Assessment Of Blood Pressure Response Research Articles

Assessment Of Blood Pressure Responses To Various Load Bearing Apparatuses In Law Enforcement Officers

BACKGROUND Recently, some law enforcement agencies have begun transitioning to load bearing vests to help distribute their equipment to reduce hip and back pain from the traditional duty belt. However, no studies have examined other health aspects such as blood pressure of a load bearing vest. PURPOSE: The purpose of this study was to determine if wearing a load bearing vest would alter systolic, diastolic, and mean arterial pressure compared to the traditional duty belt worn by law enforcement officers. METHODS: Twenty one licensed law enforcement officers (mean ± SD, age: 40.5 ± 9.4 years; BMI: 30.3 ± 5.1 kg/m2; VO2 max: 34.5 ± 5.9 ml/kg/min) completed three randomized sets of seated and standing trials for blood pressure a) seated with a weighted utility belt, standing with a weighted utility belt, b) seated with a weighted vest, standing with a weighted vest, c) seated without any apparatus, standing without any apparatus. The weight of the vest and utility belt were 13.6 kg each. RESULTS: Diastolic pressure was higher when seated with a vest, compared to seated with the belt (n = 21, p = .029, +2.6 mmHg). When separating the participants by BMI based on CDC guidelines, increases were observed for standing between normal/overweight (n = 10) and obese (n = 11) for systolic (p = .026, control +14.9 mmHg, belt +11.4 mmHg, vest +8.7 mmHg) and mean arterial pressure (p = .024, control +12.4 mmHg, belt +8.3 mmHg, vest +5.9 mmHg). The normal/overweight group experienced an increase in standing systolic pressure with the belt compared to control (p < .01, +6.7 mmHg). The same group also increased systolic and mean arterial pressures standing with a vest compared to the control trial (p < .01, +10.6 mmHg and 8.4 mmHg) respectively. There were no significant differences in blood pressures within group for obese between the three trials. CONCLUSION: An obese BMI results in a higher systolic and mean arterial pressure when standing compared to a normal/overweight BMI, regardless of apparatus. Both the traditional duty belt and load bearing vest increase standing systolic pressure compared to no apparatus in normal/overweight individuals with no changes for obese individuals. Therefore, both the traditional duty belt and load bearing vest have similar blood pressure responses.

ASSOCIATION OF PEAK OXYGEN CONSUMPTION AND SURVIVAL IN PATIENT WITH HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

Assessment of blood pressure response during cardiopulmonary exercise testing (CPET) has been shown to predict survival in patients with hypertrophic obstructive cardiomyopathy (HOCM); however, known limitations to this assessment exist. The association between peak oxygen consumption (VO2) during

Associations of the work duration, sleep duration and number of holidays with an exaggerated blood pressure response during an exercise stress test among workers

It has been reported that an exaggerated systolic blood pressure (ESBP) response during exercise, even if resting blood pressure is normal, is associated with an increased risk of future hypertension and cardiovascular disease (CVD). This study was designed to investigate the relationships of work duration, sleep duration and number of holidays with blood pressure response during an exercise stress test among normotensive workers. The subjects were 362 normotensive workers (79 males and 283 females; age, 49.1 years). A multi-stage graded submaximal exercise stress test was performed on each subject using an electric bicycle ergometer. The workload was increased every 3 minutes, and blood pressure was measured at rest and during the last 1 minute of each stage. In this study, an ESBP response during exercise was defined according to the criteria of the Framingham Study (peak systolic blood pressure ≥210 mmHg in males, or ≥190 mmHg in females). Working environments, work duration, sleep duration, number of holidays, and physical activity during commuting and work, and leisure time exercise duration were evaluated using a questionnaire. An ESBP response during exercise was observed in 94 (26.0%) workers. The adjusted odds ratio for the prevalence of an ESBP response during exercise was found to be significantly higher with an increase in work duration, decreases in sleep duration and number of holidays (p<0.05, respectively). Moreover, the highest work duration with lowest sleep duration and number of holidays groups had significantly higher adjusted odds ratio for the prevalence of an ESBP response during exercise than the lowest work duration with highest sleep duration and number of holidays groups (p<0.05, respectively). Based on our results, we consider that the assessment of blood pressure response during exercise and daily life are necessary to prevent the incidence of future hypertension, CVD and death due to overwork in workers with long-work duration, short sleep duration and small number of holidays.

Estrogens, Salt, Blood Pressure, and Cardiovascular Disease in Women

Until recently cardiovascular disease in women has been a largely neglected and poorly understood issue, in part related to the misconception of a lower incidence among females compared with males, underrepresentation of females in clinical trials and observational studies until recently, and nontraditional presentation of symptoms in many females. Women have been typically viewed as largely protected from cardiovascular disease until menopause, and thereafter a rise in prevalence has been recognized, presumably related to hormonal decline. Hormonal replacement therapy (HRT) has been viewed as a useful prophylactic approach to ward off such events after menopause as well as to minimize menopausal symptoms. However, recent studies have yielded conflicting results regarding the protective effects of estrogen administration in preventing myocardial infarction and stroke.1–3 Indeed, the results of the Women’s Health Initiative have been interpreted as showing a neutral effect of estrogen administration in women in the 50 to 59 age decile and an adverse cardiovascular effect in older subjects.1 Whereas different pharmacological regimens may have been used in these replacement trials, the impact of these regimens on known risk factors for cardiovascular disease, such as blood pressure, lipoprotein profiles, insulin sensitivity, endothelin, C- reactive proteins, and other vasoactive substances, has not been carefully investigated. The relationship between estrogen and progesterone administration in the form of oral contraceptives and blood pressure, a major risk factor for stroke and cardiovascular disease, has been recognized for 4 decades.4 Population studies have documented a small but significant rise in systolic blood pressure in women receiving oral contraceptives in the 1970s, but only a small proportion of such women demonstrated a rise into the hypertensive range. Whereas epidemiologists remind us repeatedly that a …

Clinical Experience with Perindopril in Patients Nonresponsive to Previous Antihypertensive Therapy: A Large US Community Trial

A subgroup analysis of a large US community trial was conducted to evaluate the antihypertensive efficacy and safety of perindopril, an angiotensin-converting enzyme inhibitor (ACEI), in 3159 patients who lacked blood pressure (BP) control at entry with previous antihypertensive therapy. Patients received 4 mg perindopril daily for 6 weeks. Based on physicians' assessment of BP response, the patients were then either maintained on 4 mg daily (group 1) or the dose was increased to 8 mg daily (group 2) for an additional 6 weeks. The mean baseline sitting BP was 158.2/92.9 mm Hg. Perindopril monotherapy produced a significant BP decrease from baseline of 11.6/6.5 mm Hg and 14.9/8.4 mm Hg at weeks 6 and 12, respectively. In group 1 patients, the majority of BP decrease occurred at week 6 (17.3/9.5 mm Hg) and was maintained until the end of week 12 (18.2/10.1 mm Hg). In group 2 patients, the BP decrease on the 4-mg dose was modest at week 6 by 5.2/3.1 mm Hg. However, further dose up-titration of perindopril to 8 mg resulted in a clinically significant BP decrease of 11.9/6.8 mm Hg from baseline to week 12. Significant antihypertensive effects of perindopril were also demonstrated in the special patient populations of elderly (>or=65 years), black, isolated systolic hypertension, patients with concomitant cardiovascular diseases, and patients nonresponsive to other ACEI therapy. Overall, BP control (<140/<90 mm Hg) was achieved in 40.0% of patients at week 12. Perindopril was well tolerated with cough and angioedema reported in 8.5% and 0.4% patients, respectively. Physicians assessed therapeutic response to perindopril as satisfactory in 73.8% patients who were nonresponsive to previous antihypertensive therapy. These results suggest that, in a community-based practice, perindopril monotherapy (4-8 mg/d) is an effective and safe therapeutic option in patients nonresponsive to previous antihypertensive therapy.

Prospective prognostic assessment of blood pressure response during exercise in patients with hypertrophic cardiomyopathy.

Previous studies revealed that an abnormal blood pressure response (ABPR) during exercise was common in young hypertrophic cardiomyopathy (HCM) patients and was associated with a family history of premature sudden cardiac death (SCD). This study was performed prospectively to assess the prognostic significance of blood pressure response during exercise in young patients with HCM. Maximum symptom-limited treadmill exercise testing with continuous blood pressure monitoring was performed in 161 consecutive patients 8 to 40 years old (27+/-9). A normal blood pressure response, defined as an increase in the systolic pressure of at least 20 mm Hg from rest to peak exercise in the absence of a fall of >20 mm Hg from peak pressure, was seen in 101 (63%). In 60 (37%), the blood pressure response was abnormal. There was no significant difference in patients with normal blood pressure response and ABPR in terms of age, sex, follow-up, or recognized risk factors for SCD. During the follow-up period (mean, 44+/-20 months), SCD occurred in 12 patients: 3 (3%) in the normal blood pressure response group versus 9 (15%) in the ABPR group (P<.009). ABPR had a sensitivity of 75%, a specificity of 66%, a negative predictive value of 97%, and a positive predictive value of 15% for the prediction of SCD. There was no significant difference in the incidence of other recognized risk factors between patients with SCD and the survivors. A normal exercise blood pressure response identifies low-risk young patients with HCM. An ABPR identifies the high-risk cohort; the low positive predictive accuracy, however, indicates that further risk stratification is warranted.

Does placebo lower blood pressure in hypertensive patients? A noninvasive chronobiological study.

Placebo controlled trials have generally been used in order to evaluate the antihypertensive efficacy of drugs. There is some evidence, though, that blood pressure might not be influenced by placebo. Non-invasive devices for automatic blood pressure monitoring are likely to provide a better assessment of blood pressure response to drugs, as well as to different physiologic and pathologic conditions, than the traditional sphygmomanometric devices. The aim of this study was to investigate the effect of placebo on blood pressure recorded automatically and non-invasively. For this purpose, a chronobiologic approach to the collection, evaluation and interpretation of data seemed most appropriate. A group of 12 patients with a clinical diagnosis of essential hypertension underwent automatic blood pressure monitoring in hospital for 4 days. Measurements were taken every 15 min by an oscillometric instrument with an automatically inflated cuff. After a washout period during which the patients received no treatment, pressure recording was undertaken under basal conditions for 2 days. On the third and fourth days of study, the patients received 2 tablets of placebo, one at 10 a.m. and one at 10 p.m. In each patient a highly significant circadian rhythm was documented for systolic and diastolic pressure, both under basal conditions and during placebo administration. Blood pressure mesors were higher than reference standards and were not significantly affected by placebo. The circadian amplitudes and acrophases did not differ significantly before and during placebo. Our data indicate that automatically recorded blood pressure is not influenced by placebo.