Blood Pressure Changes In Patients Research Articles

Late outcomes of renal denervation are more favourable than early ones: facts or fancies?

Following second-generation randomized trials, there is evidence that renal denervation (RDN) decreases blood pressure (BP), although to a lesser extent than suggested in the initial controlled and observational studies. The recent publication of the 36-month follow-up of the Symplicity HTN-3 trial has raised expectations, suggesting increasing, late benefits of the procedure, despite initially negative results. These findings come after those obtained at 36months in the sham-controlled trial SPYRAL HTN-ON MED and in the Global Symplicity Registry. However, they are susceptible to biases inherent in observational studies (after unblinding for sham-control) and non-random, substantial attrition of treatment groups at 36 months, and used interpolation of missing BPs. More importantly, in SPYRAL HTN-ON MED and Symplicity HTN-3, long-term BP changes in patients from the initial RDN group were compared with those in a heterogeneous control group, including both control patients who did not benefit from RDN and patients who eventually crossed over to RDN. In crossover patients, the last BP before RDN was imputed to subsequent follow-up. In Symplicity HTN-3, this particular approach led to the claim of increasing long-term benefits of RDN. However, comparison of BP changes in patients from the RDN group and control patients who did not undergo RDN, without imputation of BPs from crossover patients, does not support this view. The good news is that despite the suggestion of sympathetic nerve regrowth after RDN in some animal models, there is no strong signal in favour of a decreasing effect of RDN over time, up to 24 or even 36months. Still, current data do not support a long-term increase in the effect of RDN and the durability of RDN-related BP reduction remains to be formally demonstrated.

Gender peculiarities of blood pressure changes in patients with arterial hypertension and different biorhythms

Background. It is known that the risk of cardiovascular diseases, especially in conditions of increased rhythm of life, psycho-emotional stress, social cataclysms, is associated with various biorhythms, therefore, the study of the influence of various factors on the course of hypertension, taking into account the patient's chronotype, remains relevant. Aim of the study was to analyze the level of blood pressure in patients with arterial hypertension with different chronotypes of the female and male genders. Materials & Methods. The study included 42 patients with diagnosed essential arterial hypertension who were receiving inpatient treatment. The inclusion criterion was patients with arterial hypertension of the 2nd degree. Measurements of Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) (mmHg) were performed using the Korotkoff method. To study the chronotype, we used the validated questionnaire "Composite Scale of Morningness" and scales from official available sources. Results & Conclusions. Arterial hypertension was diagnosed in 33.33% of patients with the evening chronotype, 7.17% with the morning chronotype, and 59.53% with the intermediate chronotype. Taking into account gender, female patients with evening and morning chronotypes and male patients with an intermediate chronotype predominated. Patients with evening chronotype compared to patients with intermediate and morning chronotypes had significantly higher Body Mass Index (BMI) (by 62.69% and 40.33%), disease duration (by 42.68% and 6.23%) and SBP (by 8.21% and 12.21%), respectively. At the same time, BMI in patients with arterial hypertension with an evening chronotype was as close as possible to obesity. The obtained results can be used in the practical work of nurses for the prevention of arterial hypertension by adjusting the duration of sleep and wakefulness and the diet. Keywords: chronotype, gender, age, body mass index, relationships.

JS-HR-2: HYPERTENSION MANAGEMENT IN CKD: UPDATE FOR BETTER CARDIO-RENAL OUTCOMES

Hypertension in CKD patients is a risk factor for end-stage renal disease, cardiovascular events, and mortality. Thus, the prevention and appropriate management of hypertension in these patients are essential strategies for better cardio-renal outcomes. Recently, novel risk factors for hypertension have been reported. Circulating fibroblast growth factor 21, an endocrine hormone mainly secreted by the liver, is associated with elevated blood pressure (BP) and/or aortic stiffness with renal dysfunction. Furthermore, several promising prognostic markers for cardio-renal outcomes have been suggested. A higher urinary sodium-to-potassium ratio was independently associated with poor renal outcomes in CKD patients. Higher albumin-to-creatinine ratios significantly increased the risk of first stroke or first ischemic stroke. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) and mineralocorticoid receptor (MR) blockers are promising treatment options for better cardio-renal outcomes. The clinical use of SGLT2is has recently expanded to non-diabetic patients with CKD and heart failure as well as diabetic patients. SGLT2is have an antihypertensive effect, and the degree of BP change in patients undergoing SGLT2i therapy depends on the baseline BP; a larger reduction is observed in patients with higher baseline BP, and a minor reduction or slight increase is observed in patients with lower baseline BP. These BP regulation mechanisms may partially depend on body fluid homeostasis by SGLT2is. SGLT2is ameliorate fluid retention through osmotic diuresis and natriuresis, but are also associated with a low rate of hypovolemia, which is evident by the compensatory upregulation of renin and vasopressin levels. These fluid homeostatic mechanisms exerted by SGLT2is may contribute to the stabilization of BP and better cardio-renal outcomes. MR blockers are used in the treatment of essential hypertension and hyperaldosteronism. Recently, a new MR antagonist, finerenone, has been launched as a treatment for CKD with type 2 diabetes. In the FIDELIO-DKD study, finerenone significantly reduced the risk of kidney and cardiovascular events in CKD and type 2 diabetes.

Effects of cinepazide maleate injection on blood pressure in patients with acute ischemic stroke and hypertension

Objective: To investigate the blood pressure change in patients with acute ischemic stroke (AIS) and hypertension treated with cinepazide maleate injection. Methods: This was a subgroup analysis of post-marketing clinical confirmation study of cinepazide maleate injection for acute ischemic stroke: a randomized, double-blinded, multicenter, placebo-parallel controlled trial, which conducted in China from August 2016 to February 2019. Eligible patients fulfilled the inclusive criteria of acute anterior circulation ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 7-25. The primary endpoints were mean blood pressure of AIS patients treated with cinepazide maleate or control, which were assessed during the treatment period (14 days), and the proportion of the patients with normal blood pressure was analyzed after the treatment period. Furthermore, a subgroup analysis was performed to investigate a possible effect of the history of hypertension on outcomes. Results: This analysis included 809 patients with hypertension. There was no significant difference in patients blood pressure and the proportion of patients with normal blood pressure (60.5% vs. 59.0%,P>0.05) between cinepazide maleate group and control group. Conclusion: Administration of cinepazide maleate injection does not affect the management of clinical blood pressure in patients with AIS.

Blood Pressure Load: An Effective Indicator of Systemic Circulation Status in Individuals With Acute Altitude Sickness.

Background: Acute high altitude (HA) exposure results in blood pressure (BP) variations in most subjects. Previous studies have demonstrated that higher BP is potentially correlated with acute mountain sickness (AMS). The BP load may be of clinical significance regarding systemic circulation status.Objectives: This study aimed to examine HA-induced BP changes in patients with AMS compared to those in healthy subjects. Further, we provided clinical information about the relationship between variations in 24-h ambulatory parameters (BP level, BP variability, and BP load) and AMS.Methods: Sixty-nine subjects were enrolled and all participants ascended Litang (4,100 m above sea level). They were monitored using a 24-h ambulatory blood pressure device and underwent echocardiography within 24 h of altitude exposure. The 2018 Lake Louise questionnaire was used to evaluate AMS.Results: The AMS group comprised more women than men [15 (65.2%) vs. 13 (28.3%), P < 0.001] and fewer smokers [4 (17.4%) vs. 23 (50.0%), P = 0.009]. The AMS group exhibited significant increases in 24-h BP compared to the non-AMS group (24-h SBP variation: 10.52 ± 6.48 vs. 6.03 ± 9.27 mmHg, P = 0.041; 24-h DBP variation: 8.70 ± 4.57 vs. 5.03 ± 4.98 mmHg, P = 0.004). The variation of mean 24-h cBPL (cumulative BP load) (mean 24-h cSBPL: 10.58 ± 10.99 vs. 4.02 ± 10.58, P = 0.016; 24-h mean cDBPL: 6.03 ± 5.87 vs. 2.89 ± 4.99, P = 0.034) was also obviously higher in AMS subjects than in non-AMS subjects after HA exposure. 24-h mean cSBPL variation (OR = 1.07, P = 0.024) and 24-h mean cDBPL variation (OR = 1.14, P = 0.034) were independent risk factors of AMS. Moreover, variation of 24-h mean cSBPL showed a good correlation with AMS score (R = 0.504, P < 0.001).Conclusions: Our study demonstrated that patients with AMS had higher BP and BP load changes after altitude exposure than healthy subjects. Excessive BP load variations were associated with AMS. Thus, BP load could be an effective indicator regarding systemic circulation status of AMS.

The relationship between sarcopenia and central hemodynamics in older adults with falls: a cross-sectional study.

Falls are an important cause of morbidity and mortality in geriatric patients. Sarcopenia and central blood pressure may be associated with falls. This study aimed to investigate the association between sarcopenia and blood pressure parameters in older patients with falls. A comprehensive geriatric evaluation of 72 elderly patients was performed using established assessment tests. Peripheral and central hemodynamic measurements, including office DBP and SBP, daytime-night peripheral and central DBP and SBP, cardiac output, augmentation index, pulse wave velocity (PWV), pulse rate, and peripheral resistance and reflection, were measured with a 24-hour ambulatory blood pressure measuring device. Of 72 patients with a mean age of 77.51 ± 6.5 years, 12 (16.7%) were non-sarcopenic, 32 (44.4%) were probable, nine (12.5%) were confirmed, and 19 (26.4%) were severe sarcopenic. PWV, which is an indicator of arterial stiffness, was found to be significantly higher in the sarcopenic group. The other cardiac risk markers [daytime peripheral SBP, mean arterial pressure (night), pulse pressure (daytime), and peripheral resistance (daytime and night)] were significantly lower in the sarcopenic patients. PWV correlated with gait speed, Katz score, and hand grip strength (Spearman's rho: -0.337, -0.310, and -0.334; P < 0.001, 0.008, and 0.001, respectively). Age and hypertension were the most important factors increasing the risk of falls. Sarcopenia is associated with central and peripheral blood pressure changes in patients with falls. When sarcopenia is diagnosed in older people with falls, 24-hour ambulatory peripheral and central pressures should be evaluated for cardiac risk screening.

Patterns of blood pressure changes in patients with head and neck cancer receiving radiotherapy or chemo-radiotherapy at a tertiary cancer centre.

To evaluate patterns of blood pressure (BP) changes in patients with head and neck cancer (HNC) receiving radiation (RT)/chemo-radiation (CRT) METHODS: This study included data collection, compilation, and analysis of 451 consecutive HNC patients who underwent RT/CRT. Out of 451 patients, 376 (82%) were male and 75 (18%) were female with a median age of 52 years. Patients receiving 3DCRT experienced greater fall in BP, including for SBP and MAP, compared to those receiving IMRT-IGRT. Female patients experienced greater fall in diastolic BP as compared to male patients (p: 0.03). At the end of treatment, we observed a significant association between a fall in systolic BP (decrease by 10% of baseline) and weight loss of more than 10% of baseline weight (p: 0.03). Fall in BP during RT/CRT is significantly affected by treatment technique and sex and is strongly associated with significant weight loss.

The Effect of Autogenic Relaxation on Blood Pressure Changes in Patients with Hypertension: Literature Review

Hypertension is still the number one killer disease in Indonesia. Approximately one billion people worldwide suffer from this disease. Hypertension can be treated with pharmacological and non-pharmacological treatments. One of the non-pharmacological treatments is autogenic relaxation. This study aims to determine the effect of autogenic relaxation on hypertensive blood pressure changes. This study uses a Systematic Literature Review, a synthesis of systemic, precise, comprehensive literature studies by identifying, analyzing, evaluating through collecting existing data with an explicit search method and involving a critical review process in selecting the studies. The data from 11 journals were obtained from screening a number of journals from Science Direct, and Google Scholar. The results of the analysis showed that there was an effect of autogenic relaxation on blood pressure in hypertensive patients. Autogenic relaxation can benefit changes in blood pressure in hypertensive patients and is suitable if done regularly.

Anthropometric and blood pressure changes in patients with or without nutritional counselling during cardiac rehabilitation: a retrospective study.

Whether a patient's outcomes are better when receiving nutritional counselling during cardiac rehabilitation (CR) has been scarcely described. We compared changes in weight, waist circumference (WC) and blood pressure (BP) in patients attending CR with and without nutritional counselling. A retrospective analytical study was conducted in which two groups of patients who completed a phase II CR (36 sessions) were compared: CONTROL [n=144, mean (SD) age=59(12)years, 17% females], comprising patients without nutritional counselling (attended between 2003 and 2009), and NUT [n=128, mean (SD) age=60(13)years, 27% females], comprising patients with dietitian-delivered nutritional counselling (attended between 2010 and 2019). Repeated-measures analysis of variance was used to compare changes in weight, WC, and BP during CR between groups. Logistic regression models determined the probability of reducing weight and systolic BP (SBP). NUT group decreased weight [-1.3(3.1)kg; P<0.0001] and WC [-3.0(3.8)cm; P<0.0001] to a greater extent than CONTROL [weight: -0.4(3.1)kg; P=0.51; WC: -1.4(4.5)cm; P=0.02]. In CONTROL, 7% reduced≥5% weight and 31% reduced≥10mmHg SBP, whereas, in the NUT group, 18% reduced≥5% weight and 47% reduced≥10mmHg SBP. Patients in NUT (versus CONTROL) were more likely to lose≥5% of weight (odds ratio=4.27, 95% confidence interval=1.69-10.80; P<0.01) and reduce SBP≥10mmHg (odds ratio=3.15, 95% confidence interval=1.58-6.27; P<0.01). Patients who received nutritional counselling during CR improved anthropometric measures and were more likely to lose weight and reduce SBP than patients without nutritional counselling.

Real-Time Cuffless Continuous Blood Pressure Estimation Using Deep Learning Model.

Blood pressure monitoring is one avenue to monitor people’s health conditions. Early detection of abnormal blood pressure can help patients to get early treatment and reduce mortality associated with cardiovascular diseases. Therefore, it is very valuable to have a mechanism to perform real-time monitoring for blood pressure changes in patients. In this paper, we propose deep learning regression models using an electrocardiogram (ECG) and photoplethysmogram (PPG) for the real-time estimation of systolic blood pressure (SBP) and diastolic blood pressure (DBP) values. We use a bidirectional layer of long short-term memory (LSTM) as the first layer and add a residual connection inside each of the following layers of the LSTMs. We also perform experiments to compare the performance between the traditional machine learning methods, another existing deep learning model, and the proposed deep learning models using the dataset of Physionet’s multiparameter intelligent monitoring in intensive care II (MIMIC II) as the source of ECG and PPG signals as well as the arterial blood pressure (ABP) signal. The results show that the proposed model outperforms the existing methods and is able to achieve accurate estimation which is promising in order to be applied in clinical practice effectively.

Gambaran Perubahan Tekanan Darah Pada Pasien Gagal Ginjal Kronik Yang Menjalani Terapi Hemodialisis Di Ruang Hemodialisa Rumah Sakit TK. II Pelamonia Makassar

Background: The kidneys have a very important role in maintaining a healthy body. The kidneys experience acute renal failure when the kidney cannot function suddenly. Without kidney replacement therapy, deaths from metabolic disorders can occur quickly. One kidney replacement therapy can be done is hemodialysis. Although hemodialysis is safe and beneficial for patients, it does not mean without side effects. Various complications can occur when patients undergo hemodialysis one of which is intradialisis hypertension. This complication can lead to new, more complex problems, including discomfort, increasing stress affecting the quality of life, worsening the patient's condition and even causing death. Objective To determine the description of blood pressure changes in patients with chronic renal failure undergoing hemodialysis therapy in the Hemodialysis room at TK II Pelamonia Hospital Makassar. Methods: This study used a descriptive survey method with a case study approach. Results: Research shows that patients undergoing hemodialysis therapy experience changes in blood pressure in pre and post hemodialysis. Conclusion: There is an effect of hemodialysis on changes in blood pressure in patients with kidney failure in the Hemodialysis Room of TK. II Pelamonia Hospital Makassar.

The Effect of Garlic Capsule on the Prevention of Preeclampsia in High-risk Turkmen Pregnant Women

ObjectivesThe current study aimed at evaluating the efficacy of garlic capsules in reducing the risk of preeclampsia in high-risk Turkmen pregnant women in Golestan Province, Iran.MethodsThe current double-blind, randomized, clinical trial was performed in Islamic Azad University, Pharmaceutical Sciences Branch and health centers of Golestan Province. Primigravid pregnant women who were high-risk for preeclampsia, with a first-degree family history of preeclampsia, were enrolled in the study. A total of 112 participants were randomly allocated into the groups receiving either garlic capsules (800 mg/day) or placebo for two months (from 28th to 36th weeks of gestation) and the outcomes between the two groups were compared during the study. Pregnancy outcomes included high systolic and diastolic blood pressures, increased level of fasting blood sugar, and weight gain. The outcomes were measured at three time points: at the beginning of the study, as well as one and two months after the intervention.ResultsUsing repeated measurement analysis, no significant different was found between the two garlic and placebo groups in terms of changes in the systolic blood pressure, one and two months after the intervention (P > 0.05). There was also no significant difference between the two groups over the follow-up period in terms of the diastolic blood pressure (P = 0.602).ConclusionsIt seems that administration of garlic capsules during the pregnancy had no effect on the systolic and diastolic blood pressure changes in patients with a positive family history of preeclampsia.

Blood presure variability in patients with obstructive sleep apnea syndrome and heart failure with preserved ejection fraction.

The aim of the study was to investigate the features of daily blood pressure changes in patients with obstructive sleep apnea syndrome (OSAS) and heart failure with preserved ejection fraction based on the data of daily blood pressure monitoring. Materials and methods. 86 patients with OSAS and HFpEF (group 1), 74 patients with HFpEF without OSAS (2nd group) and 52 patients with OSAS and without HF (group 3) were examined. All participants of the study underwent cardio-respiratory monitoring, ABPM, echocardiography, NT-proBNP. Results. SABP and DABP in patients with HFpEF and OSAS were generally higher in the day and night than in comparison groups. "Non-dipper" dominated among the pathological daily profiles. As results of the multivariate regression analysis, it was found that the level of SABP at night was determined by IAH (β=0,386, p&lt;0,05) and MeanSaO2 (β=0,339, p&lt;0,05). The DABP level at night was determined by the IAH (β=0.412, p&lt;0.05). Conclusions. Patients with OSAS and HFpEF have insufficient reduction in blood pressure at night and greater variability of blood pressure overnight. With the increase of OSAS severity more often daily profiles "non-dipper" and "night-peaker" are recorded, the variability of blood pressure increases. When performing a multivariate regression analysis, it was found that the level of SABP at night was determined by IAH (β=0,386, p&lt;0,05) and MeanSaO2 (β=0,339, p&lt;0,05); DABP level at night was determined by the IAH (β=0,412, p&lt;0,05).

Patterns of Orthostatic Blood Pressure Changes in Patients with Orthostatic Hypotension.

Background and PurposeThe objective of this study was to determine the patterns of blood pressure (BP) changes during the head-up tilt (HUT) test, particularly in terms of its clinical significance for patients with orthostatic hypotension (OH).MethodsOH was divided into four categories based on systolic BP changes occurring within the first 10 minutes of the HUT test: sustained orthostatic hypotension (SOH), progressive orthostatic hypotension (POH), orthostatic hypotension with partial recovery (OHPR), and transient orthostatic hypotension (TOH).ResultsIn total, 151 patients were analyzed: 65 with SOH, 38 with POH, 21 with OHPR, and 27 with TOH. POH patients exhibited the greatest reduction in systolic BP after HUT and were also the most likely to develop symptoms requiring early termination of the HUT test (42.1%, p<0.001). Additionally, SOH patients exhibited smaller heart-rate variation with deep breathing values (p=0.003) and Valsalva ratios (p=0.022) compared to POH patients. The sweat volume was greatest in OHPR patients.ConclusionsClinical characteristics, including the findings of autonomic function tests, differed between the OH patient groups. This might reflect differences in the underlying pathophysiologic mechanisms. Determining the patterns of BP changes during the HUT test may facilitate the development of effective management strategies in patients with OH.

The relationship between orexin levels and blood pressure changes in patients with narcolepsy.

Study objectiveNarcolepsy type 1 (NT1) is caused by a deficiency or absence of the neurotransmitter orexin. NT1 is also associated with a reduced nocturnal “dipping” of blood pressure (BP). The study objective was to analyze whether nocturnal BP values differed in patients depleted of orexin, versus those in whom production was preserved.MethodsWe performed a retrospective analysis of the polysomnographic recordings, orexin levels, and BP values of patients with NT1. Data was collected from a total of 21 patients, divided into two groups as follows: those with a complete depletion of orexin (n = 11) (Group1), and those with a remaining, limited presence of orexin (n = 10) (Group 2).ResultsThe groups did not differ in terms of the clinical features of NT1 or sleep characteristics, with an exception of increased number of cataplexy episodes and increased percentage of sleep stage 2 in the Group 1. Daytime and nocturnal BP did not differ between the groups. Most patients, regardless of group, had a non-dipping blood pressure pattern, and no difference in dipping prevalence was observed between groups. The amplitude of the daytime to nighttime change in BP did not differ between the groups.ConclusionsNon-dipping BP patterns are frequent among patients with narcolepsy type 1, but we saw no evidence that they depended on whether orexin levels were above or below the assay detection threshold. Therefore, our results do not support the hypothesis that in patients with narcolepsy type 1 residual orexin levels play a role in the control of nocturnal BP dipping.

Prognostic value of long-term blood pressure changes in patients with chronic heart failure.

Chronic heart failure (CHF) is the final stage of many heart diseases. To improve outcomes, important risk factors for adverse clinical events in the CHF population need to be identified. The aim of the present study was to delineate the influence of long-term blood pressure (BP) changes on prognosis and mortality in a real-world cohort of CHF patients. This is a retrospective longitudinal analysis. Repeated office BP measurements were scheduled during follow-up visits every 3-6 months. The primary endpoint was time to death or heart transplantation (HTx). A Cox regression with time-dependent strata was used to analyse the effect of systolic BP (SBP) values and its change during follow-up on the primary endpoint. A total of 927 patients presented with a median survival of 7.7 [95% confidence interval (CI) 6.6-9.8] years. During follow-up, 220 patients died and 70 patients underwent HTx. The BP stratum with the most stable values showed the best survival. Blood pressure changes with an increase or decrease greater than ±10 mmHg per year led to a significantly worse outcome [hazard ratio (HR) 1.8 and 2.0, respectively]. The stratum with the lowest SBP levels (<90 mmHg) had the highest mortality. Multiple regression analysis showed a HR factor of 17 (95% CI 9.7-29) in comparison with the stratum with SBP ≥130 mmHg. Low SBP (<90 mmHg) and pronounced long-term changes in SBP were associated with poor survival in patients with CHF. Additional prospective studies are warranted to further specify optimal BP targets in patients with CHF.

PP.32.09] EPISTAXIS

Objective Background: Epistaxis and hypertension are frequent diseases in the adult population. A relationship between the increase of the blood pressure (BP) and the prevalence and incidence of epistaxis has been suggested (Kikidis et al, 2013). Design and method: Aim of our study was to analyze blood pressure changes in patients with active or recent onset epistaxis (<12 hours) from admission to the emergency department (ED) to discharge. Patients and methods: 126 consecutive subjects (84 males, age range 15–93 years, mean age 67 ± 17 years) admitted to the ED (April 2014-February 2015) with primary epistaxis, were prospectively evaluated. BP was measured with an automatic device (OMRON MT10-E) in accordance to ESH-ESC guidelines 2013; measurements were performed at admission to the ED and 30 minutes after the ear, nose and throat (ENT) specialist visit (and possible hemostasis). Results Results: a diagnosis of hypertension was present in 68% of subjects; 75% of them were on antihypertensive treatment, 35% of them reported adequate BP control, 17% had diabetes mellitus and 25% dyslipidemia. A statistically significant reduction in BP was observed from admission to the ED and to the end of ENT evaluation (from 142 ± 21/84 ± 13 mmHg to 135 ± 21/81 ± 13 mmHg, p = 0.001), while no significant changes were observed in heart rate (from 76 ± 15 to 72 ± 13 b/min). Conclusions Conclusions: results obtained in this group of patients with primary epistaxis show a prevalence of hypertension similar to that of a general population. An accurate BP measurement shows a significant reduction at the end of the ENT specialist evaluation compared to baseline measurement, in both hypertensive and normotensive subjects.

Comparative Assessment of the Effects of Three Local Anesthetics: Lidocaine, Prilocaine, and Mepivacaine on Blood Pressure Changes in Patients with Controlled Hypertension.

Given large number of patients with hypertension attending dental clinics and the profound effects of local anesthetics containing vasoconstrictors, this study aimed to compare the effects of lidocaine 2% + epinephrine, prilocaine 3% + felypressin0.03, and mepivacaine 3% on blood pressure changes. The current study was carried out from May 2014 to February 2015.Patients with controlled hypertension (systolic blood pressure<159.94 mmHg before the injection) who attended Zahedan dental school (Zahedan , Iran) for the extraction of a mandibular tooth were selected and randomly allocated to three groups of 20. Groups 1-3 received lidocaine 2% + epinephrine, prilocaine 3% + felypressin 0.03 units, and mepivacaine3%, respectively. Patients were only included if they were injected with a maximum of two 1.8 ml cartridges (3.6 ml) for tooth extraction (maximum epinephrine dose of 0.04 mg was maintained in systemic patients).The collected data were analyzed using the analysis of variance (ANOVA) in SPSS 19.0. (SPSS Inc., Chicago, IL, USA)RESULTS: No significant differences were observed between the systolic and diastolic blood pressure of the three groups. The three evaluated local anesthetic solutions had similar effects in patients with controlled hypertension. While no significant changes in blood pressure were observed in three groups, all dental procedures on the mentioned group of patients have to be performed under careful monitoring and aspiration. Moreover, the maximum epinephrine dose (0.04mg) should never be exceeded in these patients.

Blood pressure changes in patients with chronic heart failure undergoing slow breathing training

Background. Slow breathing training (SBT) has been proposed as a new non-pharmacological treatment able to induce favorable effects in patients with chronic heart failure (CHF). However, no information is available regarding its effects on orthostatic blood pressure (BP) changes in these patients, an issue of practical relevance given the reported BP-lowering effect of SBT. The aim of this study is to evaluate the influence of SBT on BP and whether SBT induces orthostatic hypotension (OH) or changes in quality of life (QoL) in CHF patients. Methods. The analysis was performed as part of an ongoing crossover open trial aimed at assessing the clinical effectiveness of SBT in treated patients with CHF. The patients underwent 10–12 weeks of SBT with the RESPeRATE device and 10–12 week follow-up under usual care. Patients were randomly divided into two groups: group I began with SBT, followed by usual care; group II began with usual care, followed by SBT. Patients undergoing SBT were asked to perform each day two separate 15 min sessions of device-guided SBT at a breathing frequency of 6 breaths/min. In all patients, before the enrollment and after each study phase, clinical data collection and BP measurements in sitting, supine and standing position were performed. OH was defined as a decrease of ≥ 20 mmHg in systolic blood pressure (SBP) or ≥ 10 mmHg in diastolic blood pressure (DBP) within 3 min of standing. QoL was assessed three times at the beginning, and after each phase of the study by the Minnesota Living with Heart Failure (MLHF) questionnaire. Results. Forty patients (two equal groups) completed the study, with the following baseline characteristics: 32 males/eight females, age 63.3 ± 13.4 years, 25 with ischemic CHF, 37 in New York Heart Association class II and three in class III, left ventricular ejection fraction 30.8 ± 6.7%, mean BP 138.7 ± 16.5/83.1 ± 11.5 mmHg, 23 with arterial hypertension and four with a history of stroke. There were no significant differences between the groups in clinical characteristics, SBP and DBP at rest, while seated and before and after standing up. OH prevalence was low and did not change during the study (10% vs 10%). No significant difference in average SBP and DBP changes secondary to body position were found when comparing the two study phases. Decrease in MLHF score was observed in group I during SBT (p = 0.002), but not in group II. Conclusions. Our data indicate that SBT is safe, does not affect the prevalence of OH in CHF patients and shows a non-significant tendency to improve QoL. These results should be confirmed in a larger sample of patients to support the safety of SBT and its possible benefits as a novel component of cardiorespiratory rehabilitation programs in CHF.

Association between physical activity advice only or structured exercise training with blood pressure levels in patients with type 2 diabetes: a systematic review and meta-analysis.

Diabetes is associated with marked cardiovascular morbidity and mortality. However, the association between different types of exercise training and blood pressure (BP) changes is not fully clear in type 2 diabetes. The aim of this systematic review and meta-analysis of randomized controlled clinical trials (RCTs) was to determine the effects of structured exercise training (aerobic [AER], resistance [RES], or combined [COMB]) and physical activity (PA) advice only on BP changes in patients with type 2 diabetes. Searches in five electronic databases were conducted to retrieve studies published from 1980 to 2013. Eligible studies were RCTs consisting of structured exercise training or PA advice versus no intervention in patients with type 2 diabetes. We used random effect models to derive weighted mean differences (WMDs) of exercises on absolute changes in systolic BP (SBP) and diastolic BP (DBP). A total of 30 RCTs of structured training (2,217 patients) and 21 of PA advice (7,323 patients) were included. Data were extracted independently in duplicate. Structured exercise was associated with reductions in SBP (WMD -4.22 mmHg; 95% confidence interval [CI] -5.89 to -2.56) and DBP (WMD -2.07 mmHg; 95% CI -3.03 to -1.11) versus controls. In structured exercise interventions, AER and RES were associated with declines in BP, and COMB was not associated with BP changes. However, in sensitivity analysis, a high-intensity protocol within COMB was associated with declines in SBP (WMD -3.30 mmHg; 95% CI -4.71 to -1.89). Structured exercise longer than 150 min/week was associated with greater BP reductions. PA advice only was associated with reduction in SBP (WMD -2.97 mmHg; 95% CI -4.52 to -1.43) and DBP (WMD -1.41 mmHg; 95% CI -1.94 to -0.88) versus controls. AER, RES, and high-intensity combined training are associated with BP reduction in patients with type 2 diabetes, especially in exercise programs lasting more than 150 min/week. PA advice only is also associated with lower BP levels.