Different contribution of SBP and DBP variability to vascular events in patients with stroke

Dai, Liye; Cheng, Aichun; Hao, Xiwa; Xu, Jin; Zuo, Yingting; Wang, Anxin; Meng, Xia; Li, Hao; Wang, Yilong; Wang, Wenjuan

doi:10.1136/svn-2019-000278

Cited by 10 publications

(8 citation statements)

References 30 publications

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“…Our finding was consistent with the post hoc analysis of the Blood Pressure and Clinical Outcome in TIA and IS trial (BOSS), in which cardiovascular events were only related to diastolic BPV (defined as the SD and coefficient of variation of the DBP) rather than systolic BPV in patients with a history of ischemic stroke and transient ischemic attack. 22 Similar findings were also reported in the Action to Control Cardiovascular Risk in Diabetes trial (ACCORD) in which diastolic BPV was strongly associated with coronary heart disease, especially in patients with a low baseline BP. 23 In addition, diastolic BPV has been reported as a risk factor for cognitive decline and stroke recurrence.…”

Section: Discussionsupporting

confidence: 79%

“…23 In addition, diastolic BPV has been reported as a risk factor for cognitive decline and stroke recurrence. 9,22,24 These findings might indicate that diastolic BPV becomes more important for older adults with hypertension and that it is essential to monitor the DBP in older adults. The underlying mechanism for the significance of diastolic BPV in older adults might be the fluctuation and reduction of coronary perfusion during diastole, which leads to coronary hypoperfusion and exacerbates myocardial ischemia.…”

Section: Discussionmentioning

confidence: 98%

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Visit-to-Visit Blood Pressure Variability and Cardiovascular Outcomes in Patients Receiving Intensive Versus Standard Blood Pressure Control: Insights From the STEP Trial

Song

Bai

et al. 2023

Hypertension

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Background: The clinical prognostic value of visit-to-visit blood pressure (BP) variability (BPV) is debatable, and relative studies among patients receiving BP control to achieve lower BP targets are limited. Methods: We analyzed a dataset from the STEP trail (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) to investigate the relationship between visit-to-visit BPV and cardiovascular events in patients with hypertensive aged 60 to 80 years. Visit-to-visit BPV was defined as the coefficient of variation, SD, delta, average real variability, and variability independent of the mean of BP measured at 6-, 9-, 12-, 15-, and 18-month follow-up visits. We computed hazard ratios for the risks associated with a 1-SD increase in BPV indexes in multivariable cox regression models. Results: Among 7678 patients from the STEP trial, after adjustment for multiple confounders, diastolic BPV indexes were significantly associated with the primary composite end point (hazard ratios ≥1.21; P ≤0.029) in the standard group, while there was no association between the clinical outcomes and systolic BPV ( P ≥0.091). In the intensive treatment group, either systolic or diastolic BPV was no association with clinical outcomes( P ≥0.30). Sensitivity analyses using an alternative method to calculate BPV based on 7 BP records generated confirmatory results. Conclusions: In older adults with hypertension, visit-to-visit diastolic BPV is an independent predictor of adverse health outcomes in the standard treatment group. However, BPV did not have prognostic value in the intensive treatment group. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03015311.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 98%

Visit-to-Visit Blood Pressure Variability and Cardiovascular Outcomes in Patients Receiving Intensive Versus Standard Blood Pressure Control: Insights From the STEP Trial

Song

Bai

et al. 2023

Hypertension

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“…The reversion of increased BP by HEP supplementation was more evident for DBP since the CRP group under SD displayed significantly lower values than the CR group. It can be noted that the repercussion of SBP and DBP in cardiovascular disease development may be different; e.g., variability in DBP has been recently suggested as a more important predictor of cardiovascular adverse events than SBP in certain patients (with stroke), and DBP and isolated diastolic hypertension seem to be more related to the drive of coronary risk in younger subjects. , Moreover, the pectin-supplemented animals showed a higher percentage of heart weight than both C and CR animals. Although cardiac hypertrophy is usually considered a risk factor, the surrounding observed physiological conditions suggest that such increase in the relative heart weight might be associated with a favorable cardiovascular profile, as may happen, for instance, in trained athletes …”

Section: Discussionmentioning

confidence: 99%

Supplementation with the Prebiotic High-Esterified Pectin Improves Blood Pressure and Cardiovascular Risk Biomarker Profile, Counteracting Metabolic Malprogramming

García-Carrizo

Galmés

Palou

et al. 2022

J. Agric. Food Chem.

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Supplementation with the prebiotic pectin is associated with beneficial health effects. We aimed to characterize the cardioprotective actions of chronic high-esterified pectin (HEP) supplementation (10%) in a model of metabolic malprogramming in rats, prone to obesity and associated disorders: the progeny of mild calorie-restricted dams during the first half of pregnancy. Results show that pectin supplementation reverses metabolic malprogramming associated with gestational undernutrition. In this sense, HEP supplementation improved blood pressure, reduced heart lipid content, and regulated cardiac gene expression of atrial natriuretic peptide and lipid metabolism-related genes. Moreover, it caused an elevation in circulating levels of fibroblast growth factor 21 and a higher expression of its co-receptor β-klotho in the heart. Most effects are correlated with the gut levels of beneficial bacteria promoted by HEP. Therefore, chronic HEP supplementation shows cardioprotective actions, and hence, it is worth considering as a strategy to prevent programmed cardiometabolic alterations.

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“…Previous research showed that SBP was associated with stroke recurrence[ 25 ]. Turana et al [ 26 ] also found that SBP was positively correlated with stroke incidence, and adherence to hypertension treatment is to be the main goal in the prevention of stroke occurrence in several countries in Asia.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for relapse and nomogram for relapse probability prediction in patients with minor ischemic stroke

Lei¹,

Yin²,

Huang³

et al. 2021

WJCC

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BACKGROUND The identification of risk factors for recurrence in patients with minor ischemic stroke (MIS) is a critical medical need. AIM To develop a nomogram for individualized prediction of in-hospital recurrence in MIS patients. METHODS Based on retrospective collection, a single-center study was conducted at the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2019. Univariate and multivariate logistic regression analyses were used to determine the risk factors associated with MIS recurrence. The least absolute shrinkage and selection operator regression was performed for preliminary identification of potential risk factors. Uric acid, systolic blood pressure, serum total bilirubin (STBL), and ferritin were integrated for nomogram construction. The predictive accuracy and calibration of the nomogram model were assessed by the area under the receiver operating characteristic curve (AUC-ROC) and Hosmer-Lemeshow test, respectively. RESULTS A total of 2216 MIS patients were screened. Among them, 155 were excluded for intravascular therapy, 146 for unknown National Institutes of Health Stroke Scale score, 195 for intracranial hemorrhage, and 247 for progressive stroke. Finally, 1244 patients were subjected to further analysis and divided into a training set ( n = 796) and a validation set ( n = 448). Multivariate logistic regression analysis revealed that uric acid [odds ratio (OR): 0.997, 95% confidence interval (CI): 0.993-0.999], ferritin (OR: 1.004, 95%CI: 1.002-1.006), and STBL (OR: 0.973, 95%CI: 0.956-0.990) were independently associated with in-hospital recurrence in MIS patients. Our model showed good discrimination; the AUC-ROC value was 0.725 (95%CI: 0.646-0.804) in the training set and 0.717 (95%CI: 0.580-0.785) in the validation set. Moreover, the calibration between nomogram prediction and the actual observation showed good consistency. Hosmer-Lemeshow test results confirmed that the nomogram was well-calibrated ( P = 0.850). CONCLUSION Our present findings suggest that the nomogram may provide individualized prediction of recurrence in MIS patients.

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Different contribution of SBP and DBP variability to vascular events in patients with stroke

Cited by 10 publications

References 30 publications

Visit-to-Visit Blood Pressure Variability and Cardiovascular Outcomes in Patients Receiving Intensive Versus Standard Blood Pressure Control: Insights From the STEP Trial

Visit-to-Visit Blood Pressure Variability and Cardiovascular Outcomes in Patients Receiving Intensive Versus Standard Blood Pressure Control: Insights From the STEP Trial

Supplementation with the Prebiotic High-Esterified Pectin Improves Blood Pressure and Cardiovascular Risk Biomarker Profile, Counteracting Metabolic Malprogramming

Risk factors for relapse and nomogram for relapse probability prediction in patients with minor ischemic stroke

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