Project description:L’âge et les comorbidités cardiovasculaires sont des facteurs indépendants de mortalité et d’hospitalisation en unité de soins intensifs chez les patients atteints de coronavirus 19 (COVID-19), contrairement à l’hypertension artérielle (HTA). La forte prévalence de l’HTA chez les personnes âgées, coronariens ou insuffisants cardiaques, explique l’importante prévalence de l’HTA parmi les patients hospitalisés et présentant des formes sévères de COVID-19. L’HTA, en tant que premier facteur de risque de morbi-mortalité cardiovasculaire, constitue le lit des comorbidités cardiovasculaires qui favorisent les formes sévères de COVID-19. L’hypothèse d’une surexpression de l’enzyme de conversion de l’angiotensine de type 2 membranaire par les inhibiteurs de l’enzyme de conversion et antagonistes des récepteurs de l’angiotensine 2, favorisant l’invasion cellulaire par le severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reste hypothétique, est insuffisante pour expliquer la pathogénie de ce virus, et ne doit pas amener à interrompre ces traitements. Les patients hypertendus et cardiovasculaires doivent faire l’objet d’une surveillance particulière en raison de leur susceptibilité aux formes graves de COVID-19, de leur risque accru de complications cardiovasculaires aiguës ou de décompensation de maladies cardiovasculaires chroniques. Le risque d’infection par le SARS-CoV-2 ne doit pas détourner les soignants et les patients de la prise en charge des urgences cardiovasculaires, même en temps d’épidémie.
Project description:BackgroundVarious sequelae have been described after nonsevere coronavirus disease 2019 (COVID-19), but knowledge on postacute effects on blood pressure is limited.MethodsThis is a cross-sectional analysis of blood pressure profiles in individuals after nonsevere COVID-19 compared with matched population-based individuals without prior COVID-19. Data were derived from the ongoing and prospective Hamburg City Health Study, a population-based study in Hamburg, Germany, and its associated COVID-19 program, which included individuals at least 4 months after COVID-19. Matching was performed by age, sex, education, and preexisting hypertension in a 1 : 4 ratio.ResultsFour hundred and thirty-two individuals after COVID-19 (mean age 56.1 years) were matched to 1728 controls without prior COVID-19 (56.2 years). About 92.8% of COVID-19 courses were mild or moderate, only 7.2% were hospitalized, and no individual had been treated on an intensive care unit. Even after adjustment for relevant competing risk factors, DBP [+4.7 mmHg, 95% confidence interval (95% CI) 3.97-5.7, P < 0.001] was significantly higher in individuals after COVID-19. For SBP, a trend towards increased values was observed (+1.4 mmHg, 95% CI -0.4 to 3.2, P = 0.120). Hypertensive blood pressures at least 130/80 mmHg (according to the ACC/AHA guideline) and at least 140/90 mmHg (ESC/ESH guideline) occurred significantly more often in individuals after COVID-19 than matched controls (odds ratio 2.0, 95% CI 1.5-2.7, P < 0.001 and odds ratio 1.6, 95% CI 1.3-2.0, P < 0.001, respectively), mainly driven by changes in DBP.ConclusionBlood pressure is higher in individuals after nonsevere COVID-19 compared with uninfected individuals suggesting a significant hypertensive sequela.
Project description:Within an individual, diastolic blood pressure (DBP) is negatively related to sympathetic burst incidence, such that lower pressure is associated with high burst incidence. Our goal was to explore the use of a calculation of a DBP "error signal" in the control of muscle sympathetic nerve activity in men and women. Baseline muscle sympathetic nerve activity was measured in healthy young men (n=22) and women (n=28). Women had significantly lower muscle sympathetic nerve activity than men (29+/-3 versus 43+/-2 bursts per 100 heartbeats; P<0.05). For each individual, the DBP at which there is a 50% likelihood of a muscle sympathetic nerve activity burst, the "T50" value, was calculated. Mean DBP was subtracted from the T50 blood pressure as an approximate error signal for burst activation. Error signal was negative in both sexes, indicating that DBP in both sexes was higher than the DBP value associated with a 50% burst likelihood. However, average error signal was significantly larger in women (-4+/-2 mm Hg) than in men (-1+/-0 mm Hg; P<0.05 versus women). We conclude that women operate at a mean DBP greater than their T50 compared with men, and this may be a contributing factor to low basal muscle sympathetic nerve activity in women. The relationship between error signal and burst incidence may provide important insight into the control of muscle sympathetic nerve activity across sexes and in various populations.
Project description:Two recent examinations reported a strong association between blood pressure (BP) and resting energy expenditure (REE), independent of body mass and body composition. Both reports postulate that neurohumoral processes that contribute to variation in REE may partly mediate the body mass effect on BP. Therefore, we examined the relationship of REE and BP in 108 asymptomatic women (a) to confirm previous findings in a novel population and (b) to examine the impact of a marker of sympathetic tone on this relationship, as this was indicated as a potentially salient intermediary in previous reports. All testing was performed during a 4-day admission to the General Clinical Research Center. Resting energy expenditure was measured by indirect calorimetry, body composition was determined by dual-energy x-ray absorptiometry, and 24-hour fractionated urinary norepinephrine was determined by high-performance liquid chromatography. Multiple linear regression revealed REE as a significant predictor of systolic BP (? = 0.30, P = .04), independent of race (? = 0. 28, P = .01), age (? = -0.02, P = .80), height (? = -0.38, P = .08), fat mass (? = 0.22, P = .20), fat-free mass (? = 0.08, P = .65), and 24-hour fractionated urinary norepinephrine (? = 0.06, P = .57); and the same model using diastolic BP as the dependent variable approached significance (? = 0.24, P = .09). This study affirms previous findings that REE may be a potential mediator in resting BP, independent of many well-cited factors and, additionally, a marker of sympathetic tone.
Project description:What is the central question of this study? Does ageing influence the respiratory-related bursting of muscle sympathetic nerve activity (MSNA) and the association between the rhythmic fluctuations in MSNA and blood pressure (Traube-Hering waves) that occur with respiration? What is the main finding and its importance? Despite the age-related elevation in MSNA, the cyclical inhibition of MSNA during respiration is similar between young and older individuals. Furthermore, central respiratory-sympathetic coupling plays a role in the generation of Traube-Hering waves in both young and older humans. Healthy ageing and alterations in respiratory-sympathetic coupling have been independently linked with heightened sympathetic neural vasoconstrictor activity. We investigated how age influences the respiratory-related modulation of muscle sympathetic nerve activity (MSNA) and the association between the rhythmic fluctuations in MSNA and blood pressure that occur with respiration (Traube-Hering waves; THW). Ten young (22 ± 2 years; mean ± SD) and 10 older healthy men (58 ± 6 years) were studied while resting supine and breathing spontaneously. MSNA, blood pressure and respiration were recorded simultaneously. Resting values were ascertained and respiratory cycle-triggered averaging of MSNA and blood pressure measurements performed. The MSNA burst incidence was higher in older individuals [22.7 ± 9.2 versus 42.2 ± 13.7 bursts (100 heart beats)(-1), P < 0.05], and was reduced to a similar extent in the inspiratory to postinspiratory period in young and older subjects (by ∼ 25% compared with mid- to late expiration). A similar attenuation of MSNA burst frequency (in bursts per minute), amplitude and total activity (burst frequency × mean burst amplitude) was also observed in the inspiratory to postinspiratory period in both groups. A significant positive correlation between respiratory-related MSNA and the magnitude of Traube-Hering waves was observed in all young (100%) and most older subjects (80%). These data suggest that the strength of the cyclical inhibition of MSNA during respiration is similar between young and older individuals; thus, alterations in respiratory-sympathetic coupling appear not to contribute to the age-related elevation in MSNA. Furthermore, central respiratory-sympathetic coupling plays a role in the generation of Traube-Hering waves in both healthy young and older humans.
Project description:There are concerns that hypertension control may decrease during the COVID-19 pandemic. This study evaluated the impact of the COVID-19 pandemic on office blood pressure (OBP) and home blood pressure monitoring (HBPM) control in a large Brazilian nationwide sample. The results of an adjusted spline analysis evaluating the trajectory of OBP and HBPM control from 01/Jan/2019 to 31/Dec/2020 among independent participants who were untreated (n = 24,227) or treated (n = 27,699) with antihypertensive medications showed a modest and transient improvement in OBP control among treated individuals, which was restricted to the early months following the COVID-19 pandemic outbreak. Furthermore, slight reductions in OBP and HBPM values were detected in the early months following the COVID-19 pandemic outbreak among treated (n = 987) participants for whom blood pressure measurements before and during the pandemic were available, but not among untreated (n = 495) participants. In conclusion, we found no major adverse influence of the COVID-19 pandemic on OBP and HBPM control in a large nationwide sample.
Project description:Background and Objectives: The objective of this study is to examine the effect of the BNT162b2 vaccine on systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) before and 15 min after two doses that were given 21 days apart. Materials and Methods: This active surveillance study of vaccine safety was conducted on 15 and 16 March (for the first dose) and 5 and 6 April (for the second dose) 2021 in an academic hospital. For both doses, SBP, DBP, MAP, and PP levels were measured before and 15 min after both doses were given to healthcare workers over the age of 18. The results of the study were based on measurements of the mean blood pressure (BP), the mean changes in BP, and the BP trends. Results: In total, 287 individuals received the vaccine. After the first dose, 25% (n = 72) of individuals had a decrease in DBP of at least 10 mmHg (mean DBP decrease: 15 mmHg, 95% CI: 14–17 mmHg), and after the second dose it was 12.5% (mean DBP decrease: 13 mmHg, 95% CI: 12–15 mmHg). After the first dose, 28.6% (n = 82) had a PP that was wider than 40 mmHg. After the first dose, 5.2% and 4.9% of the individuals experienced an increase or decrease in SBP, respectively, of more than 20 mmHg. After the second dose, the SBP of 11% (n = 32) decreased by at least 20 mmHg. Conclusions: Improved understanding of vaccine effects on BP may help address vaccine hesitancy in healthcare workers.
Project description:Blunted blood pressure (BP) dipping is an established predictor of adverse cardiovascular outcomes. Although blunted BP dipping is more common in African Americans than whites, the factors contributing to this ethnic difference are not well understood. This study examined the relationships of BP dipping to ethnicity, body mass index (BMI), sleep quality, and fall in sympathetic nervous system (SNS) activity during the sleep-period.On three occasions, 128 participants with untreated high clinic BP (130-159/85-99 mm Hg) underwent assessments of 24-h ambulatory BP (ABP), sleep quality, (evaluated by sleep interview, self-report, actigraphy) and sleep-period fall in sympathetic activity (measured by waking/sleep urinary catecholamine excretion).Compared to whites (n = 72), African Americans (n = 56) exhibited higher sleep-period systolic (SBP) (P = 0.01) and diastolic BP (DBP) (P < 0.001), blunted SBP dipping (P = 0.01), greater BMI (P = 0.049), and poorer sleep quality (P = 0.02). SBP dipping was correlated with BMI (r = -0.32, P < 0.001), sleep quality (r = 0.30, P < 0.001), and sleep-period fall in sympathetic activity (r = 0.30, P < 0.001). Multiple regression analyses indicated that these three factors were independent determinants of sleep-period SBP dipping; ethnic differences in dipping were attenuated when controlling for these factors.Blunted BP dipping was related to higher BMI, poorer sleep quality, and a lesser decline in sleep-period SNS activity. Although African-American ethnicity also was associated with blunted dipping compared to whites in unadjusted analyses, this ethnic difference was diminished when BMI, sleep quality, and sympathetic activity were taken into account.