Artery Pressure In Patients Research Articles

Improvement in the electrocardiograms associated with right ventricular hypertrophy after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

BackgroundBalloon pulmonary angioplasty (BPA) is a treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods and resultsIn 60 patients with CTEPH, we examined the hemodynamic data before and after BPA. In addition, the sequential ECG findings for right ventricular hypertrophy (RVH) were assessed. The mean pulmonary arterial pressure (mPAP) decreased from 38 ± 11 to 20 ± 4 mm Hg (p < 0.05). The ROC analysis showed that the S waves in V5, R waves in V1 + S waves in V5, S waves in I, and QRS axis were significant predictors of an mPAP ≧ 30 mm Hg (AUC > 0.75, p < 0.01). The predictive values for the mPAP before the BPA were the S and R waves in lead V6, and P waves in lead II (33.417 + 0.078 × P in II − 0.10 × R in V6 + 0.012 × S in V6). The change in the mPAP (ΔmPAP) correlated with the change in the amplitudes of the ECGs: ΔS wave in lead I (R = 0.544, p < 0.001), ΔR in V1 + S in V5 (R = 0.476, p < 0.001), and ΔP wave in II (R = 0.511, p < 0.001). At 6 months of follow-up, the improvement in an R in V1 + S in V5 of ≧10 mm implied a better functional status. ConclusionBPA therapy reduced the pulmonary arterial pressure in patients with CTEPH and was associated with an improvement in the ECG findings related to RVH.

Endothelial dysfunction and elemental status in children with chronic kidney disease

Objective: evaluation of markers of endothelial dysfunction (endothelin-1 and nitric oxide) and elemental status (zinc, iron, magnesium) in children and adolescents at different stages of chronic kidney disease (CKD). The study includes 104 patients aged 2 to 17 years with different stages of CKD: 63 patients with I stage of CKD, and 26 patients with CKD stage III and 15 patients with CKD V stage. Results: in patients with CKD, endothelin-1 increased with simultaneous decrease in production of nitric oxide in the progression of CKD from I to V stage. The increase of the content of endothelin-1 by 2.5 times determined in patients with stage V CKD, which was accompanied by a decline of the ratio of the concentrations of NO/ET-1 by 5.5 times. In patients with CKD, elemental status impairments were detected, manifested by a decrease in the content of zinc, iron, and magnesium in the serum of blood at the first stage, with the maximum implementation in stage III CKD. Hypertension was detected in 68.3% of patients with CKD. Direct correlations were found between the content of serum iron and magnesium with the level of arterial pressure in patients with stage I CKD. In III and V stage CKD, a direct correlation of serum magnesium with blood pressure level and nitric oxide concentration was established. Conclusion: children with CKD have endothelial dysfunction and elemental status disorders, beginning with the first stage of CKD development, which can be considered as factors determining the progression of the pathological process in the kidneys.

INTERDEPENDENCE OF VARIABILITY OF THE HEART RHYTHM WITH DAILY PROFILE OF ARTERIAL PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION

The article analyzes the interrelation of the heart rate variability with the daily profile of arterial pressure in patients with arterial hypertension.Objective: to study the relationship between heart variability indices the daily profile of blood pressure in patients with arterial hypertension I-II stage.Material and methods. A survey of 145 patients with stage I and II hypertension, aged 29 to 53 years old (average age - 46.75 ± 0.56 years) was performed. According to a result of 24-hour daily blood pressure monitoring, all patients were divided into 3 groups: 62 patients with normal blood pressure decrease at night (dippers); 67 patients with insufficient decrease in blood pressure at night (non-dipper); 16 patients with excessive nightly decrease in blood pressure (over-dipper).Results: under background conditions patients with an insufficient (non-dipper) or surplus (over-dipper) decline HELL at night were characterized by less general power of spectrum (ТР) and VLF of modulations. In addition, substantial increase of sympatic trend in (non-dipper) and parasympathetic trend in (over-dipper) attracts attention. Thus, LF part of vibrations of LF% in the group of patients of made 35,34±2,25%, and significantly exceeded the value of analogical index in the group of (22,75±1,15%, p <0,01), but the part of HF of vibrations of HF% in the group of patients of over-dipper, having made 32,96±1,18%, significantly exceeded the value for an analogical index in the group of (14,92±0,95%, p <0,01) and (17,43±1,12%,p <0,02). Non-dipper were characterized by the least values of cute modulations and index of sympatho-vagal balance (p <0,01).Conclusion. It has been established that, the inherent vegetative maintenance of cardiac activity was preserved for the patients in the category of dipper and overdipper. At the same time, patients who have a daily profile of overseas dippery type, are characterized by adequate functioning of the sympathetic department of the autonomic nervous system against a background of high activity of the parasympathetic link. Patients who belong to the non-dipper category show a decrease in the adaptive capacity of the sympathetic nervous system against a background of hyperparasympathicotonia in a state of rest and an adequate response to parasympathetic modulation during the loading test.

Activity of non-specific inflammatory process in arterial hypertension in patients with type 2 diabetes

One of the main factors of cardiovascular risk in both the general population and in patients with type 2 diabetes is arterial hypertension (AH). An important pathogenetic link in many cardiovascular diseases, including AH, is nonspecific inflammation in the intima of the vessels, where the C-reactive protein (CRP) level in the serum is a special prognostic marker.The objective: to determine the relationship between the marker level of the nonspecific inflammatory process of the C-reactive protein and the level of arterial pressure in patients with type 2 diabetes.Materials and methods. The study included 145 patients with type 2 diabetes (72 men and 73 women, the average age was 53.0 (49,0–60,5) years). A complex examination during 3 years of observation was carried out: an analysis of the dynamics of blood pressure (BP) and determination of serum CRP. Statistical analysis of the data and processing of the results were carried out using the integrated software package «SPSS Statistics 20».Results. According to the results of the dynamic observation: mean SBP levels are 140,0 (130,83–150,0) mmHg, DBP – 85,0 (80,0–91,67) mmHg, hrCRP – 4,2 (2,91–5,8) mg/l. Patients with type 2 diabetes were divided into three groups depending on the mean level of SBP: group I – 55 patients (37,9%) with an average SBP level&lt;135 mmHg, group II – 51 patients (35,2%) with a mean SBP of 135–149 mmHg, group III – 39 patients (26,9%) with an average SBP&gt;150 mmHg. Patients of group III had significantly higher average levels of hsCRP (5,0 (3,8–6,15) mg/l) compared to patients with sufficient control of CAT from group I (3,33 (2,0–5,8) mg/l) (p&lt;0,05). Also in group III there was a bigger portion of people with high CVD risk with an average hsCRP &gt;3,0 mg/l. The direct correlation with the medium strength between the hsCRP in the blood serum and the level of BP in patients with type 2 diabetes was found (r = 0,32; p&lt;0,05).Conclusions. In patients with type 2 diabetes with higher BP the number of hsCRP in the blood serum is significantly higher; the direct correlation with the medium strength between the hsCRP in the blood serum and the level of BP in patients with type 2 diabetes is observed, that can be a prognostic marker of CVD progression.

Prognostic Value of Mean, Diastolic, and Systolic Pulmonary Artery Pressure in Patients With End-stage Lung Disease Referred for Lung Transplantation

BackgroundPulmonary hypertension (PH) is a common complication in end-stage lung disease (esLD). The aim of this study was to establish the best threshold values for mean, systolic, and diastolic artery pressure (mPAP, dPAP, and sPAP, respectively) to identify patients with esLD referred for lung transplantation and to predict 1-year prognosis. MethodsSixty-five patients were enrolled in the study (75% men) with a mean age of 53.3 ± 9.5 years; 31% had chronic obstructive pulmonary disease (COPD), 57% had idiopathic pulmonary fibrosis (IPF), and 12% had interstitial lung diseases (ILDs). The mean period of observation was 14.4 ± 5 months. We assessed invasively mPAP, dPAP, and sPAP, as well as pulmonary capillary wedge pressure (PCWP), using a Swan-Ganz catheter. Receiver-operating characteristic (ROC) curves were constructed to identify the best cutoff points for mPAP, dPAP, and sPAP to predict survival. The study endpoint was defined as 1-year mortality before transplantation. Survival analysis was completed according to the Kaplan-Meier method. ResultsDuring follow-up, 30 (46.1%) patients died and 19 (29%) underwent lung transplantation. Based on ROC curve analysis, we estimated mPAP ≥30 mm Hg, dPAP ≥20 mm Hg, and sPAP ≥44 mm Hg as the best threshold values with the highest sensitivity (70%, 70%, and 73%, respectively) and specificity (76%, 69%, and 72%, respectively) and the acceptable area under curve (0.67, 0.68, and 0.72, respectively). The negative predictive values for mPAP, dPAP, and sPAP were higher than the positive predictive values (79%, 77%, and 81% vs 67%, 61%, and 64%, respectively). We also constructed Kaplan-Meier curves for mPAP, dPAP, and sPAP threshold values. There were significant differences in 1-year survival between patients with and without PH for mPAP, dPAP, and sPAP threshold values (P = .005, P = .035, and P < .001; respectively). ConclusionElevated mPAP, dPAP, and sPAP are related to worse prognosis in patients with esLD referred for lung transplantation.

Reappraisal of the reliability of Doppler echocardiographic estimations for mean pulmonary artery pressure in patients with pulmonary hypertension: a study from a tertiary centre comparing four formulae.

Different Doppler echocardiography (DE) models have been proposed for estimation of mean pulmonary arterial pressures (PAMP) from tricuspid regurgitation (TR) jet velocity. We aimed to compare four TR-derived DE models in predicting the PAMP measured by right heart catheterization (RHC) in different groups of precapillary pulmonary hypertension (PH). A total of 287 patients with hemodynamically pre-capillary PH were enrolled (mean age = 51 ± 17.4 years, 59.9% female). All patients underwent DE before RHC (< 3 h) and four formulae (F) were used for TR-derived PAMP estimation (PAMP-DE). These were as follows: F1 = Chemla (0.61 × systolic pulmonary artery pressure [PASP] + 2); F2 = Friedberg (0.69 × PASP − 0.22), F3 = Aduen (0.70 × PASP); and F4 = Bech-Hanssen (0.65 × PASP − 1.2). The PASP and PAMP (mmHg) measured by RHC were 89.1 ± 30.4 and 55.8 ± 20.8, respectively. In the overall PH group, DE estimates for PASP (r = 0.59, P = 0.001) and PAMP (r = 0.56, P = 0.001 for all) showed significant correlations with corresponding RHC measures. Concordance was noted between Chemla and Bech-Hanssen, and Aduen and Bech-Hanssen. The Bland–Altman plot showed that Chemla and Bech-Hanssen overestimated and Friedberg and Aduen underestimated PAMP-RHC measures. Paired-t test showed significant systematic biases for Aduen and Bech-Hanssen while Passing-Bablok non-parametric analysis revealed significant systematic biases all four PAMP-DE estimates. There was poor agreement between PAMP-RHC measures and PAMP-DE deciles (Kappa values were 0.112, 0.097, 0.095, and 0.121, respectively). This study showed a poor agreement between PAMP-DE estimates by four TR-derived formulae and PAMP-RHC in patients with PH, regardless of the etiology. However, these results can not be fully extrapolated to a normal population and did not address the reliability of DE estimates for PH screening procedures.

MANAGEMENT OF PATIENTS WITH ALZHEIMER’S DISEASE

The article presents a literature review on the management of patients with Alzheimer’s disease (AD). Psychosocial and behavioural trends form the core of the management of a patient with AD and should be used as early as possible and remain in use for the rest of her/his life. Inhibitors of central acetylcholinesterase (donepizil, galantamine, rivastigmine) and memantine are able to improve cognitive functions. Stroke prevention has been considered the mainstay in reducing the risk of developing AD and the progression of its symptoms. Gradual normalization of arterial pressure in patients with hypertension reduces the risk of various types of dementia, including asthma. The use of a large number of fresh fruits or vegetables, the Mediterranean diet, regular exercise and mental activity are associated with a decrease in the incidence of AD. The article discusses the management of patients with AD in our country, the use of Cerebrolysin and methods of vaccination.

Catheter-Based Renal Nerve Ablation as a Novel Hypertension Therapy: Lost, and Then Found, in Translation.

The hypothesis that renal nerves mediate, at least in part, the pathogenesis and maintenance of hypertension is based on decades of preclinical studies and, to a certain extent, recent clinical trials of catheter-based renal nerve ablation (CBRNA) in humans. The first 2 clinical trials for CBRNA, Symplicity HTN-1 and Symplicity HTN-2, reported sustained reductions in arterial pressure in patients with drug-resistant hypertension and set the stage for the first blinded US trial, Symplicity HTN-3. However, Symplicity HTN-3 failed to reach its 6-month efficacy end point, thus jeopardizing the clinical application of CBRNA in the United States. The goal of this article is to reexamine the feasibility of CBRNA to treat hypertension. Preclinical studies on the role of renal nerves in hypertension have been extensively reviewed,1,2 as have the Symplicity HTN-1, 2, and 3 trials.3–7 Therefore, we will review these topics only briefly to provide context for the primary purpose of this article which is to answer the following question: is the outcome of Symplicity HTN-3 because of the failure to translate preclinical knowledge to the clinic, or is our basic understanding of the mechanisms by which renal nerves contribute to hypertension flawed? The kidney is innervated by sympathetic efferent fibers that modulate 3 pharmacological targets for the treatment of hypertension: renin release, tubular sodium reabsorption, and renal vascular resistance.1,2 Although conventional pharmacological treatments of these targets lower arterial pressure, patients often present with negative side effects which may lead to drug incompliance. One rationale for CBRNA is that this treatment would suppress renin release, tubular sodium reabsorption, and renal vasoconstriction, while avoiding the side effects associated with more globally acting pharmacotherapies. The kidney is also innervated by renal afferent fibers that provide the central nervous system sensory information related to the …

Особенности структурного ремоделирования сердца при хронической фибрилляции предсердий на фоне ишемической болезни сердца с артериальной гипертензией

To reveal the peculiarities of structural myocardial remodeling in patients with chronic atrial fibrillation (AF) against the background of chronic ischemic heart disease (CIHD) with arterial hypertension (AH). Two groups of patients with CIHD with AH were formed: 1st - against the background of chronic AF (n=44) and 2nd - without FP (n=100). Anthropometric, general clinical and echocardiographic data were evaluated. Left ventricular hypertrophy (LVH) was observed in all patients with FP and in 96% of patients without FP, the groups did not differ in types of LVH (u-test Mann-Whitney p=0.7489). In both groups dominated by concentric hypertrophy: in the 1st group of 22 (50%) and in the 2nd group - 51 (51%), Fisher's exact test p=1,0. The linear dimensions of both atria were larger in group 1: the ratio of the left atrium/body surface area (BSA) in group 1 was 2.7 [2.2; 3] cm/m2 versus 2.1 [1.8; 2.5] cm/m2 in group 2 (U-test p=0.000004); the attitude of the right atrium / BSA - in the 1st group and 2.9 [2,4; 3,2] cm/m2 vs 2.3 [2,2; 2,6] cm/m2 in the 2nd group (U-test p&lt;0.0000001). The level of calculated systolic pulmonary artery pressure in patients with AF was higher than in control: 38 [32; 41] mm Hg. vs. 27 [24; 31] mm Hg. art. respectively (U-test p&lt;0.0000001). A more severe stage of chronic heart failure (CHF) was diagnosed in patients of the 1st group (U-test p=0.0000001). In patients with combination like hibs and hypertension remodeling affects both the LV and the atrium. In the presence of AF in such patients, structural changes in atria are more significant. AF itself is a predictor of chf and can contribute to the progression of heart failure in patients with CIHD and AH.

Changes in arterial pressure and markers of nitric oxide homeostasis and oxidative stress following surgical correction of hydronephrosis in children

ObjectiveRecent clinical studies have suggested an increased risk of elevated arterial pressure in patients with hydronephrosis. Animals with experimentally induced hydronephrosis develop hypertension, which is correlated to the degree of obstruction and increased oxidative stress. In this prospective study we investigated changes in arterial pressure, oxidative stress, and nitric oxide (NO) homeostasis following correction of hydronephrosis.MethodsAmbulatory arterial pressure (24 h) was monitored in pediatric patients with hydronephrosis (n = 15) before and after surgical correction, and the measurements were compared with arterial pressure measurements in two control groups, i.e. healthy controls (n = 8) and operated controls (n = 8). Markers of oxidative stress and NO homeostasis were analyzed in matched urine and plasma samples.ResultsThe preoperative mean arterial pressure was significantly higher in hydronephrotic patients [83 mmHg; 95% confidence interval (CI) 80–88 mmHg] than in healthy controls (74 mmHg; 95% CI 68–80 mmHg; p < 0.05), and surgical correction of ureteral obstruction reduced arterial pressure (76 mmHg; 95% CI 74–79 mmHg; p < 0.05). Markers of oxidative stress (i.e., 11-dehydroTXB2, PGF2α, 8-iso-PGF2α, 8,12-iso-iPF2α-VI) were significantly increased (p < 0.05) in patients with hydronephrosis compared with both control groups, and these were reduced following surgery (p < 0.05). Interestingly, there was a trend for increased NO synthase activity and signaling in hydronephrosis, which may indicate compensatory mechanism(s).ConclusionThis study demonstrates increased arterial pressure and oxidative stress in children with hydronephrosis compared with healthy controls, which can be restored to normal levels by surgical correction of the obstruction. Once reference data on ambulatory blood pressure in this young age group become available, we hope cut-off values can be defined for deciding whether or not to correct hydronephrosis surgically.

Association of Admission Glucose Level and Improvement in Pulmonary Artery Pressure in Patients with Submassive-type Acute Pulmonary Embolism.

Objective The admission glucose level is a predictor of mortality even in patients with acute pulmonary embolism (APE). However, whether or not the admission glucose level is associated with the severity of APE itself or the underlying disease of APE is unclear. Methods This study was a retrospective observational study. A pulmonary artery (PA) catheter was used to accurately evaluate the severity of APE. The percentage changes in the mean PA pressure (PAPm) upon placement and removal of the inferior vena cava filter (IVCF) were evaluated. We hypothesized that the admission glucose level was associated with the improvement in the PA pressure in patients with APE. Patients A total of consecutive 22 patients with submassive APE who underwent temporary or retrievable IVCF insertion on admission and repetitive PA catheter measurements upon placement and removal of IVCFs were enrolled. Results There was a significant positive correlation between the admission glucose levels and the percentage changes in the PAPm (r=0.543, p=0.009). A univariate linear regression analysis showed that the admission glucose level was the predictor of the percentage change in PAPm (β coefficient=0.169 per 1 mg/dL; 95% confidence interval, 0.047-0.291; p=0.009). A multivariate linear regression analysis with the forced inclusion model showed that the admission glucose level was the predictor of the percentage change in PAPm independent of diabetes mellitus, PAPm on admission, troponin positivity, and brain natriuretic peptide level (all p＜0.05). Conclusion The admission glucose level was associated with the improvement in the PAPm in patients with submassive-type APE.

Endomorphins potentiate acid-sensing ion channel currents and enhance the lactic acid-mediated increase in arterial blood pressure: effects amplified in hindlimb ischaemia.

Chronic limb ischaemia, characterized by inflammatory mediator release and a low extracellular pH, leads to acid-sensing ion channel (ASIC) activation and reflexively increases mean arterial pressure; endomorphin release is also increased under inflammatory conditions. We examined the modulation of ASIC currents by endomorphins in sensory neurons from rats with freely perfused and ligated femoral arteries: peripheral artery disease (PAD) model. Endomorphins potentiated sustained ASIC currents in both groups of dorsal root ganglion neurons, independent of mu opioid receptor stimulation or G protein activation. Intra-arterial administration of lactic acid (to simulate exercising muscle and evoke a pressor reflex), endomorphin-2 and naloxone resulted in a significantly greater pressor response than lactic acid alone, while administration of APETx2 inhibited endomorphin's enhancing effect in both groups. These results suggest a novel role for endomorphins in modulating ASIC function to effect lactic acid-mediated reflex increase in arterial pressure in patients with PAD. Chronic muscle ischaemia leads to accumulation of lactic acid and other inflammatory mediators with a subsequent drop in interstitial pH. Acid-sensing ion channels (ASICs), expressed in thin muscle afferents, sense the decrease in pH and evoke a pressor reflex known to increase mean arterial pressure. The naturally occurring endomorphins are also released by primary afferents under ischaemic conditions. We examined whether high affinity mu opioid receptor (MOR) agonists, endomorphin-1 (E-1) and -2 (E-2), modulate ASIC currents and the lactic acid-mediated pressor reflex. In rat dorsal root ganglion (DRG) neurons, exposure to E-2 in acidic solutions significantly potentiated ASIC currents when compared to acidic solutions alone. The potentiation was significantly greater in DRG neurons isolated from rats whose femoral arteries were ligated for 72h. Sustained ASIC current potentiation was also observed in neurons pretreated with pertussis toxin, an uncoupler of G proteins and MOR. The endomorphin-mediated potentiation was a result of a leftward shift of the activation curve to higher pH values and a slight shift of the inactivation curve to lower pH values. Intra-arterial co-administration of lactic acid and E-2 led to a significantly greater pressor reflex than lactic acid alone in the presence of naloxone. Finally, E-2 effects were inhibited by pretreatment with the ASIC3 blocker APETx2 and enhanced by pretreatment with the ASIC1a blocker psalmotoxin-1. These findings have uncovered a novel role of endomorphins by which the opioids can enhance the lactic acid-mediated reflex increase in arterial pressure that is MOR stimulation-independent and APETx2-sensitive.

Decreased haptoglobin levels inversely correlated with pulmonary artery pressure in patients with pulmonary arterial hypertension: A cross-sectional study.

We investigated the serum haptoglobin levels in patients with pulmonary arterial hypertension (PAH) based on the hypothesis that haptoglobin levels would reflect subclinical hemolysis due to microangiopathy in pulmonary arterioles.This cross-sectional study included 3 groups of patients attending Hokkaido University Hospital: PAH, chronic thromboembolic pulmonary hypertension (CTEPH), and connective tissue diseases (CTD) without PAH (CTD-non-PAH) group. Serum haptoglobin levels were measured by standardized turbidimetric immunoassay in all patients. Demographic data, laboratory results, right heart catheter, and echocardiographic findings were extracted from the medical records. Decreased haptoglobin levels were defined as below 19 mg/dL based on the 95th percentile of healthy controls.Thirty-five patients in PAH group including 11 with idiopathic PAH (IPAH) and 24 with CTD-associated PAH (CTD-PAH), 27 in CTEPH group, and 32 in CTD-non-PAH group were analyzed. Serum haptoglobin levels in PAH group (median 66 mg/dL) were significantly lower than those in CTEPH group (median 94 mg/dL, P = .03) and CTD-non-PAH group (median 79 mg/dL, P = .03). The prevalence of decreased haptoglobin levels was 26% in PAH group, 15% in CTEPH group, and 6% in CTD-non-PAH group. Serum haptoglobin levels had a significant negative correlation (r = −0.66, P < .001) with mean pulmonary artery pressure in PAH group, particularly in CTD-PAH subgroup (r = −0.74, P < .001), but no correlation in IPAH subgroup (r = −0.52, P = .13) and in CTEPH group (r = −0.17, P = .41). Follow-up cases of CTD-PAH showed lowering pulmonary artery pressure led to normalizing serum haptoglobin levels.Serum haptoglobin levels decreased in PAH patients and inversely correlated with pulmonary artery pressure in CTD-PAH patients, suggesting their potential as a surrogate marker for CTD-PAH.

EFFECT OF 30° HEAD-UP POSITION ON INTRACRANIAL PRESSURE CHANGE IN PATIENTS WITH HEAD INJURY IN SURGICAL WARD OF GENERAL HOSPITAL OF Dr. R. SOEDARSONO PASURUAN

Background: Head-injured patients have traditionally been maintained in the head-up position to ameliorate the effects of increased intracranial pressure (ICP). However, it has been reported that the 15 degrees head-up position may improve cerebral perfusion pressure (CPP) and outcome. We sought to determine the impact of 30 and 15 degrees on intracranial pressure change.Methods: This was a quasi-experimental study with posttest only control time series time design. There were 30 head-injured patients was selected using consecutive sampling, with 15 assigned in the treatment (30° head-up position) and control group (15° head-up position). Intracranial pressure variable was identified using the level of consciousness and mean arterial pressure parameters. Wilcoxon signed rank test was used for data analysisResults: Findings showed p-value 0.010 (0.05) on awareness level and p-value 0.031 (0.05) on mean arterial pressure, which indicated that there was a statistically significant effect of the 30° head-up position on level of awareness and mean arterial pressure.Conclusion: There was a significant effect of the 30° head-up position on intracranial pressure changes, particularly in the level of awareness and mean arterial pressure in patients with head injury. It is recommended that for health workers to provide knowledge regarding this intervention to prevent increased intracranial pressure.

Evaluation of pulmonary artery pressure in patients with juvenile systemic lupus erythematosus (jSLE).

Juvenile systemic lupus erythematosus (jSLE) is a chronic multisystemic autoimmune disease. Previous studies among adults have shown impaired right ventricular (RV) function in patients with SLE. Also, these patients may develop pulmonary artery hypertension (PAH), which is one of the most threatening complications of SLE. Nevertheless, studies on PAH among jSLE patients are still rare. The aim of this study was to assess the RV function in jSLE patients by Doppler echocardiography (Echo Doppler). We also estimated pulmonary artery systolic pressure (PASP) and mean pulmonary artery pressure (mPAP) in these patients. A total of 38 jSLE patients and 40 sex- and age-matched controls were retrospectively analyzed. All patients underwent combined M-mode, cross-sectional echo, and Doppler Echo examination. The RV function was significantly impaired in jSLE patients compared to controls. PASP and mPAP were normal in 37 out of 38 patients (97.37%), however, the mean values of PASP and mPAP were significantly higher in jSLE patients compared to controls (26.90 mmHg versus 21.71 mmHg and 12.63 mmHg versus 9.89 mmHg, respectively) [p < 0.05]. Only one patient (2.6 %) had elevated mPAP (60 mmHg). The right cardiac catheterization confirmed PAH in this patient. Although PAH was detected only in one patient, there was a marked increase of PAP in our jSLE patients. Overall, PASP and mPAP were significantly higher in jSLE patients compared to healthy controls. Prospective studies with ethnically diverse cohorts could give more insight on the relevance of PAP and PHT in patients with jSLE.

Chloroquine Is a Potent Pulmonary Vasodilator that Attenuates Hypoxia‐Induced Pulmonary Hypertension

Sustained pulmonary vasoconstriction and excessive pulmonary vascular wall thickening are two major causes for elevated pulmonary vascular resistance and pulmonary arterial pressure in patients with pulmonary arterial hypertension. Chloroquine, as an anti‐malaria agent, is found to have inhibitory effects on autophagy and a relaxant effect on airway smooth muscle cells. In this study, we observed that chloroquine (100–200 μM) significantly attenuates agonist‐ and high K+‐induced contraction in isolated rat pulmonary artery (PA). Pretreatment with L‐NAME or indomethacin and functional removal of endothelium failed to inhibit chloroquine‐induced relaxation in isolated PA rings pre‐constricted with phenylephrine or 40 mM K+. In pulmonary arterial smooth muscle cells (PASMCs), extracellular application of chloroquine significantly attenuated store‐operated Ca2+ entry induced by passive depletion of intracellularly stored Ca2+ in the sarcoplasmic reticulum using cyclopiazonic acid and partially inhibited ATP‐induced Ca2+ entry. Furthermore, chloroquine was shown to effectively attenuate Ca2+ entry via voltage‐dependent Ca2+ channels (VDCC). In vivo experiments showed that 50mg/kg chloroquine treatment (ip injections) significantly attenuated the development of pulmonary hypertension in rats exposed to chronic hypoxia (10% O2 for 3 weeks). These data indicate that chloroquine is a potent vasodilator of PA and a potential blocker of VDCC, store‐operated Ca2+ channels and receptor‐operated Ca2+ channels in PASMCs. The therapeutic potential of chloroquine on pulmonary hypertension is likely due to the combination of its vasodilative, anti‐proliferative and anti‐autophagic effects.Support or Funding InformationThis work was supported in part by the grants from the National Natural Science Foundation of China (81630004, 81470246, 81220108001, 81520108001), Guangzhou Department of Education Yangcheng Scholarship (12A001S), and Guangdong Province Universities, Colleges Pearl River Scholar Funded Scheme of China and China Scholarship Council (201608440324), as well as from the National Heart, Lung and Blood Institute of the National Institutes of Health (HL115014, HL066012).

Effects of an alveolar recruitment maneuver on subdural pressure, brain swelling, and mean arterial pressure in patients undergoing supratentorial tumour resection: a randomized crossover study

Although recruitment maneuvers have been advocated as part of a lung protective ventilation strategy, their effects on cerebral physiology during elective neurosurgery are unknown. Our objectives were to determine the effects of an alveolar recruitment maneuver on subdural pressure (SDP), brain relaxation score (BRS), and cerebral perfusion pressure among patients undergoing supratentorial tumour resection. In this prospective crossover study, patients scheduled for resection of a supratentorial brain tumour were randomized to undergo either a recruitment maneuver (30 cm of water for 30 sec) or a "sham" maneuver (5 cm of water for 30 sec), followed by the alternative intervention after a 90-sec equilibration period. Subdural pressure was measured through a dural perforation following opening of the cranium. Subdural pressure and mean arterial pressure (MAP) were recorded continuously. The blinded neurosurgeon provided a BRS at baseline and at the end of each intervention. During each treatment, the changes in SDP, BRS, and MAP were compared. Twenty-one patients underwent the study procedure. The increase in SDP was higher during the recruitment maneuver than during the sham maneuver (difference, 3.9 mmHg; 95% confidence interval [CI], 2.2 to 5.6; P < 0.001). Mean arterial pressure decreased further in the recruitment maneuver than in the sham maneuver (difference, -9.0 mmHg; 95% CI, -12.5 to -5.6; P < 0.001). Cerebral perfusion pressure decreased 14 mmHg (95% CI, 4 to 24) during the recruitment maneuver. The BRS did not change with either maneuver. Our results suggest that recruitment maneuvers increase subdural pressure and reduce cerebral perfusion pressure, although the clinical importance of these findings is thus far unknown. This trial was registered with ClinicalTrials.gov, NCT02093117.

CLINICAL PICTURE OF ARTERIAL HYPERTENSION ASSOCIATED WITH DUODENAL ULCER IN AMBULATORY PRACTICE OF DISTRICT THERAPEUTIST AND POLYCLINIC SURGEON

Aim. To characterize the clinical peculiarities of duodenal ulcer (DU) associated with arterial hypertension (AH) including the conditions of acute gastrointestinal hemorrhage (GIH). Materials and methods. The examination of 25 patients suffering from AH associated with DU, 45 AH patients during the first 2-5 days from the onset of acute gastrointestinal hemorrhage, 63 patients with GIH without AH, 48 patients with isolated AH course, 69 patients with DU exacerbation without AH was carried out. Results. When the existing DU was associated with AH, there was growing of the intensity of pain and dyspepsic syndrome. When the existing AH was associated with DU, vice versa, clinical picture of duodenal ulcer was not quite evident. A great concentration of Helicobacter pylori antibodies was revealed, when AH was associated with GIH. The critical course of AH was more often determined in case of AH and DU association. Conclusions. You should be careful when using Algover’s index (“shock” index) and modern classifications of hemorrhage according to the degrees of severity, taking into account higher initial values of arterial pressure in patients with AH associated with acute GIH.

The Effects of Statins on Pulmonary Artery Pressure in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial.

Objective:Pulmonary hypertension is a serious complication in patients suffering from chronic obstructive pulmonary disease (COPD). The aim of this study is to investigate the effects of atorvastatin in reducing pulmonary arterial pressure in COPD patients.Methods:This double-blind, randomized trial was conducted on 42 known cases of COPD with systolic pulmonary arterial pressure of more than 25 mmHg. The patients were randomly assigned into two groups, 21 patients with atorvastatin treatment (40 mg/daily for 6 months) and 21 patients without receiving atorvastatin. All the patients participated voluntarily and provided written informed consent. The trial was registered in the Iranian Registry of Clinical Trials. Pulmonary pressure was also anticipated by Doppler echocardiography with peak pressure gradient of tricuspid regurgitation. Both groups were tested with echocardiography to measure systolic pulmonary pressure at baseline and posttreatment. Statistical analysis includes Chi-square, Student's t-test, and Wilcoxon test. P < 0.05 was considered statistically significant.Findings:The mean age was 65.8 ± 11.5 years for atorvastatin group and 63.7 ± 7.6 years for control group (P = 0.45). Baseline and posttreatment mean systolic pulmonary artery pressure (PAP) levels in the atorvastatin group were 48.9 ± 3.3 and 38.4 ± 1.9 mmHg, respectively (P = 0.007). In the control group, mean systolic PAP levels at baseline and 6 months later were 45.6 ± 3.1 and 38.9 ± 2.4 mmHg, respectively (P = 0.073). The patients treated with atorvastatin showed significant decrease in total cholesterol (P = 0.001) and low-density lipoprotein cholesterol (P = 0.008).Conclusion:A 40 mg dose of atorvastatin daily for 6 months may have beneficial effects in reducing PAP in patients with COPD. Further studies are necessary to find long-term effects of statins in COPD patients.

EVALUATION OF THE INFLUENCE OF RENAL CYSTS ON THE LEVEL OF ARTERIAL PRESSURE REDUCTION AFTER RENAL DENERVATION IN PATIENTS WITH RESISTANT HYPERTENSION. THE BIENNIAL INSPECTION

Aim. We evaluated the influence of renal cysts on the efficiency of reduction of arterial pressure in patients with treatment-resistant hypertension after renal denervation. Materials and Methods. A total of 33 patients (aged 57.8±8.75 years) with treatment-resistant hypertension were included. All patients underwent radiofrequency ablation (RFA) of the sympathetic nerves of renal arteries. The average level of arterial pressure was as high as 137–210/57–148 mm Hg according to 24-h monitoring. MRI studies were performed using MRI scanner “Titan Vantage” (by Toshiba Medical Ltd., 1.5 Т) in T1-W and T2-W spin-echo models. After this, the intravenous contrast enhancement was carried out (with 0.5 М solution, 0.2 ml/Kg), with subsequently repeated acquisition of Т1-weighted spin-echo images 3-5 min after contrast injection, employing exactly the same protocols as before enhancement. Results. Preoperative images demonstrated cysts in kidneys in half of patients (16 individuals). Positive effect (the arterial pressure decreased by 10 mm Hg) was observed in 70% of them. However, in 30% of population, the arterial pressure increased. Among the patients without cysts in the kidneys, negative effect was observed in 8% only, and positive effect was found in 77% of patients (arterial pressure decreased by over 20 mm Hg). Conclusion. There is a statistically significant trend towards a greater antihypertensive effect of renal denervation in patients without cystic changes in the renal parenchyma (cortex). Thus, MRI is of prognostic value for prediction of renal denervation efficacy.