis showed that WPCO and CS were significantly positively correlated with MMSE and MoCA scores, respectively. These findings may provide evidence of impaired cognitive function in hypertension and can enhance the understanding on neurovascular coupling.

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“…Most studies have found hypertension and HHcy to be independent stroke predictors. In a retrospective analysis of 20 702 hypertensive patients from the China Stroke Primary Prevention Trial, visit-to-visit SBP variability was an independent predictor of primary stroke, independent of mean SBP over the follow-up period 18 . A prospective cohort study identified HHcy associated with ischemic stroke (hazard ratio, 2.18; 95% CI, 1.65–2.89).…”

Section: Discussionmentioning

confidence: 97%

Association between homocysteine and conventional predisposing factors on risk of stroke in patients with hypertension

Hui

Han

et al. 2018

Sci Rep

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Previous studies have focused mostly on independent effects of the stroke risk factors, whereas little attention has been paid to interactions between individual factors which may be important for stroke prevention. We collected data related to the patients’ demographic characteristics, history of chronic diseases and lifestyle factors in 2258 patients with primary hypertension. Logistic regression models based on odds ratio (OR) with their associated 95% confidence interval (CI) were used to estimate an independent effect of homocysteine (Hcy) on the risk of stroke but also include the interactions between Hcy and other risk factors. Hcy was associated with an increased OR of the risk of stroke in both hypertension patients (OR, 1.027; 95% CI, 1.016–1.038; P < 0.001) and H-type hypertension patients (OR, 1.026; 95% CI, 1.014–1.037; P < 0.001), after adjustment for potential confounding factors. Among the hypertension participants, three tests of interactions between Hcy and other risk factors were statistically significant: sex, systolic blood pressure and diastolic blood pressure. In conclusion, complexities of the interactions of Hcy stratified by sex and blood pressure need to be considered in predicting overall risk and selecting certain treatments for stroke prevention.

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China Stroke Primary Prevention Trial: Visit‐to‐Visit Systolic Blood Pressure Variability Is an Independent Predictor of Primary Stroke in Hypertensive Patients

Cited by 24 publications

References 32 publications

Use of atypical antipsychotics and risk of hypertension: A case report and review literature

Use of atypical antipsychotics and risk of hypertension: A case report and review literature

Alteration in Brain Functional and Effective Connectivity in Subjects With Hypertension

Association between homocysteine and conventional predisposing factors on risk of stroke in patients with hypertension

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