Average Blood Pressure Research Articles

8429 Serotonin Receptor Antagonist Alleviates Vascular Defects Produced by Selective Serotonin Reuptake Inhibitor Treatment During Gestation

Abstract Disclosure: L.P. Agnew: None. R. Domingues: None. A. Weichmann: None. L.L. Hernandez: None. Maternal mental health is critical for both mother and infant and often antidepressant therapy outweighs the potential risks of selective serotonin reuptake inhibitor (SSRI) treatment; however, SSRI use is associated with adverse neonatal outcomes. Preliminary work in our laboratory revealed placental apoptosis in pregnant dams treated with fluoxetine (FLX) and dams genetically deficient for the serotonin transporter gene. We hypothesize that SSRIs decrease placental blood flow, causing apoptosis and organ death via signaling through the serotonin 2A/2C receptors. Pregnant female C57BL6 mice were randomized to be treated daily, via I.P. injection, from E10-17.5 with saline (CON; n=6), 2 mg/kg FLX (n=5), or 2 mg/kg ketanserin plus 2 mg/kg FLX (n=5). On E17.5, using high-resolution ultrasound imaging, we identified the uterine artery, individual umbilical cords, and placental disc blood vessels. We calculated blood pressure, blood volume, blood flow rate, and heart rate in the uterine artery, umbilical cord, and placental disc. FLX (decreased blood volume in the uterine artery compared to ketanserin plus FLX (48.42 ± 18.26, 116.54 ± 45.25; p=0.0077), and decreased average (89.38 ± 31.50) and peak (130.36 ± 39.05) blood velocity in the uterine artery compared to ketanserin plus FLX average (162.76 ± 68.46; p=0.0322) and peak (236.77 ± 92.43; p=0.0242) blood velocity. FLX decreased average (0.04 + 0.02) and peak (0.07 ± 0.04) blood pressure in the uterine artery compared to ketanserin and FLX treated animals average (0.12 ± 0.10; p=0.0634) and peak (0.25 ± 0.19; p=0.0412) blood pressure. Ketanserin plus FLX (391 ± 38.29) decreased heart rate (BPM) in the placental disc compared to untreated controls (450.67 ± 26.08; p=0.0128). In the umbilical cord, ketanserin plus FLX (393 ± 28.25) decreased BPM compared to CON (450.17 ± 29.44; p=0.0078) and compared to FLX treatment alone (437.20 ± 17.28; p=0.0450). FLX treatment of dams during pregnancy reduces blood flow volume, heart rate, and blood flow velocity to the placenta via the uterine artery. The use of ketanserin, an inhibitor of serotonin receptor 2A/2C signaling, in combination with FLX, reduced the effects of FLX on the uterine artery. These data suggest that treatment with ketanserin could be utilized to alleviate the reproductive side effects of antidepressant usage for pregnant mothers while allowing the mother to remain on antidepressants. Future research should further investigate the effects of SSRI and ketanserin on blood flow to the fetus through the umbilical cord. Presentation: 6/2/2024

8429 Serotonin Receptor Antagonist Alleviates Vascular Defects Produced by Selective Serotonin Reuptake Inhibitor Treatment During Gestation

Abstract Disclosure: L.P. Agnew: None. R. Domingues: None. A. Weichmann: None. L.L. Hernandez: None. Maternal mental health is critical for both mother and infant and often antidepressant therapy outweighs the potential risks of selective serotonin reuptake inhibitor (SSRI) treatment; however, SSRI use is associated with adverse neonatal outcomes. Preliminary work in our laboratory revealed placental apoptosis in pregnant dams treated with fluoxetine (FLX) and dams genetically deficient for the serotonin transporter gene. We hypothesize that SSRIs decrease placental blood flow, causing apoptosis and organ death via signaling through the serotonin 2A/2C receptors. Pregnant female C57BL6 mice were randomized to be treated daily, via I.P. injection, from E10-17.5 with saline (CON; n=6), 2 mg/kg FLX (n=5), or 2 mg/kg ketanserin plus 2 mg/kg FLX (n=5). On E17.5, using high-resolution ultrasound imaging, we identified the uterine artery, individual umbilical cords, and placental disc blood vessels. We calculated blood pressure, blood volume, blood flow rate, and heart rate in the uterine artery, umbilical cord, and placental disc. FLX (decreased blood volume in the uterine artery compared to ketanserin plus FLX (48.42 ± 18.26, 116.54 ± 45.25; p=0.0077), and decreased average (89.38 ± 31.50) and peak (130.36 ± 39.05) blood velocity in the uterine artery compared to ketanserin plus FLX average (162.76 ± 68.46; p=0.0322) and peak (236.77 ± 92.43; p=0.0242) blood velocity. FLX decreased average (0.04 + 0.02) and peak (0.07 ± 0.04) blood pressure in the uterine artery compared to ketanserin and FLX treated animals average (0.12 ± 0.10; p=0.0634) and peak (0.25 ± 0.19; p=0.0412) blood pressure. Ketanserin plus FLX (391 ± 38.29) decreased heart rate (BPM) in the placental disc compared to untreated controls (450.67 ± 26.08; p=0.0128). In the umbilical cord, ketanserin plus FLX (393 ± 28.25) decreased BPM compared to CON (450.17 ± 29.44; p=0.0078) and compared to FLX treatment alone (437.20 ± 17.28; p=0.0450). FLX treatment of dams during pregnancy reduces blood flow volume, heart rate, and blood flow velocity to the placenta via the uterine artery. The use of ketanserin, an inhibitor of serotonin receptor 2A/2C signaling, in combination with FLX, reduced the effects of FLX on the uterine artery. These data suggest that treatment with ketanserin could be utilized to alleviate the reproductive side effects of antidepressant usage for pregnant mothers while allowing the mother to remain on antidepressants. Future research should further investigate the effects of SSRI and ketanserin on blood flow to the fetus through the umbilical cord. Presentation: 6/2/2024

8437 Improved Quality Of Life&Blood Pressure Following Diagnosis And Medical Management Of Primary Aldosteronism (PA) / Georgian Experience

Abstract Disclosure: Q. Gvazava: None. N. Zavrashvili: None. N. Shonia: None. Improved Quality of Life and Blood Pressure Following Diagnosis and Medical Management of Primary Aldosteronism (PA) - Georgian Experience Introduction: PA is the most common cause of secondary hypertension which still remains as an underdiagnosed condition in many countries, including Georgia. The choice of pharmacological or surgical therapy depends on the results of computed tomography scans of the adrenal glands and adrenal venous sampling. In patients with bilateral aldosterone hypersecretion, the optimal is a low-sodium diet and lifelong treatment with a mineralocorticoid receptor antagonist administered at a dosage to reach a high-normal serum potassium concentration. Discussion: 60 y/o male with a 17-year history of hypertension. He was treated with 3 drug-program: valsartan, amlodipine, bisoprolol. BP was not adequately managed with systolic BP >140 mm/Hg. Patient had a history of hypokalaemia and required regular potassium supplements. Patient had never been evaluated for possible PA. We planned case detection test, which came up positive, with increased aldosterone, suppressed renin concentration and increased aldosterone-renin ratio. Abdominal CT performed 1 year ago for another reason revealed “normal” adrenals.After discussing treatment options patient preferred medical management and Eplerenone was started, dose titrated accordingly, K supplements were discontinued which over time resulted in decrease in requirement of his other antihypertensive medications, with BP adequately managed. Patient’s quality of life improved significantly, he has shared his test results and progress on his follow up visits; He is very grateful and feels content with the treatment. We present another case of 49 y/o male patient with a 19 year history of hypertension. Patient was treated with 4 drug-regimen: Valsartan, Hydrochlorothiazide, Amlodipine, nebivolol with average BP findings – 140/90 mm/Hg.Case detection test was positive with increased aldosterone, suppressed renin and increased aldosterone-renin ratio. Patient required confirmatory testing. Salt loading was done which confirmed the diagnosis of PA. On unenhanced CT of the abdomen, bilateral adrenal hyperplasia was found. Patient was started on Eplerenone, on follow up, his BP findings are significantly improved, number of BP meds are also decreased. Conclusion: Diagnosis of PA provides clinicians with unique opportunity to cure or effectively improve hypertension and hypokalaemia, as well as to prevent potential target organ damage and complications. That’s why the importance of increased awareness and having high clinical suspicion cannot be understated. Presentation: 6/3/2024

Predictors of the development of abnormal patterns of circadian blood pressure rhythm in patients with hypertension after a new coronavirus infection

Objective. To determine the predictors of the development of abnormal patterns of circadian blood pressure (BP) rhythm in patients with arterial hypertension (AH) after a new coronavirus infection (NСVI). Materials and methods. The study is a comparative clinical research of the same patients with hypertension before and after NCVI with retrospective evaluation of the data. Within 2 years from 842 patients with cardiovascular risk factors, according to the inclusion and non-inclusion criteria 70 patients with target levels of office BP, home monitoring and 24-hour blood pressure monitoring (ABPM) on the background of a continuous antihypertensive therapy were included in the study. Abnormal patterns of circadian BP were recorded after NCVI during ABPM in all of them. All patients with hypertension underwent a complete examination before and after NCVI. Results. After NCVI in patients with AH who had achieved the target ranges of office BP before its development, at home measurement and ABPM against the background of continuous antihypertensive therapy with high adherence to treatment, in more than 50 % of patients BP readings were not in the target values, in more than 50 % of the examined patients, BP variability was higher than the permissible values, in 73 % of patients the average daily BP was above 53 mm Hg. Abnormal patterns of circadian BP rhythm in patients with hypertension after NCVI were detected in 61.5 %: "Non-dipper" in 28.6 %; "Night-dipper" – in 21.9 %, masked nocturnal hypertension – in 17.1 %. Conclusion. The indicative significance of the development of abnormal patterns of circadian BP rhythm in patients with hypertension after NCVI was demonstrated by 3 qualitative indicators: glomerular filtration rate with cystatin C 60 ml/min/1.73 m2, cardio-ankle vascular index (CAVI) ≥ 9, and a high frequency of AGT gene polymorphism – T/T genotype (in 54.3 % of patients).

A sub-study of the POISE-3 randomized trial examined effects of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of acute kidney injury

In this pre-specified sub-study of the POISE-3 trial, we examined the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of postoperative acute kidney injury (AKI). Altogether, 7307 patients were included from 110 hospitals in 22 countries. Patients were 45 years and older, had or were at risk of atherosclerotic disease, took at least one antihypertensive medication, and were scheduled for noncardiac surgery. Hypotension-avoidance strategy: (i) target intraoperative mean arterial pressure (MAP) 80 mmHg or over, (ii) on day of surgery and for two days after, hold renin-angiotensin-aldosterone system inhibitors and use other antihypertensives in stepwise fashion if systolic blood pressure (SBP) 130 mmHg or more. Hypertension-avoidance strategy: (i) target intraoperative MAP 60 mmHg or more, (ii) continue all antihypertensives before and after surgery. Primary outcome: postoperative AKI, an increase in serum creatinine concentration of either 26.5 μmol/L or more (0.3 mg/dL or more) within 48 hours of randomization or 50% or more within seven days of randomization. The hypotension-avoidance group (3654 patients) used fewer antihypertensive medications than the hypertension-avoidance group (3653 patients); specifically, 6% vs. 38% used an ACEI or ARB on the day of surgery, and 6% vs. 47% and 7% vs. 50% one and two days after surgery, respectively. Patients also spent about half as much intraoperative time with a MAP under 80 mmHg (27 vs. 60 minutes, respectively), but had little difference in average BP before or after surgery. There was no significant difference in AKI risk (15.1% vs. 14.4%). Results were consistent with other definitions of AKI and in patients with preexisting chronic kidney disease. Thus, a hypotension-avoidance strategy targeting a MAP greater than 80 mmHg in the operating room and discontinued blood pressure medication during the perioperative period did not confer a lower risk of AKI compared to a hypertension avoidance strategy. Clinical trial registration number: NCT03505723.

De Novo Atherosclerotic Renal Artery Stenosis Covered Stent Treatment for Resistant Hypertension (ARTISAN) Results

BackgroundAtherosclerotic renal artery stenosis (ARAS) may provoke hypertension and/or impaired kidney function. Some patients develop uncontrolled hypertension and deteriorating kidney function despite optimal medical therapy. In these patients, endovascular treatment is an important therapeutic option. ARTISAN was a prospective, open-label, single-arm, multicenter clinical trial to evaluate the safety and effectiveness of the iCast RX covered stent both functionally for reestablishing renal artery flow, and clinically for controlling resistant hypertension. MethodsPatients considered for enrollment had average systolic blood pressure (SBP) ≥155 mm Hg despite taking 3 antihypertensive medications. Prior to enrollment and covered stent placement, angiographic confirmation of ARAS ≥80% with physiologic significance was required. Clinical assessments were performed at 30 days, 9 months, and annually through 36 months. Covered stent safety and efficacy were based on 9-month coprimary end points, including primary vessel patency and SBP improvement at 9 months. Secondary outcomes included target lesion revascularization, major adverse events, and secondary patency. ResultsSixty-eight of the planned 138 subjects were enrolled. Primary patency was seen in 94.3% of subject lesions; the mean SBP reduction was 15.7 mm Hg. The functional and clinical end points met prespecified performance goals of 70% primary patency (P < .0001) and ≥10 mm Hg SBP decrease (P = .0192), respectively, at 9 months. Six subjects (8.8%) experienced 7 major adverse events within 36 months. The clinically driven target lesion revascularization rate was 7.3% at 36 months. ConclusionsThe high primary patency and improvement in SBP, persisting through 36 months, suggest that the iCast RX covered stent is safe and effective for the treatment of appropriately selected patients with ARAS.

Findings of Hypotension in Spinal Anesthesia Patients with Lumbar 3-4 And Lumbar 4-5

Background: Hypotension is a common complication associated with spinal anesthesia, often resulting from sympathetic nerve block. Factors such as the type of drug, patient positioning, injection site, dosage, and age influence the incidence of hypotension. Purpose: This study aimed to evaluate the incidence of hypotension in patients receiving spinal anesthesia at the lumbar 3-4 (L3-L4) and lumbar 4-5 (L4-L5) injection sites. Methods: A quantitative descriptive study with a cross-sectional approach was conducted, involving 190 respondents selected via purposive sampling. Univariate data analysis was performed. Findings: Findings indicated that patients receiving spinal anesthesia at the L3-L4 site experienced an average systolic blood pressure decrease of 24.69% and a diastolic decrease of 16.17%. In contrast, patients with L4-L5 injections showed a lesser reduction, with systolic pressure dropping by 15.51% and diastolic pressure by 12.31%. Additionally, the pulse rate decreased progressively within the first 20 minutes following induction. The average pulse rate at the 20th minute was 75.06 for patients with L3-L4 injections and 75.65 for those with L4-L5 injections. Conclusion: The study highlights that the incidence of hypotension varies based on the spinal injection site, with more significant decreases in blood pressure observed in patients receiving injections at L3-L4 compared to L4-L5. These findings have important implications for anesthesia management in clinical practice.

Effects of Oral Butyrate on Blood Pressure in Patients With Hypertension: A Randomized, Placebo-Controlled Trial.

The microbiota-derived short chain fatty acid butyrate has been shown to lower blood pressure (BP) in rodent studies. Nonetheless, the net effect of butyrate on hypertension in humans remains uncovered. In this study, for the first time, we aimed to determine the effect of oral butyrate on BP in patients with hypertension. We performed a double-blind randomized placebo-controlled trial including 23 patients with hypertension. Antihypertensive medication was discontinued for the duration of the study with a washout period of 4 weeks before starting the intervention. Participants received daily oral capsules containing either sodium butyrate or placebo with an equivalent dosage of sodium chloride for 4 weeks. The primary outcome was daytime 24-hour systolic BP. Differences between groups over time were assessed using linear mixed models (group-by-time interaction). Study participants (59.0±3.7 years; 56.5% female) had an average baseline office systolic BP of 143.5±14.6 mm Hg and diastolic BP of 93.0±8.3 mm Hg. Daytime 24-hour systolic and diastolic BP significantly increased over the intervention period in the butyrate compared with the placebo group, with an increase of +9.63 (95% CI, 2.02-17.20) mm Hg in daytime 24-hour systolic BP and +5.08 (95% CI, 1.34-8.78) mm Hg in diastolic BP over 4 weeks. Butyrate levels significantly increased in plasma, but not in feces, upon butyrate intake, underscoring its absorption. Four-week treatment with oral butyrate increased daytime systolic and diastolic BP in subjects with hypertension. Our findings implicate that butyrate does not have beneficial effects on human hypertension, which warrants caution in future butyrate intervention studies. URL: https://onderzoekmetmensen.nl/; Unique identifier: NL8924.

CLINICAL OUTCOMES OF MONO-THERAPY VERSUS DUAL ANTIHYPERTENSIVE THERAPY IN PATIENTS PRESENTING AT TEHSIL HOSPITAL IN PAKISTAN

Hypertension, a prevalent and potentially life-threatening condition, remains a significant public health concern in Pakistan. This article aims to investigate and compare the clinical outcomes of antihypertensive monotherapy versus combination therapy in patients treated at Tehsil Hospital, a critical healthcare facility in the Tehsil region of Pakistan. Objective: To assess and compare the clinical outcomes of hypertensive patients treated with monotherapy and those receiving a combination of antihypertensive medications at Tehsil Hospital, Pakistan. Methods: The study was carried out at Tehsil Hospital, Punjab-Pakistan. All adult participants (30 ≥ and ≤70 years) who were on antihypertensive medicine for at least 6 weeks and were diagnosed as hypertensive (average blood pressure of &gt;140/90 mm Hg on at least two clinic visits) were included in the study from April 11 to June 20, 2022. The data was analyzed by SPSS 20. Statistical tests like chi-square were applied to obtain the required results. Results: A total of 136 study subjects were enrolled. Out of these, 113(81%) were male subjects, 23(17%) were female, 12(17.6%) smokers, and patients suffering from chronic liver disease were as 26(38.2%) treated with mono-therapy as compared with dual therapy with significant p-value 0.00 and 0.001. Other co-morbidities like the previous history of IHD, DM, and chronic kidney disease were treated with both therapies with insignificant p-values as &gt; 0.05. Clinical outcomes were observed, and it was shown that more patients with stroke were treated with mono-therapy as p-value &gt; 0.05 while comparing with major bleeding and control of hypertension showed a significant p-value of &lt;0.05. Conclusion: Treatments in combination are effective and advised. The most important element in the management of hypertension, irrespective of whether medication is utilized, the goal is to get blood pressure down to the desired amount. Effective communication is essential for doctors, other healthcare professionals, and patients to treat patients.

Analysis of the Effect of Hypertension Gymnastics on Lowering Blood Pressure in Hypertension Patients in the Tapunggaya Health Center Work Area

Introduction: WHO states that hypertension has attacked 22% of the world's population. While the number of hypertension in Southeast Sulawesi itself reached 26.53% or 314,454. One of the non-pharmacological treatments for hypertension is hypertension exercise and the DASH Diet (Dietary Approaches to Stop Hypertension) is a diet pattern aimed at lowering blood pressure by limiting salt intake, saturated fat, and increasing food intake that contains a lot of potassium, calcium, magnesium and high-fiber foods. This study is to analyze the Effect of Hypertension Exercise on Lowering Blood Pressure in Hypertension Patients in the Tapunggaya Health Center Work Area. Method: This type of research is quantitative with an experimental approach with a pretest-posttest design. The research sample was 284 people using a simple random sampling technique. The data collection tool used a blood measurement observation sheet. The statistical test used was the Paired Sample T-Test. Result: Obtained Results before hypertension exercise treatment on decreasing systolic blood pressure average 148 after treatment average blood pressure 134 mmHg. And the results before treatment diastolic blood pressure average 91 and 96 mmHg after treatment average mmHg. Based on the T-test obtained (P value = 0.00 with alpha &lt;0.05). It can be concluded that there is a significant effect between hypertension exercise on decreasing blood pressure. Conclusion: There is an effect of hypertension exercise therapy to lower blood pressure in hypertension sufferers. It is expected that hypertension sufferers can continue hypertension exercise to lower blood pressure.

Impact of Systolic and Diastolic Blood Pressure on Cardiovascular Health Outcomes

Background: One well-known risk factor for cardiovascular (CV) disease that significantly raises morbidity and mortality rates globally is hypertension. Optimising treatment options requires an understanding of the distinct effects of diastolic and systolic blood pressure on CV outcomes. The study aims to examine into how the effects of both systolic hypertension (SH) and diastolic hypertension (DH) affected the frequency of major CV events, such as hemorrhagic, ischemic, and myocardial infarction (MI). Methods: A retrospective cohort research comprising 180 patients was carried out, with automated oscillometric cuffs being used to measure blood pressure. The burdens of SH and DH, which were determined as continuous variables from weighted average blood pressure, were the main predictors. A composite of ischemic stroke, MI, or hemorrhagic stroke was the main result. Logistic regression and bivariate and multivariable Cox survival analyses were included in the statistical studies. Results: The study population had average age of 65.4 years, with 52% males and 48% females. During the observation period, 45 composite outcome events occurred (25% incidence rate). Bivariate Cox analysis showed significant associations between SH burden (HR: 1.45, p&lt;0.001) and diastolic hypertension burden (HR: 1.30, p=0.015) with the composite outcome. Multivariable analysis confirmed these associations, with consistent findings in logistic regression models. Conclusion: Both SH and DH burdens are significant predictors of adverse CV outcomes. Effective management of both blood pressure components is essential for reducing the risk of ischemic stroke, MI, and hemorrhagic stroke. Recommendations: To lower the risk of significant CV events, clinicians should monitor and treat both systolic and diastolic blood pressure in individuals with hypertension. Subsequent studies ought to investigate the underlying mechanisms of these correlations and assess the effectiveness of focused interventions. Keywords: Hypertension, Cardiovascular Outcomes, Diastolic Blood Pressure, Systolic Blood Pressure.

Optimal blood pressure control with fewer antihypertensive medications: Achieved mostly in low-risk hypertensive patients.

Recent studies indicate that intensive blood pressure (BP) targets can be reached with less than two medications. This cross-sectional study, involving 4991 individuals from the Majiapu community, assessed the correlation between BP control and the burden of antihypertensive drugs. Participants on medication were categorized into controlled (BP<140/90mm Hg) and uncontrolled (BP≥140/90mm Hg) groups, with the former further divided into optimal (BP<130/80mm Hg) and good control (BP<140/90 but >130/80mm Hg) subgroups. Multivariate logistic regression analyzed factors affecting hypertension control across these BP categories. The study found that, 54% of participants had hypertension. Of those treated (62.5%), 55.7% achieved BP control, including 23.15% maintaining BP below 130/80mm Hg. The average number of antihypertensive medications was 1.61 for the controlled group (with an average BP of 126.6/76mm Hg) and 1.75 for the uncontrolled group (with an average BP of 150.6/84.0mm Hg). Additionally, the average number of antihypertensive medications was 1.66 in the good control group and 1.55 in the optimal control group. The uncontrolled group had a higher mean systematic coronary risk estimation (SCORE) of 5.59, against 3.97 and 2.5 in the good and optimal control groups, respectively. Key factors linked to poor BP control included age over 65, male sex, obesity, and former smoking, whereas lipid-lowering medication use was associated with better control. In conclusions, patients needing fewer antihypertensive drugs to achieve stricter targets may have a lower risk profile. Notably, only a small proportion of treated patients are low-risk individuals who can easily achieve BP levels below 130/80mm Hg.

Hypertension and its correlation with autonomic nervous system dysfunction, heart rate variability and chronic inflammation

Objective This study investigates the relationship between hypertension, dysregulation of the autonomic nervous system, heart rate variability (HRV), and chronic inflammation. Methods We analysed a cohort of 50 hypertensive patients treated at the affiliated Hospital of Jianghan University. The average systolic and diastolic blood pressures (BPs) in this group were 155.26 and 95.32 mmHg, respectively. A control group of 50 healthy volunteers, undergoing routine physical examinations at the same hospital, was also analysed. Results The average systolic BP of the control group was 115.64 ± 10.27 mmHg, and the average diastolic BP was 75.33 ± 8.25 mmHg. In contrast, the experimental group exhibited an average systolic BP of 155.26 ± 20.13 mmHg and an average diastolic BP of 95.32 ± 12.16 mmHg. Both systolic and diastolic BPs were significantly higher in the hypertensive group (p < 0.05). The experimental group also demonstrated reduced HRV and skin conductance response, alongside increased BP variability (BPV), urinary epinephrine levels and prolonged pupillary light reaction time compared to controls (p < 0.05). Notably, Standard Deviation of Normal to Normal Intervals (SDNN) and Root Mean Square of Successive Differences (RMSSD) values were significantly lower in the experimental group (p < 0.05). Furthermore, levels of inflammatory markers such as CRP, TNF-α, IL-6 and IL-1β were markedly elevated in hypertensive patients (p < 0.05). Negative correlations were observed between systolic and diastolic BP with HRV metrics, while positive correlations were found between BP and BPV as well as urinary adrenaline levels. Conclusions The findings indicate that hypertension is closely associated with autonomic nervous system dysfunction, reduced HRV and increased chronic inflammation. A comprehensive approach to hypertension management should integrate these interrelated physiological and pathological mechanisms, with potential therapeutic interventions targeting autonomic function and inflammatory states.

Increased lipoprotein (a) as an additional factor in the failure to achieve target blood pressure levels and lipid spectrum optimal parameters in patients with arterial hypertension and multifocal atherosclerosis

Aim. To establish the frequency of achieving target of blood pressure (BP) levels and lipid spectrum parameters (LS) in patients with arterial hypertension (AH) and multifocal atherosclerotic lesion (MFAL) with normal and elevated levels of lipoprotein (a) (Lp(a)) in real clinical practice.Material and methods. The study included 110 patients with AH and MFAL, median age was 59.0 (51.0; 64.3) years. Depending on the level of Lp(a), all patients were divided into 2 groups: group 1 — 72 patients (65.5%), Lp(a) level was ≤50 mg/dl (13.2 (3.7; 21.1)), group 2 — 38 patients (34.5%) Lp(a) level was &gt;50 mg/dl (89.5 (62.5; 110.0)). The diagnosis of MFAL included damage to two or more arterial basins according to carotid artery, abdominal aorta and lower extremities arteries duplex scan. Patients of both groups received antihypertensive, lipid-lowering, and antiplatelet therapy.Results. Patients in groups 1 and 2 showed similar blood pressure levels and frequency of antihypertensive therapy use. In both groups, the majority of patients were on a free combination of antihypertensive drugs, only a third of patients used a fixed combination. In most cases, patients of both groups did not reach the target blood pressure levels (63.9% — group 1, 55.3% — group 2), despite the fact that the average blood pressure figures were relatively low (132;83 mmHg in each group). Drug control was also unsatisfactory in both groups, regardless of the level of Lp(a). However, all drug indicators were significantly worse in group 2, despite comparable lipid-lowering therapy, which more often included statin monotherapy. Combination therapy with lipid-lowering drugs was used in patients of groups 1 and 2 only in 20.8% and 10.5%, respectively. Parameters of low-grade inflammation high-sensitivity C-reactive protein and interleukin-6 did not differ between the groups and did not exceed the reference values.Conclusion. An increased level of Lp(a) may be accompanied by drug disorders and increased BP in patients with MFAL. Due to the lack of effective Lp(a) reducing therapy, the prevention of cardiovascular events in such patients should focus on BP and lipid spectrum correction. The use of fixed combinations, including antihypertensive and lipid-lowering drugs, can lead to improved adherence to therapy, increased BP and LS control.

Effects of field activities by age of 119 emergency response team on the blood pressure, pulse, respiration, and quality of cardiopulmonary resuscitation

This study analyzed the physical changes according to age and the quality of cardiopulmonary resuscitation through experiments by 119 EMT in transporting equipment at the first aid site and performing post-cardiopulmonary resuscitation. In all ages, cardiopulmonary resuscitation was performed without physical load and CPR was performed after moving the equipment, first, the pulse was significantly increased, and the average pulse was measured higher than in other higher age groups under the age of 30. Second, respiratory changes were significantly increased, and average breathing was measured higher than in other higher age groups when CPR was performed after wearing personal protective equipment and moving the equipment. Third, as for changes in blood pressure, all blood pressure rose, and the average blood pressure in the 40s and older was measured higher than that of the younger age. Fourth, in the quality change of cardiopulmonary resuscitation, the pressure rate was found to have a statistically significant difference in those under 30, 30 to 34, and 35 to 39 years of age, and it was measured that the speed was maintained without change in those over 40. Finally, there was a statistically significant difference in pressure depth between those under 30 and those under 35-39 years old, and the average depth was measured deeper than other higher age groups, so it is necessary to develop differentiated education and training methods at those under 30 years of relatively little experience.

A Pilot Project to Implement a Pharmacist-Managed Remote Blood Pressure Monitoring Service

Background: Clinicians often hesitate to adjust antihypertensive medications based solely on clinic blood pressure (BP) readings. Limitations to obtaining home readings include access to sphygmomanometers and ability to provide accurate, reliable readings upon follow-up. Objective: This study examined whether an online platform linked to remote BP monitoring improved BP management and facilitated effective clinical interventions by pharmacists. Methods: Thirty patients with uncontrolled hypertension were enrolled and provided a remote BP monitor for home use. BP data downloaded to an online platform were monitored by two clinic pharmacists. Daily BP checks were requested (up to twice daily), and pharmacists called patients approximately weekly for 6 months. Through approved protocols, pharmacists individualized interventions to improve patient care. Descriptive statistics were used for demographic and clinical data. Results: The average systolic BP reduction was 39 mmHg (IQR = 17-52.5) for the 21 patients included in analysis. A target BP &lt;140/&lt;90 was achieved by 67%, and 76% had improved BP control. Patients utilized the cuff 2-4 times (n = 10) or &gt;5 times weekly (n = 11). Through 261 patient contact attempts, the pharmacists requested more BP checks (n = 62), changed medications (n = 57), or provided non-pharmacologic counseling (n = 24) most often. Medication changes commonly included dose increases (n = 35) and additional agents (n = 17) for BP control. Spironolactone (n = 5) and thiazide diuretics (n = 5) were the most added medications. Conclusions: Most patients were willing to check their BP when provided with devices. The majority achieved a clinically significant decrease in home BP readings, demonstrating that pharmacist-driven home-monitoring programs can improve the optimization of hypertension regimens.

Unattended versus conventional blood pressure measurements in hospitalized hypertensive patients.

This study aims to compare the differences between unattended and conventional blood pressure measurements in hospitalized hypertensive patients. In fall of 2019, hypertensive patients at Ruijin Hospital underwent two rounds of unattended and conventional (nurse-monitored) blood pressure measurement. Both rounds used the same electronic blood pressure monitor with measurements taken three times, 30 s apart. Comparison was made using intra-class correlation coefficients, Bland-Altman plots, paired t-tests, etc. Among the 92 subjects in the study, the median age was 50 years old, with women accounting for 33.7%. Among the subjects, the median duration of hypertension was 8.0 years. The prevalence of diabetes, coronary heart disease, and stroke were 26.1%, 5.4%, and 6.5%, respectively. Whether unattended or conventional measurements were taken first, the average blood pressure measured first was slightly higher than the one measured later, but the difference was within 1-2 mmHg. Except that the average DBP during the round of conventional blood pressure measurements was significantly reduced by 1.6 mmHg compared to the conventional DBP, there were no other significant differences. Subgroup analysis by age, gender, BMI, and diabetes showed no significant difference in blood pressure measurement results between unattended and conventional methods. No significant difference was observed between unattended and conventional methods of blood pressure measurement in hospitalized hypertensive patients. Unattended blood pressure measurement can be adopted as the current standard for blood pressure management in hospitalized patients.

Effect of perioperative management on early graft function in living donor paediatric kidney transplantation

Abstract Background Paediatric kidney transplantation has an increased risk of surgical and vascular complications, with intensive care monitoring required postoperatively. This study aimed to determine if perioperative management affects early graft function in living donor paediatric kidney transplantation. Methods Clinical data was extracted from the electronic medical record for living donor kidney transplants at two paediatric centres covering the state of New South Wales (NSW), Australia from 2009 to 2021. Estimated glomerular filtration rate (eGFR) of 7 days and 1-month post-transplant were calculated as measures of early graft function. Results Thirty-nine eligible patients (female n (%) 13 (33%)) with a median (IQR) age of 6 (3–9) years and pre-transplant eGFR of 7 (6–10) mL/min/1.73 m2 were analysed. Mean (SD) central venous pressure (CVP) after revascularisation was 11 (4) mmHg. Intraoperatively, mean volume of fluid administered was 84 (39) mL/kg, and 34 (87%) patients received vasoactive agents. Average systolic blood pressure (BP) in the first 24-h post-transplant was 117 (12) mmHg. Postoperatively, median volume of fluid administered in the first 24 h was 224 (159–313) mL/kg, and 17 (44%) patients received vasoactive agents. Median eGFR 7 days and 1-month post-transplant were 115 (79–148) and 103 (83–115) mL/min/1.73 m2, respectively. Linear regression analyses demonstrated that after adjusting for age, the average CVP after revascularisation and average systolic BP in the first 24-h post-transplant were not associated with eGFR in the first month post-transplant. Conclusions Targeted intraoperative and postoperative fluid and haemodynamic characteristics were achieved but did not correlate with early graft function. Graphical Abstract

Effectiveness of Acupressure Therapy in Reducing Blood Pressure Hypertension sufferers

Hypertension is a disease that causes complications in sufferers, thereby reducing the sufferer's quality of life. Increased blood pressure in hypertension sufferers can be controlled with pharmacological and non-pharmacological therapy, one of which is using acupressure therapy. This study aims to determine the effectiveness of providing acupressure therapy in reducing blood pressure for hypertension sufferers in the Bukit Raya Village Sub-district Health Center Work Area, East Lampung. This research design is quantitative analytical with a Quasi-Experimental approach using a one group pretest and posttest design. The results of the research conducted showed that the average systolic blood pressure before acupuncture therapy was 168 with a standard deviation of 26.943. After therapy the average blood pressure value decreased to 122 with a standard deviation of 3.535. Meanwhile, the average diastolic blood pressure before acupressure therapy was 103 with a standard deviation of 11.18. After therapy the average blood pressure value decreased to 71 with a standard deviation of 2.204. Seeing the effectiveness of acupressure therapy in lowering blood pressure in hypertensive patients, this therapy can be applied as a non-pharmacological treatment for patients who experience high blood pressure. Keywords: Acupressure, blood pressure, hypertension

Clinical correlates of medication adherence in individuals with bipolar disorder and comorbid hypertension.

Individuals with bipolar disorder (BD) have high rates of suboptimal medication adherence, medical illness, and premature mortality, largely from cardiovascular causes. This analysis examined the association between adherence to antihypertensive and BD medications and clinical symptoms in patients with BD and comorbid hypertension (HTN) from an ongoing trial to optimize adherence. Inclusion criteria were a BD diagnosis, treatment with antihypertensives, adherence challenges, and poorly controlled HTN. Adherence was measured via self-report using the Tablets Routine Questionnaire and using eCAP, an electronic pillcap which captures openings. Average systolic blood pressure (SBP) was calculated from 12 readings over 1week. The Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS) assessed BD symptoms. A total of 83 participants with BD and HTN were included. Adherence to BD and antihypertensive medications were positively correlated. eCAP openings showed more missed doses than self-reported antihypertensive adherence. BD medication adherence was positively correlated with BPRS at baseline; antihypertensive adherence was negatively correlated with SBP at screening. Antihypertensive adherence improved and SBP decreased between screening and baseline. Adherence levels fluctuated over time and differed based on measurement method in people with comorbid BD and HTN. Self-reported BD adherence was positively related to global psychiatric symptoms and antihypertensive adherence was related to better SBP control. Monitoring both medication and blood pressure led to change in self-reported adherence. BD symptom severity may indicate poor adherence in patients with BD and should be considered in treatment planning.