Arterial Pressure Research Articles

Adherence to antihypertensive medications in Omani patients: a comparison of drug biochemical analysis and the Morisky Medication Adherence Scale.

Medication nonadherence is a major risk factor for suboptimal or failed hypertension pharmacologic therapy. To determine the nonadherence rate to antihypertensive medications using high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) and the self-reported Morisky Medication Adherence Scale (MMAS). This study used a prospective cross-sectional cohort design. Patients with hypertension aged ≥18 years and prescribed at least one antihypertensive medication were recruited from an outpatient hypertensive clinic at a tertiary healthcare institution in Oman. Adherence was assessed using LC-MS/MS urine analysis and the MMAS. In total, 162 patients completed the MMAS questionnaire and provided urine samples for LC-MS/MS analysis. The overall mean age of the cohort was 55 ± 13 years, and 57% of the patients were men. The mean systolic and diastolic blood pressures were 146 ± 18 mmHg and 79 ± 10 mmHg, respectively. Using the MMAS method, 65% of the patients reported nonadherence. However, LC-MS/MS analysis revealed that only 27% of the patients were nonadherent. The adherent group by LC-MS/MS had significantly lower systolic (P = 0.026) and diastolic blood pressures (P < 0.001) than the nonadherent group, whereas no differences were observed using the MMAS method. There was weak or no agreement between the MMAS and LC-MS/MS results (P = 0.142). Almost one-fourth of our patients with hypertension were nonadherent to their medications. There was a weak concordance between the MMAS and LC-MS/MS methods in detecting medication nonadherence. Further research into noninvasive convenient adherence scales or methods and their correlations with LC-MS/MS analysis is warranted.

A bovine model of hypoxia-induced pulmonary hypertension reveals a gradient of immune and matrisome response with a complement signature found in circulation.

Pulmonary hypertension (PH) is a progressive vascular disease characterized by vascular remodeling, stiffening, and luminal obstruction, driven by dysregulated cell proliferation, inflammation, and extracellular matrix (ECM) alterations. Despite the recognized contribution of ECM dysregulation to PH pathogenesis, the precise molecular alterations in the matrisome remain poorly understood. In this study, we employed a matrisome-focused proteomics approach to map the protein composition in a young bovine calf model of acute hypoxia-induced PH. Our findings reveal distinct alterations in the matrisome along the pulmonary vascular axis, with the most prominent changes observed in the main pulmonary artery. Key alterations included a strong immune response and wound repair signature, characterized by increased levels of complement components, coagulation cascade proteins, and provisional matrix markers. Additionally, we observed upregulation of ECM-modifying enzymes, growth factors, and core ECM proteins implicated in vascular stiffening, such as collagens, periostin, tenacsin-C, and fibrin(ogen). Notably, these alterations correlated with increased mean pulmonary arterial pressure and vascular remodeling. In the plasma, we identified increased levels of complement components, indicating a systemic inflammatory response accompanying the vascular remodeling. Our findings shed light on the dynamic matrisome remodeling in early-stage PH, implicating a wound-healing trajectory with distinct patterns from the MPA to the distal vasculature. This study provides novel insights into the molecular underpinnings of PH pathogenesis and highlights potential biomarkers and therapeutic targets within the matrisome landscape.

Oscillatory blood pressure values in newborn infants: observational data over gestational ages.

Normative blood pressure (BP) values on preterm infants exist but are based on small cohorts of infants. Utilizing electronic medical records (EMR), we can explore earlier gestational ages (GA) and follow their progression to 40 weeks corrected gestational age (CGA). A retrospective cohort study of infants within the SSM Health System from 7/01/2013 through 6/30/2023. Infants born at >22 0/7 weeks but < 41 weeks GA were included if any BP measurements existed (n=29,323 infants, 1.4 million BPs). Data was extracted electronically from EMR using Microsoft SQL. Systolic BP (SBP), mean arterial pressures (MAP), and Diastolic BP (DBP) were determined for each week of life from birth and percentile ranges (1st to 99th) for infants alive at CGA, and BP patterns for GA determined. Percentiles for SBP, DBP and MAP are provided. There is a rapid increase in BP at all gestations during the first two weeks, thus BP values are higher at any CGA in infants born at an earlier GA than infants born at that GA. For MAP values between the 5th and 10th percentile, the GA is appropriate for first week then use CGA + 5 mmHg. After the first week, 2.8 X CGA is between 90 and 95 percentile for SBP. . . The BP is dependent on the gestational age at birth and the corrected gestational age when it is measured. SBP, MAP, and DBP all increase rapidly in the two weeks of life prior to a gradual increase over time.

Lassen's Cerebral Autoregulation Plot Revisited and Validated 65 Years Later: Impacts of Vasoactive Drug Treatment on Cerebral Blood Flow.

Niels Lassen's seminal 1959 cerebral autoregulation plot, a cornerstone in understanding the relationship between mean arterial pressure (MAP) and cerebral blood flow (CBF), was based on preexisting literature. However, this work has faced criticism for selective data presentation, leading to inaccurate interpretation. This review revisits and validates Lassen's original plot using contemporary data published since 2000. Additionally, we aim to understand the impact of vasoactive drug treatments on CBF, as Lassen's referenced studies used various drugs for blood pressure manipulation. Our findings confirm Lassen's concept of a plateau where CBF remains relatively stable across a specific MAP range in awake humans with normal brains. However, significant variations in cerebral autoregulation among different populations are evident. In critically ill patients and those with traumatic brain injury, the autoregulatory plateau dissipates, necessitating tight blood pressure control to avoid inadequate or excessive cerebral perfusion. A plateau is observed in patients anesthetized with intravenous agents but not with volatile agents. Vasopressor treatments have population-dependent effects, with contemporary data showing increased CBF in critically ill patients but not in awake humans with normal brains. Vasopressor treatment results in a greater increase in CBF during volatile than intravenous anesthesia. Modern antihypertensives do not significantly impact CBF based on contemporary data, exerting a smaller impact on CBF compared to historical data. These insights underscore the importance of individualized blood pressure management guided by modern data in the context of cerebral autoregulation across varied patient populations.

Ultrasonographic Evaluation of Systemic Venous Congestion in Maintenance Hemodialysis Patients During Fluid Removal.

Fluid overload is a frequent and serious complication in hemodialysis patients. The combination of multiple point of care ultrasound (POCUS) measurements can identify significant venous congestion but its usefulness to determine ultrafiltration (UF) requirements and dry weight is unknown. Therefore, we evaluated prospectively patients in maintenance hemodialysis to establish the correlations between changes in venous congestion parameters and fluid removal. This was a prospective, single-center, observational study. POCUS venous congestion measurments were performed in 22 patients during 32 online post-dilutional hemodiafiltration sessions and findings were correlated with UF volume, central venous pressure and body water composition determined by multifrequency bioelectric impedance analysis (BIA). The pre dialysis weight was on average 1.9 kg above the BIA estimated dry weight, the average initial IVC diameter was <2 cm. An initial abnormal Hepatic Vein (HV) waveform was present in 26% (8) of the measurements. The average UF volume was 2084 ± 655 ml and correlated with changes in inferior vena cava (IVC) diameter (R= 0.34, CI 95% (0.18, 0.56) p < 0.05) but not with any other POCUS venous congestion parameters. Normalization of the IVC diameter and HV waveform was observed during the first UF hour in all initially altered measurements. Diameter reduction in the IVC correlated with total body water volume reduction estimated with BIA when measured immediately after fluid removal (R= 0.34, CI 95% (0.08, 0.56) p<0.05) Conclusion. Reduction in IVC diameter had a modest but significant correlation with UF volume in our patients on maintenance hemodiafiltration. POCUS may be used to monitor patients during UF.

Blood pressure variability associated with falls in nursing home residents.

High variations in serially measured blood pressures (BPs) portend a variety of adverse clinical events including dementia, cardiovascular sequelae and frailty. In this study, systolic blood pressure variability (BPV) was examined for its association with fall frequency and time to next fall among older adults living in nursing homes. BP values and falls over time were extracted from medical records of nursing home residents aged ≥65 years over a 10-month period. BPV was measured as the standard deviation of 17 to 20 systolic values, and its correlation with falls and time to next fall were evaluated according to quartile values. One hundred patient charts were analyzed with nearly 2000 BP data points. All older adults had at least one fall incident. Higher BPV was related to more falls, shorter time between the first and second fall and fewer average days between falls. Subgroups of high BP and different diagnoses affected this association between BPV and falls. People who fall often show a high variability in BP; as the number of falls increases, the BPV also increases. This study suggests that BPV may be marker for patients who might benefit from more aggressive application of fall reduction strategies. Geriatr Gerontol Int 2024; ••: ••-••.

Cerebral Overperfusion Despite Reduced Cortical Metabolism Is Associated with Postoperative Delirium in Cardiac Surgery Patients: A Prospective Observational Study.

Background: Decreased cerebral oximetry (rSO2) in cardiac surgery is associated with postoperative delirium (POD). However, interventions optimizing intraoperative rSO2 are inconclusive. Methods: In this prospective observational cohort study, the relationship between rSO2, middle cerebral artery blood flow velocity (MCAV), and processed EEG was assessed in cardiac surgery patients with and without POD. MCAV was continuously recorded by transcranial Doppler sonography (TCD), together with continuous rSO2 and bispectral index (BIS) monitoring. Cardiopulmonary bypass (CPB) flow rate was adjusted according to body surface area. The cohort was divided into the POD and control groups, according to the postoperative results of the confusion assessment method (CAM/CAM-ICU), the 4A's test (4AT), and the Delirium Observation Scale (DOS). A mixed model analysis was performed for intraoperative raw data. The cerebral autoregulation index was calculated from TCD, rSO2, and arterial pressure values. Differences in impaired autoregulation were compared using the Mann-Whitney U test. Results: A total of 41 patients were included in this study. A total of 13 patients (36.11%) developed postoperative delirium. There were no significant differences in the baseline characteristics of patients with or without POD. Patients with POD had lower BIS values during CPB (adjusted mean difference -4.449 (95% CI [-7.978, -0.925])). RSO2 was not significantly reduced in POD, (adjusted mean difference: -5.320, 95% CI [-11.508, 0.874]). In contrast, MCAV was significantly increased in POD (10.655, 95% CI [0.491, 20.819]). The duration of cerebral autoregulation impairment did not differ significantly for TCD and cerebral oximetry-derived indices (p = 0.4528, p = 0.2715, respectively). Conclusions: Our results suggest that disturbed cerebral metabolism reflects a vulnerable brain which may be more susceptible to overperfusion during CPB, which can be seen in increased MCAV values. These phenomena occur irrespectively of cerebral autoregulation.

Autoregulatory dysfunction in adult Moyamoya disease with cerebral hyperperfusion syndrome after bypass surgery

Cerebral hyperperfusion syndrome (CHS) is a serious complication after bypass surgery in Moyamoya disease (MMD), with autoregulatory dysfunction being a major pathogenesis. This study investigated the change of perioperative autoregulation and preoperative prognostic potentials in MMD with postoperative CHS. Among 26 hemispheres in 24 patients with adult MMD undergoing combined bypass, 13 hemispheres experienced postoperative CHS. Arterial blood pressure and cerebral blood flow velocity were perioperatively measured with transcranial Doppler ultrasound during resting and the Valsalva maneuver (VM). Autoregulation profiles were discovered in both the CHS and non-CHS groups using mean flow index (Mxa), VM Autoregulatory Index (VMAI), and a new metric termed VM Overshooting Index (VMOI). The CHS group had inferior autoregulation than the non-CHS group as indicated by VMOI on preoperative day 1 and postoperative 3rd day. Deteriorated autoregulation was observed via Mxa in the CHS group than in the non-CHS group on the postoperative 3rd and discharge days. Postoperative longitudinal autoregulation recovery in the CHS group was found in a logistic regression model with diminished group differences over the time course. This work represents a step forward in utilizing autoregulation indices derived from physiological signals, to predict the postoperative CHS in adult MMD.

Efficacy of Cytoreg in the treatment of diabetic foot disease.

Complications from diabetic foot wounds, including bacterial infection, ulceration and gangrene, are major causes of hospitalisation and are responsible for 85% of amputations in patients with diabetes. Given that orally administered investigational therapeutic Cytoreg (Cytorex de Venezuela SA, Venezuela), a defined aqueous mixture of hydrofluoric, hydrochloric, sulfuric, phosphoric, citric and oxalic acids, has been shown to increase levels of arterial blood oxygen in a Wistar rat model, oral and oral+topical Cytoreg were tested on patients with diabetic foot ulcers (DFUs) under a humanitarian, compassionate-use protocol. All patients received oral Cytoreg (5.0 ml concentrate in fruit juice) for 30 days; half also received weekly wound washing with Cytoreg concentrate in isotonic saline (1:50 volume/volume) (oral+topical group). In addition to standard clinical observations, wounds were monitored against the Saint Elian checklist system for the diabetic foot. A total of 10 patients took part in the study. Complete wound closure was observed in 4/5 patients in the oral+topical group; in the remaining patient, necrotic and fibrin tissues on the wound edges were eliminated. Half (2/4) of the patients receiving oral-only Cytoreg experienced complete wound closure; one patient in this group was removed prematurely because of an unrelated illness and was not replaced. During the study, no significant differences were observed between groups in either the oxygen saturation of the affected tissues or in insulin and glycaemia levels (p<0.05). Significant increases in arterial haemoglobin and arterial oxygen partial pressure (p<0.05) were observed, and significant decreases were measured in the levels of glycosylated haemoglobin, aspartate aminotransferase, glutamic-pyruvic transaminase, creatine and urea (p<0.05). The results of this study justify an expanded clinical study for the treatment of DFUs with Cytoreg.

Vasodilatory shock: a review of pathophysiology and vasopressor therapy

Vasodilatory shock is characterised by a global loss of vasomotor tone, leading to maldistribution of blood volume, low systemic arterial pressure and hypoperfusion. This syndrome can be caused by sepsis, anaphylaxis and a wide range of other aetiologies. This review article explores the pathophysiology of vasodilatory shock, including well-understood mechanisms and emerging avenues of future investigation. Options for vasopressor therapy are reviewed, including evidence from preclinical canine models, small animal clinical research, large human clinical trials and the Surviving Sepsis Campaign. Recommendations for rational vasopressor choice are extrapolated from this evidence. Future directions include the development of novel vasoactive agents, clinical data comparing the safety and effectiveness of vasopressors in small animals and the development of a veterinary-specific consensus statement guiding best practices for the treatment of vasodilatory shock.

The Neurological and Hemodynamics Safety of an Airway Clearance Technique in Patients with Acute Brain Injury: An Analysis of Intracranial Pressure Pulse Morphology Using a Non-Invasive Sensor.

Patients with acute brain injury (ACI) often require mechanical ventilation (MV) and are subject to pulmonary complications, thus justifying the use of Airway Clearance Techniques (ACTs), but their effects on intracranial pressure (ICP) are unknown. This study investigates the neurological and hemodynamics safety of an ACT called ventilator hyperinflation (VHI) in patients with ACI. This was a randomized clinical equivalence trial, which included patients aged ≥ 18 years with a clinical diagnosis of hemorrhagic stroke, with symptom onset within 48 h. The participants were randomly allocated to the Experimental Group (EG, n = 15), which underwent VHI followed by tracheal aspiration (TA), and the Control Group (CG, n = 15), which underwent TA only. Neurological safety was verified by analyzing the morphology of the ICP wave through the non-invasive B4C sensor, which detects bone deformation of the skull, resulting in a P2/P1 ratio and TTP, and hemodynamics through a multi-parameter monitor. Evaluations were recorded during five instances: T1 (baseline/pre-VHI), T2 (post-VHI and before TA), T3 (post-TA), T4 and T5 (monitoring 10 and 20 min after T3). The comparison between groups showed that there was no effect of the technique on the neurological variables with a mean P2/P1 ratio [F (4,112) = 1.871; p = 0.120; np2 = 0.063] and TTP [F (4,112) = 2.252; p = 0.068; np2 = 0.074], and for hemodynamics, heart rate [F (4,112) = 1.920; p = 0.112; np2 = 0.064] and mean arterial pressure [F(2.73, 76.57) = 0.799; p = 0.488; np2 = 0.028]. Our results showed that VHI did not pose a neurological or hemodynamics risk in neurocritical patients after ACI.

Comment on “The Impact of Mean Arterial Pressure during Cardiopulmonary Bypass on Postoperative Outcomes in Coronary Artery Bypass Graft Surgery"

The Article Abstract is not available.

Effects of systemic ventricular assist in failing Fontan patients: a theoretical analysis using a computational model

Mechanical circulatory support is a potential treatment for failing Fontan patients. In this study, we performed a theoretical analysis using a computational model to clarify the effects of systemic ventricular assist device (VAD) in failing Fontan patients. Cardiac chambers and vascular systems were described using the time-varying elastance model and modified Windkessel model, respectively. A VAD was simulated as a nonlinear function. In systolic and diastolic ventricular dysfunction and atrioventricular valve regurgitation models, systemic VAD increased the cardiac index and decreased the central venous pressure (CVP). However, in the high pulmonary vascular resistance model, CVP became extremely high above 15 mmHg to maintain the cardiac index when the pulmonary vascular resistance index (PVRI) was above 5 Wood units m2. In Fontan patients with ventricular dysfunction or atrioventricular valve regurgitation, systemic VAD efficiently improves the hemodynamics. In Fontan patients with PVRI of > 5 Wood units m2, systemic VAD seems ineffective.

The hemodynamic effects of protamine in pediatric patients undergoing pulmonary artery reconstruction and unifocalization surgery: A Pilot Study.: Hemodynamic effects of protamine in children.

ObjectivesTo determine protamine administration increases pulmonary artery pressures in patients undergoing unifocalization or pulmonary artery reconstruction surgeries. Design: Retrospective database study. SettingA large pediatric heart center within an academic quaternary care facility. ParticipantsAll patients undergoing pulmonary artery reconstruction or unifocalization procedure identifiable within the data warehouse. InterventionsWe collected data from Stanford University's data repository, formatted it, and analyzed it using RStudio (v 2023.06.1+524). Measurements and Main ResultsOur primary outcome is the change in pulmonary artery pressure (PAP) after an administration of protamine. Secondary outcomes include changes in the mean arterial pressure, the ratio of systolic pulmonary artery to systemic artery pressure, right sided filling pressure, and left atrial pressure. After a protamine bolus, we found a difference in PAP (Friedman X2 = 49.46, p <0.001). When compared to two minutes before its administration, the PAP was higher at two minutes (29.00 mmHg versus 25.00 mmHg, p <0.001), five minutes (30.00 mmHg versus 25.00 mmHg, p <0.001) and ten minutes (31 mmHg versus 25 mmHg, p < 0.001). When co-administered with calcium, there was also a significant increase in PAP (Friedman X2 = 28.11, p < 0.001), with a higher PAP ten minutes after calcium administration when compared to two minutes before (32 mmHg versus 26 mmHg, p < 0.001) Conclusions: Protamine administration led to a small increase in PAP after separation from cardiopulmonary bypass in patients undergoing pulmonary artery reconstruction or unifocalization surgeries. Calcium co-administration did not lead to a greater increase in PAP.

Epidemiological Profile and Correlates for Left Ventricular Diastolic Dysfunction among Patients Attending a Tertiary Health Facility in India

Background: There is an increasing recognition that congestive heart failure (CHF), caused by diastolic dysfunction (DD) (diastolic heart failure), is common and causes significant morbidity and mortality. Methods: The institution-based cross-sectional study was conducted among 119 subjects to determine the epidemiological profile, and regression analysis was used to evaluate the association of clinico-social correlates with the likelihood of developing DD. Result: The mean age of subjects was 51.6(±17.7) years. The mean systolic (SBP) and diastolic blood pressures (DBP) were 130(±18.9) mm Hg and 82.1(±11.1) mm Hg, respectively. Thirty-three (27.7%) subjects were hypertensive. Twelve (10%) were diabetic and experienced heart failure. DD was present in 54 (45.4%) subjects. Age, diabetes, ejection fraction (EF), and interventricular septal thickness in diastole (IVSd) were significant (P &lt; 0.05) correlates of DD. Mean values of age, body mass index (BMI), EF, IVSd, and left ventricular posterior wall thickness in diastole (LVPWD) were higher in subjects with DD. Hypertension contributed to 1.63 times greater odds of developing DD. Conclusion: The prevalence of DD increased with age among hypertensive and diabetic participants. Preventive strategies directed toward identifying subclinical signs of early stage and aggressive blood pressure and blood sugar control are likely to offer the greatest promise for reducing the incidence of DD.

Beef Consumption and Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BackgroundResults from observational studies suggest associations of red meat intake with increased risk of cardiovascular disease (CVD); however, randomized controlled trials (RCT) have not clearly demonstrated a link between red meat consumption and CVD risk factors. Further, the specific effects of beef, the most consumed red meat in the US, have not been extensively investigated. ObjectiveTo perform a systematic review and meta-analysis of RCT data evaluating the effects of minimally or unprocessed beef intake on cardiovascular risk factors in adults. MethodsA search of the literature was conducted using PubMed and CENTRAL databases. RCTs in adults that provided diets with fresh or minimally processed beef were included. Data were extracted and pooled estimates from random effects models were expressed as standardized mean differences (SMD) between the beef intervention and comparator intervention with less or no beef. Sensitivity and subgroup analyses were also performed. ResultsTwenty relevant RCTs that met the criteria were included. Beef intake did not impact blood pressure or most lipoprotein-related variables, including total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglycerides (TG), non-HDL-C, apolipoprotein (apo) A, apo B, and very low-density lipoprotein cholesterol (VLDL-C). Beef consumption had a small, but significant effect on low-density lipoprotein cholesterol (LDL-C) [0.11 (95% CI: 0.008, 0.20), p = 0.03] corresponding to ∼ 2.7 mg/dL higher LDL-C in diets containing more beef compared to low or no beef comparator diets. Sensitivity analyses show this effect was lost when one influential study was removed. ConclusionsDaily unprocessed beef intake did not significantly affect most blood lipids, apolipoproteins, or blood pressures, except for a small increase in LDL-C compared to diets with less or no beef. Thus, there may be other factors influencing the association of red meat and beef on CVD risk that deserve further investigation. Registry and registry number for systematic reviews or meta-analysesThis study was registered at INPLASY 202420013 (doi:10.37766/inplasy2024.2.0013).

An underrecognized phenotype of pulmonary emphysema with marked pulmonary gas exchange but with mild or moderate airway obstruction

In patients with pulmonary emphysema and mild to moderate airflow limitation, one does not expect the features marked exertional dyspnea and hypoxemia as well as a profound decrease in diffusing capacity of the lung for carbon monoxide (DLCO). Here we describe this phenotype and its prognosis. From our database, we retrospectively selected cases associating emphysema, exertional breathlessness, O2 requirement at least upon exercise, forced expiratory volume in 1 sec (FEV1) ≥ 50% predicted, and DLCO ≤ 50% predicted, without associated combined pulmonary fibrosis and emphysema, right-to-left shunt, or severe pulmonary hypertension. Over a 12-year period, we identified 16 patients with emphysema and the above presentation. At the initial evaluation, the median age was 62 years (interquartile range 53.8–68.9). The median FEV1 and DLCO% predicted and mean pulmonary artery pressure were 86 (65–95)%, 38 (31–41)%, and 20 (17–25) mm Hg, respectively. On room air, the median arterial partial pressure of oxygen and partial pressure of carbon dioxide in arterial blood were 63.5 (55.8–69) mm Hg and 34.5 (31–36) mm Hg with increased median alveolar-arterial oxygen difference (46 [39–51] mm Hg). After the initial evaluation, the respiratory condition worsened in 13 of 14 (92.8%) patients with one or more re-evaluations (median follow-up 2.6 [0.9–5.8] years). In 12, lung transplantation was considered. Four patients died after 5.8, 5.7, 7.1, and 0.8 years of follow-up, respectively. We describe an underrecognized phenotype of pulmonary emphysema featuring a particular profile characterized by marked exertional dyspnea, impaired pulmonary gas exchange with low DLCO and marked oxygen desaturation at least on exercise but with mild or moderate airway obstruction.

DETERMINATION OF THE AMOUNT OF POLYPHENOLS IN THE FOOD SUPPLEMENT "ASBOSIM" USED IN THE TREATMENT OF HYPERTENSION DISEASE

It is known that one of the diseases that are difficult to treat in modern medicine is an increase in blood pressure, i.e. hypertension. Hypertension is a pathology of the cardiovascular system, a complex disease characterized by an increase in arterial pressure, followed by organomorphological changes. Hypertension is mainly caused by constant nervousness, depression and stress, increased amount of adrenaline in the blood, alcohol consumption, excessive obesity and other factors. This disease is one of the main diseases that lead to complications such as myocardial infarction, stroke, heart attacks, and heart and kidney failure. The main symptoms of high blood pressure are headache, dizziness, ringing in the ears and heart failure. High blood pressure is more common in middle-aged and elderly people.

Second-trimester Uterine Artery Doppler Pulsatility Index in Singleton Pregnant Women with and without Risk of Pre-eclampsia

Background: Preeclampsia (PE) is gestational hypertension and one of the most serious disorders in pregnant women. Objective: This study aimed to compare second-trimester uterine artery Doppler pulsatility index (UAPI) in singleton pregnant women with and without risk of PE. Methods: A case-control study was carried out among 200 singleton pregnant women in the second trimester of pregnancy, who were referred to Imam Hospital in Ahvaz (Iran). The data were recorded on their demographic, obstetric, clinical characteristics, and Doppler indices. The average UA-PI value was considered as the mean PI between the right and left arteries. Women who were categorized into Groups 1 and 2 had a moderate-high and low risk of PE, respectively. Results: The mean UA-PI, right UA-PI, left UA-PI, systolic and diastolic blood pressures (BP), age, body mass index (BMI), and abdominal circumference (AC) of women in Group 1 were significantly higher than those in Group 2 (p&lt;0.05). Furthermore, Group 1 had a higher frequency of abortions, comorbidities, abnormal UA Doppler results, and nulliparous women than Group 2 (p&lt;0.05). Based on maternal age (&lt;35, ≥35), BMI (&lt;25, ≥25), comorbidities (yes, no), and nulliparity (yes, no) categories, those who were in Group 1 had a significantly higher mean systolic and diastolic BP, UA-PI, right UA-PI, and left UA-PI than their counterparts in Group 2 (P&lt;0.001). Conclusion: This study declared the second-trimester UA-PI had good potential for timely prediction of PE risk in pregnant women.

Intra-aortic balloon pump synchronized with chest compressions improves outcome during cardiopulmonary resuscitation in experimental cardiac arrest

BackgroundIntra-aortic balloon pump (IABP) and resuscitative endovascular balloon occlusion of the aorta (REBOA) are two endovascular intervention methods for circulatory support. The aim of this study was to compare the hemodynamic effects of simultaneous mechanical chest compressions (MCC) with IABP, REBOA and those with only MCC (overall and detailed in the MCC cycle) and return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR) in experimental non-traumatic cardiac arrests (CA). MethodCA was electrically induced (ventricular fibrillation) in 24 anesthetized pigs, which then were randomized to MCC synchronized IABP (n = 8), total occluded REBOA (n = 8), or control (n = 8). After 10 min of CA, CPR with MCC was started followed by one of the interventions after one minute of CPR. Every other minute after MCC start, the pigs were defibrillated with 200 J if VF/ventricular tachycardia, and after six minutes, adrenaline was administered and repeated every four minutes. The proportions of ROSC were calculated. Hemodynamic variables, including systemic blood and coronary perfusion pressures (CPP), and carotid and iliac blood flows, were collected and analyzed with 0.02 s resolution. ResultsIn both the IABP and REBOA groups, 7 of 8 animals (87.5 %) achieved ROSC, in contrast with 2 of 8 (25 %) in the control group (P = 0.04). IABP and REBOA significantly increased systemic arterial pressure (P = 0.002 and P = 0.015, respectively), and REBOA also increased CPP and carotid blood flow when compared to controls (P = 0.007 and P = 0.03, respectively). Animals with IABP had a preserved blood flow in the iliac artery during CPR. No differences were detected after ROSC in hemodynamic, metabolic, and organ injury variables between the REBOA and IABP groups. ConclusionBoth IABP and REBOA increased the proportion of ROSC compared to controls. However, REBOA occluded distal blood flow, while IABP maintained it. This study suggests that MCC synchronized IABP could be an adjunct in the treatment of non-traumatic CA.