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Am J Hypertens. 2019 May 9;32(6):538-546. doi: 10.1093/ajh/hpz011.

High Home Blood Pressure Variability Associates With Exaggerated Blood Pressure Response to Cold Stress.

Author information

1
Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland.
2
Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
3
Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
4
Center for Life Course Epidemiology and Systems Medicine, University of Oulu, Oulu, Finland.
5
Oulu City Hospital, Oulu, Finland.
6
Center for Military Medicine, The Finnish Defence Forces, Helsinki, Finland.
7
Unit of General Practice, Oulu University Hospital, Oulu, Finland.
8
Research Unit of Biomedicine, and Biocenter Oulu, University of Oulu, Oulu, Finland.
9
Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland.
10
Center for Life Course Health Research, University of Oulu, Finland.
11
Healthcare and Social Services of Selänne, Pyhäjärvi, Finland.
12
Finnish Institute of Occupational Health, Oulu, Finland.

Abstract

BACKGROUND:

Exaggerated sympathetic cardiovascular (CV) reactivity to stress associates with elevated risk for clinical and preclinical end points of CV disease. It would be useful to identify these individuals, preferably from feasible measurements commonly used in health care. Our study examined the association between home blood pressure (BP) variability and cardiac workload response to whole-body cold exposure.

METHODS:

Seventy-five men (55-65 years, 46 hypertensive) measured BP at home twice in the morning and evening for a week. We computed systolic home BP variability as SD of daily means and divided the subjects into groups demonstrating either high or low BP variability. They were exposed to whole-body cold exposure (-10 °C, wind 3 m/second, 15 minutes, winter clothes, standing). BP and heart rate were measured at 3-minute intervals during, and 15 minutes before and after the exposure. Rate-pressure product (RPP) was calculated to represent cardiac workload.

RESULTS:

Subjects with high systolic home BP variability demonstrated a greater RPP increase in cold conditions compared to those with low BP variability [mean change from baseline (95% CI): 1,850 (1,450 to 2,250) bpm × mm Hg vs. 930 (610, 1,250) bpm × mm Hg, P < 0.01]. This was related to the augmented systolic BP change [31(28, 35) mm Hg vs. 23(20, 26) mm Hg, P < 0.01]. Home BP variability correlated with cold-related RPP (rS = 0.34, P = 0.003) and systolic BP (rS = 0.38, P < 0.001) responses.

CONCLUSIONS:

Moderate whole-body cold exposure increased BP and cardiac workload more among those with higher systolic home BP variability, independently of home BP level. Elevated home BP variability may indicate augmented sympathetically mediated vascular reactivity for environmental stressors.

PUBLIC TRIALS REGISTRY NUMBER:

Trial Number NCT02007031.

KEYWORDS:

blood pressure; cold temperature; environmental health; essential hypertension; home blood pressure monitoring; hypertension; physiological stress reactivity

PMID:
30984970
DOI:
10.1093/ajh/hpz011

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