Low blood pressure (hypotension) – Symptoms and causes

Overview

Low blood pressure might seem desirable, and for some people, it causes no problems. However, for many people, abnormally low blood pressure (hypotension) can cause dizziness and fainting. In severe cases, low blood pressure can be life-threatening.

A blood pressure reading lower than 90 millimeters of mercury (mm Hg) for the top number (systolic) or 60 mm Hg for the bottom number (diastolic) is generally considered low blood pressure.

The causes of low blood pressure can range from dehydration to serious medical disorders. It’s important to find out what’s causing your low blood pressure so that it can be treated.

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Symptoms

For some people, low blood pressure signals an underlying problem, especially when it drops suddenly or is accompanied by signs and symptoms such as:

• Dizziness or lightheadedness
• Fainting
• Blurred or fading vision
• Nausea
• Fatigue
• Lack of concentration

Shock

Extreme hypotension can result in this life-threatening condition. Signs and symptoms include:

• Confusion, especially in older people
• Cold, clammy, pale skin
• Rapid, shallow breathing
• Weak and rapid pulse

When to see a doctor

If you have signs or symptoms of shock, seek emergency medical help.

If you have consistently low blood pressure readings but feel fine, your doctor will likely just monitor you during routine exams.

Even occasional dizziness or lightheadedness may be a relatively minor problem — the result of mild dehydration from too much time in the sun or a hot tub, for example. Still, it’s important to see your doctor if you have signs or symptoms of low blood pressure because they can point to more-serious problems. It can be helpful to keep a record of your symptoms, when they occur and what you’re doing at the time.

Causes

Blood pressure is a measurement of the pressure in your arteries during the active and resting phases of each heartbeat.

• Systolic pressure. The top number in a blood pressure reading is the amount of pressure your heart produces when pumping blood through your arteries to the rest of your body.
• Diastolic pressure. The bottom number in a blood pressure reading refers to the amount of pressure in your arteries when your heart is at rest between beats.

Current guidelines identify normal blood pressure as lower than 120/80 mm Hg.

Blood pressure varies throughout the day, depending on:

• Body position
• Breathing rhythm
• Stress level
• Physical condition
• Medications you take
• What you eat and drink
• Time of day

Blood pressure is usually lowest at night and rises sharply on waking.

Blood pressure: How low can you go?

What’s considered low blood pressure for you may be normal for someone else. Most doctors consider blood pressure too low only if it causes symptoms.

Some experts define low blood pressure as readings lower than 90 mm Hg systolic or 60 mm Hg diastolic. If either number is below that, your pressure is lower than normal.

A sudden fall in blood pressure can be dangerous. A change of just 20 mm Hg — a drop from 110 systolic to 90 mm Hg systolic, for example — can cause dizziness and fainting when the brain fails to receive enough blood. And big drops, such as those caused by uncontrolled bleeding, severe infections or allergic reactions, can be life-threatening.

Conditions that can cause low blood pressure

Medical conditions that can cause low blood pressure include:

• Pregnancy. Because the circulatory system expands rapidly during pregnancy, blood pressure is likely to drop. This is normal, and blood pressure usually returns to your pre-pregnancy level after you’ve given birth.
• Heart problems. Some heart conditions that can lead to low blood pressure include extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure.
• Endocrine problems. Parathyroid disease, adrenal insufficiency (Addison’s disease), low blood sugar (hypoglycemia) and, in some cases, diabetes can trigger low blood pressure.
• Dehydration. When your body loses more water than it takes in, it can cause weakness, dizziness and fatigue. Fever, vomiting, severe diarrhea, overuse of diuretics and strenuous exercise can lead to dehydration.
• Blood loss. Losing a lot of blood, such as from a major injury or internal bleeding, reduces the amount of blood in your body, leading to a severe drop in blood pressure.
• Severe infection (septicemia). When an infection in the body enters the bloodstream, it can lead to a life-threatening drop in blood pressure called septic shock.
• Severe allergic reaction (anaphylaxis). Common triggers of this severe and potentially life-threatening reaction include foods, certain medications, insect venoms and latex. Anaphylaxis can cause breathing problems, hives, itching, a swollen throat and a dangerous drop in blood pressure.
• Lack of nutrients in your diet. A lack of the vitamin B-12, folate and iron can keep your body from producing enough red blood cells (anemia), causing low blood pressure.

Medications that can cause low blood pressure

Some medications can cause low blood pressure, including:

• Water pills (diuretics), such as furosemide (Lasix) and hydrochlorothiazide (Microzide, others)
• Alpha blockers, such as prazosin (Minipress)
• Beta blockers, such as atenolol (Tenormin) and propranolol (Inderal, Innopran XL, others)
• Drugs for Parkinson’s disease, such as pramipexole (Mirapex) or those containing levodopa
• Certain types of antidepressants (tricyclic antidepressants), including doxepin (Silenor) and imipramine (Tofranil)
• Drugs for erectile dysfunction, including sildenafil (Revatio, Viagra) or tadalafil (Adcirca, Alyq, Cialis), particularly when taken with the heart medication nitroglycerin (Nitrostat, others)

Types of low blood pressure

Doctors often break down low blood pressure (hypotension) into categories, depending on the causes and other factors. Some types of low blood pressure include:

• Low blood pressure on standing up (orthostatic or postural) hypotension). This is a sudden drop in blood pressure when you stand up from a sitting position or after lying down.

  Gravity causes blood to pool in your legs when you stand. Ordinarily, your body compensates by increasing your heart rate and constricting blood vessels, thereby ensuring that enough blood returns to your brain.

  But in people with orthostatic hypotension, this compensating mechanism fails and blood pressure falls, leading to dizziness, lightheadedness, blurred vision and even fainting.

  Orthostatic hypotension can occur for various reasons, including dehydration, prolonged bed rest, pregnancy, diabetes, heart problems, burns, excessive heat, large varicose veins and certain neurological disorders.

  A number of medications also can cause orthostatic hypotension, particularly drugs used to treat high blood pressure — diuretics, beta blockers, calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors — as well as antidepressants and drugs used to treat Parkinson’s disease and erectile dysfunction.

  Orthostatic hypotension is especially common in older adults, but it also affects young, otherwise healthy people who stand up suddenly after sitting with their legs crossed for long periods or after squatting for a time.

• Low blood pressure after eating (postprandial hypotension). This drop in blood pressure occurs one to two hours after eating and affects mostly older adults.

  Blood flows to your digestive tract after you eat. Ordinarily, your body increases your heart rate and constricts certain blood vessels to help maintain normal blood pressure. But in some people these mechanisms fail, leading to dizziness, faintness and falls.

  Postprandial hypotension is more likely to affect people with high blood pressure or autonomic nervous system disorders such as Parkinson’s disease.

  Eating small, low-carbohydrate meals; drinking more water; and avoiding alcohol might help reduce symptoms.

• Low blood pressure from faulty brain signals (neurally mediated hypotension). This disorder, which causes a blood pressure drop after standing for long periods, mostly affects young adults and children. It seems to occur because of a miscommunication between the heart and the brain.
• Low blood pressure due to nervous system damage (multiple system atrophy with orthostatic hypotension). Also called Shy-Drager syndrome, this rare disorder has many Parkinson disease-like symptoms. It causes progressive damage to the autonomic nervous system, which controls involuntary functions such as blood pressure, heart rate, breathing and digestion. It’s associated with having very high blood pressure while lying down.

Risk factors

Low blood pressure (hypotension) can occur in anyone, though certain types of low blood pressure are more common depending on your age or other factors:

• Age. Drops in blood pressure on standing or after eating occur primarily in adults older than 65. Neurally mediated hypotension primarily affects children and younger adults.
• Medications. People who take certain medications, for example, high blood pressure medications such as alpha blockers, have a greater risk of low blood pressure.
• Certain diseases. Parkinson’s disease, diabetes and some heart conditions put you at a greater risk of developing low blood pressure.

Complications

Even moderate forms of low blood pressure can cause dizziness, weakness, fainting and a risk of injury from falls.

And severely low blood pressure can deprive your body of enough oxygen to carry out its functions, leading to damage to your heart and brain.

Sept. 22, 2020

Low Blood Pressure | NHLBI, NIH

Blood pressure is the force of blood pushing against the walls of your arteries as the heart pumps blood. It is usually described as two numbers: systolic and diastolic. The numbers record blood pressure in millimeters of mercury (mm Hg), with systolic listed above diastolic. For most adults, a healthy blood pressure is usually less than 120/80 mm Hg. Low blood pressure is blood pressure that is lower than 90/60 mm Hg.

Some people have low blood pressure all the time, and it is normal for them. Other people experience a sudden drop in blood pressure or have low blood pressure that may be linked to a health problem. Many systems of the body, including organs, hormones, and nerves, regulate blood pressure. For example, the autonomic nervous system sends the “fight-or-flight” signal that, depending on the situation, tells the heart and other systems in the body to increase or decrease blood pressure. Problems with the autonomic nervous system, such as in Parkinson’s disease, can cause low blood pressure.

Other causes of low blood pressure include medicines, bleeding, aging, and conditions such as dehydration, pregnancy, diabetes, and heart problems. Older adults have a higher risk for symptoms of low blood pressure, such as falling, fainting, or dizziness upon standing up or after a meal. Older adults are also more likely to develop low blood pressure as a side effect of medicines taken to control high blood pressure.

For many people, low blood pressure goes unnoticed. Others feel light-headed, confused, tired, or weak. You may have blurry vision, a headache, neck or back pain, nausea, or heart palpitations. Sitting down may relieve these symptoms. If blood pressure drops too low, the body’s vital organs do not get enough oxygen and nutrients. When this happens, low blood pressure can lead to shock, which requires immediate medical attention. Signs of shock include cold and sweaty skin, rapid breathing, a blue skin tone, or a weak and rapid pulse. If you notice signs of shock in yourself or someone else, call 9-1-1.

Your doctor will use a blood pressure test to diagnose low blood pressure. Other tests may include blood, urine, or imaging tests and a tilt table test if you faint often. You may not need treatment for low blood pressure. Depending on your signs and symptoms, treatment may include drinking more fluids, taking medicines to raise your blood pressure, or adjusting medicines that cause low blood pressure. Recommended lifestyle changes include changing what and how you eat and how you sit and stand up. Your doctor may also recommend compression stockings if you have to stand for long periods.

Visit Low Blood Pressure for more information about this topic.

Understanding Blood Pressure [Ultimate BP by Age Chart]

We all know that understanding blood pressure & maintaining healthy readings are important for our overall health and longevity. After all, it’s one of the most talked about indicators of health, particularly when it comes to your heart.

But what exactly is blood pressure? Do you know what your blood pressure numbers mean? Compare your measurements to the charts below and read about understanding blood pressure readings.

Nov. 2017 American Heart Association New Blood Pressure Chart Guidelines and Updates:

The American Heart Association recently released a new set of stricter guidelines. Changing the numbers means that more Americans will now meet the guidelines for high blood pressure, also known as hypertension. Here are some of the changes:

• Greater Emphasis on Measurements
• The AHA is putting more pressure on Americans to stay on top of their readings. They recommend that routine measurements are taken on a regular basis at home, and not just at the doctor’s office..

• Guidelines Remove “Prehypertension”
• By eliminating the Prehypertension category, more Americans now fall into the range of high blood pressure. The goal behind these changes is to initiate prevention, evaluation, and treatment of higher numbers far sooner than in the past.

• New “Elevated” Blood Pressure
• Measurements ranging from 120-129 mm Hg (systolic) and less than 80 mm Hg (diastolic)

• Hypertension Stage 1
• Previously defined as greater than 140 to 153 mm Hg (systolic) over 90 to 96 mm Hg (diastolic)
• New definition = 130 to 139 mm Hg (systolic) over 80 to 89 mm Hg (diastolic)

• Hypertension Stage 2

• Previously defined as greater than 160 mm Hg (systolic) over 100 mm Hg (diastolic)
• New definition = 140/90 mm Hg or greater

General Blood Pressure Ranges

The chart below provides a general overview of blood pressure ranges updated to match the new American Heart Association guidelines. Take your blood pressure and identify your systolic & diastolic readings to compare ranges on the chart, OR enter your results in the blood pressure calculator to learn more about causes, symptoms, and treatment for your blood pressure readings

Keep in mind that it is possible for your readings to be affected by other factors like age, medication, & sometimes even gender. Check out the chart below for a breakdown of blood pressure ranges by age.

Remember, your blood pressure is recorded as two numbers – systolic and diastolic – diagnosing high or low blood pressure only requires one of these numbers to be outside of the healthy range.

Blood Pressure Chart by Category:

The categories above are based off the official American Heart Association blood pressure guidelines, which were recently updated in November of 2017 ( Chart Reference)

*For proper blood pressure diagnosis, talk to your primary care physician or cardiologist

Looking to track your blood pressure? Understand your readings and learn ways you can improve your blood pressure with our FREE PDF. Download it Now!

Blood Pressure Calculator: Understanding your Blood Pressure Numbers

Please remember that for an official blood pressure diagnosis and treatment regimen, you must consult your primary physician or medical care professional  who will do a thorough assessment to determine the proper diagnosis.

Enter both Systolic & Diastolic readings (in mm Hg) below. Results will display the corresponding blood pressure category & information regarding the causes, symptoms, and treatment options for your range of blood pressure.

Normal Blood Pressure Chart by Age

How Age Affects Blood Pressure

For infants, toddlers, and pre-adolescent aged children, doctors follow separate guidelines and standards to define high blood pressure. Average readings tend to be lower at a younger age and increase as you grow older . During late adolescence (around 17-19 yrs old) doctors typically begin to follow the standard adult guidelines for high blood pressure.

As you age, your risk of developing high blood pressure increases.

Click Here for Pediatric Blood Pressure Chart by Age Reference

Charted Blood Pressure Ranges

The following table provides a rough guide to understanding blood pressure as you age. Start by taking your blood pressure to find your systolic (top number) & diastolic (bottom number) pressure. Then, locate your age range in the right-hand column to see where your readings fall.

S = Systolic Pressure
D = Diastolic Pressure

Blood pressure charts aren’t commonly broken down by age, however, pediatric charts are often separated into ranges for infants, toddlers, and pre-adolescents. Pediatric standards for high and low blood pressure differ from those used for adults. Sometimes gender can influence readings, but measurements are still compared on the same scale. ( Chart reference)

Click here to download your FREE + PRINTABLE Blood Pressure PDF & make understanding your readings easy. 

Locate your readings on the chart above & Click below to learn more about your blood pressure:

*Remember to always consult with your doctor for an accurate diagnosis and treatment plan when it comes to your blood pressure readings.

What Affects Blood Pressure?

Personal characteristics which play a role in blood pressure readings are:

• Gender and Blood Pressure

According to the National Institute on Aging, males are more likely to have high blood pressure before age 55,  while normal blood pressure for women tends to rise after menopause. Women are less likely than men to experience complications associated with high blood pressure.

However, regardless of differences in the prevalence and complications of high blood pressure between the sexes, treatment and diagnosis are the same for both men and women.

• Normal Blood Pressure By Age

As you age, your body goes through many changes that can put you at risk for other conditions. If you’re over 50, having a higher than usual systolic pressure might increase your risk of developing heart disease. Systolic blood pressure tends to increase steadily over time due to stiff arteries, a build-up of plaque, and a higher rate of cardiac and vascular disease. This means older adults need to be even more vigilant about monitoring their blood pressure and practicing heart-healthy self-care.

• Height and Blood Pressure

Height isn’t a risk factor but taller people tend to have higher blood pressure because this offsets gravity and other factors to ensure the brain – the highest organ – gets enough blood flow and oxygen. However, the effect of height is minor, so it’s not taken into account in blood pressure range guidelines.

Traits can be passed from one generation to the next. This is known as heredity. There is a genetic role in high blood pressure, heart disease, and other heart conditions. However, researchers believe that it may be partly due to sharing common environments and other behaviors that can increase your risk.

• Normal Blood Pressure and Heart Rate

While a rising heart rate will increase blood flow through the body, it does not necessarily correspond with an increase in the pressure of that blood flow. This is because blood vessels can increase in size (dilate) to facilitate larger quantities of blood. Even if your heart rate were to double, your normal blood pressure & high pulse may only slightly increase blood pressure.

Understanding Blood Pressure Measurements

Understanding blood pressure numbers is a crucial part of overall well-being. When your heart beats, it moves blood through your body to deliver oxygen and other nutrients. The blood pushes on the walls of the blood vessels as it travels through the body. The force of the blood pressing against the vessel walls is known as blood pressure.

Your blood pressure readings consist of two numbers:

Systolic Blood Pressure

Your systolic blood pressure measures the pressure on the walls of the vessel as your heart is contracting or beating. It is recorded as the top number in your blood pressure reading.

Diastolic Pressure

Your diastolic blood pressure is the pressure in the vessels while the heart is relaxed, in between heartbeats. It is recorded as the bottom number in your blood pressure reading.

Your blood pressure is reported by placing the systolic number over the diastolic number. For example, your blood pressure might be reported as 120/80. To be diagnosed with high blood pressure, only one of these numbers must be outside of the normal range. But, remember that one high reading doesn’t mean there’s a problem. High blood pressure is a condition that can only be diagnosed by your doctor.

Normal Blood Pressure

Normal blood pressure can range from 110 to 134 (systolic) over 75 to 87 (diastolic), depending on your age.

Recent updates by the American Heart Association now recognizes normal blood pressure as readings of 90/60 mm Hg or less

If your blood pressure reading is defined as ‘normal,’ that means you’re within the healthy range – which is great news for your arteries, heart, brain, and kidneys!

How to Maintain Normal Blood Pressure Level

Here are some tips to help keep your blood pressure readings within the normal and healthy range:

A diet rich in fresh fruits and vegetables, whole grains, nuts, seeds, and lean protein sources like fish and beans goes a long way toward maintaining normal blood pressure and heart health.

Be sure to avoid processed foods, trans fats, and red meat, and cut down on your intake of sugar and saturated fat.

Season your food with herbs and spices instead of salt – which is known to raise blood pressure. The American Heart Association recommends an ideal limit of no more than 1,500 mg of sodium a day (a little over half a teaspoon of salt). Bear in mind that over 75% of our sodium intake comes from the salt already added to processed foods and restaurant meals, and not from the salt shaker.

A high salt intake throws off the balance of sodium and potassium in the body, increasing fluid retention, and putting excess strain on the kidneys and the blood vessels that serve them. Potassium-rich foods such as potatoes, bananas, avocados, sweet potatos, and dark leafy greens will help lessen the effects of sodium.

• Exercise Regularly or Stay Active

Make sure to engage in regular activities to keep blood pressure within the normal range. Exercise causes the body to release nitric acid, which helps blood vessels to dilate, reducing blood pressure.

Regular activity also helps with weight loss, stress reduction, and overall heart health.

Resistances bands are simple way to add routine exercise into your daily life & maintain normal readings or lower high blood pressure. ( Find the Best Resistance Band Sets Here)

• Maintain a Healthy Weight

Staying within a healthy weight range for your height is important to keep blood pressure under control. Excess pounds are a risk factor for heart disease and type 2 diabetes, two conditions associated with high blood pressure.

Control stress levels. Stress causes an increase in blood pressure, so staying cool and calm can help you maintain your healthy blood pressure readings. Relaxation techniques like deep breathing, meditation, and yoga are proven stress-busters.

Too much alcohol increases blood pressure and contributes to weight gain. According to the, Mayo Clinic, women of any age and men over 65 should enjoy no more than one drink a day, and men under 65 should have no more than two drinks daily.

Smoking increases blood pressure and heart rate and raises the risk of heart attack or stroke. Nicotine also leads to narrowing and hardening of the arteries, which can increase your blood pressure readings.

Elevated Blood Pressure (previously labeled Prehypertension)

Recently added by the AHA, Elevated blood pressure is the new “Prehypertension” (so to say)

This range of blood pressure was previously defined as slightly elevated blood pressure that may lead to hypertension if left untreated. Measurements ranged from 130 to 146 (systolic) over 85 to 91 (diastolic), depending on age. New standards now classify Elevated Blood Pressure as:

• Measurements ranging from 120-129 mm Hg (systolic) and less than 80 mm Hg (diastolic)

Causes of elevated blood pressure are the same as the causes of hypertension, and the treatment options are similar.

At this stage, there may be no noticeable hypertension symptoms , but damage to the body may still be occurring, and your risk of heart attack and stroke is increased.

Click below to learn more about what causes elevated blood pressure, the symptoms & the best treatment methods

Stage 1 Hypertension

Readings in this category range from 130 to 139 mm Hg (systolic) over 80 to 89 mm Hg (diastolic), depending on age.

Recent updates by the American Heart Association now recognizes stage 1 hypertension as readings of 130/80 mm Hg or higher.

Stage 1 hypertension, which can be caused by everything from poor diet to stress, is considered to be mild to moderate high blood pressure.

Many people with stage 1 hypertension don’t experience any noticeable symptoms . However, your doctor may decide that you need treatment, even without symptoms. It’s vital that you follow up with your primary care doctor for any blood pressure concerns.

If not addressed, stage 1 hypertension will increase your risk of heart attack, stroke, and other serious health issues. It may also progress to stage 2 hypertension – a more severe type of high blood pressure.

Click below to learn more about what causes stage 1 hypertension, the symptoms & the best treatment methods

Stage 2 Hypertension

Blood pressure readings higher than 1 40/90 mm Hgindicate stage 2 hypertension, which is considered severe high blood pressure.  This is a serious condition and requires immediate treatment – which includes eliminating the root causes of the condition.

Recent updates by the American Heart Association now recognizes stage 1 hypertension as readings of 140 /9 0 mm Hg or higher

Stage 2 hypertension is severe high blood pressure. 

At this stage, you may be noticing some symptoms of hypertension and your risk of heart attack, stroke, and other serious health issues greatly increase.

Click below to learn more about what causes stage 2 hypertension, the symptoms & the best treatment methods

Hypertensive Crisis:

The term Hypertensive Crisis encompasses both Hypertensive Urgency and Hypertensive Emergency. These conditions are caused by untreated hypertension and require immediate attention.

If your blood pressure reading is 180/120 or higher, wait about five minutes and retake your blood pressure. If you have two readings that are this high, but you aren’t having any other concerning symptoms such as chest pain, back pain, shortness of breath, change in vision, numbness/weakness, or difficulty speaking – you are experiencing hypertensive urgency.

Contact your physician immediately to discuss next steps. This type of blood pressure problem can usually be handled by adjusting your medications, but it is crucial that you speak to your doctor.

If your blood pressure reading is 180/120 or higher and you’re experiencing symptoms such as shortness of breath, back pain, chest pain, numbness/weakness, change in vision, or difficulty speaking – you’re having a hypertensive emergency and need to seek emergency medical attention. Do not wait to see if your blood pressure improves. Call 911 or head to the nearest emergency room. To treat this serious condition, doctors may give you blood pressure medications intravenously (IV),  or other treatments aimed to decrease your risk of long-term effects.

If left untreated, you might begin to experience signs of organ damage that include:

• Body weakness or numbness
• Trouble breathing
• Chest pain
• Back pain
• Slurred speech
• Headache
• Seizure
• Changes in vision

Treatment for a Hypertensive Crisis

If you are experiencing a Hypertensive Crisis, never wait for your blood pressure to come back down before seeking medical attention. Treatment options include blood pressure medication administered through IVs and specific therapy treatment for possible organ damage.

Causes of High Blood Pressure

For many people, no one specific factor leads to the development of high blood pressure. It tends to develop gradually over time as a result of age and the build-up of fatty deposits in the arteries.

However, some lifestyle factors can speed up the onset of high blood pressure. A few of these factors include a high-sodium diet, too much alcohol, inactivity, and stress.

Health conditions like thyroid disease, kidney disease, and sleep apnea might increase your risk of high blood pressure. Taking medications such as prescription drugs, decongestants, and pain relievers may also be contributing factors.

Hypertension Symptoms and Risks

Risks associated with high blood pressure can become life-threatening if not adequately monitored or addressed ( Image reference).

Most people with high blood pressure, particularly prehypertension and stage 1 hypertension, don’t experience any symptoms.

Even at stage 2, hypertension may not cause any noticeable effects. Those who do experience symptoms may notice:

• Headaches
• Nosebleeds
• Shortness of breath

However, even in the absence of symptoms, the elevated blood pressure is still damaging your blood vessels and heart and increasing the risk of heart attack, heart disease, stroke, and more.

For these reasons, regular check-ups along with at-home blood pressure monitoring are necessary to stop progression or reverse some of the damage done.

Treatments for High Blood Pressure

Whether you have prehypertension, or full-blown hypertension at any stage, the treatments options are the same. However, those with more severe high blood pressure may need to be more aggressive in their approach than those with blood pressure readings which are close to normal. Common treatment regimen include…

At Home Monitoring

A small, portable, at-home blood pressure monitor cuff is a convenient way to stay on top of your readings throughout the day ( Image Reference).

If you have any of the health conditions associated with high blood pressure, including sleep apnea, kidney problems, or thyroid disease, it’s esstenial to follow the treatment plan you were prescribed. Invest in an at-home blood pressure monitor to help track your readings. Careful monitoring can:

• Identify abnormal measurements
• Recognize lifestyle habits that increase your blood pressure
• Monitor in-between routine doctor visits
• Keep track of blood pressure while on medication

Healthy Diet

A healthy, balanced, diet helps to keep high blood pressure at bay ( Image Reference).

What you put in your body can have a profound impact on your health. Choose to fill your plate with fresh fruits and vegetables, whole grains, nuts, seeds and lean protein sources like fish and beans. Make sure to incorporate drinks that lower blood pressure and avoid diuretics.

For lower blood pressure and all-around better health, avoid processed foods, trans fats, and red meat, and cut down on your intake of sugar and saturated fat.

Ditch the Salt

Too much dietary salt disturbs the delicate balance of sodium and potassium in the body. This increases fluid retention and puts excess strain on the kidneys and the blood vessels around the kidneys.

The American Heart Association recommends people consume no more than 1,500 mg of sodium a day – which is a little over half a teaspoon of salt. It’s not just the salt in the salt shaker you should be concerned with – research shows that over 75% of our sodium intake comes from the salt already added to processed foods and restaurant meals.

Potassium-rich foods such as potatoes, bananas, avocados, sweet potatos, and dark leafy greens will help lessen the effects of sodium.

Stay Active

Make sure to engage in regular activities to bring your blood pressure back into the normal range.

Exercise causes the body to release nitric acid, which helps blood vessels to dilate, reducing blood pressure. Regular activity also helps with weight loss, stress reduction, and heart health.

Walking, cycling, swimming, water aerobics, golf (without a cart), and yoga are all fantastic exercises for adults of all ages.

Don’t forget that other everyday activities which involve movement – known as incidental physical activities – can contribute to improved fitness levels, at least according to some research. This includes things like moderate intensity gardening, vacuuming, washing the car, or walking around the supermarket.

Maintain a Healthy Weight

Carrying excess weight can be dangerous to your heart health, as it requires your arteries to work harder. Set goals and track progress with a simple at home scale ( See Product on Amazon).

If you are overweight, If you’re overweight, talk to your doctor about a weight loss regimen. Losing as little as 5 pounds can make a difference!

Being overweight or obese is also a risk factor for heart disease and type 2 diabetes, two conditions associated with high blood pressure.

Stop Stressing

Stress and anxiety may be contributing to your elevated blood pressure results. Practice relaxation techniques like deep breathing, meditation, and yoga on a regular basis to lower your blood pressure, and even bring it back within the normal range.

Enjoy Alcohol in Moderation (or Not at All!)

While we’ve all heard the health benefits of a glass of red wine now and then, too much alcohol increases blood pressure, contributes to weight gain, and can cause you to make poor food choices.

For better health, women of any age and men over 65 should enjoy no more than one drink a day, and men under 65 should have no more than two.

Quit Smoking

There are no health benefits to smoking! Nicotine not only increases blood pressure and heart rate, but it also raises the risk of heart attack or stroke, and leads to narrowing and hardening of the arteries.

Discuss Medication with a Doctor

When dealing with high blood pressure readings, it’s necessary to consult with your doctor to find proper ways to manage and prevent hypertension.

Depending on your age, lifestyle, and blood pressure readings, your doctor may recommend medication as part of a treatment program for hypertension.

It’s not clear if medication is beneficial for adults who have prehypertension alone. However, if you have another medical condition along with prehypertension, such as diabetes or kidney disease, your doctor might decide it’s best to start treatment as early as possible.

Those with stage 1 and stage 2 hypertension may be prescribed one or more of the following drugs:

• ACE inhibitors
• Aldosterone antagonists
• Alpha blockers
• Alpha-beta blockers
• Angiotensin II receptor blockers (ARBs)
• Beta-blockers
• Renin inhibitors
• Thiazide diuretics
• Vasodilators

Hypotension (Low Blood Pressure)

While all the focus seems to be on high blood pressure, low blood pressure (hypotension) is also a potentially dangerous condition. In severe cases, it can cause shock – a life-threatening condition that occurs when the body isn’t receiving adequate blood flow.

A reading of less than 90 (systolic) or 60 (diastolic) can indicate low blood pressure, although this may vary from person to person. As a result, you may not experience any symptoms of hypotension even if your blood pressure readings indicate you have it. In cases like this, a doctor may or may not recommend interventions.

Causes of Hypotension

There are several possible causes of low blood pressure, and you must find the root cause raise your readings back to a normal range.

Possible causes include:

• Anaphylaxis – a severe allergic reaction
• Blood loss
• Dehydration
• Heart problems such as low heart rate, heart attack, or heart failure
• Low blood sugar or diabetes
• Medications such as diuretics, alpha blockers, beta blockers, some antidepressants, erectile dysfunction treatments, and drugs for Parkinson’s disease
• Nutrient deficiencies, particularly a lack of Vitamin B12 and folate
• Pregnancy
• Septicemia – a severe infection in the bloodstream
• Thyroid conditions

Low blood pressure can also be encountered when moving quickly to a standing position after sitting or lying down. Hypotension after meals (postprandial hypotension) is common in older adults.

Symptoms and Risks of Hypotension

If you have low blood pressure, you may experience:

• Blurred vision
• Dizziness
• Extreme tiredness
• Fainting
• Inability to concentrate
• Lightheadedness
• Nausea

Severe cases of hypotension can result in shock – a life-threatening condition which requires emergency medical intervention. Shock is characterized by:

• A weak and rapid pulse
• Cold and clammy skin
• Confusion, especially in older adults
• Quick and shallow breathing

Treatments for Hypotension

If your hypotension is just slightly below the healthy range and doesn’t cause you any symptoms, it’s unlikely you need treatment.

Those who do experience symptoms may wish to:

Increase Fluid Intake

Water is a staple in any healthy diet, but maintaining hydration and avoiding diuretics can help to increase low blood pressure ( Image Reference).

Drinking more water will help to raise blood volume and prevent dehydration. Steer clear of coffee, tea, and alcohol – which are diuretics – and can increase your risk of becoming dehydrated.

Eat a Balanced Diet with Regular Meals

A diet rich in fresh fruits and vegetables, whole grains, nuts, seeds and lean protein sources like fish and beans is important for blood pressure and heart health. Avoid processed foods, trans fats, and red meat, and cut down on your intake of sugar and saturated fat.

As blood pressure tends to drop after eating, several smaller, low-carb meals spaced throughout the day may help ease symptoms. It can also be helpful to reduce your intake of high-carbohydrate foods like potatoes, white pasta, and white bread.

Add More Salt

People with low blood pressure may actually benefit from a little extra dietary sodium, which can help to raise blood pressure.

However, it’s important to discuss this with your doctor first, because too much salt can cause heart failure, especially in older adults or those with underlying health conditions.

Invest in Compression Stockings

These stockings – which are often used to treat varicose veins – help those with hypotension by preventing blood from pooling in the legs.

Discuss Medication with a Doctor

Some medications are available to help those with hypotension – a doctor will be able to advise you of your options.

Slowly Change Body Positions

Hypotension which causes symptoms from quickly changing body positions can be remedied by slowing down and noticing how you move.

Be sure to move from a sitting position to a standing one gently. Before getting out of bed in the morning, practice some deep breathing exercises, and slowly move from a horizontal position to a sitting one, before gently standing upright.

If you notice symptoms while standing by crossing your legs and squeezing your thighs.

Good Practices for Taking Your Blood Pressure

While monitoring your blood pressure at home is a great way to keep your health on track, it’s cruical that you use the device properly. For accurate readings, follow these good practice guidelines:

Next time you have a doctor’s appointment, bring along your home monitor and have your doctor compare readings between your device and theirs. You should re-test for accuracy in this manner if you drop or damage the device.

To confirm that you are using your device properly, ask your doctor to watch you take a reading. For the greatest accuracy, take two or three readings each time, leaving two minutes between results.

When taking your blood pressure, it’s imperative that the cuff is put on correctly before starting the measurment. Be sure to refer to your device’s manual for specifications and instructions on proper placement. Also, ensure that the cuff is appropriately sized for your arm. Universal cuff sizes work for most, but custom small or large cuffs are available.

You should measure your blood pressure in the morning, but not immediately after waking. Make sure to take a reading before you exercise, eat, or take medications.

In the evening, take a second reading, ensuring it’s not within 30 minutes of eating, smoking, or consuming caffeine or alcohol.

Use the same arm each time you take your blood pressure. Prop up the arm, at heart level, on a steady surface, using a cushion if necessary. You should place the cuff against your bare skin rather than your clothing.

1. Be sure to sit in a comfortable and upright position throughout the measurement
2. Do not cross your legs
3. Avoid talking until results are displayed

Stress can cause your blood pressure to shoot up, which can leave you feeling even more stressed! Stay Zen-like before taking your daily readings for a more accurate result.

If your device doesn’t automatically log your results, write them down on a dedicated notepad. It’s normal for there to be some variation in readings. For example, your blood pressure numbers are often higher in the morning or when taken at the doctor’s office.

However, if you have concerns about any of your blood pressure readings, contact your doctor.

Understanding Blood Pressure Infographic – Know Your Numbers

Having blood pressure outside the normal range puts your health in jeopardy. If it’s too high, you’re at risk of serious medical conditions, including heart attacks and stroke. Blood pressure that’s too low can be life-threatening in severe cases.

Regardless, ALWAYS discuss readings and health conditions with your physician to ensure accurate results and the safest actions for your health.

Keep in mind that you can have high blood pressure and not even know it. This silent condition might be doing untold harm to your body. Knowing your numbers is the only way to find out for sure if your blood pressure readings fall within the optimal range, and making smart lifestyle choices is the only way to keep them there!

Stay consistent with your health. Use the infographic below as a reminder and helpful guide to understanding your blood pressure readings. View below or click image for free PDF 🙂

Sources:

https://www.health.harvard.edu/blog/new-high-blood-pressure-guidelines-2017111712756

New blood pressure guidelines put half of U.S. adults in unhealthy range

Chart Reference

Socioeconomic inequalities in blood pressure: co-ordinated analysis of 147,775 participants from repeated birth cohort and cross-sectional datasets, 1989 to 2016 | BMC Medicine

Blood Pressure Range Chart – Vaughn’s Summaries

This is the average blood pressure for men and women by age

IT’S important to keep an eye on your blood pressure.

If you want to keep track of how your blood’s pumping… here’s all you need to know.

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Use our guide for checking your blood pressure from homeCredit: Getty Images

What is the average blood pressure for men and women?

The average blood pressure differs depending on your age.

• 1 – 12 months 90/60
• 1 – 5 years 95/65
• 6 – 13 years 105/70
• 14 – 19 years 117/77
• 20 – 24 years 120/79
• 25 – 29 years 121/80
• 30 – 34 years 122/81
• 35 – 39 years 123/82
• 40 – 44 years 125/83
• 45 – 49 years 127/84
• 50 – 54 years 129/85
• 55 – 59 years 131/86
• 60 – 64 years 134/87

What is a normal blood pressure reading?

The ideal blood pressure should be below 120 and over 80 (120/80) and most UK adults have blood pressure in the range 120 over 80 (120/80) to 140 over 90 (140/90).

The higher number is the systolic pressure, which is the force at which your heart pumps blood around your body, and the lower number is the diastolic pressure, the resistance to the blood flow in the blood vessels.

You can request a blood pressure reading at your local GP – it only takes a minute or so.

Blood pressure is measured with an instrument called a sphygmomanometer, where a a cuff is placed around your arm and inflated with a pump until the circulation is cut off.

Then, a small valve slowly deflates the cuff, and the doctor measures blood pressure.

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Symptoms of high blood pressure include severe headaches and fatigueCredit: Getty – Contributor

How can I monitor my blood pressure at home?

If you want to measure your blood pressure at home, you will need to a buy a blood pressure monitor.

It’s particularly important if a doctor has told you to monitor your blood pressure regularly.

If you are about to check your levels, avoid smoking, exercise, caffeine and stress directly before as these can affect your blood pressure.

Roll up your sleeve and sit with your arm resting palm-up on the arm of the chair.

Make sure you’re relaxed, in a quiet space and you don’t need to use the bathroom – as this can change the reading.

Then follow these simple steps:

1. Locate your pulse on the inside of your elbow with your index and middle finger
2. Secure the cuff of the monitor onto your arm using the fabric fastener to make sure it’s in place
3. Inflate and deflate the cuff using the instructions on the monitor – machines can differ
4. Keep your arm straight for the most accurate reading
5. Record the reading from the machine, as well as any special circumstances at the time (meals, stress, exercise etc.)

What are the risks if your blood pressure is too high or too low?

If your blood pressure is too high (know as hypertension), it puts extra strain on your arteries (and your heart) and this may lead to heart attacks and strokes.

For the most part, the lower your blood pressure the better.

However, if you experience symptoms of dizziness, nausea, fainting and dehydration, then low blood pressure may be a problem.

If you experience any of those symptoms, it’s best to see your GP.

High blood pressure ‘hypertension’ raises the risk of heart attacks and strokes

Frontiers | The Role of Metabolic Syndrome in Endometrial Cancer: A Review

Introduction

Endometrial cancer is one of the most common gynecological malignancies. The latest cancer statistics from the American Cancer Society showed that in 2018, the number of new cases of endometrial cancer in the United States was 63,230, and the number of deaths was 11,350. The incidence of malignant endometrial tumors in women ranked fourth, and the incidence of death from endometrial cancer ranked sixth (1). With the increasing incidence of metabolic diseases (obesity, diabetes and hypertension), the incidence of endometrial cancer is increasing, and affecting younger populations worldwide. It is estimated that the incidence of endometrial cancer will increase to 42.13 per 100,000 people in the United States by 2030 (2). In recent years, early diagnosis, surgery, radiotherapy and chemotherapy can significantly improve the therapeutic effect of patients, but the treatment of early lesions and the need to retain fertility, late and recurrent patients is still limited. A clinical analysis of 276 patients with endometrial cancer showed that the 5-year disease-free survival rate and the 5-year overall survival rate were 82.3 and 81%, respectively, and the recurrence rate and the cancer-related mortality rate were 14.5 and 15.9%, respectively (3).

Regarding the pathogenesis of endometrial cancer, the traditional view is that long-term non-progesterone estrogen overstimulation of the endometrium is the main cause of endometrial hyperplasia and endometrial cancer. Estrogen can bind with nuclear estrogen receptor (ER) and play a “genotype”-regulatory effect by regulating the transcription of specific target genes. Additionally, our previous studies have found that estrogen can also induce Ca²⁺ influx by binding to the G protein-coupled estrogen receptor (GPER) on the cell membrane surface, activating the calcium channel Cav1.3, and activating the downstream signal transduction pathway (MAPK/Erk) rapidly, thereby promoting the proliferation of endometrial cancer. This process does not involve gene transcription and protein synthesis; therefore, it is called the “non-gene-transcription effect” (4). At present, long-term progesterone is commonly used in the clinical treatment of endometrial cancer. However, the overall effective rate of progesterone therapy for primary endometrial cancer is only 50–70%, and the recurrence rate is as high as 40% (5, 6). The objective response rate of progesterone therapy for advanced and recurrent endometrial cancer is only 15–20% (7). Interestingly, recent studies have shown that serum estrogen levels in patients with endometrial hyperplasia and endometrial cancer are not elevated compared with those in the normal control group (8). Moreover, epidemiological studies have shown that long-term estrogen exposure in post-menopausal women does not increase the risk of endometrial cancer (9). Traditional views do not explain why endometrial cancer still occurs in post-menopausal women with low estrogen levels. These studies suggest that local estrogen sensitivity, rather than increased circulating estrogen, may drive the occurrence and development of endometrial cancer. At the same time, other factors besides estrogen may also induce the occurrence and development of endometrial cancer.

Endometrial cancer is often associated with obesity, diabetes, and hypertension. These conditions are commonly known as the metabolic triad of endometrial cancer. Epidemiological studies showed that the risk of endometrial cancer in diabetic patients was 2.12 times higher than that in normal patients, while the risk of endometrial cancer in those who were overweight (BMI ≥ 25 kg/m²) was 2.45 times higher than that in the control group. The risk of endometrial cancer in obese patients with hypertension was 3.5 times higher than that in the control group. Additionally, endometrial cancer is one of the cancers most closely related to metabolic diseases (10). Several studies have shown that metabolic syndrome caused by obesity, diabetes and hypertension is closely related to the incidence and adverse prognosis of endometrial cancer. A meta-analysis of six studies reported that metabolic syndrome is closely associated with increased risk of endometrial cancer in women (relative risk: 1.89, 95% CI 1.34–2.67) (11). A new research reported that there was a very high prevalence of metabolic syndrome in women newly diagnosed with endometrial cancer (12). A prospective case control study reported that women newly diagnosed with endometrial cancer have a higher prevalence of incident hyperglycemia, total: HDL cholesterol ratio, and three or more cardiovascular risk factors than women without endometrial cancer (13). All these studies suggest that metabolic syndrome is closely related to the incidence of endometrial cancer. However, the exact mechanism of metabolic syndrome affecting the occurrence and development of endometrial cancer has not been determined to date, which may be related to the elevation of such metabolites as blood sugar, insulin, insulin-like growth factor and triglyceride in serum (14, 15). The dynamic interaction between cells and the cell microenvironment plays an important role in regulating the growth of normal tissues and cancer cells. The tumor cell microenvironment includes tumor cells and other cells, such as fibroblasts, lymphocytes, macrophages, adipocytes, and other secreted factors, to form a unique tumor microenvironment system. An abnormal imbalance of the cell microenvironment often leads to tumorigenesis (16). It is suggested that molecules related to metabolic syndrome can accelerate the progression of endometrial cancer not only by acting directly on tumor cells but also by further remodeling the immune microenvironment of tumors.

In this review, we focus on the metabolic microenvironment of endometrial cancer and summarize the key molecular signaling pathways of obesity, diabetes and hypertension-related metabolic syndrome affecting the occurrence, development and prognosis of endometrial cancer, aiming to explore new methods of early prevention, and targeted treatment of endometrial cancer.

Molecular And Metabolic Mechanisms Underlying the Obesity-Endometrial Cancer Link

Epidemiological data showed that obesity is closely related to the increase in the incidence of various cancers. Some scholars have confirmed the causal relationship between obesity and breast cancer by constructing a genetically engineered mouse model and have shown that obesity is closely related to the increase in the survival rate of residual cancer cells (17). A meta-analysis of 26 studies in the United States showed that every five units increase in body mass index (BMI) increased the risk of endometrial cancer by 50% [relative risk [RR], 1.50; 95% CI, 1.42–1.59] (18). A study reported that a history of bariatric surgery and maintained normal weight after surgery is associated with a 71 and 81% reduced risk for uterine malignant tumors (19). These findings suggest that obesity may be a modifiable risk factor related to development of endometrial cancer. However, the mechanism by which obesity increases the risk of endometrial cancer has not been elucidated. At present, the possible mechanisms are as follows: obese patients are often accompanied by insulin resistance (hyperinsulinemia), abnormal fat metabolism (leptin, adiponectin disorders), hyperglycemia, hyperlipidemia, and chronic inflammation. These factors may promote the occurrence and development of tumors (Figure 1). To explore the key mechanism of obesity-induced endometrial cancer occurrence and development, it is helpful to provide a new intervention target for the treatment of patients with metabolic syndrome.

Figure 1. Dysfunctional adipose tissue in obesity.

Adipocyte-Derived Estrogen Signaling

Endometrium is a highly dynamic tissue controlled by ovarian steroids, estrogen and progesterone. Long-term estrogen stimulation without progesterone antagonism is a key factor in the occurrence of endometrial cancer. The decline of ovarian function in post-menopausal women is accompanied by a decrease in hormone levels. However, post-menopausal women are still prone to endometrial cancer. It has been reported that adipose-derived aromatase converts circulating androstenedione into estradiol, leading to elevated serum estradiol levels, which binds to estrogen receptors α and β (ERα and ERβ), eventually leading to recruitment of transcription factors, and gene transcription may be activated or repressed (20). Thus, in post-menopausal women, adipose tissue is the main source of estrogen biosynthesis. In addition, obesity can lead to hyperinsulinemia, which can reduce the synthesis of sex hormone binding protein (SHBG) by increasing the bioavailability of insulin-like growth factor-1 (IGF-1), thereby leading to an increase in estrogen levels. Therefore, obesity increases the risk of endometrial cancer, possibly by indirectly affecting estrogen levels. A meta-analysis showed that hormone replacement therapy (HRT) could modified the BMI-endometrial cancer risk association, however, menopausal status and histologic subtype did not significantly impact upon these associations (21). These findings support the hypothesis that hyperestrogenia is an important mechanism underlying the BMI-endometrial cancer association. Additional studies are needed to explore the exact mechanism mediating the link between body adiposity and endometrial cancer.

Adipocyte-Derived Insulin Resistance

In obese patients, excessive accumulation of adipose tissue leads to elevated levels of circulating free fatty acids and increased expression of serum adipokines, such as leptin, visfatin, and cytokines, which ultimately leads to insulin resistance. Hyperinsulinemia with a decrease in the serum level of IGF-1 binding protein and an increase in IGF-1 is most often caused by insulin resistance. Obesity-induced chronic low-grade inflammation is an important factor leading to insulin resistance. Obesity-related inflammation is characterized by increased macrophage infiltration and increased expression of inflammatory cytokines in adipose tissue (22). Recently, studies have reported that endoplasmic reticulum chaperone 78 (GRP78) plays an important role in obesity-induced insulin resistance by regulating macrophages (23). The level of the proinflammatory cytokine TGF-α in adipose tissue of obese mice was significantly increased, which was closely related to insulin resistance (24). There are a large number of inflammatory mediators, such as C-reactive protein (CRP), interleukin-6 (IL-6), and plasminogen activator inhibitor-1 (PAI-1), that are elevated in the plasma of obese patients or animals and are closely related to insulin resistance (25). The obesity-induced inflammatory response inhibits insulin signaling in adipocytes and hepatocytes through a variety of signaling pathways, including inhibition of the expression of insulin receptor substrate 1 (IRS-1) and insulin receptor (IR) in insulin signaling pathways and inhibition of PPAR gamma function, and ultimately leads to insulin resistance (26, 27). Increased insulin and IGF-1 can stimulate the proliferation of endometrial cancer cells by binding to IR and IGF-1 receptors (IGF-1R) and activating downstream signaling pathways (28).

Synergistic Interaction of Estradiol and Insulin Signaling

There are both genotypic transcriptional and non-transcriptional effects in estrogen signal transduction: estrogen binds to ERα in the nucleus to exert genotypic effects, and the estrogen receptor GPER is located on the cell membrane to exert non-genotypic transcriptional effects. Studies have shown that estrogen combined with insulin can significantly promote the proliferation of endometrial cancer cells compared with estrogen or insulin alone (29). The combination of estrogen and a high-fat diet (mimic insulin resistance) could significantly stimulate the increase of endometrial glands in C57BL/6 mice. The nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), peroxisome proliferator activated receptor (PPAR) and LXR/RXR signaling pathways may be involved in this process (30). Insulin upregulates TET1 and then upregulates GPER expression, which enhances the sensitivity of endometrial cancer cells to estrogen (31). Studies have found that estrogen and IGF-1 can synergistically promote the development of tumors in mice by activating MAPK and AKT signaling pathways (32). Other studies have found that estrogen may bind to IGF-1R and exert non-genetic transcriptional effects through the Ras/MAPK signaling pathway (33). How insulin and IGF-1 interact with estrogen in signaling pathways to promote the development of endometrial cancer warrants further investigation.

Adipose-Derived mTOR Signaling

Compared with non-obese patients, the activity of VEGF-mTOR in obese endometrial cancer patients increased significantly, suggesting that adipocyte-derived VEGF-mTOR signaling is a potential target for the treatment of obese women with endometrial cancer (34). Adipose tissue mesenchymal stem cell-derived medium can activate Akt/mTOR and promote the proliferation and invasion of cancer cells (35). A new bidirectional inhibitor of PI3K and mTOR is more effective than a simple inhibitor of mTOR (rapamycin) in inhibiting endometrial cancer (36). It is suggested that mTOR signaling may be a key pathway connecting obesity and endometrial cancer, which needs to be verified in a clinical trial.

Adipose-Derived Stem Cells

Adipose-derived stem cells play an important role in the tumor microenvironment. Obesity can promote the transformation of adipose-derived stem cells (ASCs) into cancer-related fibroblasts (CAFs), thereby promoting the proliferation and invasive phenotype of cancer cells (37). In addition, adipose-derived stem cells can promote ER + breast cancer cell metastasis independently of estrogen signaling (38). Leptin secreted by adipose-derived stem cells promotes the growth and metastasis of ER + breast cancer by increasing the expression of ER receptor and aromatase (39). It has been reported that ASCs can fuse with endometrial cancer cells, and the fused endometrial cancer cells present a fibroblast-like appearance of mesenchymal phenotype accompanied by downregulation of E-cadherin expression and upregulation of Vimentin expression (40). Further study of the role of ASCs in the occurrence of endometrial cancer will help to elucidate how obesity increases the risk of endometrial cancer.

Adipose-Derived Adipokines

Adiponectin

Adiponectin is a cytokine secreted mainly by adipocytes. Epidemiological studies have shown that adiponectin levels in the blood circulation of patients with endometrial cancer are decreased (41). Serum low adiponectin levels are closely related to insulin resistance, hyperinsulinemia, obesity, and hypertension (42). A meta-analysis showed that serum adiponectin levels were negatively correlated with the risk of endometrial cancer, especially in post-menopausal women who did not receive HRT (43). In a meta-analysis of 26 studies, for each 1 μg/ml increase of adiponectin, there was a 3% reduction of summary relative risk (SRR) in endometrial cancer risk, and a 14% reduction for each increase of 5 μg/ml (44). Abnormal expression of serum adiponectin is also closely related to the occurrence and development of prostate cancer, breast cancer and colon cancer (45–47). However, the antitumor effect of adiponectin on endometrial cancer mainly depends on the alteration of systemic metabolic state or the direct interaction with tumor cells warrants further study.

Adiponectin exerts its biological effects mainly by binding to adiponectin receptors. Three types of adiponectin receptors have been identified: adiponectin receptor 1 (AdipoR1), adiponectin receptor 2 (AdipoR2), and T-cadherin. AdipoR1 is mainly expressed in skeletal muscle and epithelial cells, and AdipoR2 is most abundant in the liver (48). AMPK is an important signaling pathway downstream of adiponectin. The adiponectin/AdipoR1 signaling axis can promote the phosphorylation of the AMPK Thr172 site by inducing phosphorylation of the tumor suppressor gene LKB1. AMPK phosphorylation also plays an important role in energy metabolism by activating the TSC2 tumor suppressor (49, 50). Studies have shown that there is no significant difference in the expression of AdipoR1 and AdipoR2 in normal endometrial tissues. In endometrial cancer tissues, the expression of AdipoR1 is higher than that of AdipoR2. Adiponectin/AdipoRs can inhibit the proliferation, adhesion and invasiveness of endometrial cancer cells by activating the downstream LKB1-AMPK/S6 signal axis (51). Adiponectin can not only inhibit the proliferation and migration of endometrial cancer cells through the AMPK/mTOR/S6K1 signaling pathway but can also enhance the sensitivity of endometrial cancer cells to insulin through the AMPK/S6K1/IRS1 signaling pathway (52). Adiponectin increases insulin sensitivity mainly by activating p38MAPK activity. It has been reported that the highly conserved 13-residue segment (ADP-1) of adiponectin can promote the translocation of glucose transporter 4 (GLUT4) to the cell membrane, reduce the blood sugar level of db/db mice and promote the secretion of insulin by pancreatic beta cells, thereby improving the metabolism of glucose and fatty acids (53). In addition, the anti-proliferative effect of adiponectin is related to a variety of cell cycle regulators, cyclin D1, D2, ERK1/2, and Akt.

It is worth noting that adiponectin not only affects the tumor cells themselves but also regulates the tumor immune microenvironment. In contrast, it has been reported that the deletion of adiponectin may promote the transformation of M2 tumor-associated macrophages to M1 type through the p38MAPK signaling pathway, thereby inhibiting the growth of tumors (54). Therefore, on the one hand, adiponectin can reduce the occurrence of endometrial cancer by changing the metabolic state of the whole body; on the other hand, it can directly inhibit the proliferation of endometrial cancer cells. The decrease in serum adiponectin levels in obese patients is closely related to the increased risk of endometrial cancer (44).

Visfatin

Visfatin is an insulin-like adipokine identified in recent years. Visfatin is highly expressed in many metabolically related tumors, and its increased expression is closely related to the increased risk of cancer (55). It has been reported that decreased serum adiponectin or increased visfatin levels are independent risk factors for endometrial cancer. The visfatin:adiponectin ratio in the endometrial cancer was significantly higher than the control, which has certain reference value for the diagnosis of endometrial cancer (56). With the increase of BMI, the level of visfatin in obese patients increases significantly. The increase in serum visfatin level is closely related with risk of myometrial invasion (OR: 1.091; 95%CI:1.021–1.166) and lymph node metastasis (OR: 1.018; 95%CI:1.000–1.035) of endometrial cancer. A high level of visfatin suggests poor prognosis in patients with endometrial cancer, which may be a potential therapeutic target for endometrial cancer (57, 58). Studies have shown that visfatin can upregulate the expression of IR and insulin receptor substrate (IRS) 1/2, and it can coactivate the PI3K/Akt and MAPK/ERK1/2 signaling pathways with insulin to promote the proliferation and inhibit apoptosis of endometrial cancer cells (59). Exogenous visfatin can promote the proliferation of breast cancer cells by promoting ERα phosphorylation and activating estrogen response element (ERE)-dependent signaling pathways (60). However, it has not been reported whether visfatin can also enhance estrogen-dependent ER signaling and accelerate the development of endometrial cancer. In addition, visfatin has been reported to be abnormally expressed in a variety of tumors, which can increase the risk of multiple tumors and become a potential molecular marker for the early detection of tumors (55). Therefore, the combination of visfatin and adiponectin may be a marker for the early clinical diagnosis of endometrial cancer and may provide new targets for clinical intervention.

Leptin

Leptin is an important adipokine encoded by the obesity gene. Leptin plays an important role in regulating food intake, energy consumption and promoting cell growth by combining with leptin receptor (ObR). Recent studies have found that abnormal expression of leptin and leptin receptor signaling related to obesity plays an important role in the development of breast, colon and endometrial cancer (61, 62). A meta-analysis showed that high levels of leptin can significantly increase the risk of endometrial cancer (risk ratio, RR = 2.55) and that high levels of leptin are an independent risk factor for endometrial cancer (63). The expression of leptin and ObR is positively correlated with the invasiveness of tumors and BMI of patients but is negatively correlated with histological grade. The elevated expression of leptin and ObR is closely related to lymph node metastasis and poor survival prognosis, as well as the positive expression of ERs (64). However, whether the leptin signaling pathway can influence the development of endometrial cancer by affecting the classical estrogen signaling pathway remains to be further confirmed. Studies have shown that the expression of ObR in poorly differentiated endometrial cancer tissues is significantly higher than that in well-differentiated endometrial cancer tissues, and leptin can inhibit the apoptosis of endometrial cancer cells by activating the NIK/IKK signaling pathway. Elevated leptin levels can influence epithelial polarity and promote malignant transformation through overactivation of the PI3K/Akt signaling pathway (65). Leptin also promotes the proliferation and invasion of endometrial cancer cells by activating STAT3 and ERK1/2, JNK signaling pathways. Correspondingly, this proliferation is inhibited when the JAK/STAT3 pathway is blocked (66). Other studies have reported that the leptin-2548 G/A SNP may be involved in the occurrence and development of endometrial cancer (67). It has been reported that leptin can upregulate the expression of STAT3-CPT1B and plays an important role in maintaining the stem and drug resistance of breast cancer cells (68). However, the role of leptin in the maintenance stem cell of endometrial cancer has not been determined to date and requires further study. Elevated leptin levels suggest the presence of endometrial cancer, and serum leptin levels may be an effective tool for assessing the clinical staging of endometrial cancer (69). Although elevated leptin level is a high-risk factor for endometrial cancer, whether it is the most critical molecule associated with obesity and endometrial cancer warrants further investigation.

Adipose-Derived Inflammatory Cytokines

Inflammation is the core stage of tumorigenesis and development. It has been reported that 18% of cancer cases worldwide are related to chronic infection, which implies a potential relationship between cancer and inflammation. In a lean state, a balance between adipocytes and immune cells can maintain normal metabolism throughout the body. However, in obese people, this balance translates into a markedly inflammatory adipose tissue microenvironment. Obesity-related adipose inflammation can increase the secretion of pro-inflammatory factors, cause systemic metabolic disorders, and change the microenvironment of tumors, thereby significantly increasing the risk of cancer in obese people. Several studies have confirmed that obesity-related inflammatory cytokines are involved in tumorigenesis.

IL-6

IL-6 is an inflammatory cytokine that plays an important role in many physiological and pathological processes. IL-6 is closely associated with a three times increased risk of mortality in overweight/obese patients (70). Studies have confirmed that IL-6 is closely related to the occurrence of a variety of tumors, including endometrial cancer. Adipose-derived IL-6 can promote the proliferation, invasion and angiogenesis of endometrial cancer cells by activating the JAK/STAT3 signaling pathway (71). The elevated plasma level of IL-6 is closely related to the poor prognosis of tumors (72). In addition, estrogen can promote the expression of IL-6 in endometrial cancer cells by binding to GPER on the cell surface (73). It has been reported that estrogen (E2) can promote the expression of IL-6 by binding with nuclear receptor ERα, and IL-6 can promote the synthesis of aromatase by binding with IL-6R of basal cells, thereby accelerating the synthesis of estrogen and forming a positive feedback loop (74). A new study confirms that blocking IL-6-driven inflammatory signaling can inhibit the spread of cancer cells to the liver (75). IL-6 is likely to play a prominent role in the development of endometrial cancer, and it appears to be one of the major mechanisms involved in the obesity-cancer link.

TNF-α

TNF-α is an inflammatory cytokine secreted by macrophages and adipocytes. It is an important regulator of adipose tissue metabolism and plays an important role in immune regulation, inflammatory response and anti-tumor response. However, recent studies have found that TNF-α is also an endogenous tumor-promoting factor that can promote the proliferation, invasion and metastasis of cancer cells. The level of TNF-α in circulating blood of obese patients is increased, and the increased level of TNF-α is closely related to the poor prognosis of endometrial cancer patients (76). In addition, studies have reported that 11 cancer markers in overweight patients are significantly higher than those in normal weight patients, including ANG-2, sFASL, HB-EGF, IL-8, PLGF, TGF-α, TNF-α, uPA, VEGF-A, VEGF-C, and VEGF-D (77). Compared with lean mice, C57BL/6 mice induced by a high-fat diet had higher levels of serum free fatty acids and TNF-α and higher accumulation of macrophages in adipose tissue (78). A case-control study showed that elevated levels of TNF-α and its soluble receptors (sTNFR1 and sTNFR2) were associated with an increased risk of endometrial cancer [TNF-α-odds ratio [OR]: 1.73; sTNFR1-[OR]:1.68; sTNFR2-[OR]:1.53] (79). Regarding the mechanism of TNF-α in promoting tumorigenesis and development, it has been reported that chronic inflammation induced by obesity promotes the accumulation of macrophages in adipose tissue. TNF-α released by M1 macrophages can promote metastasis and inhibit apoptosis of ovarian cancer cells by activating the signaling pathway of NF-κB (80). TNF-α is also a key factor driving the expression of the aromatase gene, and IL-10 can regulate the expression of aromatase in adipose tissue by inhibiting the TNF-α signaling pathway (81). Moreover, TNF-α could induce serine phosphorylation of IRS-1 and inhibit its triggering of downstream signals, leading to insulin resistance. Insulin resistance-induced hyperinsulinemia and IGF-1 can further enhance the biological effects of TNF-α by activating the TNF-α signaling pathway (80). TNF-α inhibited apoptosis in cancer cells by activating the NF-κB signaling pathway. Although several pathways between TNF-α and tumors have been identified, the precise mechanism of obesity-related TNF-α involved in the development of endometrial cancer remains to be further investigated.

PAI-1

Plasminogen activator inhibitor-1 (PAI-1) is a protease inhibitor produced by vascular endothelial cells, stromal cells and adipocytes in adipose tissue. Recent studies have found that PAI-1 not only plays an important role in influencing insulin signaling but also plays an important biological role in influencing the invasion, invasion and metastasis of obesity-related tumors (82). PAI-1 is highly expressed in endometrial cancer tissues and is closely related to the poor prognosis of endometrial cancer (83). Studies have reported that PAI-1 may mediate the transcriptional regulation of adipose-derived stem cells in endometrial cancer (84). Therefore, PAI-1 represents a potential therapeutic target.

Effect of Obesity on the Tumor Immune Microenvironment

Obesity can promote adipocytes to secrete pro-inflammatory factors, such as TNF-α, IL-6, and IL-18. These pro-inflammatory cytokines can further enhance the infiltration of inflammatory cells, mainly macrophages and T lymphocytes, thereby promoting abnormal proliferation and transformation of normal cells (85). Studies have shown that 16 weeks of aerobic and endurance training can reduce the expression of inflammatory cytokines (IL-6 and TNF-α) in adipose tissue and induce the transformation of inflammatory M1 macrophages into anti-inflammatory M2 macrophages (86). It has been found that adipose tissue-derived leptin can promote the differentiation of Th27 cells and promote T cell function by regulating cell metabolic reprogramming (87). Recent studies have shown that obesity can increase the infiltration of tumor-related macrophages, upregulate the production of IL-1β, and promote angiogenesis and tumor progression (88). It has been reported that M2 macrophages infiltrated in the microenvironment of endometrial cancer can enhance the sensitivity of endometrial cancer cells to estrogen by releasing cytokine IL17A and upregulating the expression of ERα through TET1-mediated epigenetics (8). These studies indicated that obesity may further promote the occurrence and progression of endometrial cancer by affecting the immune microenvironment of tumors.

Type 2 Diabetes And Endometrial Cancer

Most epidemiological studies suggested that diabetes is a risk factor for endometrial cancer incidence; for example, a meta-analysis of 16 studies showed that diabetes was statistically significantly associated with an increased risk of endometrial cancer (summary RR 2.10, 95% CI 1.75–2.53), and there was a stronger association with a adjusting for age (RR 2.74, 95% CI 1.87–4.00) (89). Also, diabetes is closely related to increased cancer-specific mortality (HR 2.09, 95% CI 1.31–3.35) and mortality from non-cancer related causes in women with endometrial cancer (90). Therefore, these studies show that diabetes increases both the risk and mortality rates of endometrial cancer.

Effect of Hyperglycemia on Endometrial Cancer

Hyperglycemia is an important clinical characteristic of type 2 diabetes mellitus. Systemic hyperglycemia provides favorable conditions for energy metabolism of cancer cells. Previous studies have confirmed that elevated serum glucose can directly regulate cancer-related signaling pathways, especially to meet the needs of rapid proliferation of cancer cells, and can promote the process of glycometabolism reprogramming (91). Metabolic reprogramming is one of the important hallmarks of tumor cells, which are different from normal cells. Even in the presence of abundant oxygen, ~80% of tumor cells metabolize glucose and produce ATP mainly through aerobic glycolysis, also known as the Warburg effect. In addition to the rapid production of energy, glycolysis can also produce a large number of metabolic intermediates, which can be used to synthesize biological macromolecules needed for the rapid growth of tumors, including nucleotides, fatty acids, and proteins.

Glucose transporter (GLUT) is the main carrier of glucose uptake by cells. When glucose enters the cell, GLUT transports allosteric to transport glucose into the cell to support the high glycolysis rate. It has been reported that high glucose could promote the expression of vascular endothelial growth factor (VEGF)/VEGFR and the process of (epithelial-mesenchymal transition) EMT by regulating the expression of ERα/GLUT4, thereby promoting the proliferation and invasion of endometrial cancer cells (92). In addition, high glucose can increase the activity of glucose uptake and glycolysis by regulating AMPK/mTOR/S6 and MAPK pathways, thereby leading to increased invasiveness of endometrial cancer cells. Moreover, high glucose can promote the proliferation of endometrial cancer cells by activating STAT3 expression, which can be inhibited by metformin (93). The activity of glucose metabolism is closely related to the concentration of glucose outside the cell. However, it is not clear how cells perceive external glucose levels and regulate glycolysis pathway activity. AMPK, an adenylate-activated protein kinase, is a key protein for the perception of extracellular glucose concentration (94). It was reported that high extracellular glucose levels regulate the protein level of CARM1 by reducing AMPK phosphorylation, thereby inhibiting GAPDH methylation, which further promotes the activity of the GAPDH enzyme and glycolysis pathway (95). This study reveals the mechanism by which cells perceive extracellular glucose levels and regulate the rate of glycolysis, helping to elucidate the mechanism by which cancer cells perceive and utilize glucose.

Pyruvate kinase isozymes M2 (PKM2) is a key metabolic enzyme that promotes glycolysis and plays an important role in tumorigenesis through the Warburg effect. It has been reported that high glucose could promote the abnormal expression of PKM2. Overexpression of PKM2 could promote the accumulation of glycolysis intermediates (pyruvate and lactic acid), provide precursors for the synthesis of biomacromolecules, and lead to cell proliferation and tumorigenesis (96). Lactic acid is a key metabolite of glycolysis in cancer cells. The accumulation of extracellular lactic acid has an important impact on the metabolism of cancer cells and the transformation of non-cancer cells into cancer cells, including metabolic reprogramming, tumor inflammation, and angiogenesis. Recent studies have found that lactic acid produced by glycolysis of cancer cells can inhibit the function of macrophages through a hypoxia-inducible factor-mediated mechanism, induce the transformation of anti-tumor type M1 macrophages into M2, and promote the invasion and migration of cancer cells (97). Interestingly, M2 macrophages are the predominant tumor-associated macrophages in endometrial cancer and play an important role in the occurrence and development of endometrial cancer (98). Monocarboxylate Transporter 1 (MCT1) is an important protein for lactic acid and pyruvate uptake by cells, while MCT4 is an important protein for cell transport of lactic acid and pyruvate, which play an important role in regulating lactic acid metabolism. It has been reported that MCT1 was an independent prognostic biomarker in endometrial cancer (99). A recent study reported that the use of monocarboxylic acid transporter (MCT) inhibitors can reverse the inhibition of lactic acid on macrophage lysosomes (100). Therefore, MCT1 inhibition may have potential as a treatment for endometrial cancer. It is suggested that the enhancement of glycolysis activity and metabolites, such as lactic acid, in endometrial cancer under a high glucose environment may lead to acidification of the tumor microenvironment. The acidic environment may be perceived by tumor-related macrophages, which depend on the monocarboxylic acid transporter 1 (MCT1) pathway to induce macrophage transformation from M1 to M2, thus accelerating the progress of endometrial cancer. These studies suggested that managing hyperglycemia or targeting glycometabolism may be a potential therapeutic strategy for endometrial cancer.

Effect of Insulin Resistance on Endometrial Cancer

Insulin resistance and hyperinsulinemia are important characteristics of obesity and diabetes. The expression of insulin and IGF-1 was significantly increased in diabetic patients, and high insulin levels were an independent factor of endometrial cancer (28, 101, 102). High insulin and IGF-1/2 levels in diabetic patients can accelerate the transformation of androstenedione into estrogen by aromatase and increase estrogen levels by inhibiting the synthesis of SHBG. Long-term estrogen stimulation without progesterone antagonism can cause endometrial dysplasia or even malignant transformation (103). It has been reported that after adjusting for BMI, age and histological type, the high expression of IR/IGF-1R is closely related to prognostic high-risk factors, such as the progression of endometrial cancer and lymph node infiltration (104).

Insulin can activate the phosphoinositide 3-kinase (PI3K)/AKT or mitogen-activated protein kinase (MAPK)/extracellular signaled regulated kinase ERK signaling pathway through binding to IR/IGF-1R to promote EMT of endometrial cancer, which leads to increased proliferation and invasion of endometrial cancer cells, inhibits apoptosis of cancer cells and promotes angiogenesis of tumors (105). In addition, insulin could upregulate the expression of vascular endothelial growth factor, thereby stimulating angiogenesis, which is closely related to the occurrence and development of tumors (106). Recent studies have reported that insulin signal-dependent phosphorylation initiates glucose metabolism prior to glucose transport; thus, the metabolism of glucose is diverted to a specific direction of glycolysis (107). In this way, insulin signaling plays a key role in glycometabolism reprogramming, and insulin resistance can promote the occurrence and development of endometrial cancer through an indirect pathway or ligand-receptor direct pathway.

IR-A has high affinity for insulin and IGF-II but binds IGF-I with low affinity. IGF-1R has high affinity for IGFs. However, blocking IGF-IR and IR does not completely prevent the growth stimulation of insulin-like growth factor or insulin on cancer cells, suggesting that other receptors may be involved in complex signal transduction systems. Our previous studies found and confirmed for the first time the expression of Hybrid-R in endometrial cancer, which can promote the proliferation and inhibit apoptosis of endometrial cancer cells through the MAPK/ERK signaling pathway (22). Hybrid-R is expected to provide a new therapeutic target and strategy for the precise treatment of endometrial cancer patients with insulin resistance and hyperinsulinemia.

Metformin in the Treatment of Endometrial Cancer

Metformin, an insulin sensitizer, is considered a potential anticancer drug. Our previous clinical studies have found that metformin combined with progesterone treatment can significantly improve the efficacy of endometrial cancer patients with poor progesterone treatment (108). It has been reported that plasma hyperglycemia and high levels of IGF-1 in patients with endometrial cancer can be reversed by conventional doses of metformin (109). Metformin can significantly inhibit the proliferation of endometrial cancer cells, which may be related to the activation of AMPK signaling and the inhibition of the mTOR signaling pathway (110). In contrast, some studies have shown that metformin does not reduce the risk of endometrial cancer, nor can it improve the overall survival of patients (111). Correspondingly, studies have found that metformin does not affect the PI3K-Akt-mTOR and insulin signaling pathways and has no effect on weight loss (112). It is of great clinical significance to further study the mechanism of abnormal glucose metabolism promoting endometrial cancer, reveal the key molecule of endometrial cancer caused by metabolic diseases, and find new effective preventive or anti-cancer drugs that can replace metformin.

Other Types OF Diseases OF Metabolic Syndrome And Endometrial Cancer

Dyslipidemia is closely related to the incidence of various cancers (113). It was reported that patients with hyperglycemia, hyperlipidemia and hypertension are twice as likely to develop endometrial cancer as normal people (114). The BMI of patients was positively correlated with serum palmitic acid, oleic acid and stearic acid levels. The increase of free fatty acids in obese patients can indirectly promote the proliferation of endometrial cancer cells by increasing the level of estradiol (115). The BMI of patients with endometrial cancer was significantly higher than that of normal controls. At present, there are many studies on the relationship between endometrial cancer and obesity and diabetes, but there are few studies on the relationship between endometrial cancer and hypertension and lipid disorders. The possible mechanisms of abnormal blood lipids associated with the risk of endometrial cancer are as follows: activation of fatty acid and amino hexose pathways leads to the production of reactive oxygen species (ROS) in mitochondria, which induces oxidative stress in cells. Excessive aggregation of ROS clusters interacts with lipids, proteins and DNA in cells, causing changes in membrane and enzyme functions, inducing cell damage, and ultimately leading to tumorigenesis (116). Recent studies have reported that serum cholesterol is elevated in obese people. Cholesterol activates the transcriptional activity of endometrial cancer cells through an ER-dependent pathway and promotes the proliferation of endometrial cancer cells (117). Moreover, recent studies have found that elevated circulating free fatty acids may be an important factor in linking obesity and tumorigenesis, which can promote the proliferation and invasion of breast cancer cells through ERα signaling and the mTOR signaling pathway (118). It has been reported that A-FABP released from adipose tissue can promote the dryness and invasiveness of breast cancer cells (119). Taken together, abnormal lipid metabolism, especially elevated free fatty acids, is closely related to the progression of endometrial cancer. Can fatty acids participate in the occurrence and development of endometrial cancer through an ER-dependent pathway remains to be thoroughly characterized.

Hypothyroidism is a type of reduced metabolic syndrome caused by a decrease in thyroid hormone synthesis and secretion or by inadequate physiological effects. Brinton et al. indicated that EC is related to previous diagnoses of thyroid diseases (RR = 1.52, 95% CI 1.17–1.98) (120). It has been reported that the incidence of hypothyroidism in EC patients is significantly increased. Serum TSH level before treatment is an independent risk factor for poor prognosis of EC (121). Additionally, elevated TSH levels have been reported to increase the incidence of MS (122). At present, there are few studies on thyroid function and endometrial cancer. Several studies have shown that hypothyroidism is closely related to MS, PCOS, elevated serum leptin levels, and dyslipidemia. Hypothyroidism may promote the occurrence and development of endometrial cancer by indirectly increasing the risk factors of endometrial cancer or through direct interaction (123). Studies examining the relationship between thyroid function (TSH level) and endometrial cancer will provide new insights into the mechanism of endometrial cancer.

Conclusion

Metabolic syndrome is a complex disorder defined by a cluster of metabolic risk factors that includes insulin resistance, hyperinsulinemia, impaired glucose tolerance, type 2 diabetes mellitus, dyslipidemia, and visceral obesity. Obesity, diabetes and hypertension are the metabolic triad of endometrial cancer. There was a very high prevalence of metabolic syndrome in women newly diagnosed with endometrial cancer. In this article, we review potential pathways directly linking metabolic syndrome with cancer (Figure 2). Obesity-related insulin resistance, leptin and lactone levels are closely related to the occurrence and development of endometrial cancer. Decreased serum adiponectin levels and increased chronic inflammation in obese patients are important factors for increasing the risk of endometrial cancer. Obesity and diabetes have many common pathological characteristics: insulin resistance (hyperinsulinemia), abnormal fat metabolism (elevated leptin, decreased adiponectin), hyperglycemia, hyperlipidemia and chronic inflammation. Many studies have reported that these characteristics can promote the occurrence and development of endometrial cancer by directly acting on tumor cells or regulating the tumor microenvironment. Therefore, there is an urgent need to intervene in chronic diseases related to metabolic syndrome to reduce the incidence of endometrial cancer. A commentary by MacKintosh et al. indicated obese undergoing bariatric surgery or medical weight loss management could reduce the risk of endometrial cancer and hyperplastic abnormalities of the endometrium may be reversible through weight loss (124). Studies have assessed the effects of obesity and weight-loss surgery on endometrial morphology and molecular signaling pathways in endometrial cancer. It was found that insulin resistance (HbA1c, HOMA-IR) and inflammation (hsCRP, IL-6) circulating biomarkers decreased, while reproductive biomarkers (LH, FSH, SHBG) increased significantly (125). C-peptide, insulin, C-reactive protein, leptin, IL-1Ralpha, and IL-6 decreased significantly, while SHBG, IGFBP1, and adiponectin increased significantly in weight-loss interventions in endometrial cancer (126). Thus, bariatric surgery may reduce the risk of endometrial cancer by improving obesity-induced inflammation. However, the role of bariatric surgery in the treatment of endometrial hyperplasia still need conclusive or convincing evidence. Recently, seven markers based on the BMI-sensitive pathway of insulin resistance, adipoR1, adipoR2, ObR, IRβ, IRS-1, IGF-1R, and IGF-2R, have been proposed to develop a new molecular typing system for endometrial cancer. However, no effective molecular typing system and molecular typing markers have been found for endometrial cancer (127). A research proposed a pragmatic endometrial cancer risk prediction model, which included obesity, reproduction, insulin resistance, and genetic risk. This model plays an important role in identifying individuals at high risk of endometrial cancer and guiding preventive treatment of specific disease targets (128). Except for obesity, reproduction, insulin resistance, and genetic risk, the other metabolic syndrome related high risk factors for endometrial cancer as mentioned in the text should also be considered and a large prospective cohort of asymptomatic women is required. Similarly, studies incorporating biomarkers (adiponectin, estradiol, interleukin-1 receptor antagonist, tumor necrosis factor-and triglyceride) into the risk prediction model of endometrial cancer have found that they can modestly improve the predictive ability of endometrial cancer (129). Despite different studies, new molecular markers have been reported, but to date, no reliable molecular markers have been applied to clinical molecular typing. Our recent study found that serum total calcium may be a more sensitive metabolic syndrome parameter than hyperlipidemia in patients with endometrioid cancer (130).

Figure 2. Potential pathways directly linking metabolic syndrome with endometrial cancer.

Therefore, it is necessary to screen new markers based on systemic metabolomic changes and to reveal new molecular typing methods and risk prognostic models of endometrial cancer based on serum metabolomic changes. With the frequent application of proteomics, metabolomics, and transcriptomes, the role of key molecules in identifying metabolic syndrome-related diseases in endometrial cancer is of great significance for the early prevention and treatment of endometrial cancer. In conclusion, endometrial cancer is a type of metabolic disease-related tumor. Elucidating the specific roles and mechanisms of metabolic syndrome-related diseases in endometrial cancer is expected to provide a new target for the early prevention and treatment of endometrial cancer. Although the study of the association between metabolic syndrome and cancer may provide an effective therapeutic target for endometrial cancer, improving lifestyle is still the most important component in preventing the morbidity and mortality of endometrial cancer associated with metabolic syndrome. Further in vivo and clinical studies are needed to investigate the therapeutic targeting of the metabolic microenvironment in metabolic syndrome-related endometrial cancer.

Author Contributions

XY and JW wrote and approved the final version of this manuscript.

Funding

This work was supported by the National Natural Science Foundation of China (grant nos. 81672571 and 81874108), Special Projects for Strengthening Basic Research of Peking University (grant no. BMU2018JC005), and National Key Technology Research and Development Program (grant no. 2015BAI13B06).

Conflict of Interest Statement

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.

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Hypertension and hypotension – treatment with osteopathy

Osteopathic treatment is a special branch of medicine, which uses both an independent therapeutic approach and a complex one in conjunction with medical treatment, depending on the severity of the patient’s symptoms, as well as the degree of complexity of his disease.

A distinctive feature of osteopathy is that the specialist perceives the patient’s body as a single whole, a system in which everything is interconnected.

The osteopathic doctor diagnoses the root cause of the disease, which saves time for the patient.The accompanying symptoms disappear unnoticed and the patient has no cause for concern.

When starting the examination of a patient, an osteopathic doctor assesses the physical and emotional state. If there are problem areas, a specialist identifies them. Further, the doctor conducts careful work to place the displaced bones in place, to relax the muscles, the tone of which is increased. Using special techniques of osteopathy, the specialist restores the normal blood supply to the body. The consequence of this effect is the improvement of lymph flow.Fascia (connective tissue covering organs, blood vessels, nerves), muscle tissues are being worked out. The joints return to their normal position for proper functioning.

Osteopath gives the necessary recommendations, answers all questions of interest. After each osteopathy session, the body starts self-regulation and healing. The metabolism is normalized, the work of the nervous and endocrine systems is restored, psychoemotional stress goes away. After a course of osteopathy, headache, irritability, apathy or aggression, pain in the back, joints and muscles disappear, and the correct beautiful posture gradually returns.

An osteopathic doctor always monitors and, if necessary, corrects all processes. The number of sessions is purely individual for each patient. We are interested in your speedy recovery. Osteopathy sessions can significantly improve your well-being, a sense of your own body and the quality of life in general.

Her name is HYPOTONIA – articles and news PharmacyMos

Is It Safe?

Hypotension (hypotension) is a violation of blood pressure, its insufficiency.Blood is not pumped as intensively as it should, slower than necessary for the normal functioning of the body. Reduced pressure is considered to be below 100/60 mm Hg. Art., and for young people under 25 years old – already 105/60.

Most often, hypotension occurs from a violation of vascular tone. When the blood vessels are healthy, they can quickly narrow and widen as the heart contracts. In a hypotonic person, the vessels are sluggish, they work slowly and do not keep up with the rhythm of the heart. Therefore, the blood moves sluggishly. In fact, there is stagnation of blood in the arteries.To remove this stagnation, the heart is forced to work harder – and at low pressure, a faster pulse is most often observed.

Between the upper systolic pressure (when the heart is in maximum contraction) and the lower diastolic (when the heart is in maximum relaxation) there should be a difference (pulse pressure) of no more than 40 mm Hg. Art. And no less. Any deviations from this figure lead to damage to the cardiovascular system.

With hypotension, the heart is forced to work hard to provide the body with a normal blood supply.

With a constant deficit in the supply of oxygen to the organs, blood disrupts the work of organs and a disease occurs.

Many people do not realize that low blood pressure provokes insufficient blood supply to all internal organs and tissues, and, what is most dangerous, to the brain. Against this background, oxygen starvation occurs. This is why fatigue, decreased performance, headaches, dizziness occur!

Therefore, it is important to diagnose hypotension in a timely manner and carefully treat it

Low blood pressure and high pulse rates can lead to serious cardiovascular problems such as arrhythmias.A high pulse diagnoses the intense work of the heart, which is forced to quickly pump large volumes of blood. Flaccid vessels do not allow blood to move at a normal rate. The load on the heart increases many times over.

A low pulse at normal pressure is not hypotension. If a low pulse is observed with hypotension, this is a symptom of very serious diseases such as coronary heart disease.

How to recognize the “hypo” prefix

Hypotension has many faces.For example, you might feel overwhelmed after a good night’s sleep. You can always be in a zero mood. Hands and feet may be cold. Pale skin. In the head there are often incomprehensible sensations – compressed, crushed, spinning, hurting. These are all signs of hypotension.

In addition to the above, hypotension manifests itself in many other features.

You should be alert if someone close to you have the following symptoms:

• dizziness, dull, pressing or throbbing headaches in the temples, often on the forehead, on the back of the head, fainting – especially in a stuffy room;
• apathy, lethargy, drowsiness, decreased performance, weakness, weakness;
• memory impairment, absent-mindedness;
• meteorological dependence.At low atmospheric pressure – headache, body aches;

90,049 people practically turn into an “owl”. He gets up hard in the morning, working capacity appears only in the afternoon;

• rapid pulse, shortness of breath in the absence of heart disease, sleep disturbance;

90,049 people often yawn – this is from lack of oxygen, and not from the desire to sleep;

• pale skin, cold extremities – impaired thermoregulation, increased sweating;
• irritability, emotional instability.

People with low blood pressure can hardly tolerate any changes in the environment – changes in air temperature, humidity, stuffiness, especially emotional stimuli. Often, hypotensive patients cannot stand bright light; a sunny day is painful for them. They practically cannot stand loud sounds. They are irritable, almost always in a bad mood. Depression is often accompanied by hypotension.

In past centuries, hypotension was considered a female disease. Indeed, the weaker sex is sick with it more often than the strong.Typically, hypotension affects women between the ages of thirty and forty, sometimes from nineteen to thirty.

Absolutely healthy people, for example, athletes, can also get hypotension. The cause of hypotension in athletes is constant intense physical activity. In such cases, the human body simply begins to respond to bodily fatigue and works in a more economical mode. This hypotension is called “fitness hypotension.”

“Root” of the disease

Low blood pressure arises from a variety of reasons: psychological, emotional, with severe physical exertion, as a consequence of the underlying disease.And also – against the background of prolonged psycho-emotional stress, panic attacks, depression, stress, neuroses.

Sometimes the symptoms of hypotension occur in healthy people as well as a reaction to climate change, to increased physical activity. This reaction of the body is called adaptive hypotension. It often (but not always!) Goes away on its own.

There is also symptomatic hypotension, which develops as a concomitant ailment against the background of infectious and non-infectious diseases (heart, lungs, liver).Treatment of hypotension in this case will be aimed at eliminating the underlying disease.

There is also neurocirculatory hypotension. This independent disease, as a rule, occurs against the background of nervous stress, psychological overload, mental fatigue, negative psycho-emotional background and other types of imbalance of the nervous system. In this case, they speak of primary hypotension, which requires targeted treatment to restore the balance of the nervous system and eliminate the symptoms of low blood pressure.

Hypotension can be caused by the influence of climatic conditions, i.e. if a person moved to a city with a different climate. And the adaptation period will be held under the banner of “HYPOTONIA”. The body can react with reduced pressure to radiation, electromagnetic fields, high humidity. Hypotension can also develop as an allergic reaction to certain sound or color stimuli.

Broad Spectrum

Reduced pressure is primary and secondary.

Primary hypotension is an independent disease. Its cause is often the low activity of the autonomic nervous system – psychoemotional stress. Sometimes primary hypotension is called idiopathic.

The most common secondary hypotension occurs as a reaction of the body to the underlying disease. It can occur for the following reasons:

• blood loss, especially in women with heavy menstruation;
• dehydration;
• diseases of the heart and blood vessels – atherosclerosis, arrhythmia, circulatory disorders, heart failure, poor vascular tone, vegetative-vascular dystonia;
• diseases of the gastrointestinal tract – peptic ulcer, hepatitis, pancreatitis;
• diseases of the urinary system – cystitis;
• endocrine diseases – diabetes, more often – decreased adrenal function, hypothyroidism;
• respiratory diseases – pneumonia, bronchitis, tuberculosis;
• brain trauma, osteochondrosis of various localization;
• diet abuse, vitamin deficiency E, C, group B;
• neurosis, depression, lack of sleep, chronic fatigue;
• intoxication.

Hypotension is acute and chronic

Acute form can be perceived as collapse – a sharp drop in vascular tone, as shock – paralytic vasodilation. There is a sharp decrease in the supply of oxygen to the brain, hypoxia occurs, and the functions of vital organs decrease. In acute hypotension, urgent medical attention is needed. The severity of the disease is determined not by the height of the pressure, but by the speed and degree of its decrease.

Acute hypotension occurs as a concomitant disease in severe diagnoses – appendicitis, heart attacks, thromboembolism, arrhythmias and cardiac dysfunction, severe allergic reactions, large blood loss, severe intoxication, sepsis, dehydration, infections.Acute hypotension is a complication of another disease.

Chronic low blood pressure is often called physiological. It is often found in athletes, residents of the High North, mountainous regions or the tropics. Chronic hypotension increases the risk of coronary heart disease and ischemic stroke. In young people, it reduces the ability to work, worsens the quality of life.

Got up, fell … gypsum

Orthostatic hypotension also happens – a sharp decrease in pressure when changing body position, getting out of bed, chair, chair.It is more common during adolescence. If the body is in a lying position for a long time (with prolonged illnesses) or a sitting position (lessons, lectures, travel), then when standing up, blood cannot immediately flow to the brain in sufficient quantities, the pressure drops, the eyes darken, the head is dizzy, the legs become cottony … Even fainting occurs.

The reasons are the main diseases – atherosclerosis, anemia, diabetes, taking antidepressants and simply dehydration.It is more common in the morning, sometimes leads to fainting, falling, fortunately, the attack lasts 1-3 minutes. But during this time, you can suffer a lot.

Randomness

Hypotension is most often diagnosed by accident. The doctor offers a patient with fatigue and dizziness several times a day for several days to measure the pressure – the so-called pressure profile. After a few days, a person is surprised to learn about the presence of hypotension.

Cunning, not love

Hypotension can provoke the development of serious diseases: nervous, cardiovascular, digestive and other systems.

Hypotension is especially dangerous for expectant mothers. Because with poor blood supply, the fetus begins to experience oxygen starvation. When the placenta is poorly supplied with oxygen, blood, the development of the child can be disrupted.

And in pregnant women with hypotension, toxicosis often develops at a later date.Therefore, hypotension is not as safe as many people think.

Treat? Treat!

It is imperative to treat hypotension. With the right approach and complex treatment, it passes quickly and without consequences.

Treatment of hypotension should be individualized, based on the causes of the disease. Medical treatment will be prescribed by a doctor, traditional medicine methods are chosen in accordance with the causes of hypotension. There are general guidelines that will always help you recover faster.For hypotensive patients, prevention can completely replace treatment.

Hypotonic patients are prohibited from low physical activity, work in hazardous work, professional sports. Do not abuse caffeine. The body quickly gets used to it. And instead of a cup of coffee, you will have to consume more than 5 cups a day. And this will lead to health problems.

With reduced pressure, it is necessary to be in the air more often – at least 30 minutes a day. Go in for sports, temper, visit the pool.Physical activities in the fresh air are useful – without fanaticism, to slight fatigue. Various types of massage help well.

Since the most common cause of the disease is the wrong way of life, then the method of treatment is clear – to correct the way of life, to observe the daily regimen. For example, if there is sleepiness, sleep more. A rested body will quickly cope with other symptoms.

So, the normalization of the way of life (work, rest, sleep). It is imperative to include rest in the daily routine, get enough sleep.Hypotensives need more time to sleep than all other people!

First, it is necessary to restore the balance of the nervous system, eliminate chronic fatigue, increase vitality, improve sleep, improve psycho-emotional state. You need to start by adjusting emotions: react less to unpleasant words, manifestations of hostility. Maintain a good mood, do not worry about trifles.

Closing in four walls is contraindicated! You need an active emotional life: meeting interesting people, concerts, exhibitions, hobbies.Try to participate in social life, find a balance between openness and excessive emotional sensitivity. That is, do not be sad, do not yearn, do not be “bummer”.

Don’t overeat. Include potassium-rich foods in your diet – potatoes, eggplants, apricots, dried apricots, and prunes. Add to your daily menu food containing calcium, vitamin D, B vitamins. Bread, milk, nuts, honey, beets, beet juice are very useful.

These simple recommendations, oddly enough, help to improve the blood supply to the brain and the whole body, to improve the work of blood vessels.When the blood vessels are in order, the level of vitality in the body rises, the body’s ability to recuperate improves, and the effects of stress are eliminated.

Source: Altai Ekaterina, journalist

Hypotension – low blood pressure

Lectures

Photo: FA Bobo / PIXSELL / PA Images

What does low blood pressure mean?

Elena Kovalenko

March 11, 2016 11:00

Blood pressure is the pressure exerted by blood moving along the walls of blood vessels.It depends on the resistance of blood vessels, the amount of blood and the strength of the heartbeat. Any jump or drop in pressure affects breathing rate, body temperature, and heart rate. Most often, such a difference hides a disturbance in the work of internal organs and does not pass without a trace.

Pressure below 90 to 60 is considered to be reduced pressure. It is important to understand that even if one of the indicators is below normal, then you should think about visiting a doctor.

Symptoms of low blood pressure:

• Pulsating headache (most often in the temporal or occipital regions)
• Sudden onset of nausea and vomiting
• A sharp deterioration in well-being during a change of weather
• Darkening in the eyes
• Fainting
• Weakness and fatigue
• Feeling of lack of air
• Coldness of hands and feet, acute sensitivity to temperature changes

Types of low pressure:

1.Orthostatic hypotension

The main symptom of this disease is a decrease in pressure with a sharp rise. For example, a person lay on the bed for a long time, got up and immediately experienced dizziness or even loss of coordination when lifting. Causes of orthostatic hypotension include pregnancy, fever, and neurological diseases. The key risk group is people over 65.

2. Shay-Drager syndrome

This syndrome is also called multisystem atrophy with orthostatic hypotension or myeloencephalopathy.

The cause of the disease lies in disorders of the nervous system and begins to manifest itself in acute vascular insufficiency. The syndrome is currently incurable. The average life expectancy after diagnosis is 10 years.

3. Postprandial hypotension

The first sign is a sharp drop in blood pressure immediately after eating. The risk group is people with Parkinson’s disease.

4. Dystonia or vegetative-vascular hypotension

A pressure jump occurs after a long standing in one place.Most often, people who are in stuffy and hot rooms suffer from this type of low pressure. This disease is caused by a disruption in the blood communication between the brain and heart. Blood rushes to the lower extremities, and the brain decides that the pressure is increasing, sends a signal to the heart to lower the heart rate, thereby lowering the pressure even more. The risk group includes adolescents aged 12 to 18 years.

5. Accelerated pulse at low pressure

If you know that you have problems with low blood pressure, and the pulse at rest has jumped above 80 beats per minute, you should immediately consult a doctor in order to avoid serious consequences for the whole body.

What is the threat of low blood pressure?

It is generally accepted to consider hypotension as a less dangerous disease in comparison with the disease of high blood pressure – hypertension, but one should not assume that these problems can be solved on their own and will not bring harm to health.

Hypotension causes a sharp decrease in blood flow to the brain and heart, causing sudden fainting and dizziness. Such situations can lead to physical injury and loss of performance.

Most often, hypotension occurs in the elderly, children and adolescents suffer from vegetative-vascular dystonia.It can also occur as a concomitant disease with Parkinson’s disease or diseases of the cardiovascular system.

How to normalize low blood pressure?

1. Ambulance drugs

The most common drugs for low blood pressure are citramone, tinctures of Eleutherococcus and ginseng, pantocrine, Chinese magnolia vine. These drugs should be taken systematically, since the full effect will manifest itself only after their accumulation in the body.

2. Visit a doctor

A general practitioner will select the best combination of medications for you based on blood tests, age and concomitant diseases. Remember, an individual approach can significantly shorten the duration of treatment.

3. Don’t drink coffee.

Avoid caffeine and caffeine-containing products. It is he who first of all contributes to an increase in heart rate.

4. Drink plenty of water

Large amounts of fluid thin the blood and improve its circulation throughout the body.

5. Rest

Yes, the world is fast and cruel, but remember that first of all you need to take care of yourself. Take time to rest and recuperate.

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24-hour central aortic pressure and arterial stiffness monitoring in women with postmenopausal osteoporosis | Tsaren

RATIONALE

Recently, the attention of researchers is directed to the study of the parameters of the central pressure in the aorta, measured by a non-invasive method, as well as related indicators reflecting arterial stiffness.This interest is explained by the fact that central aortic pressure and vascular stiffness parameters are better predictors of cardiovascular events than blood pressure measured at the periphery [1]. The development of cardiovascular diseases is associated with an increase in arterial stiffness [2–4]. This integral indicator is used to analyze the hemodynamic changes observed in various clinical conditions. Arterial stiffness is influenced by age, arterial hypertension, smoking, etc.etc. [5,6]. As the stiffness of the arteries increases, the pulse wave velocity increases and the reflected wave returns to the aorta during systole, which leads to an increase in pulse pressure and augmentation pressure. These central pressure readings can be used to assess vascular stiffness. In addition, central pressure reflects blood flow in the coronary and cerebral arteries in the aorta and is a more significant predictor of cardiovascular events.

The problems of the late postmenopausal period are cardiovascular diseases and osteoporosis, leading to premature death.Not manifesting itself clinically at the early stages of development, subsequently lead to an increase in morbidity, mortality and require significant material costs [7]. The general pathogenetic mechanisms of the development of cardiovascular diseases and osteoporosis are discussed. In turn, osteoporosis is considered as one of the risk factors for cardiovascular events and a component of the cardiovascular continuum [7]. Thus, it has been demonstrated that women with low bone mineral density are more likely to develop severe coronary atherosclerosis, and the risk of heart attacks and strokes increases [8, 9].There are studies devoted to arterial stiffness in women with osteoporosis, where the authors studied the pulse wave velocity (PWV) and the thickness of the intima-media complex [10]; women with postmenopausal osteoporosis. In recent years, it has become possible to measure central pressure and PWV indicators during the day using the Vasotens technology.It has been shown that a sphygmogram recorded on the brachial artery, as an input signal, also allows the reconstruction of indicators of central aortic pressure by means of mathematical processing. In the software of the BPLab apparatus, which is used for this study, PWV is calculated using the propagation time of the pulse wave reflected from the aortic bifurcation so that it coincides with PWV in the carotid-femoral segment. This calculation allows comparison of arterial stiffness values ​​obtained by means of BPLab with measurements on Sphigmocor.The literature contains data on the high comparability of these methods [11].

TARGET

To evaluate indicators of central aortic pressure and arterial stiffness during 24-hour monitoring in postmenopausal women, depending on the presence of osteoporosis.

METHODS

Study design

An observational one-stage continuous single-center uncontrolled study was carried out.

Compliance Criteria

Criteria for inclusion in the study were: female gender, age over 50 years, the presence of menopause.Exclusion criteria: endocrine system disease, severe heart failure, respiratory failure, secondary osteoporosis.

Conditions

The study was carried out on the basis of the National Healthcare Institution “Road Clinical Hospital at st. Chita-2 “

Study duration

The study was conducted from September 2011 to May 2012.

Description of medical intervention

To verify osteoporosis, all women underwent anamnesis to identify risk factors for osteoporosis and low-energy fractures, X-ray osteodensitometry in two areas – the lumbar vertebrae and the femoral neck.The diagnosis of postmenopausal osteoporosis was made in accordance with the 2012 Clinical Guidelines for the Prevention and Management of Patients with Osteoporosis [12]. In addition, the absolute ten-year risk of fractures was calculated for all patients – major osteoporotic (MO) – the risk of osteoporotic fractures of any localization and hip fracture (HF) – the risk of hip fracture. All women underwent 24-hour blood pressure monitoring (ABPM). ABPM was performed before the appointment of antihypertensive drugs or 2 days after their withdrawal.

Main study outcome

The end points of the study were indicators of central aortic pressure: systolic pressure in the aorta (SADao), diastolic pressure in the aorta (DADao), mean pressure in the aorta (Cp ADao), pulse pressure in the aorta.

Additional study outcomes

Additionally, the following parameters were analyzed: the absolute ten-year risk of osteoporotic fractures, the presence of osteoporotic fractures, the number of fractures in history, as well as additional parameters of arterial stiffness: augmentation index (Alxao), pulse pressure amplification (PPA), – calculated as the ratio of the pulse pressure of the brachial artery to the central pulse rate, pulse wave velocity (PWV), arterial stiffness index (ASI), ambulatory stiffness index (AASI), augmentation index per day (Alxao avg.), average augmentation index per day, reduced to heart rate (Alxao avg. to heart rate), average daily pulse blood pressure (pulse blood pressure average). The daily central pressure profiles for SBP and DBP were determined.

Subgroup analysis

All women participating in the study were divided into two groups. The division into groups was carried out depending on the established diagnosis of osteoporosis. The first group consisted of postmenopausal women with an established diagnosis of osteoporosis, 36 people, the second group – 43 women was the comparison group.

Methods of registration of outcomes

To identify risk factors for osteoporosis and osteoporotic fractures, a questionnaire from the online FRAX program was used and anamnesis was collected to determine the number of osteoporotic fractures. X-ray densitometry was performed on a Challenger apparatus, France. The absolute ten-year risk of osteoporotic fractures was assessed using the FRAX program posted on the website www.shef.ac.uk/FRAX, Russian version, Russian model based on the assessment of clinical factors and the index of bone mineral density of the femoral neck.24-hour monitoring of central aortic pressure and arterial stiffness parameters was performed using the BPLab v. 3.2 (“Petr Telegin”, Russia).

Ethical review

The study was approved by the local ethics committee at the State Budgetary Educational Institution of Higher Professional Education ChGMA (protocol No. 20 of 22.03.2011).

Statistical Analysis

Statistical processing was performed using the Statistica 6.0 software using nonparametric criteria since the distribution of features was asymmetric: Walda-Wolfowitz, chi-square.Correlation analysis was performed using Spearman’s rank correlation (for quantitative values) and gamma correlation to establish the relationship between a history of low-energy fractures (taken into account as a qualitative sign) and parameters of central pressure and arterial stiffness. Differences were considered significant at p <0.05.

RESULTS

Objects (participants) of research

The first group consisted of patients with an established diagnosis of osteoporosis – 36 women, the second group was a comparison group – 43 women.The groups were matched for age, weight, and BMI. The absolute ten-year risk of osteoporotic and hip fractures was statistically significantly higher in the first group. The average number of fractures in the first group was 1.6 ± 0.96. The clinical characteristics of the groups are presented in Table 1.

Table 1. Clinical characteristics of patients

24-hour central pressure and arterial stiffness parameters were monitored in 79 women; daily central pressure profiles were determined based on the degree of nighttime decrease in systolic and diastolic pressures.

Main results of the study

When analyzing the indicators of central aortic pressure given in Table 2, in women with osteoporosis, there is an increase in average daily SBP by 4.52%, DBP by 8.3%, mean BP in the aorta by 5.24%, amplification pressure in the aorta ( PPA) by 6.7% compared to the control group (see Table 2).

Table 2. Parameters of central aortic pressure and arterial stiffness during 24-hour monitoring in women with osteoporosis

The main marker that determines arterial stiffness is the pulse wave velocity (PWV), which can be investigated in various ways. Currently, the reference method is the measurement on the carotid-femoral segment using applanation tonometry. In this case, sphygmograms are recorded from the carotid and femoral arteries with simultaneous recording of an ECG.At present, it is possible to measure this indicator during the day when performing ABPM with the BPLab apparatus, but the two-point method is not applicable for daily monitoring. At the same time, as indicated in the literature, the propagation time of the pulse wave reflected from the aortic bifurcation can be used to assess PWV [13].

In the group of women with osteoporosis, the average PWV per day was 2% higher than in the control. In previous publications, we have shown that in women with osteoporosis, PWV, measured on the carodid-femoral segment, using applanation tonometry also showed a statistically significant excess compared with the group without osteoporotic fractures and BMD reduction [14].In addition to the increase in PWV, we analyzed other indicators of arterial stiffness. So it was found that in the group of women with osteoporosis, the arterial stiffness index (ASI) was 1.6% higher compared to the control. Studies have shown a direct relationship between the arterial stiffness index and the risk of developing coronary artery disease [15]. In 2006, the concept of the ambulatory arterial stiffness index (AASI) was introduced, which is determined by calculation by the level of SBP and DBP [16]. In the first group, this indicator was 25.9% higher.

Additional research results

To establish the relationship between the parameters of central pressure and arterial stiffness and the presence of osteoporotic fractures in the history (taken into account as a qualitative sign), a correlation analysis was performed using the γ-correlation, and also the correlation relationships between the number of osteoporotic fractures in history, the ten-year absolute risk of osteoporotic fractures were assessed. fracture of the femoral neck and parameters of central pressure and stiffness of the arteries.Since in this case the relationship was determined between quantitative values, Spearman’s rank correlation was used. The data are presented in Table 3.

Table 3. Correlation relationships between the parameters of central pressure, arterial stiffness and the presence of osteoporotic fractures in the anamnesis, their number, the risk of fractures according to FRAX

Gamma-correlation revealed a positive relationship between the levels of SBP, DBP, mean blood pressure, augmentation index reduced to heart rate in the aorta, outpatient stiffness index and the presence of osteoporotic fractures in the patient’s history.As a result of the rank correlation, a direct relationship was established between the levels of SBP, DBP, mean blood pressure, mean augmentation index reduced to heart rate in the aorta, outpatient stiffness index and absolute ten-year risk of osteoporotic fractures, as well as the number of osteoporotic fractures in history. The absolute ten-year risk of hip fracture was positively associated with SBP levels, mean blood pressure, mean aortic heart rate-normalized augmentation index, mean pulse pressure, stiffness index, and outpatient stiffness index.

A study of the degree of nocturnal decrease in central SBP in patients with postmenopausal osteoporosis revealed that only 16.4% of women in this group had a dipper profile (with a sufficient decrease in SBP at night) versus the control group, in which this profile was found in 23.5 % of patients. Regarding pathological profiles, it should be noted that in women with osteoporosis, the hyperdipper type (with an excessive decrease in SBP) was more common (Fig. 1).

Fig. 1. Profiles of central systolic aortic pressure.

Diastolic pressure profiles showed the opposite trend. Thus, in women with osteoporosis, the normal dipper DADao daily profile was more common than in the control group, 47.4% versus 26.5% (Fig. 2). Among the pathological profiles in the control group, the nightpicker type prevailed (increase in DADao at night) 1.85 times more often.

Fig. 2. Profiles of central diastolic aortic pressure.

The hyperdipper type was found with the same frequency, the nondipper type prevailed in the comparison group.

Adverse events

Not recorded during the study.

DISCUSSION

Summary of the main research result

As a result of our study, for the first time it was found that women with postmenopausal osteoporosis with daily monitoring have higher central pressure in the ascending part of the aorta and parameters of arterial stiffness.

Discussion of the main research result

It is known that indicators of central pressure to one degree or another depend on the stiffness of the arteries.Thus, the statistically significant increase in the amplification pressure in the aorta revealed by us may indicate that the increase in systolic pressure in the aorta is associated with the phenomenon of pressure augmentation, which may be associated with a higher rigidity of the arteries in the group of patients with osteoporosis. The physiological meaning of pulse wave amplification is to prevent its extinction at the periphery, ie, the descending pulse wave is “fed” with energy, as a result of which SBP increases at the periphery [17].On the other hand, the reflected waves generated in high impedance zones, propagating in the upward direction, are summed up, return to the aortic orifice and superimposed on the central wave, its diastolic part. However, with rigid arteries, the speed of reflected pulse waves increases and, returning to the center, they are superimposed on the systolic part of the central wave, which leads to an increase in SBP in the aorta. This in turn increases left ventricular afterload.

A marker of arterial stiffness is such an indicator as PWV.Our study revealed an increase in this indicator in the group of women with osteoporosis. In the work of Skripnikova I.A. et al., 2015 demonstrated that in women with low bone mass compared with the control group, PWV, measured by applanation tonometry, was also higher [10].

In addition, in the course of our study, relationships were established between some parameters of central pressure, arterial stiffness and the presence of fractures, their number and the risk of their occurrence, which may indirectly indicate the presence of a possible pathogenetic relationship between cardiovascular diseases and osteoporosis, which is widely discussed in recent times.

Study Limitations

The true reliability of the statistically significant results obtained may not be high due to the small sample of patients. To confirm the identified relationships, studies are required using a similar protocol with a large number of participants.

CONCLUSION

In conclusion, it should be noted that women with osteoporosis showed an increase in average daily SBP, DBP and average aortic pressure.It was found that in this group of patients the main indicators of arterial stiffness were increased: PWV, ASI, AASI, PPA. A direct correlation was found between the parameters of central pressure, arterial stiffness and the presence of fractures in the anamnesis, their number, as well as indicators of the absolute ten-year risk of osteoporotic fractures and hip fracture. In patients with osteoporosis, pathological profiles of systolic pressure in the aorta are more often revealed, the predominant type of which was the hyperdipper type.

ADDITIONAL INFORMATION.

Funding source . FSBEI HE Chita State Medical Academy

Conflict of interest . The authors declare no obvious and potential conflicts of interest related to the publication of this article.

Acknowledgments . The authors are grateful to the radiologists of the NUZ Road Clinical Hospital at st. Chita-2 for densitometry.

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6. Aksenova T.A., Gorbunov V.V., Parkhomenko Yu.V., Tsarenok S.Yu. 24-hour monitoring of central aortic pressure and arterial stiffness indicators in combination of hypertension with chronic obstructive pulmonary disease.// Transbaikal Medical Bulletin. – 2012. – No. 2. – S. 9-16. [Aksenova TA, Gorbunov VV, Parkhomenko YV, Tsarenok SY. Daily monitoring of the central aortic pressure and arterial stiffness in combination with hypertension and chronic obstructive pulmonary disease. Zabajkal’skij medicinskij vestnik. 2012; (2): 9-16 (In Russ.)].

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8. Vogt MT, Valentin RS, Forrest KYZ, et al. Bone Mineral Density and Aortic Calcification: The Study of Osteoporotic Fractures. J Am Geriatr Soc.1997; 45 (2): 140-145. doi: 10.1111 / j.1532-5415.1997.tb04498.x.

9. Hak AE, Pols HAP, van Hemert AM, et al. Progression of Aortic Calcification Is Associated With Metacarpal Bone Loss During Menopause: A Population-Based Longitudinal Study. Arterioscler Thromb Vasc Biol. 2000; 20 (8): 1926-1931. doi: 10.1161 / 01.atv.20.8.1926.

10.Skripnikova IA, Alikhanova NA, Tkacheva ON, et al. Bone mineral density and the state of the vascular wall depending on the status of replicative cellular aging in postmenopausal women // Osteoporosis and Osteopathy. – 2015. – T. 18. – No. 3. – C. 13-17. [Skripnikova IA, Alikhanova NA, Tkacheva ON, et al. Mineral’naya plotnost ‘kosti i sostoyanie sosudistoy stenki v zavisimosti ot statusa replikativnogo kletochnogo stareniya u zhenshchin v postmenopauzal’nom periode. Osteoporosis and Bone Diseases.2015; 18 (3): 13-17. (In Russ.)] Doi: 10.14341 / osteo2015313-17.

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14. Tsarenok S.Yu., Gorbunov V.V. Contour analysis of the central pulse wave and elastic properties of arteries in women with coronary artery disease and a high risk of osteoporotic fractures. // Transbaikal Medical Bulletin. – 2014. – No. 4. – S. 159-163. [Tsarenok SY, Gorbunov VV Contour analysis of the central pulse wave and elastic properties of arteries in women with CHD and high risk of osteoporotic fractures.Zabajkal’skij medicinskij vestnik. 2014; (4): 159-163 (In Russ.)].

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17. Nichols WW, O’Rourke MF, Vlachopoulos C. McDonald’s Blood Flow in Arteries, Sixth Edition: Theoretical, Experimental and Clinical Principles. London: CRC Press; 2011.

Just about health: what the blood pressure signals

What is this indicator and why do we need it? It’s simple.Oxygen from the air dissolves in water and under a certain physiological pressure (it is determined by two numbers and is written through a fraction, it is considered to be the norm of 120/80) enters the blood. Red blood cells are transported by red blood cells to every cell in the body.

Arterial pressure is systolic (cardiac, “upper”) – it denotes the upper number in the indicator and diastolic (renal, “lower”) – the lower number. High, low and unstable blood pressure can be recorded.

Difference between “upper” and “lower” pressure

A rise in blood pressure can be a symptom of many diseases. Sometimes a high difference between “top” and “bottom” pressure is a natural response to stress, exercise, hunger. But when such leaps are observed in the “state of rest”, this is a reason to sound the alarm.

The difference between “high” and “low” pressure (called “pulse pressure”) should ideally be 40-50 units. If the indicators differ significantly from each other up or down, this condition is difficult not to notice: a person will immediately feel a headache, weakness, drowsiness, impaired attention and irritability.

When the difference between the “upper” and “lower” pressure significantly exceeds the normal 40-50 units, it can be symptoms of atherosclerosis, pathologies of the aorta, arteries, left ventricle of the heart.

Small difference between “upper” and “lower” pressure

If the tonometer shows too little difference between systolic and diastolic pressure, you should immediately consult a doctor and take an examination: this is fraught with hypoxia, loss of vision, and sometimes can lead to cardiac arrest.The minimum difference between systolic and diastolic pressure is considered to be less than 25%.

What does the small difference between top and bottom pressure indicate? This may be evidence of left ventricular stroke, myocarditis, tachycardia, aortic stenosis, heart failure, cardiosclerosis … There can be many pathologies, and such tonometer readings are no less dangerous than the big difference.

If the “upper” pressure is much higher than the “lower”

The difference between “upper” and “lower” pressure is too high – more than 50 units.And the main reason for such deviations is, first of all, age, when the heart and blood vessels wear out and perform their functions poorly. Among the common causes, doctors also distinguish problems with the digestive organs, gallbladder, kidneys, disorders in the vessels and the brain center. But only a doctor can identify the causes of the pathology.

In any case, you cannot self-medicate here, you should undergo an examination and receive competent doctor’s appointments. There are many reasons that affect pressure, we will consider the main ones that we can correct without causing harm to the body.

How pressure rises due to stress

The root cause of increased blood pressure is stress, namely the hormone adrenaline, which is released during stress or fear. It has a powerful vasoconstrictor effect. It is a mobilizing hormone. Nature provides that if someone angered you, frightened you, you are preparing either to attack, or to run away – the vessels are strongly narrowed in order to avoid large blood loss in case of injury or injury.

But an adrenaline rush is good at critical moments in life.It is desirable that this hormone leaves the body in the next hour after stress. Otherwise, its spasmodic effect will cause a lot of harm to a person.

This state is familiar to everyone – you received, for example, unpleasant news, and suddenly something hit your head sharply, your heart ached, and after measuring the pressure it turns out that it is at “high” numbers.

If nothing is done, it will lead to a heart attack. When a vessel is severely narrowed in the heart muscle, the cells that it serves do not receive enough oxygen.When this happens for a long time, the oxygen demand of heart cells increases, long oxygen starvation leads to necrosis (death) of tissues around this vessel. If you add physical activity at this moment, the leaky muscle from disproportionate loads can rupture.

The very state of the heart has nothing to do with it. Such situations can happen to young people as well. It’s all about thick blood, and the reasons for its thickening lie in improper diet, a sedentary lifestyle, lack of proper physical activity, and non-compliance with the water-drinking balance.

Clinical and 44-hour ambulatory blood pressure, as well as indicators of central hemodynamics in patients on programmed hemodialysis | Trukhanov

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