Background and Aim: Slower lower limb blood pooling and associated blunted sympathetic activation has been detected in healthy women prone to orthostatic syncope. Whether these findings are true also for patients with vasovagal syncope (VVS) is unknown. The aim was to investigate initial blood pooling time  together with hemodynamic responses and orthostatic tolerance during lower body negative pressure (LBNP) in VVS and healthy controls.Methods and Results: Fourteen VVS women (25.7 ± 1.3 years) and 15 healthy women (22.8 ± 0.8 years) were subjected to single-step and graded LBNP to pre-syncope. Lower limb blood pooling (ml · 100 ml−1), poolingtime (s), hemodynamic responses and LBNP-tolerance were evaluated. LBNP induced comparable lower limb blood pooling in both groups . In controls, shorter poolingtime correlated to higher LBNP-tolerance  as well as better maintained stroke volume  and cardiac output . In contrast, shorter poolingtime correlated to lower LBNP-tolerance in VVS  and larger decline in stroke volume . Furthermore, in controls, shorter poolingtime correlated to baroreflex-mediated hemodynamic changes during LBNP, e.g., increased vasoconstriction (P < 0.001). In VVS, poolingtime was not correlated with LBNP-induced baroreceptor unloading, but rather highly correlated to resting calf blood flow (P < 0.001).Conclusions: Shorter poolingtime seems to elicit greater sympathetic activation with a concomitant higher orthostatic tolerance in healthy women. The contrasting findings in VVS indicate a deteriorated vascular sympathetic control suggesting well-defined differences already in the initial responses during orthostatic stress. Vasovagal syncope (VVS) is defined as a transient loss of consciousness, characterized by a sudden fall in systemic blood pressure . Second, after at least 15 min of rest an LBNP stress test (LBNPstress) was conducted in which the LBNP chamber pressure was reduced by 20 mmHg for 4 min and subsequent reductions in pressure of 10 mmHg were made every 4 min. The test was terminated according to the following criteria: (1) after completion of 4 min LBNP of 70 mmHg; (2) at the onset of presyncopal signs or symptoms ; (3) at the subjects request. LBNP tolerance index . Application of LBNP redistributes blood from the upper body to the lower extremities, leading to a central hypovolemia  were evaluated with strain gauge plethysmography during LBNP . The strain gauge was placed at the maximal circumference of the right calf and the leg was slightly elevated with the heel resting on a foot support with the lowest part of the calf ~2 cm above the floor of the LBNP chamber to avoid external pressure during blood pooling. LBNP-induced calf blood pooling and net fluid filtration were evaluated in accordance with the technique described by Lindenberger and Lanne (time) was defined in each subject .−1. Subjects were placed in the supine position with an acclimatization period of at least 15 min with the right leg slightly elevated and supported at the ankle. A strain gauge was applied at the maximal calf circumference and a cone-shaped, 22-cm-wide thigh cuff was placed on the thigh proximal to the knee on the right leg. The thigh cuff was rapidly (1–2 s) inflated to 60 mmHg using a cuff inflator, occluding venous return from the distal part of the leg . After 8 min of venous stasis, cuff pressure was reduced at a rate of 1 mmHg/s.Venous occlusion plethysmography was used for measurements of calf venous compliance, calf blood flow, and calf vascular resistance at rest. Changes in calf volume was measured in ml · 100ml−1 · mmHg−1) was calculated from the venous pressure-volume relationship during the deflation phase in accordance to the technique described by Skoog et al.  at rest. Calf blood flow was estimated as the slope of the rapid increase in calf cross-sectional area initiated by thigh cuff inflation over time  method  conducted all measurements for all participants. During the aortic flow measurements, the mean valvular velocity time integral (VTI) was registered during three consecutive heart beats, and stroke volume (SV) was calculated as the sub-valvular area × VTI. Cardiac output (CO) was calculated as the product of heart rate (HR) and SV during each measurement. Total peripheral resistance (TPR) was calculated as the ratio between mean arterial pressure (MAP) and CO during each measurement. Lower limb blood flow and maximal LBNP-induced arterial vasoconstriction were estimated during LBNP 30. Since maximal increase in vascular resistance occurs ~30 s after onset of LBNP , ruling out this confounding factor. Vascular resistance was calculated as mean arterial pressure (MAP) divided by blood flow.At rest, heart rate and blood pressure were measured with a semiautomatic blood pressure cuff positioned over the brachial artery on the right upper arm . Before and during the LBNP protocol, heart rate, and blood pressure were monitored noninvasively, beat-by-beat . From the continuous blood pressure measurement spontaneous baroreflex sensitivity was determined before the onset of LBNPat 40, 80, and 120 s) were measured noninvasively using a semiautomatic blood pressure cuff positioned over the brachial artery on the upper arm . Forearm blood flow (FBF) was measured by standard venous occlusion plethysmography  repeatedly at baseline (x6) and 40, 80, and 120 s (each x2) after the initiation of the CPT, with the arm at heart level and a strain-gauge at the maximal forearm circumference. Blood pressure and forearm blood flow were measured simultaneously, and mean forearm vascular resistance was calculated as mean arterial pressure (MAP) divided by mean FBF at baseline and CPT.To evaluate the sympathetic reflex arc, the cold pressor test (CPT) was performed in the supine position after at least 10 min of rest. The right foot was immersed into a water bath of 5°C  for 120 s. Subjects were instructed to relax, maintain normal breathing, and to avoid isometric muscular contraction throughout the test. Heart rate and blood pressure at rest and during CPT . Within-group differences were tested by paired Student's t-test with Bonferroni correction for multiple measurements (LBNP 0–40 mmHg). Repeated measure ANOVA with Bonferroni correction for multiple comparisons was used to assess cardiovascular responses during the cold pressor test. P < 0.05 were considered statistically significant. Statistical analyses were carried out using SPSS 22.0 for Windows .Data are expressed as means ± P < 0.01) and calf vascular resistance concomitantly higher (P < 0.01).Table stress. Systolic blood pressure (SBP) decreased with increasing LBNP in both controls and VVS (P < 0.05). Diastolic blood pressure (DBP) and mean arterial pressure (MAP) displayed an overall stable pattern with no systematic differences between the groups. Pulse pressure (PP) declined in both groups (P < 0.05), with VVS presenting with significant lower PP (P < 0.05). Heart rate (HR) showed a similar increase in both controls and VVS (P < 0.05). Stroke volume (SV) as well as cardiac output (CO) decreased rapidly in both groups (P < 0.05), with VVS displaying more pronounced decreases than controls (both P < 0.05). Although total peripheral resistance (TPR) seemed to increase in both groups only controls displayed a significant increase in TPR (P < 0.05). However, the variability as well as the continuous drop out during lower LBNP levels due to presyncope were greater in VVS  was higher in controls compared to VVS .Figures S Figure . The max30 was 3.1 ± 0.3 in controls and 2.9 ± 0.3 ml · 100 ml−1 in VVS, with no differences between the groups (P = 0.70). LBNP tolerance index (LTI) was higher in controls (235 ± 8 ΔmmHg · min) than VVS .The amount of pooled blood volume during LBNPtime and maximal LBNP tolerance. In controls, shorter poolingtime correlated with higher LBNP tolerance . Despite this, no overall group differences in poolingtime were seen during LBNP, being 27 ± 3 and 27 ± 2 s in controls and VVS respectively (P = 0.91).Figures time and SV, CO as well as PP  evaluated during LBNPstress at 30 mmHg. In controls, shorter poolingtime correlated to a better preserved SV  and calf blood flow (CBFrest)] and dynamic . The models explained 81% of the variance regarding poolingtime in controls (P < 0.001) and 86% in VVS (P < 0.001). In controls, only dynamic factors, i.e., CVRLBNP (P < 0.001), CBFLBNP (P < 0.001), and CBPLBNP (P < 0.01) contributed significantly to the model. In sharp contrast, only static factors, i.e., CBFrest (P < 0.001) and Crest (P < 0.05) contributed significantly to the model in VVS.Multiple linear regressions were performed to identify the determinants of poolingon Table . We diviP < 0.001, control vs. VVS, P = 0.86, Figure P < 0.001, control vs. VVS, P = 0.83, Figure P < 0.05, Figure Figures time, i.e., rapid LBNP-induced lower limb blood pooling correlated with higher LBNP tolerance and with more efficient cardiovascular regulation. In controls, poolingtime correlated with baroreceptor-induced changes in blood flow and peripheral vascular resistance; (2) In women with vasovagal syncope (VVS), shorter poolingtime correlated with defective cardiovascular compensatory responses and lower LBNP tolerance. Furthermore, in VVS, poolingtime was not correlated to baroreceptor-induced responses, but rather resting, static parameters, indicating differences in cardiovascular responses between controls and VVS even during early phases of orthostatic stress.The main findings in this study were: (1) In controls, shorter poolingon the amount blood displaced into the veins  at rest accompanied with higher arterial vasoconstriction may minimize loss of central blood volume during orthostatic stress in VVS (Figures time, i.e., Midodrine may bring the patient from the low tolerance end to the high tolerance end as depicted in Figure Decreased baroreflex-mediated sympathetic control may explain the lower overall LBNP-tolerance in VVS compared to controls, but cannot explain lower LBNP-tolerance within the VVS group in women with shorter pooling Figures , 4D–F. I Figures , 4D–F, p Figures . Althoug Figures , shown t Figures . The ratNo healthy women but seven VVS women used contraceptives. However, all measurements were conducted during the first 10 days of the follicular phase, and, as such, during a period with low concentrations of estrogen and progesterone. Furthermore, no significant differences in cardiovascular responses during LBNP were found when normally menstruating women were compare to women using oral contraceptives (Lindenberger et al., time was associated with baroreceptor-induced changes in blood flow and peripheral vascular resistance indicating that speed-dependent baroreflex-mediated sympathetic activation may in part explain individual differences in orthostatic tolerance in healthy women. In women with VVS however, rapid LBNP-induced lower limb blood pooling correlated with lower LBNP tolerance and more deficient cardiovascular responses. Further, poolingtime was primarily associated with resting calf blood flow, indicating altered sympathetic vascular control during baroreceptor unloading compared to healthy women. The contrasting findings in poolingtime and its association with hemodynamic responses and LBNP tolerance suggest well-defined differences in cardiovascular regulation during orthostatic stress in healthy women and women with VVS.In healthy women, rapid LBNP-induced lower limb blood pooling was correlated with higher LBNP tolerance and more efficient cardiovascular responses. Further, poolingJS participated in the study design, performed the experiments, interpreted the data, and drafted the first manuscript. HZ was responsible for study design, interpreted the data and revised the manuscript. TL was responsible for the study design, interpreted the data, and revised the manuscript. ML was responsible for the study design, performed the experiments, interpreted the data, and revised the manuscript.This work was supported by grants from Futurum—the Academy of Health Care, Jönköping County Council; Medical Research Council of Southeast Sweden; the Heart and Lung Foundation, and from the County Council of Östergotland.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Intensive blood pressure (BP) target decreases blood perfusion of kidneys that attenuates the benefits of BP treatment in elderly hypertensive individuals. The optimal BP goal for renal function in the hypertensive elderly has been unclear. We investigated the impact of BP on renal function to define the appropriate BP target in the elderly.A total of 28,258 elderly subjects were categorized into normotensive (Norm), hypotensive (Hypo) and hypertensive (Hyper) groups according to BP levels. Systolic, diastolic and pulse BP  were further stratified by 10 mmHg. Blood urea nitrogen, serum creatinine, uric acid, glomerular filtration rate (GFR), renal insufficiency prevalence (RIP) and proteinuria prevalence (PP) were compared among different groups and BP strata. The RIP and PP in the elderly with obesity, hyperlipidemia or diabetes in Norm, Hypo and Hyper groups were evaluated.GFR in Hypo and Hyper groups was significantly lower than that in Norm group. The RIP and PP was higher in Hypo and Hyper groups than that in the Norm group. Proteinuria became more prevalent when SBP was >140 mmHg or <90 mmHg. DBP>80mmHg increased PP while DBP<70 mmHg increased RIP. PBP>60 mmHg led to an increased RIP and PP. Obesity or hyperlipidemia only combined with hypertension caused a significantly increased RIP and PP. Diabetes independent of hypertension contributed to higher RIP and PP.The most beneficial BP target for kidney function in the elderly may be SBP of 90-140 mmHg and DBP of 70-80 mmHg. PBP <60 mmHg may be appropriate. The prevalence of hypertension has been on the rise which causes a large global economic burden worldwide , 2. HypeThe study protocol was approved by the medical ethics committee of the Third Xiang-ya Hospital. All of the subjects enrolled in this study gave informed consent to participate in this study.2 or more [2.In this cross-sectional study, 31,941 Chinese people were consecutively recruited who participated in annual physical examination in Health Examination Center of the Third Xiang-Ya Hospital in Hunan Province between 2008 and 2010. Inclusion criteria were >60 year-old, male or female. Exclusion criteria included 1) no available data on BP value, glucose concentration, cholesterol level, blood urea nitrogen (BUN) level, uric acid (UA) level, serum creatinine (Scr) level, urine analysis, body weight, or height, and 2) history of primary renal diseases; and 3) renal artery stenosis, and 4) duplicate cases. A total of 28,258 subjects met with the inclusion and exclusion criteria and were eligible for inclusion in this study. Hypertension was defined according to the JNC 7 Report , and peo or more . Hyperli or more , or pati or more  or patie or more  was defi-1.154×Age-0.203 . The CKD-EPI estimate of renal function was calculated as recommended: For women with a Scr ≤0.7, 144×(Scr/0.7)-0.329×0.993age; for women with a Scr>0.7, 144×(Scr/0.7)-1.209×0.993age; for men with a Scr ≤0.9, 141×(Scr/0.9)-0.411×0.993age; for men with a Scr >0.9, 141×(Scr/0.9)-1.209×0.993age.The examination was carried out during outpatient visit including an interview to determine the history of hypertension, diabetes and hyperlipidemia. After fasting overnight, BP was measured with an appropriately sized cuff and a mercury column sphygmomanometer in the sitting posture after a 10-min rest. Height and body weight were measured, and BMI was calculated as body weight divided by square of height. Venous blood sampling from all of the subjects was performed. Serum glucose, TC, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, blood urea nitrogen (BUN), Scr and uric acid (UA) rand Scr level were determined using standard laboratory methods. Qualitative analysis of urea protein was measured by sulfosalicylic acid method. GFR was estimated using the simplified Modification of Diet in Renal Disease (MDRD) and chronic kidney disease (CKD-EPI) equations. MDRD estimate of kidney function was calculated as 186×Scrt test for continuous variables. Multiple linear regression was performed to analyze the relationship between blood pressure and clinical or laboratory parameters. Systolic, diastolic and pulse pressure (PBP) were stratified by 10mmHg. Binary logistic regression was used to explore the effect of different SBP, DBP and PBP strata on renal insufficiency and proteinuria. SBP stratum of 100-110 mmHg, DBP stratum of 70-80 mmHg and PBP stratum of 40-50 mmHg were considered as reference. Odds ratio (OR) and 95% confidence internal (CI) were calculated. The validity of the models was confirmed by conducting the likelihood-ratio test. P value under 0.05 was considered to be statistically significant. Analysis was performed in statistical software package SPSS16.0 for Windows.Continuous variables were expressed as mean ± SD and categorical variables as percentage unless otherwise stated. The subjects were categorized into normotensive (Norm), hypotensive (Hypo) and hypertensive (Hyper) groups according to BP level. Each of Norm, Hypo and Hyper groups was further divided into control, obesity, hyperlipidemia and diabetes groups. One-way ANOVA was used to compare difference of means of continuous variables among three groups or more. Analysis of covariance was used to control for confounding factors. The significance of difference between two groups was determined by chi-square test for categorical variables and P<0.0001) but females were more likely to have hypotension than males . SBP was as high in women as in men  whereas women had lower DBP and larger PBP than men . Estimated GFR by MDRD formula was higher than that calculated by CKD-EPI equation . There was a mean difference of 3.5ml/min/1.73m2 between MDRD and CKD-EPI eGFR when their average was less than 98ml/min/1.73m2 but the difference became larger and larger when their average value was more than 98ml/min/1.73m2. Many extreme high values of GFR could be easily obtained by MDRD equation . Hypertensive group had 1.93-fold higher prevalence of renal insufficiency  and 2.24-fold higher prevalence of proteinuria  than normotensive group, while hypotensive group had 1.84-fold higher prevalence of renal insufficiency . But there was no significant difference in prevalence of proteinuria between hypotensive and normotensive groups (P=0.583). The multiple linear regression showed that 1) cholesterol and glucose levels were positively related to blood pressure only in hypertension group; 2) age was a negative factor for DBP; 3) BMI was positively correlated with blood pressure in both hypotension and hypertension groups; and 4) a decreased GFR was positively correlated to not only hypertension but also hypotension  while BUN, Scr and UA respectively increased by 0.2mmol/L, 1.93μmol/L and 7.5μmol/L . GFR decreased progressively and continuously with increase in SBP, approximately going down by 1.13ml/min/1.73m2 for every 10mmHg increase in SBP that occurs within the range of 140 to 230mmHg while BUN, Scr and UA increased by 0.08mmol/L, 1.54μmol/L and 1.73μmol/L for every 10mmHg increase in SBP. OR values of renal insufficiency and proteinuria in different SBP strata are shown in The GFR and prevalence of renal insufficiency and proteinuria in different SBP strata are presented in 2 for every 10mmHg decrease while BUN, Scr and UA respectively increased by 0.1mmol/L, 0.63μmol/L and 1.33μmol/L. When DBP ranging from 90-120mmHg increased, GFR decreased by 1.93ml/min/1.73m2 for every 10mmHg change while BUN, Scr and UA increased 0.03mmol/L, 2.8μmol/L and 2.95μmol/L. When DBP was over 120mmHg, GFR obviously decreased and BUN Scr and UA quickly increased. OR values of renal insufficiency and proteinuria in different DBP strata are shown in The GFR and prevalence of renal insufficiency and proteinuria in different DBP strata are presented in 2 for every 10mmHg increase while BUN, Scr and UA respectively increased by 0.16mmol/L, 2.27μmol/L and 5.18μmol/L. OR values of renal insufficiency and proteinuria in different PBP strata are shown in The GFR and prevalence of renal insufficiency and proteinuria in different PBP strata are presented in P>0.05).Renal insufficiency and proteinuria rate of the hypertensive and hypotensive elderly with obesity, hyperlipidemia or diabetes are presented in 2.In total, we studied 28,258 elderly subjects including hypertension, hypotension, obesity, hyperlipidemia and diabetes patients. Given the difficulties with accurate estimation of GFR and the limitations of calculating GFR by the MDRD formula, we used the new CKD-EPI equation. Although overall mean bias is smaller for the MDRD formula, the higher accuracy is reached with the CKD-EPI equation . CompareThe prevalence of hypertension increases markedly with age, such that approximately two thirds of people over 60 years of age have hypertension. This study showed the prevalence of hypertension was 68.2% among elderly in 2008 to 2010 which increased by 19% than that in 2002 . It is cP<0.0001); the prevalence of proteinuria also went up from 8.2% to 8.7% although the statistical analysis showed no significant difference between hypotensive and normotensive groups (P=0.583).It is well known that hypertension could cause severe renal damage including decreased GFR, high prevalence of renal insufficiency and proteinuria , 9, 19. Data from randomized controlled trials suggests that treating hypertension in the elderly may substantially reduce the risk of cardiovascular disease and kidney damage . HoweverP=0.012). However the Irbesartan in Diabetic Nephropathy Trial (IDNT) showed progressive lowering of BP up to DBP of 85 mmHg protected against cardiovascular event but not renal endpoint [Diabetes increases prevalence of renal insufficiency and proteinuria among the elderly , 35. It endpoint , 45. Theendpoint -48. Our Our findings suggest that while hypertension has a clear causative relationship with chronic renal damage as has been reported previously hypotension may also contribute to renal dysfunction in the elderly. And the most beneficial BP target for kidney function in the elderly may be SBP of 90-140 mmHg and DBP of 70-80 mmHg. PBP less than 60 mmHg may be appropriate. Only obesity or hyperlipidemia combined with hypertension causes kidney damage. They do not impact renal function alone. However, diabetes independent of hypertension leads to renal insufficiency and proteinuria. Diabetes confronted with hypertension enhances renal dysfunction. The hypertensive elderly patients with obesity hyperlipidemia or diabetes might need different BP target.The strategy and intensity of treatment of BP in the elderly should be based on the patient’s individual CVD risk factors and possible comorbidity conditions rather than on aggressive BP goal recommended by global guideline alone. Although our study supplies important primary evidence about BP goal in the elderly further large prospective elderly-based study will be needed to confirm our observations.


High blood pressure (HBP) is the leading risk factor for years of life lost in Brazil. Factors associated with HBP awareness, treatment and control need to be understood better. Our aim is to estimate prevalence, awareness, and types of anti-hypertensive treatment and to investigate the association of HBP control with social position. Data of 15,103  civil servants in six Brazilian state capitals collected at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010) were used to estimate prevalence and cross-sectional association of HBP control with education, per capita family income and self-reported race, using multiple logistic regression. Blood pressure was measured by the oscillometric method. 35.8% were classified as presenting HBP; 76.8% of these used anti-hypertensive medication. Women were more aware than men (84.8% v. 75.8%) and more often using medication (83.1% v. 70.7%). Adjusted HBP prevalence was, in ascending order, Whites (30.3%), Browns (38.2%) and Blacks (49.3%). The therapeutic schemes most used were angiotensin-converting enzyme inhibitors, in isolation (12.4%) or combined with diuretics (13.3%). Among those in drug treatment, controlled blood pressure was more likely in the (postgraduate) higher education group than among participants with less than secondary school education , and among Asian  and ‘Whites  compared to Blacks. Socioeconomic and racial inequality—as measured by different indicators—are strongly associated with HBP control, beyond the expected influence of health services access. High blood pressure (HBP) accounted for 9.4 million deaths and 7% of global disability-adjusted life years in 2010, making it the leading single risk factor in the global burden of disease, which iBrazil is a South American country of continental dimensions with the fifth-largest population in the world, where rates of morbidity and mortality are strongly affected by geographical, racial and social inequalities. CardiovIn Brazil, it is largely unknown how socioeconomic, racial and demographic factors influence control of HBP. Higher prevalence of hypertension and poorer therapeutic control have been noted among those of lower socioeconomic position,19. SociEstudo Longitudinal de Saúde do Adulto—Longitudinal Study of Adult Health) is a large , multiracial, multicentre cohort study focused on the risk of cardiovascular diseases, diabetes, and obesity in Brazilian adults aged 35–74 years[ELSA-Brasil (–74 years. From thDetailed information on ELSA-Brasil can be found in another publication. BrieflyFor the baseline study (2008–2010), 15,105 retired and active civil servants from 35 to 74 years old were recruited, out of which 2 individuals were excluded because of there was no information on anti-hypertensive drug use.Arterial pressure was measured after five minutes’ rest, with thQuality assurance and control procedures were implemented across centres to minimise error. Test-retest measurements were performed under similar conditions shortly after the original set of measurements. The intra-class correlation coefficients were 0.88  for systolic blood pressure and 0.89  for diastolic blood pressure.All participants were asked about use of continuous medication in the prior two weeks and wereCasual blood pressure (BP) was considered to be the mean of the last two of the three BP measurements taken. Hypertension was defined in terms of three criteria: systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or use of medication to treat HBP.To be considered an anti-hypertensive drug user a participant had to report a specific medication in at least one of the categories listed above and to respond ‘Yes’ to the question "Are any of the drugs you have taken in the past two weeks for hypertension (high blood pressure)?".Controlled blood pressure was defined as SBP <140 mm Hg and DBP <90 mm Hg.Those who responded ‘Yes’ to the question "Has a doctor ever told you that you have hypertension (high blood pressure)?" were considered to be aware of the condition of HBP, except women who reported the diagnosis only during pregnancy. Controlled HBP was defined as systolic BP < 140 mmHg and diastolic BP < 90mmHg. This study did not evaluate non-drug treatment of HBPhypertension.The following covariates were considered: age , gender, education , self-declared race  and per capita family income in US dollars (USD) —local currency, Brazilian reais (BRL) was converted to USD at a rate of BRL 2.00 = US$1.00.Cohort characteristics were summarized using prevalence of high blood pressure by age, gender, education, per capita family income and race. Prevalence adjusted for age and gender were estimated using a logistic regression model. It consThe association between covariates and controlled HBP was investigated through multiple logistic regression. We fitted four models including each socio-demographic variable step by step, in order to be able to discuss the contribution and changes of estimates in each one.The Marginal prevalence ratios were estimated as proposed by Wilcosky&Chambless. All anaApprovals were granted by all institutional review boards: Sao Paulo University, Oswaldo Cruz Foundation, Federal University of Bahia, Federal University of Minas Gerais, Federal University of Espírito Santo, and Federal University of Rio Grande do Sul. All participants signed declarations of informed consent.Prevalence of HBP was greater among the men than among the women (40.1% vs. 32.2%) and increased with age . In addiOverall, 35.8% were classified as having HBP . Of thesAmong those using anti-hypertensives, the prevalence of controlled blood pressure, adjusted for age, level of education, per capita family income and colour/race , Model 4Among the 4147 participants in treatment with drugs, the classes of anti-hypertensives most used, in isolation or combination, were: diuretics (53%); angiotensin-converting enzyme inhibitors (ACE inhibitors) (38.7%); beta blockers (31.7%); angiotensin II receptor antagonists (29.3%); calcium-channel blockers (18.9%); central action sympatholytics (1.71%); alfa-1 blockers (0.51%); vasodilators (0.4%). Among the diuretics (n = 2471), most used were thiazides (85.7%), followed by aldosterone antagonists and potassium-sparing drugs (11.6%) and loop diuretics (2.8%) (data not shown).Most used in treatment with one or more drug classes  were ACEThe drugs most used alone  were hydIn this cohort, from 35 to 74 years old, 35.8% of participants were classified as hypertensive, with greater prevalence among the men. The women showed more frequent prior awareness of their condition of HBP, use of anti-hypertensive drugs and control of blood pressure (BP). Control of BP among users of anti-hypertensive drugs varied inversely with socioeconomic position and was lower among self-reported Black participants. The drug classes most used for treatment were, in decreasing order, diuretics, ACE inhibitors, beta blockers and angiotensin II antagonists. The great majority of participants classified as having HBP used more than one anti-hypertensive drug, particularly ACE inhibitors in combination with diuretics.The prevalence of HBP found among participants in ELSA-Brasil is greater than the 28.7% reported in a meta-analysis based on 10 Brazilian cross-sectional studies[The estimate given here is also comparable with those found in the United States in 2011–12 (29.1%), England in 2006 (29%) and China in 2011–12 (40%)–36. SelfIn this study population, 80.2% of participants classified as having high blood pressure were aware of their condition, which is similar to levels in Canada (82.6%) and the United States (74%) in comparable populations ,38, in sImportantly, although awareness of a diagnosis of high blood pressure is a key factor in controlling the condition, it is not enough to assure adherence to treatment nor to change behaviour, especially because high blood pressure is generally asymptomatic. Confidence in the health system, routineAnti-hypertensive drugs were widely used, at levels similar to those reported for the populations of the United States (75.7%) and Canada (79.0%). The antControlled blood pressure in about 50% of hypertensives is in line with the literature. Less frDespite the socioeconomic position characteristics of the ELSA population and the narrower range of socioeconomic variation than for the overall population of Brazil, unequal prevalence of controlled blood pressure among users of anti-hypertensives are expressed strongly and clearly. As in other studies,53,54, pThe lower percentage of control among participants with undergraduate, as compared with postgraduate, university education is particularly striking. Given that these two groups have both studied at university level, it is improbable that differences in information as to the importance of control, nor health service use, contributed to that result. However, it is conceivable that greater autonomy and acquisition of new skills (control over work processes), which are identified as protective against men’s developing high blood pressure, may parThe association between lower socioeconomic position and greater prevalence of HBP is reported in other countries,39,5353,57. LackIn the United States, the excess of high blood pressure shown by Afro-Americans as compared with Whites has been one of the main characteristics of health inequalities,53. ExplIn addition to showing higher prevalence of HBP, Afro-Americans displayed lower blood pressure control rates, even comparing only those who use anti-hypertensive drugs,54. SociIn Brazil, empirical studies of racial inequalities in the occurrence and control of HBP are scarce, but suggest greater prevalence among Blacks –64 and aIn ELSA, Black participants represented 25% of the group with up to secondary education and only 6% of those with postgraduate education. In addition, they reported discrimination more often than participants self-reported as in other racial categories (results not presented). It can be imagined that racism and socioeconomic disadvantage act simultaneously to increase the risk of high blood pressure and decrease the opportunities to control it.This study presents results based on standardised blood pressure measurements and detailed data on anti-hypertensive drug use among 15103 participants of the ELSA-Brasil cohort. As that study was conducted in six of Brazil’s state capitals, these results offer limited scope for generalisation to Brazil’s overall adult population. Although relating to a specific population, the ELSA-Brasil results may indicate the situation of the portion of Brazil’s population comprising residents of large urban centres who are in employment. For example, lower frequencies of HBP awareness and control among men—a finding encountered universally in the available literature–constitute one important bottleneck for prevention and control of HBP in Brazil and other countries. Improved understanding of the different social roles, opportunities and constraints experienced in different manners by men and women can inform public health policies more effectively and contTo conclude, higher levels of HBP awareness and control is an essential precondition to reducing the impact of diseases, complications and deaths from cardiovascular diseases and diabetes in Brazil, which is going through a period of rather peculiar social and demographic transitions. The results of this study and future analyses of the ELSA population, which–unlike other cohorts comprising exclusively individuals with high blood pressure–is made up of workers, can yieS1 File(DOCX)Click here for additional data file.


This single blind cross-sectional study compared the vascular health of subjects suffering from severe chronic periodontitis, severe aggressive periodontitis and periodontal healthy controls by evaluating pulse wave velocity (PWV), augmentation index (AIx) and pulse pressure amplification (PPA).In a total of 158 subjects, 92 suffering from severe periodontitis and 66 matched periodontal healthy controls, PWV, AIx, central and peripheral blood pressure were recorded using an oscillometric device (Arteriograph).Subjects suffering from severe chronic or aggressive periodontitis exhibited significantly higher PWV (p = 0.00004), higher AIx (p = 0.0049) and lower PPA (p = 0.028) than matched periodontal healthy controls.The results of this study confirm the association between periodontal inflammation and increased cardiovascular risk shown by impaired vascular health in case of severe periodontitis. As impaired vascular health is a common finding in patients suffering from severe periodontal disease a concomitant routine cardiovascular evaluation may be advised. The association between oral inflammation and the risk for myocardial infarction or stroke has been firstly described already more than two decades ago The measurement of arterial stiffness by pulse wave reflection may be regarded as a prognostic significant extension of conventional vascular diagnosis. PWV is a direct marker of arterial stiffness An indirect measure of arterial stiffness and a direct measure of pulse wave reflection is the augmentation pressure and the augmentation index Both, PWV and AIx, provide essential information on the status of the arterial vascular system. The prognostic significance of arterial stiffness is very high. Measurements of PWV and AIx calculations allow stratifying patients with a high risk profile for cardiac and cerebral events who might benefit from more intensive cardiovascular treatment schemes Recently a new recording system for the assessment of vascular function on the basis of recorded pulse wave data has been developed, the so called Arteriograph. The Arteriograph was the very first validated device that allowed the measurement of PWV, AIx and central pressures by analysis of the oscillometric pressure curves registered on the upper arm with a single pressure cuff The aim of this cross sectional study was to assess the cardiovascular status of patients suffering from severe aggressive or chronic periodontitis by recording pulse wave velocity, augmentation index and central blood pressure with the Arteriograph and compare it to data recorded from matched periodontal healthy controls.This investigation was designed as a single blind cross-sectional trial. The study protocol, prepared in accordance with the declaration of Helsinki of 1973 and meeting the GCP criteria, was approved by the ethics committee of the University of Wuerzburg. All subjects included have signed the informed consent. A positive vote of the ethics committee of the University of Wuerzburg from 2009 (file #39-09) is easily available (e.g. on request via mail to the corresponding author).Study subjects were screened and recruited from individuals seeking dental care at the School of Dental Medicine of the University of Wuerzburg.Patients suffering from untreated severe generalised chronic or aggressive periodontitis were eligible for participation in test group. The diagnosis of generalised severe chronic or aggressive periodontitis was based on the classification criteria of the International Workshop for a Classification of Periodontal Diseases and Conditions The severity of disease expression was categorized according to the proposal of the working group of the Centers for Disease Control (CDC) and the American Academy of Periodontology (AAP) In order to restrict inclusion only to subjects with extensive periodontal lesions study patients additionally had to meet the following criteria: Patients with clinical detectable attachment loss ≥6 mm in a minimum of two different sextants and a minimum of six interproximal sites on six different teeth were eligible for inclusion in the test group.Individuals exhibiting minor periodontal pockets ≤3 mm were designated periodontal healthy and were eligible for inclusion in the control group.Individuals meeting the following criteria were not eligible for study participation: Less than ten natural teeth, age <18 years, pregnancy or breastfeeding, infectious disease, systematic periodontal therapy within the last five years, antibiotic medication within the last six months, intellectual inability to fully comprehend the aims of the study, severely decayed teeth, atrial fibrillation, or severe cardiac valve vitium.A total of 724 subjects were screened, 256 met the inclusion criteria. Ultimately 158 subjects  were enrolled in the study. 92 patients were assigned to the test group (severe periodontitis). 74 received the diagnosis of severe chronic periodontitis and 18 suffered from aggressive periodontitis. 66 subjects served as periodontally healthy controls. Individuals meeting the inclusion criteria after the screening examination were informed about the aims of the study and asked for their participation. All patients who participated in the study signed informed consent and received an assessment of their periodontal health by recording a comprehensive periodontal status as well as an assessment of their cardiovascular status by using the Arteriograph within the next seven days. For matching purposes furthermore age, gender, weight, height, smoking habits and the presence of known systemic medical problems (e.g. diabetes) were recorded using a questionnaire.After setting the age of the evaluated subjects to older than 35 years it was not necessary to match the patients in the sense of pair wise assignment. The limit of 35 years was chosen because in the periodontitis group no one was younger than 36. After this exclusion, except the peripheral pulse pressure, there were no significant differences between the periodontally healthy controls and the test group suffering from severe periodontal diseases regarding the following parameters: gender, age, body mass index, height, weight, smoking habits, arterial hypertension, and presence of hypercholesterolemia. The same holds true for medication  and 2.The periodontal examination comprised the following parameters: Number of intraoral visible teeth, pocket probing depth (PPD) and clinical attachment level (CAL). Measurements were performed at six sites per tooth using a CP-12 Marquis periodontal probe ; Recorded measurements were rounded to the nearest millimeter. All periodontal examinations were executed by a single clinically experienced dentist. To ensure the reproducibility of the clinical test results, an intra-individual calibration was performed. For this, 4 phantom models with periodontal defects with each 27 teeth were measured at two points in time. The examiner was calibrated if the first measurement and the measurement 48 hours later was were equal at 75% of the measurements with total agreement and 95% within±1 mm After the periodontal examination the recording of the cardiovascular parameters was performed during a subsequent appointment within the next seven days using the Arteriograph  with the corresponding TensioMed analysis software (version 1.9.9.12).In accordance with the international guidelines for the implementation of arterial stiffness measurements, all measurements were made in the same room under quiet conditions and dim illumination, unaffected by external environmental influences Firstly the distance between the sternal notch (jugulum) and the symphysis was recorded with a tape measure. Subsequently, in order to minimize sources of recording error each patient had a rest period of ten minutes before the onset of the cardiovascular measurements. All measurements were performed three times, with a predetermined free interval of two minutes between the individual measuring periods. During the examination the study subjects lay relaxed on an examination couch with eyes closed. All vascular data were recorded by the same trained medical technical assistant who was unaware of the assignment of the study subjects to the test or control group.The analysis of the Arteriograph data was performed by an experienced cardiologist (JB) who also was unaware of the assignment of the data to the different groups.Statistical data analysis was performed by a professional statistician using the WinMEDAS  statistical software package.To calculate the differences between both groups the Mann-Whitney U-test was used for continuous variables. The Chi-square-test or Fishers test for expected values below 5 was used for nominal scale data. The level of significance was set to p<0.05.The results of the PWV data analysis are depicted in The results of the calculation of the AIx data for the test and control group are shown in In the periodontally healthy controls the peripheral diastolic blood pressure was lower, peripheral systolic blood pressure higher and consequently the peripheral pulse pressure significantly higher (p = 0.0024) than the values recorded for the periodontitis group see . HoweverThe main finding of this study is that in patients suffering from severe chronic or aggressive periodontitis arterial stiffness and pulse wave reflection are significantly increased.It further supports the evidence for an association between periodontal and cardiovascular health and is in line with the data of several other studies The specific relationship between arterial stiffness and periodontitis was documented only once before in a subgroup of patients suffering from arterial hypertension Nevertheless, data analysis revealed that the mean peripheral blood pressure of both groups is within the normal range . On the basis of a routine peripheral blood pressure control by the method of Riva-Rocci, the average individual in the test group would have been classified as patient with no risk factor for cardiovascular events. This illustrates the potential benefits of the oscillometric pulse wave analysis (e.g. Arteriograph) compared to ordinary blood pressure measurements for the detection of early or preclinical signs of cardiovascular dysfunction.Another point to discuss is the diagnosis and thus the grouping of the patients. The use of the established Community Periodontal Index of Treatment Needs CPITN Particularly in young individuals with a diagnosis of aggressive periodontitis the recorded pulse wave velocity values were significantly higher than those found in the periodontally healthy controls (data not shown). This is consistent with findings from other studies documenting a much stronger association between periodontal infections and vascular endpoints in younger patients “Translating” the arterial stiffness measurements observed in this study into a biological vascular age may serve as an illustration for the importance of the present findings For the prediction of cardiovascular events the central pressure is more important than the peripheral The most frequently cited reason for the intake of beta-blocker is the diagnosis “hypertension”. Beta-blockers per se (possible exception nebivolol) affect arterial stiffness possibly indirectly by lowering of peripheral blood pressure and/or the initially ejected pressure wave without changing central hemodynamics. Though beta-blockers are known to lower PWV the group with the more frequent intake of β-blockers is showing higher PWV (the periodontitis group). One might speculate that if the intake of beta-blockers would be completely uniformly distributed, the difference in PWV of the groups could even be more pronounced. The same holds true for PPA. Nevertheless both, the intake of beta-blockers and the diagnosis hypertension, are not significantly different in both groups.This cross-sectional study shows for the first time a pathophysiological and highly significant predictive risk marker of PWV in addition to the above described pulse wave reflection to be higher in patients suffering from severe periodontitis. Further intervention studies using these markers of vascular dysfunction and vascular structure as endpoints may be required to elucidate possible causal relationships between periodontal and cardiovascular disease.


Presence of epinephrine in local anesthetic cartridge increases the duration of local anesthesia (LA), decreases the risk of toxicity, and provides hemostasis. However, the unfavorable effects are increasing heart rate (HR) and raising blood pressure (BP). The aim was to evaluate hemodynamic changes in the BP, HR, and oxygen saturation (SpO2) of normal patients undergoing tooth extraction using LA with various epinephrine concentrations. A prospective randomized clinical trial was conducted on 120 patients who were divided randomly into 3 parallel groups according to the LA received. Group 1: lidocaine 2% with epinephrine 1:80,000 (L80). Group 2: articaine 4% with epinephrine 1:100,000 (A100). Group 3: articaine 4% with epinephrine 1:200,000 (A200). Inclusion criteria: normal patients whose BP < 140/90. Exclusion criteria: hypertension, cardiovascular disease, hyperthyroidism, pregnancy, and allergy to LA. BP, HR, and (SpO2) were evaluated in 3 different time points: 3 minutes before LA, 3 minutes after LA, and 3 minutes after extraction.p=0.014). Diastolic blood pressure decreased after LA in the 3 groups; however it was significant only with L80, then increased after extraction for all. Systolic blood pressure (SBP) significantly increased after injection of L80 and continued after extraction to be significant than pre-injection. SBP significantly increased after injection of A100 then decreased after extraction. In the group of A200, SBP insignificantly decreased after injection then increased after extraction. The increasing of SBP between time point 1and 2 was significantly higher in G1 than G3 ( The changings of DBP, HR and SpO2 after anesthesia and extraction showed no significant difference among the three groups. However, A200 had significant lesser effect on SBP than L80 and the least effect on other parameters. Therefore, A200 is considered safer than L80 and A100 and is recommended for LA before teeth extraction in normal patient. Key words:Local anesthesia, lidocaine, epinephrine 1:80,000, articaine, epinephrine 1:100,000, epinephrine 1:200,000, tooth extraction. The use of local anesthetics in combination with vasoconstrictor agents is justified in dentistry. Doing so counteracts the local vasodilation effect of local anesthetic agents and delays its absorption into the cardiovascular system. These effects are beneficial in increasing the duration of local anesthesia and diminishing the risk of toxicity and also provide hemostasis during surgery .Lidocaine is an amide local anesthetic that is used extensively for pain control since its pharmacokinetic characteristics and low toxicity make it safe for use in dental practice .Also, articaine hydrochloride (HCl) is an amide local anesthetic, but it has the advantage of substitution of the aromatic ring with a thiophenic ring that increases the liposolubility of the drug as well as its potency. Moreover, articaine is the only amide LA containing an ester group in its molecular structure, thus allowing metabolization of the drug by both plasma esterases and liver .Epinephrine is the main vasoconstrictor used in dentistry . The preThis study aimed to evaluate hemodynamic changes, including blood pressure, heart rate, and oxygen saturation, in normal patients following administration of local anesthetic cartridges containing three different concentrations of epinephrine: lidocaine 2% with epinephrine 1:80,000, articaine 4% with epinephrine 1:100,000, and articaine 4% with epinephrine 1:200,000.This prospective randomized clinical trial was carried out from October 1, 2014 to January 1, 2015 in the Colleges’ Dental Hospital. One hundred-twenty patients who had single simple tooth extraction were included in the study. Dental extractions were performed by qualified dental interns under close supervision of surgery instructors. Sample size was estimated depending on a power calculation. At level of significance α = 0.05 with estimated standard deviation 1.2 and power 0.9, the sample size from each group should be at least 38.Inclusion criteria: patients who weren’t diagnosed as hypertensive and their blood pressure <140/90 mm Hg. Exclusion criteria: hypertension, cardiovascular disease, sickle cell anemia, congenital methemoglobinemia, hyperthyroidism, pregnancy, breastfeeding, allergy to local anesthetics, any contraindications to epinephrine, and if the extraction required more than 2 local anesthetic cartridges or the duration exceeded 30 minutes.The study followed the World Medical Association Declaration of Helsinki and was registered in the Colleges Research Center (USRP/2013/159). Study aims and procedures were explained to the included patients before signing the informed consents. Patients’ information was documented in questionnaire papers about the name, age, gender, mobile number, file number.Patients were divided randomly into three parallel groups; each of them contained 40 patients. One hundred-twenty questionnaires contained three groups were mixed. Each group had 40 questionnaires presented a study group and its number was written . Random distribution was achieved by asking the patient to choose one questionnaire and the type of local anesthetic was selected accordingly. Group 1: received 2 cartridges of lidociane 2% with epinephrine 1:80,000 (L 80). Group 2: received 2 cartridges of articaine 4% with epinephrine 1:100,000 (A 100). Group 3: receive 2 cartridges of articaine 4% with epinephrine 1:200,000 (A 200).All procedures in the study were performed in morning sessions with relaxed atmosphere and no preoperative anxiolytic medications were prescribed. On the dental chair, a pulse oximeter  was applied to the left index finger of the patient then heart rate and oxygen saturation were recorded. Blood pressure was measured by an electronic sphygmomanometer (OMRON® Automatic Blood Pressure Monitor). Three minutes later, aspiration was done followed by injection of 2 cartridges (each of 1.8 ml) of local anesthesia selected according to the group. If blood was encountered in the syringe, the clinician had to withdraw the needle, replace the cartridge, and repeat the aspiration then do the injection. Three minutes after anesthesia; blood pressure, oxygen saturation, and heart rate were measured again. The last measurements were taken three minutes after extraction for the same hemodynamic parameters. The differences of the four parameters between the 1st time point and the 2nd time point were calculated and compared among the three groups. Similar calculation was done for the difference between the 1st and 3rd time point. Data analyses were performed by statistical software SPSS version 22.0 for Windows.One hundred-twenty patients were included in the study; 51 were males (42.5%) and 69 (57%) were females. The mean age for all patients was (36.34 years). The patients were divided into three groups, every group included 40 patients. The mean age for G1, G2 and G3 were (38.45 years), (35.17 years) and (35.40 years) respectively. The data was analyzed by one-way repeated measures ANOVA.p=0.014) according to Chi-square test.Infiltration injections were used in 72 cases (60%) whereas nerve blocks were used in 48 cases (40%). Positive aspiration occurred 10 times (8.3%). Eight cases occurred with nerve blocks (16.7%) and 2 with infiltration injections (2.8%). The difference was statistically significant  then continued within 3 minutes after extraction (SBP3) to be significant than before injection (p=0.006). In G2, systolic blood pressure significantly increased 3 minutes after injection of L100 (SBP2) (p=0.024) then decreased 3 minutes after extraction (SBP3). In G3, systolic blood pressure insignificantly decreased 3 minutes after injection (SBP2) (p=1.000) then increased after extraction (SBP3)  p=0.02 then cop=0.010). Three minutes after extraction, diastolic blood pressure (DBP3) increased in the three groups  in the 3 groups; however, it was significant only with L80 , (p=0.000) and (p=0.001). Heart rate decreased 3 minutes after extraction in all groups (HR3)  in G1, G2, and G3. p=0.014). After extraction, oxygen saturation further decreased in G2 and G3 (SpO2)3 whereas it increased in G1 to take the same level of (SpO2)1.The mean of oxygen saturation decreased 3 minutes after local anesthetic injection (SpO2)2 in all groups but the significance presented only in G2 (p=0.014) according to one-way ANOVA: Post Hoc Multiple Comparisons test. Among the three groups, there were no significant differences on the other parameters between the three time points. These differences are available in The difference between SBP1 and SBP2 was significantly higher in G1 than G3 .Aspiration before injection of local anesthesia is essential to avoid intravascular injection, which is responsible for important variations of hemodynamic changes. Positive aspiration occurs when a stream of blood rises through the cartridge with sufficient strength to mix with the anesthetic solution. The percentage of blood aspirations reported in the literature is highly variable (3.6 % – 22%) . In thiset al. in 2006 . Additionally, we observed that diastolic blood pressure decreased after the local anesthetic injection in the 3 groups, but it was significant only with L80. In the same way, Hersh EV et al. found diastolic blood pressure tended to decrease with both formulations of local anesthetics for the first 30 minutes after injection. The decrease of diastolic blood pressure referred to the stimulation of ß2 receptors by epinephrine that leads to vasodilation of blood vessels in the skeletal muscles (In our results, a significant increase in systolic blood pressure presented after injection and after extraction in the group who received L80 whereas, the group of A100 had significant increase only after injection. On the other hand, A200 was associated with a decrease in systolic blood pressure after injection, which was found to be non-significant. Significant increase of systolic blood pressure after injection was reported with L80 as compared with the group of A200 (et al. (et al. (In contrast to our finding, in 2007, Santos CF et al.  did not  (et al. -12 when et al. in 2014 (A study performed by Kämmerer PW  in 2014  comparedet al. (et al. (The contradiction between our findings and the other studies -12 mightet al.  used onlet al. . On the  (et al. , which cet al. (et al. (et al. (et al. (With regard to the heart rate, Hersh EV et al.  and de M (et al.  found an (et al.  reported (et al.  found noet al. (et al. (We found that oxygen saturation decreased after injection in the 3 groups; however, it was only significant with A100. In contrast, Santos CF et al.  and de M (et al.  reportedIn the literature, variation of epinephrine concentrations seemed to have insignificant effect on the efficacy of local anesthesia. It was found that L80 and L200 have similar success rates for inferior alveolar nerve block . Also, aDespite the fact that aspiration procedure can avoid intravascular injection, false-negative results are not uncommon . This maVariable epinephrine concentrations used in the study differently influenced hemodynamic parameters. L80, which contained the highest concentration of epinephrine, significantly affected systolic and diastolic blood pressure, and heart rate. A100 significantly affected systolic blood pressure, heart rate. The significant influence of A200 was limited on heart rate however this effect was less than others.Based on our results, the differences of diastolic blood pressure, heart rate and oxygen saturation after anesthesia and after extraction showed no significant difference among the three groups. However, A200 had significant lesser effect on systolic blood pressure than L80 and the least effect on other parameters. Therefore, A200 is considered safer than L80 and A100 and is recommended for local anesthesia before teeth extraction in normal patient.


The human T-Cell Lymphotropic Virus Type 1 (HTLV-1) is a retrovirus associated with neurological alterations; individuals with HTLV-1 infection may develop HTLV-1 associated myelopathy / tropical spastic paraparesis (HAM/TSP). Frequent neurological complaints include foot numbness and leg weakness. In this study, we compared the distribution of the body weight on different areas of the foot in HTLV-1 patients with HAM/TSP, asymptomatic HTLV-1 patients, and healthy individuals.We studied 36 HTLV-1 infected patients, who were divided in two groups of 18 patients each based on whether or not they had been diagnosed with HAM/TSP, and 17 control subjects. The evaluation included an interview on the patient’s clinical history and examinations of the patient’s reflexes, foot skin tactile sensitivity, and risk of falling. The pressure distribution on different areas of the foot was measured with baropodometry, using a pressure platform, while the patients had their eyes open or closed.The prevalence of neurological disturbances—altered reflexes and skin tactile sensitivity and increased risk of falling—was higher in HTLV-1 HAM/TSP patients than in HTLV-1 asymptomatic patients. The medium and maximum pressure values were higher in the forefoot than in the midfoot and hindfoot in both HTLV-1 groups. In addition, the pressure on the hindfoot was lower in HAM/TSP patients compared to control subjects.The neurological disturbances associated with HTLV-1 infection gradually worsened from HTLV-1 asymptomatic patients to HAM/TSP patients. Baropodometry is a valuable tool to establish the extent of neurological damage in patients suffering from HTLV-1 infection. Retroviridae family that infects CD4 T lymphocytes and stimulates their proliferation [The human T-cell lymphotropic virus type 1 (HTLV-1) is a retrovirus of the feration –13. Depeferation .HAM/TSP progression includes the degeneration of the spinal cord columns, often the lateral columns and occasionally the anterior and posterior columns . The thoIn patients affected by HAM/TSP, the pelvic girdle and the lower limbs muscles are damaged, leading to spastic gait and decreased gait velocity and dynamic balance ,15–17. AThe feet support the body weight, especially in the orthostatic posture. Bipedal support is given by the tuberosities of the calcaneus and the heads of the first and fifth metatarsi , 21. TheThe study of plantar pressure and balance can be used to develop methods for the prevention, assessment, and treatment of pathological changes that hinder normal gait and affect the quality of life . PatientThis cross-sectional study was done at the Institute of Health Sciences, Federal University of Pará, Brazil. Written informed consent was obtained by all the study participants. All procedures were in accordance with the Declaration of Helsinki and were approved by the Ethics Committee for Research with Human Subjects, Institute of Health Sciences, Federal University of Pará (report #633.187). The subjects were diagnosed at and recruited from the Tropical Diseases Nucleus, the center for reference and assistance with HTLV-1 disease in the State of Pará. HTLV-1 infection was diagnosed by an infectologist physician according to the criteria established by the World Health Organization (WHO) , based oPatients unable to remain in standing position without assistance or suffering from conditions that may also impair the normal plantar pressure such as other neurological disorders, diabetes, rheumatic diseases, and peripheral vestibular syndrome were excluded from the study. Subjects with physiological conditions (like pregnancy) that could alter the normal plantar pressure were also excluded.Thirty-six HTLV-1 seropositive individuals were divided in two groups of 18 patients each: the subjects in the HTLV-1 group did not show any clinical conditions compatible with HAM/TSP, whereas the subjects in the HAM/TSP group met the WHO criteria for HAM/TSP diagnosis. In addition, 17 age-, sex-, and body mass index (BMI)-matched volunteers were enrolled in the control group. Additional clinical parameters such as reflexes, skin tactile sensitivity, and balance were also assessed. Patellar and Achilles reflexes were tested using a reflex hammer. Four HTLV-1 and nine HAM/TSP patients had altered Patellar and Achilles reflexes, and two HAM/TSP patients had altered patellar reflex.The tactile sensitivity of the foot plantar skin was investigated using Semmes Weinstein monofilaments. We used 5 monofilaments with force levels of 0.2, 2, 4, 10, and 300 g. The patients were lightly touched with the monofilaments in 8 different foot areas  and asked whether they felt the monofilament touching their skin. Each monofilament was used three times, starting with the lightest. The sensitivity threshold was defined as the lightest monofilament identified by the subject; whenever the threshold was higher than 0.2 g, the skin tactile sensitivity in that area was considered altered. Altered sensitivity in the forefoot, midfoot, or hindfoot was observed in respectively 13, 14, and 15 HTLV-1 patients, and in 16 HAM/TSP patients for each area.Berg balance scale was used to evaluate the balance. Postural transfers, stationary balance during sitting and standing positions, functional reach, rotational components, and base of support were assessed through 14 tasks. The total possible score of the scale is 56, and the risk of falling was classified as low (scores > 41), medium (scores from 21 to 40), or high (scores < 20). All HTLV-1 subjects had a low risk of falling, whereas HAM/TSP patients had low, medium, or high risk of falling .Barefoot plantar pressure measurements were performed using the capacitive pressure platform EPS/R1 , with 2 224 sensors distributed in 48 cm² and connected to a computer with Biomech software. Environmental illumination and sound conditions were kept constant during the evaluation of all subjects. The static analyses were performed with the individuals standing barefoot, with their feet apart at a distance proportional to the shoulders distance and their arms lying along the body. The subjects directed their gaze to a white circle target painted on the wall 1 m away. The plantar pressure was recorded in 6 sessions of 1 min each, 3 in the “open eyes” condition and 3 in the “closed eyes” condition. A 30 to 60 s rest interval separated two consecutive recording sessions. For further data analyses, the mean values calculated from the three sessions recorded in each condition were used.The medium and maximum plantar pressure values recorded in ten different regions of each foot were reported; the ten areas were the hallux—toe 1 (T1), the four other toes grouped together (T2-5), all five metatarsi individually , the midfoot (MF), and the medial and lateral heel . In each trial, the pressure on each area was calculated as percentage of the total pressure on the foot.Kruskal-Wallis test with Dunnet post-hoc test was used to compare the pressure measured in each foot region among the three groups . We also calculated the groups odds ratio to increase or decrease the medium and maximum pressure on the forefoot  and hindfoot (MH and LH). Each group was compared with the other two; the odds ratios were calculated for different forefoot and hindfoot percentage pressure values. We reported the highest percentage values associated with statistically significant odds ratios. We considered as statistically significant a p-value < 0.001 after adjustment for multiple comparisons. All statistical analyses were performed using BioStat 3.0 software .In the closed eyes condition, in the HAM/TSP group both the medium and the maximum pressure values were higher than the corresponding values in the control group at T1 (p < 0.001), higher than the corresponding values in the HTLV-1 group at T2-5 (p < 0.001), lower than the corresponding values in the control group at LH (p < 0.001), and finally the maximum pressure values were lower than the control group’s at MH (p < 0.001). We found no statistically significant differences among the three groups in the medium or maximum pressure values at M1, M2, M3, M4, M5, and MF.The means and standard deviations of the medium and maximum pressure values in each group are shown in Thus, we observed that the HAM/TSP group had a higher body weight load on the forefoot and less support on the hindfoot compared to the control group. Under physiological conditions, the percentage of the body weight load supported by the forefoot and the hindfoot is about 40% and 60% of the total pressure, respectively . We obseSimilarly, in the closed eyes condition, compared to the control group, the HAM/TSP group was 6.25 times more likely to have a medium pressure value of 60% on the forefoot and 4.76 times more likely to have a maximum pressure value of 65% on the forefoot. Finally, the HAM/TSP group was 9 times less likely to have a medium pressure value of 40% on the hindfoot and 4.34 times less likely to have a maximum pressure value of 40% on the hindfoot. Also, the reported percentages were the highest that yielded statistically significant odds ratios in closed eyes condition.The results of this work indicate that HTLV-1 infection caused a displacement of the center of pressure of the body weight towards. To avoid falling, the pressure on the forefoot was increased. The body weight load balance of HAM/TSP patients was remarkably displaced from the hindfoot to the forefoot, while HTLV-1 patients showed a relevant balance displacement to the forefoot but normal pressure loads on the hindfoot. The pressure values of HTLV-1 patients were intermediate between the values measured in controls and HAM/TSP patients, suggesting a gradual worsening of these HTLV-1 infection-related complications towards the more severe phenotype observed in HAM/TSP patients.Zunt et al.  used an Tispismana et al.  used varThese changes may be due to the disease pathophysiology, which causes spasticity, muscular weakness, abnormal joint mobility, proprioception impairment, and muscle shortening , 29. TheArnaut et al. used virtual reality to evaluate the balance, pain, and quality of life of patients with HAM/TSP . The autMany of the HTLV-1 patients who develop HAM/TSP need assistance to perform their daily activities  because of their physical disability, risk of falling, and reduced quality of life and working ability ,33,35. TChanges in plantar pressure caused by modifications in the body weight distribution on the foot were found in both groups of HTLV-1 patients. HTLV-1 asymptomatic patients and HAM/TSP patients had higher pressure loads on the forefoot compared to control individuals. HAM/TSP patients also showed lower pressure loads on the hindfoot. These findings suggest that patients with HTLV-1 may represent a transitional step in the progression from healthy individuals to patients with HAM/TSP, and that baropodometry can be a functional indicator of the neurological status of HTLV-1 infected patients.S1 DatabaseFor each foot region, we showed the database from control, HTLV-1 and HAM/TSP groups.(XLSX)Click here for additional data file.


Left ventricular hypertrophy (LVH) existed in patients with early stage chronic kidney disease (CKD). But whether insulin resistance (IR) exists in these patients and has some definite relationship with LVH, is unknown.Homeostatic model method was used for detecting homeostasis model assessment of insulin resistance (HOMA-IR) in 336 subjects including 286 patients with early stage CKD and 50 control subjects, and HOMA-IR and other clinical data in all subjects were obtained based on standard methods. Then, the relationship between LVH, IR and other relevant clinical data were analyzed.P < 0.05, respectively).IR and LVH existed in early stage CKD patients. The prevalence of LVH in patients with IR was significantly higher than those without, and patients with LVH had a higher prevalence of IR than those without. The patients with IR or LVH had lower levels of e-GFR, hemoglobin (Hb) and total cholesterol, while higher levels of blood urea nitrogen (BUN), serum creatinine (Scr), intact parathyroid hormone (iPTH), CRP and systolic blood pressure (SBP). HOMA-IR had positive correlations with left ventricular mass index (LVMI). HOMA-IR and LVMI had positive correlations with BUN, Scr, iPTH and CRP, but negative with e-GFR and Hb. Multiple linear stepwise regression analysis showed that e-GFR, FINS, Hb and SBP enter the regression equation. Binary unconditional logistic regression analysis indicated that the main risk factors for LVH were CKD and IR (Both IR and LVH existed in early stage CKD patients and were more severe with the development of CKD. IR had a significant correlation with LVH. Furthermore, decline of e-GFR, hypertension and anemia were also associated with both IR and LVH and may have some effects in the mechanism of IR on the development of LVH. Cardiovascular disease (CVD) is the most common complication in patients with chronic kidney disease (CKD) –5 and al2. The causes of CKD included chronic glomerulonephritis , IgA nephropathy  and chronic tubulointerstitial nephropathy ; and autosomal dominant polycystic kidney disease . All patients with CGN, IgAN or CTIN were diagnosed by renal biopsy.Two-hundred and eighty-six patients with CKD stage 1–3, 145 males, 141 females, age ranged from 14 to 88 years old, initial hospitalized, never accepting drugs affecting blood pressure or plasma glucose before, in the department of nephrology, Jinshan Hospital, Fudan University during the period of January 2010 to December 2012 (CKD group) were enrolled. All patients were diagnosed according to the criteria from kidney disease outcomes quality initiative (K/DOQI) and had a stable renal function at least 3 months recently, and their eGFR were above 30 ml/min 1.73/mThe exclusion criteria included history of diabetes mellitus, hypertension or other CVD; treatment with glucocorticoids in the past 6 months, or with agents, such as angiotensin converting enzyme antagonists (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs) or diuretics in the past 3 months; infection, surgery, trauma history in the past 1 month; rapid decline of renal function in the past 3 month; malignancy or pregnancy.n = 141): eGFR ≥90 ml/min 1.73/m2; Group B (n = 72): eGFR = (60–89) ml/min 1.73/m2; Group C (n = 73): eGFR = (30–59) ml/min 1.73/m2.The patients were divided into three groups according to the eGFR, namely Group A , and were of normal renal function, and urinary albumin creatinine ratio (ACR) <3 mg/mmol (spot urine), and never receiving medical treatment.All studies were approved by the Ethics Committee of Jinshan Hospital, Fudan University, and all patients gave written informed consent.Data on demographic characteristics, medical history, current medications and blood samples were collected from all subjects at the time of enrollment. Blood was collected from subjects after overnight fasting for at least 10 h. Blood urea nitrogen (BUN), serum creatinine (Scr), serum uric acid (UA), hemoglobin (Hb), fasting plasma glucose (FPG), 2-h postprandial plasma glucose (2hPG), triglycerides (TG), total cholesterol (Tch), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), calcium (Ca), phosphate (P) and urinary creatinine (Ucr) were measured with P800 automatic biochemical analyzer  and the supporting reagent. Fasting insulin (FINS) and 2-h postprandial insulin (2hINS) were measured with i2000 chemiluminescence analyzer . Twenty-four-hour urinary protein (UP) and spot urine microalbuminuria (UMA) were measured with BN ProSpec special protein analyzer . Intact parathyroid hormone (iPTH) concentrations were measured with the Roche Elecsys parathyroid hormone assay . C-reactive protein concentration was measured with enzyme-linked immunosorbent assays . All other blood tests were done in Clinical Examination Laboratory of Jinshan Hospital of Fudan University. Laboratory quality control was performed daily and met the quality control standards of clinical laboratory center of Shanghai. All data were measured based on standard clinical examination methods.All participants avoided tobacco and caffeine for at least 30 min, then emptied their bladder, quietly rested on chair for at least 5 min in a quiet environment. Before blood measurement, radial artery palpation were performed to estimate systolic pressure; then, the cuffs were inflated to a value 20 mmHg higher than the level that obliterates the radial pulse and deflated at a rate of 3–5 mmHg/s. Blood pressures were measured twice in both arms by a mercury sphygmomanometer after 5 min of standing at two visits with the participants seated, the back supported, and the arm bare and at heart level with an appropriate cuff. According to Korotkoff method, the first loud flop represented systolic blood pressure (SBP), the sound disappearance or suddenly became boring represented diastolic blood pressure, then took the average of two readings as the measurement results.All subjects underwent echocardiographic measurements in left lateral and supine position using Color Doppler ultrasound device type Vivid-7  with probe frequency of 2.5 MHz. The M-mode image obtained and the data, such as left ventricular internal diameter (LVDd), interventricular septal thickness (IVST) and left ventricular posterior wall thickness (PWT) in end-diastolic were measured under the guidance of the axis of the left ventricular segments of the two-dimensional image in the parasternal long axis for three consecutive cardiac cycles, averaged. The work was interpreted by a single reviewer who was blinded to this study.2 (m2). Overweight and obese was defined according to the Working Group on Obesity in China :Body weight index  = body weight (kg)/height2 and obese BMI ≥28 kg/m2.Overweight was defined as BMI ≥24 kg/mBody surface area (BSA) was estimated by Ye’ equations :2) = 0.607 × height (m) + 0.0127 × weight (kg) − 0.0698 .BSA (m2) = 0.568 × height (m) + 0.0126 × weight (kg) − 0.0461 .BSA (meGFR was estimated by MDRD equations .2) = 186 (Scr in µmol/l × 0.011312)−1.154 × (age)−0.203 × .eGFR (ml/min/1.73 mHomeostasis model assessment of insulin resistance (HOMA-IR) was estimated by Matthews’ equations :HOMA-IR = fasting insulin (μIU/ml) × fasting glucose (mmol/l)/22.5.The HOMA-IR value of all CKD participants was 2.16 ± 0.53, while that of the healthy ones was 1.87 ± 0.21.s (the 95th ‰) in all control subjects  + 0.6 (g).Left ventricular mass (LVM) = 0.8 × 1.04 × [(LVDd + IVST + PWT)LVMI = LVM/BSA.2 for men and >110 g/m2 for women [LVH was defined as LVMI >125 g/mor women , 16.s), those with abnormal distribution or variance homogeneity were logarithmically transformed before analysis and treated as normally distributed if met the above conditions. Two-group normally distributed data were compared using independent sample t test, and multi-group data were compared using single factor analysis of variance (one way ANOVA). Count data were expressed as the number of cases (ratio or percentage) and compared using chi-squared test (χ2 test). All multiple testing was corrected using Bonferroni correction. Single factor linear correlation analysis and multiple linear stepwise regression analysis were used to explore the associations between examined continuous variables with parametric distribution if the plot showed a linear relationship. Binary unconditional logistic regression analysis was used to explore the main risk factors. P values <0.05 were considered as statistical significance.All of the statistical analyses were performed with Statistical Package for Social Sciences, version 11.5 . In brief, continuous data with normal distribution and homogeneity of variance determined by Shapiro–Wilk test were expressed as mean ± SD . There was no difference of the concentration of ACR in the subjects between the groups , while other data of lipid profiles had no differences between the groups either : log HOMA-IR <2.287; Group IR (n = 128): log HOMA-IR ≥2.287.CKD patients were divided into two groups according to the HOMA-IR, namely Group non-IR , and Group LVH (n = 52).CKD patients were divided into two groups according to the LVMI, namely Group non-LVH .Pearson’s correlation analysis revealed that HOMA-IR was independently associated with eGFR, BUN, Scr, Hb, iPTH, CRP, LVMI, LVDd, IVST and PWT .Pearson’s correlation analysis revealed that LVMI was independently associated with HOMA-IR, FPG, FINS, 2hPG, 2hINS, eGFR, BUN, Scr, Hb, iPTH and CRP , overweight (BMI ≥24 kg/m2), obesity (BMI ≥28 kg/m2), dyslipidemia , hyperuricemia  and hypertension (SBP ≥140 mmHg and/or DBP ≥90 mmHg), which were excluded during logistic regression analysis.Binary unconditional logistic regression analysis indicated that the main risk factors were CKD and IR  and sympathetic nervous system, and sodium retention. All of these factors above-mentioned can induce in the emergence and development of IR, cause hypertension and endothelial dysfunction, and cause LVH in turn. Previous studies indicated that malnutrition and micro-inflammation, oxidative stress, endoplasmic reticulum stress, metabolic acidosis, vitamin D deficiency and secondary hyperparathyroidism, depressed serum erythropoietin and anemia, and suppressors of cytokine signaling all cause IR by suppressing insulin receptor-PI3K-Akt pathways in CKD .IR can cause hypertension in the early stage CKD patients may through various mechanisms including: (1) IR and HINS, independently of changes in glycemia, can cause sympathetic over-activity with a substantial increase in circulating noradrenaline concentration then increase peripheral vascular resistance , 30. (2)nutritional and metabolic alterations underlies CKD, including micro-inflammation, oxidative stress, IR and protein energy wasting, and IR is linked to protein energy wasting and malnutrition [Our study revealed that micro-inflammation was evident in the early CKD and was correlation with IR, which is consistent with previous studies . Previouutrition , 39, 40.utrition . Malnutrutrition . Malnutrutrition . It remaOur study revealed that the concentration of Hb was lower than that in the normal control populations. Anemia may cause sympathetic nerve activity, which is linked to IR and hypertension, increase heart rate and cardiac output, thereby increasing arterial capacity and left ventricular wall tension then cause LVH.Our study showed that the concentration of iPTH was higher than that in the normal control populations and increased with the declined of eGFR. The mechanisms through which excess PTH blunts insulin sensitivity are still uncertain, but medical treatment of hyperparathyroidism in patients with CKD could lead to correction of glucose intolerance .In summary, both IR and LVH existed in early CKD patients and were more severe with the development of early stage CKD. IR had a significant correlation with LVH, and it may be an important risk factor for the development of LVH. Furthermore, the decline of eGFR, hypertension, anemia and hyperparathyroidism were also associated with both IR and LVH and may have some effects in the mechanism of IR on the development of LVH.Since this study was a cross-sectional analysis, integrity, accuracy and controllability of data may be affected to some extent. In addition, small sample size led to inadequate power and use of a heterogeneous group of patients with CKD were limitations. It remains to be further prospective study to explore the relationship between IR and LVH in patients with CKD 1–3.


Over 7 days of treatment, LF-SBP amplitude increased . A slight increase in both HR and LF-SBPV were observed suggesting a potential sympathetic cardiovascular stimulus. Although we found a significant effect of the 1-week prednisone treatment on heart rate and low frequency power of systolic blood pressure variability, we reported neither an increase in the systolic blood pressure level nor a decrease in the baroreflex sensitivity. Therefore, the fragility of our results cannot support a deleterious effect of 1-week administration of prednisone on the autonomic cardiovascular control which might be involved in cardiovascular diseases.This study analyzed baroreflex sensitivity, heart rate and systolic blood pressure variabilities during an oral 1 week administration of prednisone. This study examined the hypothesis that prednisone might change both systolic blood pressure level and baroreflex sensitivity. Twelve physically active male subjects participated to a double-blind, randomized cross-over study consisting of two 1-week periods of treatment separated by a 4-week drug-free washout period: placebo (PLA) or prednisone (PRED). Trials were performed by each subject four times on the second (D2) and seventh (D7) day of each treatment period. ECG and blood pressure were continuously recorded to compute heart rate variability, systolic blood pressure variability and baroreflex sensitivity components with the smoothed pseudo Wigner Ville distribution and baroreflex analysis. Following D2 prednisone treatment, both HR (PLA: 60.8 ± 10.5 vs. PRED: 65.8 ± 9.1 beats min A few days of glucocorticoid intake has been shown to improve performance during submaximal exercise , blood pressure variability (SBPV) and baroreflex sensitivity (BRS) have been used to assess the autonomic cardiovascular control, to predict cardiovascular morbidity  were enrolled in the study. Before measurements, participants were familiarized with the experimental procedure and informed of the risks associated with the protocol. Ethics committee approval  and written informed consent were obtained including the authorization to publish their data. This study was a part of a larger research protocol with blood samples, biomechanical measures , local oxygen uptake measures (NIRS) and cardiovascular measures. Therefore, the protocol was drastically formatted and financed. To achieve all the measures we planned, only 12 subjects could have been involved. Only male subjects were involved to avoid the possibility of menstrual hormone interferences. They did not take any glucocorticoid or non-steroidal anti-inflammatory drug for at least 6 months prior to the study. Subjects were asked to maintain their exercise routines, normal food intake and were required to avoid competitive strenuous situations, any caffeine and alcohol for 24 h prior to each experimental session.The double-blind, randomized cross-over study consisted of two 1-week periods of treatment for each subject separated by a 4-week drug-free washout period: placebo (PLA) or prednisone (PRED). PLA (gelatin) and PRED  were packaged in identical capsules. During the experimental periods, the subjects took three capsules per day of either PLA or PRED (60 mg) at home, between 7 and 8 am, over 7 days. They were questioned about the treatment they thought they had received first and were unable to report any difference. In addition, to ensure that they exactly follow the prescription, subjects had to fill in a form each time they took their treatment. Each subject came four times at the hospital on the second  and seventh  day of each treatment period, 3 h after the capsules ingestion.ECG was digitized and recorded with a PowerLab device  with a sampling frequency of 1000 Hz. Beat to beat RR intervals were extracted from ECG using Chart7 pro soft . Extrasystoles were manually processed by averaging the short and long RR intervals respectively preceding and following the extrasystole.A Finometer device  was used to record blood pressure from a cuff placed on a middle finger. BP signal yielded by the Finometer device has been previously experimentally validated during laboratory tests . The subjects were supine and their breathing frequency was paced at 0.25 Hz during 10 min via audio feedback.The subjects had at least 20 min of rest in a supine position before cardiovascular measures.The Smoothed Pseudo Wigner–Ville Distribution (SPWVD) was used to compute instantaneous components of HRV and SBP variability. It was performed with the cardiovascular toolbox developed in the scientific environment SCILAB . The SPWVD provides a continuous evaluation of the amplitude and frequency, giving a nearly “instantaneous” complex FFT spectrum for each beat, with a high resolution achieved by independent time and frequency smoothing. Then, according to the standards  and HF (HF-BRS) bands at rest. The spectral baroreflex sensitivity (BRS) is supported by the hypothesis of a linear relation between the input (BP) and output (RR) of the model. The degree of linearity between the two signals is estimated by the value of the coherence function. Ranging from 0 to 1, it was accepted that RR and SBP spectra had a reliable linear relationship when the coherence index was higher than 0.5  and treatment duration (D2 vs. D7) were tested with a two way ANOVA for repeated measures . All pairwise multiple comparison procedures are given with the Holm-Sidak method. When the data distribution was not normal, an ANOVA on ranks was used. A p < 0.05 was considered as significant.−1, p < 0.05, Table HR increased following prednisone treatment  did not change the systolic blood pressure level in young adults. However, a slight increase in both HR and LF-SBPV were observed suggesting a potential sympathetic cardiovascular stimulus. Although we found a significant effect of the 1-week prednisone treatment on heart rate and low frequency power of systolic blood pressure variability, we reported neither an increase in the systolic blood pressure level nor a decrease in the baroreflex sensitivity. Therefore, the fragility of our results cannot support a deleterious effect of 1-week administration of prednisone on the autonomic cardiovascular control which might be involved in cardiovascular diseases.