Acute Blood Pressure Reduction Research Articles

Premorbid Blood Pressure Control Modifies Risk of DWI Lesions With Acute Blood Pressure Reduction in Intracerebral Hemorrhage.

Hypoperfusion due to blood pressure (BP) reduction is a potential mechanism of cerebral ischemia after intracerebral hemorrhage. However, prior evaluations of the relationship between BP reduction and ischemia have been conflicting. Untreated chronic hypertension is common in intracerebral hemorrhage and alters cerebral autoregulation. We hypothesized that the risk of diffusion-weighted imaging (DWI) hyperintensities from acute BP reduction is modified by premorbid BP control. Individuals enrolled in the ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage) from 2010 to 2015 were categorized as untreated, treated, or nonhypertensive based on preintracerebral hemorrhage diagnosis and antihypertensive medication use. The percent reduction of systolic BP (SBP) was calculated between presentation and 24 hours from admission. The primary outcome was the presence of DWI lesions. Using logistic regression, we tested the association between chronic hypertension status, SBP reduction, and their interaction with DWI lesion presence. From 3000 participants, 877 with available magnetic resonance imaging met inclusion (mean age, 60.5±13.3 years; 42.5% women). DWI lesions were detected in 25.9%. Untreated, treated, and no hypertension accounted for 32.6%, 47.9%, and 19.5% of cases, respectively. SBP reduction was not directly associated with DWI lesions; however, an interaction effect was observed between SBP reduction and chronic hypertension status (P=0.036). Nonhypertensive subjects demonstrated a linear risk of DWI lesion presence with greater SBP reduction, whereas untreated hypertension demonstrated a stable risk across a wide range of SBP reduction (P=0.023). Premorbid BP control, especially untreated hypertension, may influence the relationship between DWI lesions and acute BP reduction after intracerebral hemorrhage. URL: https://www.clinicaltrials.gov; Unique identifier: NCT01202864.

Left Bundle Branch Area Pacing Contributes to a Greater Acute Blood Pressure Reduction Compared to Right Ventricular Pacing.

Several previous studies have explored the potential arterial blood pressure (BP) changes in patients undergoing right ventricular pacing (RVP), however, the relationship between left bundle branch area pacing (LBBAP) and BP variations remains unknown. This study aimed to examine the acute BP variations following LBBAP and RVP implantation in patients with bradycardia. We conducted a single-center retrospective study including all patients who underwent de-novo dual-chamber pacemaker implantation between January 2019 and June 2021. Patients were divided into two groups, LBBAP and RVP, and propensity score-matching (PSM) was used to balance confounding factors. Three time periods were defined according to the timing of the implant: baseline (within 24 hours before implantation), hyper-acute period (0-24 hours post-implantation), and acute period (24-48 hours post-implantation). BP was measured at least three times per period using an arm pressure cuff and then averaged for analysis, which allowed us to determine the acute impact of pacemaker implantation on BP. From a cohort of 898 patients, 193 LBBAP receivers were matched to 193 RVP receivers. A significant decrease in systolic BP (SBP) after the implantation was observed in the study cohort, from baseline 137.3 9.2 mmHg to the acute period of 127.7 9.4 mmHg (p 0.001). The LBBAP group exhibited a greater SBP reduction than the RVP group ( 11.6 6.2 mmHg vs. 7.6 5.8 mmHg, p 0.001). In further subgroup analysis, LBBAP receivers who had high baseline SBP (p 0.001) and those without using anti-hypertensive drugs (p = 0.045) appeared to have a higher magnitude of SBP reduction. Permanent pacemaker implantation may contribute to an acute decrease in systolic BP, which was more pronounced in LBBAP receivers. Future experimental and clinical investigations are necessary to explore the underlying mechanisms and the long-term hemodynamic effects of LBBAP versus RVP.

Interaction between cerebral small vessel disease, blood pressure, and remote ischemic lesions in acute spontaneous intracerebral hemorrhage.

Acute blood pressure (BP) reduction is the first-line treatment for acute spontaneous intracerebral hemorrhage (ICH); however, recent research suggests that intensive BP reduction along with cerebral small vessel disease (cSVD) is a risk factor for remote DWI lesions (RDWILs). We aimed to delineate the interplay between cSVD and BP reduction therapy on the risk of RDWILs. We enrolled 303 patients who underwent brain magnetic resonance imaging within 7 days after acute spontaneous ICH. RDWILs were categorized as occurring in borderzone (BZ) or non-BZ areas. We examined the effect of cSVD, acute BP reduction, and their interaction on RDWILs. RDWILs were observed in 34 (11%) patients (59.8 ± 10.3-years-old, 24% male). RDWILs were associated with a larger acute weighted average mean arterial pressure (MAP) reduction in the initial 24 h after ICH onset and a higher total cerebral microbleed (CMB) count. Intensive MAP changes (odds ratio (OR) per 10 mmHg 1.76, 95% confidence interval (CI) 1.03-3.20), total CMBs burden (OR per 10 CMBs 1.21, 95% CI 1.08-1.39), and presence of lobar CMBs (OR 7.33, 95% CI 1.59-55.6) were risk factors for RDWILs at BZ, but not at non-BZ. Furthermore, a significant interaction was observed between lobar CMBs and MAP reduction on increased risk of RDWILs at BZ (p = 0.030). cSVD modulates the effect of acute BP reduction on the risk of RDWILs. Patients with extensive microangiopathy have a higher risk of developing cerebral ischemic changes in BZ during unstable hemodynamic status.

Double-blind controlled dietary cross-over intervention with differentially fertilised intact lettuce leaves shows acute reduction in blood pressure in young adults, associated with faster uptake of nitrate than of phenolics

PurposeTo compare acute effects on blood pressure (BP) of ingestion of visually similar lettuce with controlled high and low content of either nitrate or phenolic compounds.MethodsIn a randomised cross-over design, 19 healthy participants (22–31 years) received 50 g of lettuce containing either 530 mg (8.4 mmol) nitrate + 11 mg (0.03 mmol) phenolic compounds (HNLP); or 3 mg nitrate (0.05 mmol) + 77 mg (0.2 mmol) phenolic compounds (LNHP), obtained by differential fertilisation. Ambulatory BP was recorded along with plasma, salivary and urinary nitrate and nitrite and plasma concentrations of cyclic guanosine monophosphate (cGMP), phenolic metabolites, Trolox equivalent antioxidant capacity (TEAC) and ferric reducing antioxidant power (FRAP).ResultsCompared with LNHP, 3 h post ingestion of HNLP, plasma nitrate increased 0.31 ± (95%CI) 0.12 mM (+ 240%), and salivary nitrate 5.5 ± 1.4 mM (+ 910%); accumulated urinary nitrate excretion increased 188 ± 72 mg (+ 296%) (all P < 0.001). Systolic BP was reduced 4.9 ± 4.2 mmHg (P = 0.031) between 3 and 6 h after ingestion of HNLP compared with LNHP; systolic BP differences were negatively correlated (P = 0.004) with differences in saliva nitrate concentrations. LNHP increased plasma phenolics at 6 h, predominantly 3ʹ-methoxycinnamic acid-4ʹ-glucuronide (ferulic acid-4ʹ-glucuronide), 116%, 204 ± 138 nM more than HNLP (P = 0.001); increased cGMP 14% (P = 0.019); and reduced FRAP 3.1% (P = 0.009).ConclusionThe acute BP difference within 6 h of consumption matched the plasma/saliva nitrate peak, not the slower changes of plasma phenolics. This is the first double-blind controlled dietary intervention demonstrating differential effects on human physiology by consumption of an intact plant food, where compositional differences were obtained by controlling growing conditions, indicating potential opportunities for health claims relating to precision/vertical farming.Clinical trial registrationThe trial was retrospectively registered on ClinicalTrials.gov, with identifier NCT02701959, on March 8, 2016.

Acute effects of mixed circuit training on hemodynamic and cardiac autonomic control in chronic hemiparetic stroke patients: A randomized controlled crossover trial.

Objectives: To investigate whether a single bout of mixed circuit training (MCT) can elicit acute blood pressure (BP) reduction in chronic hemiparetic stroke patients, a phenomenon also known as post-exercise hypotension (PEH). Methods: Seven participants (58 ± 12 years) performed a non-exercise control session (CTL) and a single bout of MCT on separate days and in a randomized counterbalanced order. The MCT included 10 exercises with 3 sets of 15-repetition maximum per exercise, with each set interspersed with 45 s of walking. Systolic (SBP) and diastolic (DBP) blood pressure, mean arterial pressure (MAP), cardiac output (Q), systemic vascular resistance (SVR), baroreflex sensitivity (BRS), and heart rate variability (HRV) were assessed 10 min before and 40 min after CTL and MCT. BP and HRV were also measured during an ambulatory 24-h recovery period. Results: Compared to CTL, SBP (∆-22%), DBP (∆-28%), SVR (∆-43%), BRS (∆-63%), and parasympathetic activity (HF; high-frequency component: ∆-63%) were reduced during 40 min post-MCT (p < 0.05), while Q (∆35%), sympathetic activity (LF; low-frequency component: ∆139%) and sympathovagal balance (LF:HF ratio: ∆145%) were higher (p < 0.001). In the first 10 h of ambulatory assessment, SBP (∆-7%), MAP (∆-6%), and HF (∆-26%) remained lowered, and LF (∆11%) and LF:HF ratio (∆13%) remained elevated post-MCT vs. CTL (p < 0.05). Conclusion: A single bout of MCT elicited prolonged PEH in chronic hemiparetic stroke patients. This occurred concurrently with increased sympathovagal balance and lowered SVR, suggesting vasodilation capacity is a major determinant of PEH in these patients. This clinical trial was registered in the Brazilian Clinical Trials Registry (RBR-5dn5zd), available at https://ensaiosclinicos.gov.br/rg/RBR-5dn5zd. Clinical Trial Registration: https://ensaiosclinicos.gov.br/rg/RBR-5dn5zd, identifier RBR-5dn5zd

COMPARING POST-EXERCISE HYPOTENSION AFTER A HIGH-INTENSITY INTERVAL TRAINING IN MATCHED YOUNGER AND OLDER ADULTS

Objective: An acute reduction in blood pressure (BP) can be observed after a single bout of exercise. Termed postexercise hypotension (PEH), this phenomenon has been well documented in different populations after exercise of various intensities, durations, and modalities. Even though PEH has been documented in young and older adults, no previous studies have directly compared different age groups. The present study aimed to compare the PEH effect after high-intensity interval training (HIIT) in matched older and younger adults. Furthermore, within-session oxygen consumption was assessed and compared. Design and method: Forty-three participants were recruited for this study. All participants performed baseline examinations assessing body mass index (BMI), resting BP, and maximum oxygen consumption (VO2max). Thereafter, twelve younger (24.4 ± 3.1 years) and 12 older (49.5 ± 7.4 years) participants matched for BMI, BP, and VO2max-percentiles were selected for further analysis. All participants completed a HIIT protocol consisting of 4x 30-seconds exercise bouts interspersed by 3 minutes of active recovery. Both before and throughout the 45 minutes after the training, peripheral systolic (pSBP) and diastolic (pDBP) blood pressure, central systolic (cSBP) and diastolic (cDBP) blood pressure, pulse wave velocity (PWV), and heart rate (HR) were assessed. Throughout the HIIT, oxygen consumption was continuously monitored, and time spent above 75%, 85%, 95%, and 100% of VO2max was computed. Results: Both groups revealed significant (p &lt; .001) reductions over time in pSBP, pDBP, cSBP, cDBP, PWV, and HR. No significant group x time effects could be detected for pSBP (p = .581), pDBP (p = .937), cSBP (p = .691), cDBP (p = .965), PWV (p = .233), and HR (p = .711). There were no significant differences in times spent at different percentages of VO2max (p = .643). Conclusions: If matched for BMI, resting BP, and VO2max-percentiles, older and younger adults experience similar PEH effects after HIIT. Furthermore, within-session oxygen consumption was similar in both groups revealing comparable exercise intensities during the protocol. According to the present results, age does not affect PEH after HIIT.

Persistent vascular dysfunction following an acute nonpharmacological reduction in blood pressure in hypertensive patients.

Vascular dysfunction, an independent risk factor for cardiovascular disease, often persists in patients with hypertension, despite improvements in blood pressure control induced by antihypertensive medications. As some of these medications may directly affect vascular function, this study sought to comprehensively examine the impact of reducing blood pressure, by a nonpharmacological approach (5 days of sodium restriction), on vascular function in 22 hypertensive individuals (14 men/8 women, 50 ± 10 years). Following a 2-week withdrawal of antihypertensive medications, two 5-day dietary phases, liberal sodium (liberal sodium, 200 mmol/day) followed by restricted sodium (restricted sodium, 10 mmol/day), were completed. Resting blood pressure was assessed and vascular function, at both the conduit and microvascular levels, was evaluated by brachial artery flow-mediated dilation (FMD), reactive hyperemia, progressive handgrip exercise, and passive leg movement (PLM). Despite a sodium restriction-induced fall in blood pressure (liberal sodium: 141 ± 14/85 ± 9; restricted sodium 124 ± 12/79 ± 9 mmHg, P < 0.01 for both SBP and DBP), FMD (liberal sodium: 4.6 ± 1.8%; restricted sodium: 5.1 ± 2.1%, P = 0.27), and reactive hyperemia (liberal sodium: 548 ± 201; restricted sodium: 615 ± 206 ml, P = 0.08) were not altered. Similarly, brachial artery vasodilation during handgrip exercise was not different between conditions (liberal sodium: Δ0.36 ± 0.19 mm; restricted sodium: Δ0.42 ± 0.18 mm, P = 0.16). Lastly, PLM-induced changes in peak blood flow (liberal sodium: 5.3 ± 2.5; restricted sodium: 5.8 ± 3.6 ml/min per mmHg, P = 0.30) and the total vasodilatory response [liberal sodium: 2 (0.9-2.5) vs. restricted sodium: 1.7 (1.1-2.6) ml/min per mmHg; P = 0.5] were also not different between conditions. Thus vascular dysfunction, at both the conduit and microvascular levels, persists in patients with hypertension even when blood pressure is acutely reduced by a nonpharmacological approach.

Changes in Heart Rate Variability and Post-Exercise Blood Pressure from Manipulating Rest Intervals Between Sets of Resistance Training.

The purpose of this study was to compare blood pressure and heart rate variability responses in physically active men after performing resistance training sessions with rest intervals of 1 min, 2 min and 3 min. Eighteen men (age, 21.6±1.1 years; body mass, 74.1±8.1 kg; body height, 175.3±7.1 cm) who performed 180min of physical activity per week participated in this study. After determining the 15RM loads for the squat, bench press, bent-over row and deadlift, participants performed a resistance training session. Participants performed three resistance training protocols in randomized counterbalanced order. Each experimental protocol comprised different rest intervals between sets of resistance training exercises (1min, 2min or 3min). During each experimental session, participants performed three sets with a 15RM load. Blood pressure and heart rate variability were measured before and for 2h after each session. The results demonstrated a greater blood pressure (p<0.05) reduction with a longer rest interval. There was no statistically significant difference in heart rate variability changes between groups. These results indicate that 2min and 3min rest intervals while using a 15RM load provide the best stimulus for a blood pressure reduction response after a resistance training session. Our findings suggest that strength and conditioning professionals should prescribe 2min or 3min rest intervals when resistance training is performed with a 15RM load if the aim is to obtain an acute reduction in blood pressure after a resistance training session.

Blood Pressure and Blood Glucose Responses to Combined Exercise Sessions of Different Intensities in Individuals with Cardiovascular Risk Factors

ABSTRACT Objective The purpose of the present study was to verify the acute effects of blood pressure and blood glucose after two sessions of combined exercise sessions performed at two levels of intensity in trained individuals with cardiovascular risk factors. Methods Eighteen individuals (66.22 ± 8.61 years) of both sexes (6 women/12 men) with cardiovascular risk factors performed two sessions of combined exercises at different levels of intensity: moderate (MOD) and high (HI). To control the intensity of the aerobic training, the Borg Rating of Perceived Exertion (RPE) Scale was used. For the strength training, the maximum number of repetitions was carried out within a predetermined duration of sets. Blood pressure and blood glucose measurements were collected before and 20 minutes after the sessions. The data were analyzed using Generalized Estimating Equations, α 5%. Results Reductions were observed in systolic blood pressure (MOD – Δ = −4.95 mmHg; HI – Δ = −3.31 mmHg) and blood glucose (MOD – Δ = −16.06 mg/dL; HI – Δ = −29.45 mg/dL) after the two sessions, with no difference between sessions. Diastolic blood pressure did not change (p < .05). Conclusion Combined exercises sessions of moderate or high intensity can promote an acute reduction in systolic blood pressure and glycemia in individuals with cardiovascular risk factors.

Garlic promotes acute blood pressure reduction but does not enhance the postexercise hypotensive effect

Garlic promotes acute blood pressure reduction but does not enhance the postexercise hypotensive effect

Comparison of Clevidipine and Nicardipine for Acute Blood Pressure Reduction in Hemorrhagic Stroke.

Intracranial hemorrhage is associated with high mortality and morbidity. Lowering systolic blood pressure (SBP) with an intravenous antihypertensive, such as nicardipine or clevidipine, may reduce the risk of hematoma expansion and rebleeding. Previous studies comparing nicardipine and clevidipine in patients with stroke found no significant difference in blood pressure management. The inclusion of patients with ischemic stroke limited those studies because of convoluted results related to faster door-to-needle times. The purpose of this study was to compare clevidipine with nicardipine in time to goal SBP in hemorrhagic stroke. This single-center retrospective observational cohort study evaluated adult hemorrhagic patients with stroke who received clevidipine or nicardipine from January 1, 2015, to December 31, 2020. Patients were excluded if they had trauma-related hemorrhage, received concurrent continuous intravenous antihypertensives, received the study drug for less than 1-h duration, had a less than 24-h washout period between agents, required any dialysis, were pregnant, or were incarcerated. The primary outcome was time to goal SBP. Secondary outcomes included need for additional antihypertensives, percentage of time at goal SBP, all-cause mortality, 30-day readmission, rebleeding, total volume of antihypertensive infusion, hematoma expansion, intensive care unit length of stay (LOS), hospital LOS, and cost of infusion. Safety outcomes included hypotension, severe hypotension, rebound hypertension, bradycardia, tachycardia, onset of atrial fibrillation, and acute kidney injury. Of 89 patients included in this study, 60 received nicardipine and 29 received clevidipine. There was no significant difference between nicardipine and clevidipine in time to goal SBP in the unmatched cohort (30 vs. 45min; p = 0.73) or the propensity-score-matched cohort (30 vs. 45min; p = 0.47). Results were not affected by potential confounders in the multiple linear regression. The nicardipine group had a higher total volume from infusion compared with the clevidipine group (1410 vs. 330mL; p < 0.0001) but significantly lower cost ($99.6 vs. $497.4; p < 0.0001). There were no significant differences in need for additional antihypertensives, percentage of time at goal SBP, all-cause mortality, 30-day readmission, rebleeding, hematoma expansion, intensive care unit LOS, and hospital LOS. Compared with the clevidipine group, the nicardipine group had less rebound hypertension (40% vs. 75.9%; p = 0.0017) and less bradycardia (23.3% vs. 44.8%; p = 0.05). There were no significant differences in hypotension, severe hypotension, tachycardia, and acute kidney injury. In patients with hemorrhagic stroke, nicardipine appeared to have similar efficacy as clevidipine in SBP reduction, with a more likely reduction of rebound hypertension and drug cost. This retrospective study was underpowered, which may limit these implications. Further prospective studies are warranted to confirm these results.

Standalone sauna vs exercise followed by sauna on cardiovascular function in non-naïve sauna users: A comparison of acute effects.

Background and aimsSauna bathing and aerobic exercise have each been shown to affect cardiovascular function. However, direct comparisons between standalone sauna bathing and a combination of exercise and sauna on vascular indices remain limited. Therefore, we conducted a cross‐over study using matched durations to explore the hemodynamic changes of sauna exposure when compared to a combination of aerobic exercise and sauna exposure.MethodsParticipants (N = 72) with at least one cardiovascular risk factor underwent, on two separate occasions: (a) a 30‐minute sauna at 75°C (SAUNA) and (b) the combination of a 15‐minute cycling exercise at 75% maximum heart rate followed by 15‐minute sauna exposure (EX+SAUNA). Relative changes to arterial stiffness (PWV), augmentation index (Alx), brachial systolic and diastolic blood pressure (SBP and DBP), central SBP (cSBP), mean arterial pressure (MAP), and heart rate (HR) were compared PRE‐POST and pre‐ to 30‐minutes post‐intervention (PRE‐POST30).ResultsBaseline SBP and DBP were 143 (SD 18) mmHg and 86 (SD 10) mmHg, respectively. From PRE‐POST, SAUNA had lower DBP (mean difference [95% CI] 2.5 [1.0, 4.1], P = .002) and MAP (2.5 [0.6, 4.3], P = .01). However, EX+SAUNA had lower SBP (−2.7 [−4.8, −0.5], P = .02), DBP (−1.8 [−3.3, −0.4], P = .01), and MAP (−2.0 [−3.5, −0.5], P = .009) PRE‐POST30. There were no statistically significant differences between SAUNA and EX+SAUNA for other measured parameters.ConclusionThis study demonstrated that when matched for duration, EX+SAUNA and SAUNA elicit comparable acute hemodynamic alterations in middle‐aged participants with cardiovascular risk factors. The sauna is a suitable option for acute blood pressure reductions in those who are unable to perform aerobic exercise, and may be a viable lifestyle treatment option to improve blood pressure control.

Abstract 39: Acute Blood Pressure Dysregulation Increases the Risk of Border Zone Ischemic Lesions in Hypertensive Intracerebral Hemorrhage

Background: Intensive blood pressure (BP) reduction is regarded as the gold standard therapy for acute intracerebral hemorrhage (ICH), but its associations to cerebral hypoperfusion and ischemic lesions have been suspected. This study aims to investigate the impact of acute BP reduction on the development of acute ischemic lesions (AILs) at border zone (BZ) areas in patients with hypertensive ICH. Methods: We enrolled patients with acute hypertensive ICH (hemorrhagic lesions restricted to deep region [Strictly deep-ICH] or located in mixed lobar and deep areas [Mixed-ICH]) who received brain MRI within 7 days after ICH onset. BZ AILs were defined as lesions locating at BZ areas that were hyperintense on DWI sequence and hypointense on ADC series (figure). Acute SBP change was the difference between the initial SBP and the SBP recorded at 24 hours after ICH onset. Results: Of the 274 enrolled patients (62.5 ± 12.7 years old, 65% male), 11 subjects had BZ AILs. Compared to patients without BZ AILs, patients with lesions had wider amount of acute SBP reduction (71.7 ± 33.6 vs. 43.0 ± 32.2 mmHg, P = 0.023), more lobar and deep microbleeds (MB) and larger white matter hyperintensity volume (all p &lt; 0.05). Using ROC curve analysis, acute SBP drop at more than 54mmHg was linked to the occurrence of AILs (sensitivity 82%, specificity 64%, P = 0.002). In multiple logistic regression model, acute SBP decline at above 54mmHg (OR 11.45, 95%CI 2.06 - 63.49, P = 0.005) and higher deep MB burden ( P = 0.032) raised the risk of AILs after adjustment for age, sex, and image markers of cerebral small vessel disease. In subgroup analysis, larger acute SBP drop remained to be an independent risk factor for development of AILs in patients with Mixed-ICH ( P = 0.008), but not in patients with strictly deep-ICH ( P = 0.715). Conclusion: Acute SBP change in hypertensive ICH, especially in Mixed-ICH, increases the risk of AILs at BZ areas, showing widespread microangiopathy that is vulnerable to rapid BP dysregulation to ischemia.

TRIGEMINAL-CARDIAC REFLEX: A COMMON BUT UNRECOGNIZED PRESENTATION AMONG PATIENTS WITH EPISTAXIS

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Trigeminal-cardiac reflex (TCR), is a neurocardiogenic reflex which can produce sudden onset hemodynamic instability. We describe a case of TCR which was observed in a patient presenting with recurrent epistaxis. CASE PRESENTATION: A 71-year-old gentleman with a past medical history of hypertension and metastatic prostate cancer was admitted to the hospital with a chief complaint of persistent epistaxis. As conventional epistaxis management was unsuccessful, he underwent right-sided sphenoidal artery embolization followed by Foley catheter balloon packing. That night, he abruptly developed hemodynamic instability with a drop in his BP from 150/98 to 83/50mmHg, together with a rapid reduction in his HR by 25%. The patient was afebrile, awake, alert, and following commands. He was immediately started on empiric antibiotic therapy and received gentle fluid boluses. Workup for sepsis and cardiopulmonary etiologies of the hemodynamic changes, including complete blood count, comprehensive metabolic panel, blood cultures, chest imaging, and electrocardiogram, were obtained and were negative. His vitals rapidly returned to the baseline with conservative measures. However, within the next hour, the patient was noted to have another transient episode of a sudden drop in BP and HR. The septic and cardiopulmonary workup remained negative. On further chart review, the patient had reported pulling on the Foley packing due to irritation prior to the onset of the episodes. Therefore, the TCR reflex, induced when the patient applied traction on the Foley catheter, was the likely cause of these transient episodes of hemodynamic instability. The nasal packing was not immediately removed due to the high risk of rebleed. Continuous hemodynamic monitoring was maintained while the patient was advised to avoid manipulation of the packing. Once he became stable, the packing was removed, following which the episodes never recurred. DISCUSSION: Epistaxis is one of the most common causes of ER visits in the United States. TCR is defined as an acute reduction in heart rate and mean arterial blood pressure by more than 20% compared to the baseline and is usually triggered with manipulation near the trigeminal nerve endings [1]. In the case of our patient, there was a definite temporal relationship between the episodes of hemodynamic instability and the traction applied on nasal packing, which likely stimulated the nerve and activated TCR [2]. CONCLUSIONS: Although the clinical course of most epistaxis cases is benign, under-diagnosis of this unique brain stem reflex has resulted in severe consequences including patient death [2]. Therefore, trigeminal-cardiac reflex should be included as one of the differentials of acute hemodynamic instability in patients with nasal packing. Reference #1: Schaller BJ, Filis A, Buchfelder M. Trigemino-cardiac reflex in humans initiated by peripheral stimulation during neurosurgical skull-base operations. Its first description. Acta Neurochir (Wien). 2008;150(7):715-718. doi:10.1007/s00701-008-1602-1 Reference #2: Awasthi D, Roy TM, Byrd RP Jr. Epistaxis and Death by the Trigeminocardiac Reflex: A Cautionary Report. Fed Pract. 2015;32(6):45-49. DISCLOSURES: No relevant relationships by Suganya Chandramohan, source=Web Response No relevant relationships by Graciela Rojas, source=Web Response No relevant relationships by Joseph Sebastian, source=Web Response No relevant relationships by Josee Smith, source=Web Response

Post-exercise hypotension time-course is influenced by exercise intensity: a randomised trial comparing moderate-intensity, high-intensity, and sprint exercise.

Reductions in blood pressure (BP) induced by exercise training may be associated with the acute reduction in BP observed minutes to hours following an exercise session, termed post-exercise hypotension (PEH). However, the magnitude and time-course of PEH, including the optimal exercise characteristics to maximise it, are still unclear. Using a randomised crossover design, 16 normotensive participants (median age (range) 22 (19-31) years; 50% female) undertook three different exercise sessions: sprint interval exercise (SIE, 30 × 8-s sprints with 32 s recovery), high-intensity interval exercise (HIIE, 15 × 1-min intervals at 90% peak heart rate (HR) with 1-min recovery), and moderate-intensity continuous exercise (MICE, 48 min at 65% peak HR). BP and HR were monitored before and up to 90 min following each session. The three exercise sessions each showed distinct PEH and of similar overall magnitude up to 90 min post exercise; however, there were distinct differences in the time-course. Systolic BP was lower 40 min after MICE compared to HIIE (-7.7 (-13.9 to -2.4) mmHg) and diastolic BP was higher 5 min after HIIE compared to SIE (8.5 (2.3-14.7) mmHg). MICE induced lower HR up to 40 min after exercise compared to HIIE and SIE. HIIE and SIE induced PEH of similar magnitude to MICE. A phasic or 'W-shaped' time-course of PEH observed following HIIE and SIE contrasted to a distinct 'V-shaped' PEH following MICE, indicating the physiological mechanisms driving BP regulation after exercise are influenced by exercise intensity.

Prevalence of Hypertensive Emergency and Associated Factors Among Hospitalized Patients with Hypertensive Crisis: A Retrospective Cross-Sectional Study.

BackgroundHypertensive emergency (HE) is an acute stage of uncontrolled blood pressure which poses a substantial cardiovascular morbidity and mortality in developing countries. In our setting, the prevalence of HE and the characteristics of patients with a hypertensive crisis are not certainly known yet.ObjectiveThe study assessed the prevalence of hypertensive emergency and associated factors among hospitalized patients with hypertensive crisis.MethodsA retrospective cross-sectional study was conducted by reviewing records of patients having a diagnosis of hypertensive crisis with systolic/diastolic blood pressure raised to more than 180/120 mmHg admitted to Ayder Comprehensive Specialized Hospital (ACSH) from September 2018 to August 2019. Patients’ medical records with complete information were enrolled consecutively. Socio-demographic, clinical characteristics, and other related variables were collected using a structured data collection tool from patient medical records. Data were entered and analyzed using SPSS version 20. Logistic regression was employed to determine factors associated with HE.ResultsA total of 141 patients’ records with a diagnosis of a hypertensive crisis were enrolled in the study; the majority were females 77 (54.6%) and residing in the urban setting 104 (73.8%). The mean age of the participants was 58.8 years. HE was found in 42 (29.8%) of patients. Intravenous Hydralazine 39 (27.7%) and oral calcium channel blocker 102 (72.3%) were the prescribed drugs for acute blood pressure reduction in the emergency setting. Surprisingly, patients who had no history of hypertension (adjusted odds ratio (AOR)=2.469; 95% confidence interval (CI): 0.176‒0.933) and female sex (AOR=2.494; 95% CI: 1.111‒5.596) were found to be independently associated factors with HE.ConclusionThe prevalence of HE was found to account a significant proportion of patients. Hence, hypertensive patients should be strictly managed accordingly, and promoting screening programs could reduce the risk of target organ damage.

Postexercise Hypotension, Aortic Pressure And Autonomic Modulation In Men Living With Hiv

A single session of aerobic exercise reduces blood pressure vs. pre-exercise, which is referred as postexercise hypotension (PEH). Changes in cardiac autonomic control and local vasodilatation contribute to PEH. HIV-infected patients present higher risk of hypertension, autonomic and endothelial dysfunction, which may influence the PEH. However, this phenomenon has never been studied in this population. PURPOSE: To investigate the effects of acute aerobic exercise upon systemic blood pressure, aortic pressure, and cardiac autonomic modulation in men living with HIV. METHODS: After cardiopulmonary exercise testing, 10 HIV-infected (HIV: 47.5 ± 9.7 yrs; 25.2 ± 3.0 kg.m-2) and 14 healthy men (CTL: 40.1 ± 10.5 yrs; 25.8 ± 3.4 kg.m-2) underwent cycling bouts expending 150 kcal at 50% oxygen uptake reserve (time to achieve 150 kcal - HIV: 24.1 ± 5.5 and CTL: 23.1 ± 3.0 min) and control sessions (20 min), in a randomized counterbalanced order. Systolic blood pressure (SBP), aortic pressure, and heart rate variability were assessed 30 min before and 60 min after each session, by means of oscillometric digital monitor, pulse wave reflection (tonometry), and beat-to-beat heart rate intervals, respectively. Comparisons within-between sessions were made using 2-way ANOVA with repeated measures (P ≤ 0.05). RESULTS: No difference was detected between groups for maximal oxygen uptake (HIV: 27.3 ± 4.2 vs. CTL: 31.4 ± 6.8 mL·kg-1·min-1; P= 0.1) and SBP at rest (HIV: 117.2 ± 11.6 vs. CTL: 112.2 ± 8.9 vs mmHg; P= 0.2). Resting aortic pressure was higher in HIV (107.0 ± 9.3 mmHg) vs. CTL (100.0 ± 4.3 mmHg; P= 0.03), while standard deviation of NN intervals (SDNN) was lower in HIV (28.3 ± 11.2 ms) vs. CTL (43.9 ± 20.8 ms; P= 0.04). In CTL, SBP (-9.3 ± 5.9 mmHg; P= 0.01), aortic pressure (-6.3 ± 4.6 mmHg; P= 0.03), and SDNN (-23.4 ± 44.5 ms; P= 0.05) decreased after submaximal exercise vs. control sessions. No significant change occurred in HIV for SBP (-4.2 ± 18.9 mmHg; P= 0.5), aortic pressure (-5.1 ± 13.0 mmHg; P= 0.2), or SDNN (+5.5 ± 25.6 ms; P= 0.4). CONCLUSION: Healthy, but not HIV-infected men, exhibited acute blood pressure reduction after submaximal aerobic exercise. The higher central arterial stiffness and lower vagal modulation among HIV patients may help to explain the absence of PEH in this group. Supported by FAPERJ Grant.

Changes in Heart Rate Variability and Post Exercise Blood Pressure from Manipulating Load Intensities of Resistance-Training

Background: The isolated effect of resistance training (RT) on heart rate variability (HRV) and blood pressure (BP) is crucial when prescribing suitable training programmes for healthy individuals. Objective: The purpose of this study was to compare BP and HRV responses in physically active men after an acute RT session with loads of 5-, 10- or 15-repetition maximums (5RM, 10RM and 15RM). Method: Eighty-one men (age: 21.6±1.1yr; body mass: 74.1±5.8 kg; height: 175.3 ±7.1cm) who performed moderate to vigorous physical activities for at least 30 min a day on most days of the week participated in this study. After the of 5RM loads for the bent-over row (BR), bench press (BEP), Dead-lift (DL) and squats (SQ), participants were divided into three training load groups (15RM = GrpL, 10RM = GrpM or 5RM = GrpH). During the experimental session, each group (n=27) performed 3 sets for each of the four exercise, with 2-min rest intervals between sets and exercises with their assigned training load. BP and HRV were measured prior to, immediately after, and at 15-min intervals until two hours post-experiment. Results: All three groups attained improved BP (p = .001) reductions and longer HRV (p = .0001) changes after an acute exercise session but the GrpM (10RM) and and GrpL (15RM) performed better than GrpH (5RM). Conclusion: Strength and conditioning professionals may prescribe exercises with 10-15RM loads if the aim is to obtain an acute reduction in BP after an RT session.

Laparoscopic Renal Denervation System for Treating Resistant Hypertension: Overcoming Limitations of Catheter-Based Approaches.

In a pivotal clinical trial, the percutaneous catheter-based renal denervation system developed to treat resistant hypertension did not show effectiveness in reducing blood pressure because of its fundamental limitation to ablate deeper nerves present around the renal artery. We propose a new renal denervation strategy called laparoscopicdenervation system (LDS) based-on laparoscopy procedure to ablate the renal nerves completely but inhibit the thermal arterial damage.The system has flexible electrodes to bend around the arterial wall to ablate nervesThe simulation study using validated in-silico models evaluated the heat distributionon the outer arterial wall,and an acute animal study (swine model) was conducted to demonstrate the feasibility of LDS in vivo. The simulation studyconfirmedthat LDS could localize the heat distributionbetween the electrode and the outer arterial wall. In the animal study, we could maximize nerve denervation by the localizing ablation energy within the renal nerves and achieve nerve denaturationand decrease in neural density by 20.78% (P < 0.001), while maintaining a constant tip temperature of 65 °C for the duration of 70 s treatment. The study confirmed intact lumen artery through histological analysis and acute reduction in systolic blood pressure by 9.55 mmHg (p < 0.001) Conclusion: The LDS presented here has potential to effectively and safely ablate the renal nerves, independent of anatomical variation and nerve distribution, to control hypertension in real clinical conditions. LDS approach is innovative, inventive, and presents a novel technique totreat hypertension.

Abstract TMP19: MRI Characteristics and Predictors of Diffusion Weighted Hyperintense Lesions After Spontaneous Intracerebral Hemorrhage: A Secondary Analysis of MISTIE-III

Introduction: Mechanisms of diffusion weighted hyperintense lesions (DWIHL) after spontaneous intracerebral hemorrhage (ICH) are controversial. We evaluated mechanism and outcome of DWIHL. Methods: Protocolized MRI scans within 7 days from ICH were reviewed from MISTIE-III trial. Imaging analysis included DWIHL, leukoariosis (Fazekas score), enlarged perivascular space (EPVS), and cerebral microbleeds. Multivariable logistic regression analysis was performed to assess predictors and outcomes of having DWIHLs. Favorable outcome was defined as modified Rankin Score 0-3 at 12 months. Results: Of 499 patients, 300 underwent DWI studies (62% lobar ICH; 38% deep ICH) and 178 (59%) had acute DWIHLs (66% lobar; 34% deep). DWIHL locations were perihematomal in 140 (79%); and remote in 96 (54%). In multivariable regression analysis, DWIHLs were associated with initial mean arterial pressure [MAP] (odds ratio [OR]: 1.004; 95% confidence interval [CI]: 1.002-1.01), initial ICH volume (OR: 1.004; 95%CI: 1.001-1.01), NIHSS at randomization (OR: 1.01; 95%CI: 1.01-1.02), hypertension history (OR: 1.41; 95%CI: 1.04-1.93), and Fazekas score (OR: 1.04; 95%CI: 1.01-1.08). Patients with DWIHLs were less likely to have favorable outcome (66% vs. 50%; OR: 0.89; 95%CI: 0.81-0.99) after adjusting for ICH severity; however, the presence of DWIHLs did not confer an independent mortality risk at 12 months. In addition, perihematomal DWIHLs were associated with ICH volume (OR: 1.003; 95%CI: 1.00-1.01), NIHSS (OR: 1.01; 95%CI: 1.00-1.02), deep location (OR: 1.25; 95%CI: 1.10-1.42), and centrum semiovale EPVS score (OR: 0.99; 95% CI: 0.99-1.00). Remote DWIHLs were associated with Fazekas score (OR: 1.17; 95%CI: 1.06-1.29), centrum semiovale EPVS score (OR: 1.01; 95%CI: 1.00-1.01), atrial fibrillation (OR: 1.40; 95%CI: 1.04-1.90), and maximal ΔMAP on first 24 hours (OR: 1.004; 95%CI: 1.001-1.006). Conclusions: DWIHLs were common (59%) in patients after spontaneous ICH, predominantly in lobar locations and were associated with unfavorable neurologic outcome. While perihematomal DWIHLs were associated with ICH severity, remote DWIHLs suggested different mechanisms including acute blood pressure reduction, cardiac emboli, and white matter disease severity.