Blood Pressure Curve Research Articles

Effects of maternal calcium supplementation on offspring blood pressure and growth in childhood and adolescence in a population with a low-calcium intake: follow-up study of a randomized controlled trial

BackgroundThe World Health Organization recommends calcium supplementation (1500–2000 mg/d) during pregnancy for women with a low-calcium intake. ObjectivesThe purpose of this study was to investigate whether pregnancy calcium supplementation affects offspring blood pressure and growth in The Gambia where calcium intakes are low (300–400 mg/d). MethodsFollow-up of offspring born during a randomized controlled trial of pregnancy calcium supplementation (ISRCTN96502494, 1996–2000) in which mothers were randomly assigned to 1500 mg Ca/d (Ca) or placebo (P) from 20 wk pregnancy to delivery. Offspring were enrolled at age 3 y in studies where blood pressure and anthropometry were measured under standardized conditions at approximately 2-yearly intervals. Mean blood pressure and growth curves were fitted for females and males separately, using the longitudinal SuperImposition by Translation and Rotation (SITAR) mixed effects model. This generates 3 individual-specific random effects: size, timing, and intensity, reflecting differences in size, age at peak velocity, and peak velocity through puberty relative to the mean curve, respectively. ResultsFive hundred twenty-three singleton infants were born during the trial (maternal group assignment: Ca/P = 259/264). Four hundred ninety-one were enrolled as children (females: F-Ca/F-P = 122/129 and males: M-Ca/M-P = 119/121) and measured regularly from 3.0 y to mean age 18.4 y; 90% were measured on ≥8 occasions. SITAR revealed differences in the systolic blood pressure and height curves between pregnancy supplement groups in females, but not in males. F-Ca had lower systolic blood pressure than F-P at all ages (size = −2.1 ± SE 0.8 mmHg; P = 0.005) and lower peak height velocity (intensity = −2.9 ± SE 1.1%, P = 0.009). No significant pregnancy supplement effects were seen for other measures. ConclusionsThis study showed, in female offspring, that pregnancy calcium supplementation may lower systolic blood pressure and slow linear growth in childhood and adolescence, adding to evidence of offspring sexual dimorphism in responses to maternal supplementation. Further research is warranted on the long-term and intergenerational effects of antenatal supplementations.This trial was registered at ISRCTN Registry as ISRCTN96502494.

Blood pressure in preterm infants with bronchopulmonary dysplasia in the first three months of life

BackgroundNeonatal hypertension is common in preterm infants with bronchopulmonary dysplasia (BPD). Our study aimed to examine blood pressure variation in the first three months of life in preterm BPD patients.MethodsWe conducted a retrospective, single-centre study at the Neonatal Intensive Care Unit of the University of Szeged, Hungary. We collected blood pressure data from 26 preterm infants (born at < 30 weeks gestation) with moderate or severe BPD over three years (2019–2021). We calculated the BPD group's daily average blood pressure values and used previously defined normal blood pressure values from a preterm patient group born at < 30 weeks gestation as a reference. We used 19,481 systolic, diastolic and mean blood pressure measurement data separately to calculate daily average blood pressures.ResultsWe found a statistically significant correlation between the blood pressure values of the BPD patient group and the reference data. The difference between the blood pressure curve of the group with BPD and that of the reference group was also statistically significant. We also analysed individual patients' daily average blood pressure values and found that 11 patients (42%) had hypertensive blood pressure values for three or more days within the first 90 days of life. Within this group, our statistical analysis showed a 25% chance of acute kidney injury.ConclusionThe blood pressure of the BPD group not only correlated with but also significantly differed from the reference data. Hypertension lasting three or more days occurred more frequently in patients with acute kidney injury accompanied by BPD.Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

Estimation of aortic stiffness by finger photoplethysmography using enhanced pulse wave analysis and machine learning.

Aortic stiffness plays a critical role in the evolution of cardiovascular diseases, but the assessment requires specialized equipment. Photoplethysmography (PPG) and single-lead electrocardiogram (ECG) are readily available in healthcare and wearable devices. We studied whether a brief PPG registration, alone or in combination with single-lead ECG, could be used to reliably estimate aortic stiffness. A proof-of-concept study with simultaneous high-resolution index finger recordings of infrared PPG, single-lead ECG, and finger blood pressure (Finapres) was performed in 33 participants [median age 44 (range 21-66) years, 19 men] and repeated within 2 weeks. Carotid-femoral pulse wave velocity (cfPWV; two-site tonometry with SphygmoCor) was used as a reference. A brachial single-cuff oscillometric device assessed aortic pulse wave velocity (aoPWV; Arteriograph) for further comparisons. We extracted 136 established PPG waveform features and engineered 13 new with improved coupling to the finger blood pressure curve. Height-normalized pulse arrival time (NPAT) was derived using ECG. Machine learning methods were used to develop prediction models. The best PPG-based models predicted cfPWV and aoPWV well (root-mean-square errors of 0.70 and 0.52 m/s, respectively), with minor improvements by adding NPAT. Repeatability and agreement were on par with the reference equipment. A new PPG feature, an amplitude ratio from the early phase of the waveform, was most important in modelling, showing strong correlations with cfPWV and aoPWV (r = -0.81 and -0.75, respectively, both P < 0.001). Using new features and machine learning methods, a brief finger PPG registration can estimate aortic stiffness without requiring additional information on age, anthropometry, or blood pressure. Repeatability and agreement were comparable to those obtained using non-invasive reference equipment. Provided further validation, this readily available simple method could improve cardiovascular risk evaluation, treatment, and prognosis.

Нарушения сердечного ритма и профиль артериального давления у пациентов с боевыми травмами

Aim. To investigate possible rhythm and conduction disturbances, as well as the blood pressure (BP) profile in young and middle-aged patients with combat wounds. Materials and methods. The cross-sectional study enrolled 102 patients who suffered limb injuries in the period from 13 to 114 days (median 38 days) before admission to the hospital. The age of the patients included in the study ranged from 20 to 59 years, with an average of 35.7±8.5 years. Patients underwent Holter ECG monitoring and 24-hour BP monitoring. The following questionnaires and scales were used: a questionnaire to identify signs of autonomic changes (A. Vein), a scale for assessing the severity of psychophysiological response to stress, an insomnia severity index, the Hamilton scale for assessing anxiety, the Hamilton scale for assessing depression, a questionnaire for PTSD screening, visual analog pain scale. Results. The mean heart rate per day reached 84.6±11.1 per minute, the minimum heart rate was 56.9±10.1, the maximum heart rate was 134.4±18.6 per minute. The group mean duration of tachycardia was 498.1±316 minutes (8 hours 18 minutes). There was an inverse correlation between the age of patients and the duration of tachycardia per day (r=-0.29; p=0.04), maximum heart rate (r=-0.28; p=0.007), minimum heart rate per day (r=-0.23; p=0.02). In patients 20-29 years old, the maximum heart rate reached 141.4±19.4, in patients over 40 years old – 134.3±17.9 (p=0.009). The mean value of the circadian index for the group was 1.17±0.13 (0.68-1.47). In 69.7%, the circadian index was rigid. Heart rate variability was within normal values in 32.2% of the examined patients, in 48.8% it was reduced, and in 19.1% it was sharply reduced. Heart rhythm disturbances were recorded in 65.5% of patients. The most frequently detected sinus arrhythmia (in 76.2% of cases of all arrhythmias), migration of the supraventricular pacemaker (in 27.0%) and atrial rhythm (in 11.1%). Arterial hypertension was detected in 67.7% of the examined patients. The maximum systolic BP (SBP) corresponding to arterial hypertension of the 1st degree was registered in 43.9% of patients, grade 2 – in 19.7%, grade 3 – in 3.0%, high normal BP – in 16.7%, normal BP – in 16.7%. Maximum diastolic BP (DBP) corresponding to grade 1 hypertension was found in 30.8% of patients, grade 2 – in 30.8%, grade 3 – in 15.4%, high normal BP – in 10.8%, normal BP – in 12.3%. The mean daily SBP was 126 mm Hg, DBP was 81 mm Hg. The mean daytime SBP was 128 mm Hg, DBP was 82 mm Hg. The mean nighttime SBP is 118 mm Hg, DBP is 77 mm Hg. The maximum SBP was 148 mm Hg, DBP was 97 mm Hg. When analyzing the types of daily BP curves, the vast majority of patients (44.6%) were classified as “non-dipper” type, both for SBP and DBP. Conclusions. The study results indicate that patients with combat injuries very often have sinus tachycardia, which is recorded over a long period of time. Heart rate is highest in the youngest injured patients and decreases as age increases. Sinus arrhythmia is very common, other rhythm and conduction disorders are much less common. High BP, especially DBP, is often recorded.

Heart rate complexity helps mortality prediction in the intensive care unit: A pilot study using artificial intelligence

BackgroundIn intensive care units (ICUs), accurate mortality prediction is crucial for effective patient management and resource allocation. The Simplified Acute Physiology Score II (SAPS-2), though commonly used, relies heavily on comprehensive clinical data and blood samples. This study sought to develop an artificial intelligence (AI) model utilizing key hemodynamic parameters to predict ICU mortality within the first 24 h and assess its performance relative to SAPS-2. MethodsWe conducted an analysis of select hemodynamic parameters and the structure of heart rate curves to identify potential predictors of ICU mortality. A machine-learning model was subsequently trained and validated on distinct patient cohorts. The AI algorithm’s performance was then compared to the SAPS-2, focusing on classification accuracy, calibration, and generalizability. Measurements and main resultsThe study included 1298 ICU admissions from March 27th, 2015, to March 27th, 2017. An additional cohort from 2022 to 2023 comprised 590 patients, resulting in a total dataset of 1888 patients. The observed mortality rate stood at 24.0%. Key determinants of mortality were the Glasgow Coma Scale score, heart rate complexity, patient age, duration of diastolic blood pressure below 50 mmHg, heart rate variability, and specific mean and systolic blood pressure thresholds. The AI model, informed by these determinants, exhibited a performance profile in predicting mortality that was comparable, if not superior, to the SAPS-2. ConclusionsThe AI model, which integrates heart rate and blood pressure curve analyses with basic clinical parameters, provides a methodological approach to predict in-hospital mortality in ICU patients. This model offers an alternative to existing tools that depend on extensive clinical data and laboratory inputs. Its potential integration into ICU monitoring systems may facilitate more streamlined mortality prediction processes.

Cumulative Diastolic Blood Pressure Burden in Normal Systolic Blood Pressure and Cardiovascular Disease.

The clinical significance of isolated diastolic hypertension defined by the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines remains inconsistent. We examined whether long-term diastolic burden predicts the first major adverse cardiovascular event in participants with sustained and untreated normal systolic BP. The Mass General Brigham Biobank is a New England health care-based cohort recruited between 2010 and 2021. A total of 15 979 participants aged 18 to 64 years and without prior cardiovascular disease, antihypertensives, or high systolic BP were studied. The cumulative diastolic burden was determined as the area under the curve for diastolic BP (DBP) ≥80 mm Hg over 5 years before enrollment. Major adverse cardiovascular event was defined as a composite of first incident ischemic heart disease, stroke, heart failure, or all-cause death. Of the 15 979 participants, mean (SD) age at enrollment was 47.6 (14.3) years, 11 950 (74.8%) were women, and the mean (SD) systolic BP and DBP were 118.0 (12.9) and 72.2 (9.3) mm Hg, respectively. Over a median (interquartile range) follow-up of 3.5 (1.8-5.4) years, 2467 (15.4%) major adverse cardiovascular events occurred. Using Cox proportional hazards regression, each SD increase in cumulative DBP was independently associated with a hazard ratio (95% CI) of 1.06 (1.02-1.10) without effect modification by sex (P=0.65), age (P=0.46), or race/ethnicity (P=0.24). In addition to traditional risk factors, cumulative DBP modestly improved the discrimination C index (95% CI) from 0.74 (0.72-0.75) to 0.75 (0.74-0.76; likelihood ratio test, P=0.037). Among individuals with normal systolic BP, cumulative DBP may augment cardiovascular disease risk stratification beyond a single DBP measure and traditional risk factors.

Abstract P147: Cumulative Diastolic Blood Pressure Burden In Normal Systolic Blood Pressure And Cardiovascular Disease

Introduction: The clinical significance of isolated diastolic hypertension defined by the 2017 American College of Cardiology/American Heart Association Blood Pressure (BP) Guideline remains controversial. We examined whether long-term diastolic burden independently predicts the first major adverse cardiovascular event (MACE) in participants with sustained untreated normal systolic BP. Methods: We identified 18,181 Mass General Brigham Biobank participants aged 18 to 64 years with untreated systolic BP &lt;130 mmHg. Cumulative diastolic burden was determined as the area under curve for diastolic BP (DBP) ≥80 mmHg over a 5-year period prior to enrollment. Hazard ratio (HR) between cumulative diastolic burden and MACE was estimated using Cox proportional hazards regression. Prognostic value of enrollment and cumulative DBP was compared. Results: Of the 18,181 participants, mean [SD] age at enrollment was 47.6 [14.3] years, 13,574 [74.7%] were female, and 2853 (15.7%) MACE occurred over a median [IQR] follow-up of 3.5 [1.9-5.3] years. Each SD increase in cumulative DBP was associated with HR (95% CI) of 1.07 (1.03-1.11), adjusting for age, sex, race, body mass index, systolic BP, lipids, diabetes, smoking, statin, and antihypertensives initiation during follow-up. In addition to traditional risk factors, cumulative DBP improved the discrimination C index (95% CI) from 0.732 (0.724-0.742) to 0.739 (0.732-0.748) (Likelihood ratio test P =0.021), whereas inclusion of enrollment DBP did not improve prognosis. Conclusions: Among individuals with normal systolic BP, cumulative DBP may augment risk stratification beyond a single DBP measure and other traditional risk factors.

Arterial stiffness for the early prediction of pre-eclampsia compared with blood pressure, uterine artery Doppler and angiogenic biomarkers: a prospective cohort study.

Our aim was to evaluate the ability of arterial stiffness parameters to predict pre-eclampsia early compared with peripheral blood pressure, uterine artery Doppler and established angiogenic biomarkers. Prospective cohort study. Tertiary care antenatal clinics in Montreal, Canada. Women with singleton high-risk pregnancies. In the first trimester, arterial stiffness was measured by applanation tonometry, along with peripheral blood pressure and serum/plasma angiogenic biomarkers; uterine artery Doppler was measured in the second trimester. The predictive ability of different metrics was assessed through multivariate logistic regression. Arterial stiffness (carotid-femoral pulse wave velocity, carotid-radial pulse wave velocity) and wave reflection (augmentation index, reflected wave start time), peripheral blood pressure, ultrasound indices of velocimetry and circulating angiogenic biomarker concentrations. In this prospective study, among 191 high-risk pregnant women, 14 (7.3%) developed pre-eclampsia. A first-trimester 1m/s increase in carotid-femoral pulse wave velocity was associated with 64% increased odds (P < 0.05), and a 1-millisecond increase in time to wave reflection with 11% decreased odds for pre-eclampsia (P < 0.01). The area under the curve of arterial stiffness, blood pressure, ultrasound indices and angiogenic biomarkers was 0.83 (95% confidence interval [CI] 0.74-0.92), 0.71 (95% CI 0.57-0.86), 0.58 (95% CI 0.39-0.77), and 0.64 (95% CI 0.44-0.83), respectively. With a 5% false-positive rate, blood pressure had a sensitivity of 14% for pre-eclampsia and arterial stiffness a sensitivity of 36%. Arterial stiffness predicted pre-eclampsia earlier and with greater ability than blood pressure, ultrasound indices or angiogenic biomarkers.

S-11-1: ARTERIAL STIFFNESS AND HEMODYNAMIC PARAMETERS FOR THE EARLY PREDICTION OF PREECLAMPSIA: A PROSPECTIVE COHORT STUDY

Objective: Preeclampsia is a leading complication of pregnancy, yet there remains no reliable clinical tool for its early prediction. Assessment of vascular dysfunction, a central feature of preeclampsia, by arterial stiffness and hemodynamic measurements could be a promising tool for preeclampsia prediction. This study aimed to evaluate 1) arterial stiffness and hemodynamic parameters as an early predictive tool for preeclampsia, and 2) longitudinal changes in these parameters and identify changepoints prior to preeclampsia onset. Design and method: In this prospective longitudinal cohort study of women with singleton high-risk pregnancies (n = 236), arterial stiffness (carotid-femoral pulse wave velocity, cfPWV) and wave reflection (augmentation index [AIx], and time to wave reflection [T1R]) were assessed using applanation tonometry (SphygmoCor, AtCor) at 10–13 weeks and repeated every 4 weeks throughout pregnancy. Circulating angiogenic biomarkers (soluble fms-like tyrosine kinase, and placental growth factor) were measured (Quantikine, R&amp;D Systems) at each trimester, and a bilateral uterine artery Doppler (UAD) was performed in the second trimester. The predictive ability of arterial stiffness was compared to that of peripheral blood pressure, UAD indices, as well as angiogenic biomarkers. Furthermore, changepoints in cfPWV, AIx, and T1R were compared between women who did and did not subsequently develop preeclampsia. Results: A first-trimester 1 m/s increase in cfPWV was associated with 64% increased odds (p &lt; 0.05), while a 1 ms increase in T1R with 11% decreased odds for preeclampsia (p &lt; 0.01). The area under the curve of arterial stiffness, blood pressure, ultrasound indices, and angiogenic biomarkers was 0.84, 0.68, 0.66, and 0.64, respectively (Figure). A changepoint in cfPWV was detected at 14–17 weeks. cfPWV then increased in women who subsequently developed preeclampsia but decreased in women who did not; a 1.2 m/s difference in cfPWV between the groups was observed at 22–25 weeks. An increase in AIx was noted at 18–21 weeks while at 30–33 weeks in women who did and did not develop preeclampsia, respectively. Conclusions: Arterial stiffness and wave reflection were higher in the first trimester and throughout pregnancy in women destined to develop preeclampsia. These indices predicted preeclampsia earlier (in the first trimester) and with greater ability than blood pressure, UAD, and/or angiogenic biomarkers. Furthermore, altered vascular adaptations in the early second trimester were observed in women who subsequently developed preeclampsia. These findings demonstrate the potential clinical utility of arterial stiffness and hemodynamic parameters as an early screening tool for preeclampsia, which can be used to inform clinical management of high-risk pregnancies.

Myocardial Work: a Systematic Review of Novel Echocardiography Method and Clinical Applications

Background: Myocardial work (MW) is a novel imaging modality that has emerged as a potential left ventricular (LV) function assessment in various clinical settings. MW calculates speckle-tracking echocardiography strain curves with an estimated LV pressure curve by non-invasively utilizing standard brachial blood pressure curves. Objective: This study aimed to provide a summary of current knowledge of non-invasive MW and its clinical applications, including in heart failure, coronary artery disease, cardiomyopathy, and hypertension. In addition, the limitations, and recommendations of MW in clinical practice are discussed. Methods: We searched the PubMed database using the following keywords: (myocardial constructive work) OR (wasted septal work) OR (global myocardial work) OR (myocardial work) OR (myocardial constructive work) OR (novel echocardiography). We further subjected 12 studies to full-text review and included them in this systematic review. Results: While MW indices, particularly global work index and global constructed work, have shown good correlations with ejection fraction (EF) and strain parameters, the opportunity of offering incremental information that is unaffected by loading conditions has made MW application particularly useful in a variety of clinical settings. Conclusion: Compared to EF and global longitudinal strain, MW is a promising test with higher sensitivity and accuracy for identifying individuals with cardiovascular disease. Clinicians should also evaluate symptoms and electrocardiographic findings until extensive multicenter studies validating this strategy are performed to establish the incremental value of MW in daily echocardiographic assessments.

Short-Term Effects of Spirulina Consumption on Glycemic Responses and Blood Pressure in Healthy Young Adults: Results from Two Randomized Clinical Trials.

The effects of spirulina consumption added in foods were investigated in two crossover clinical trials (n = 13 different healthy adults). In Trial-1 adults consumed cookies with-and-without spirulina (3.12 g per 100 g final product; 2.5 g spirulina per 50 g available carbohydrates) according to glycemic index (GI) methodology. In Trial-2, adults consumed 4 g, 6 g, and 8 g spirulina as beverage diluted in 50 g D-glucose vs. 50 g plain D-glucose. Capillary blood glucose samples were collected at 0, 15, 30, 45, 60, 90, and 120 min and blood pressure (BP) was measured at beginning and end of each visit in both trials. Trial-1: both cookies with and without spirulina provided medium GI values (59 and 60, respectively, on glucose-scale), but no significant differences were found for BP. Trial-2: both 4 g and 8 g spirulina lowered postprandial glucose at 120 min (95% CI: -1.64 to -16.12 and -1.23 to -15.87, respectively). The results explained 29% of variation. Only 8 g spirulina decreased significantly 90-120 min area under the curve (AUC) for glucose and systolic BP (-4%). No differences were found for fasting glucose. Adding spirulina to cookies did not affect glucose responses and BP. Only 8 g provided significantly lower 90-120 min-AUC for glucose and BP compared to 4 g, 6 g-and-D-glucose, indicating advantages to glycemic control and hypertension.

The effect of topical airway anesthesia on hemodynamic profiles during the induction period in patients undergoing cardiac surgery: Study protocol for a randomized controlled trial.

BackgroundPatients scheduled for cardiac surgery are often accompanied by cardiac dysfunction and hemodynamic instability. However, the conventional induction strategy for anesthesia using high-dose intravenous anesthetics is often associated with persistent and recurrent hypotension after tracheal intubation. The purpose of this study is to investigate the effects of topical airway anesthesia on the hemodynamic profile of patients undergoing cardiac surgery during the induction period.MethodsThis is a superiority, single-blind, randomized controlled study with two parallel groups. Participants scheduled to undergo elective cardiac surgery will be allocated into two blocks according to the New York Heart Association (NYHA) classification and then randomly assigned to the following two groups at a 1:1 ratio: the conventional induction group and the combined topical airway anesthesia induction group. The combined topical airway anesthesia induction strategy includes aerosol inhalation airway anesthesia, subglottic airway anesthesia, and general anesthesia induction using low-dose intravenous anesthetics. The primary outcome is the area under the curve (AUC) of blood pressure below baseline mean arterial pressure (MAP) from 3 to 15 min after endotracheal intubation. Secondary outcomes include the AUC above baseline MAP and below baseline MAP at other time points, the highest and lowest arterial blood pressure values during the induction period, type and dose of vasoactive drugs, incidence of arrhythmias, cardiac function, and the incidence of postoperative hoarseness and sore throat.DiscussionThe study will explore whether aerosol inhalation airway anesthesia and subglottic airway anesthesia could reduce the incidence and duration of hypotension during the induction period in patients undergoing cardiac surgery.Clinical Trial RegistrationThis trial was registered on www.ClinicalTrials.gov (NCT05323786).

Stroke volume variation as an index of fluid responsiveness can be impaired by mental stress.

Cardiac stroke volume variation (SVV) measurement is one of the techniques to detect fluid-responsive hypovolemia in patients under mechanical ventilation. There is an ongoing effort to apply SVV for this purpose also in conscious patients. However, the effect of mental stress often occurring in conscious patients as a potential confounding factor on SVV is not known. The aim of our study was to compare effect of simulated hypovolemia and mental stress on SVV in healthy volunteers in the context of potential confounders - breathing pattern, respiratory sinus arrhythmia magnitude and sex. We examined 102 young healthy volunteers (58 females), mean age 18.6 years. Finger arterial blood pressure was recorded by volume-clamp photoplethysmographic method (Finometer Pro, FMS, Amsterdam, Netherland). From the blood pressure curve, a built in ModelFlow algorithm calculated stroke volume values (SV) for each heartbeat. Respiratory volume was recorded using calibrated respiratory inductive plethysmography (RespiTrace, NIMS, Miami Beach, FL, USA). During four phases of examination protocol (supine rest, head-up tilt (HUT), supine recovery, mental arithmetic task (MA)) we analyzed SVV related to respiratory activity. While during HUT we found an expected increase in SVV together with mean SV decrease, SVV significantly decreased during MA. The observed changes during MA could be attributed to an increased respiratory rate and/or decreased respiratory sinus arrhythmia. Sex related differences in SVV responses to HUT and MA were observed. We conclude that mental stress together with respiratory sinus arrhythmia and respiratory pattern changes can significantly influence SVV as a potential index of fluid responsiveness in conscious patients.

Norepinephrine versus phenylephrine infusion for preventing postspinal hypotension during cesarean section for twin pregnancy: a double-blinded randomized controlled clinical trial

BackgroundCompared with singleton pregnancy, twin gestation is featured by a greater increase in cardiac output. Therefore, norepinephrine might be more suitable than phenylephrine for maintaining blood pressure during cesarean section for twins, as phenylephrine causes reflex bradycardia and a resultant decrease in cardiac output. This study was to determine whether norepinephrine was superior to phenylephrine in maintaining maternal hemodynamics during cesarean section for twins.MethodsInformed consent was obtained from all the patients before enrollment. In this double-blinded, randomized clinical trial, 100 parturients with twin gestation undergoing cesarean section with spinal anesthesia were randomized to receive prophylactic norepinephrine (3.2 μg/min) or phenylephrine infusion (40 μg/min). The primary outcome was the change of heart rate and blood pressure during the study period. The secondary outcomes were to compare maternal complications, neonatal outcomes, Apgar scores and umbilical blood acid-base status between the two vasopressors.ResultsThere was no significant difference observed for the change of heart rate between two vasopressors. The mean standardized area under the curve of heart rate was 78 ± 12 with norepinephrine vs. 74 ± 11 beats/min with phenylephrine (mean difference 4.4, 95%CI − 0.1 to 9.0; P = .0567). The mean standardized area under the curve of systolic blood pressure (SBP) was significantly lower in parturients with norepinephrine, as the mean of differences in standardized AUC of SBP was 6 mmHg, with a 95% CI from 2 to 9 mmHg (P = .0013). However, requirements of physician interventions for correcting maternal hemodynamical abnormalities (temporary cessation of vasopressor infusion for reactive hypertension, rescuing vasopressor bolus for hypotension and atropine for heart rate less < 50 beats/min) and neonatal outcomes were also not significantly different between two vasopressors.ConclusionInfusion of norepinephrine was not associated with less overall decrease in heart rate during cesarean section for twins, compared with phenylephrine.Trial registrationChinese Clinical Trial Registry (ChiCTR1900021281).

A randomized controlled trial of bedside ultrasound RUSH process to improve the quality of anesthesia for elderly emergency surgery patients.

Objectives:The rapid ultrasound in shock examination (RUSH process) is an assessment of patient’s heart function, volume status, and vasculature, which can help anesthesiologist understand the patient’s physical condition. In this study, the RUSH process was applied to elderly emergency surgery patients to evaluate whether it is beneficial to maintain the patient’s vital signs stable during the operation.Methods:In this randomized controlled clinical study one hundred elderly patients who needed general anesthesia and emergency surgery from January 2021 to July 2021 were randomly divided into RUSH group (Group-A, n=52) and control group (Group-B, n=48). The main result include the area under the intraoperative blood pressure curve (AUC), liquid input, urine output, lactic acid levels, number of vasoactive drugs used.Results:There were no significant differences in patients’ basic information, preoperative blood pressure, intraoperative blood loss, intraoperative fluid input, intraoperative blood transfusion, and urine output. Intraoperative systolic blood pressure less than 90mmHg AUC of Group-A is less than Group-B(P<0.05), diastolic blood pressure less than 60mmHg AUC of Group-A is less than Group-B(P<0.05). After the operation, the blood gas analysis lactic acid level in Group-A was lower than that in Group-B(P<0.05). Group-A used more vasoactive drugs than Group-B(P<0.05).Conclusion:The bedside ultrasound RUSH process is of great significance for anesthesiologist to understand the preoperative physical condition of elderly emergency surgery patients, and is beneficial to maintain the stability of intraoperative vital signs.

Association of long-term exposure to PM2.5 with hypertension prevalence and blood pressure in China: a cross-sectional study

ObjectiveEvidence of the effects of long-term fine particulate matter (PM2.5) exposure on hypertension and blood pressure is limited for populations exposed to high levels of PM2.5. We aim to assess...

Does Interrupting Prolonged Sitting With 10- or 20-Min Standing Attenuate Postprandial Glycemia and Blood Pressure in Middle-Aged and Older Adults With Type 2 Diabetes?

We carried out three types of 2-hr experimental sessions with middle-aged and older adults with Type 2 diabetes in order to examine the acute effect of interrupting prolonged sitting with varying periods of standing on postprandial glycemia and blood pressure (BP): (a)prolonged sitting after breakfast; (b)standing for 10min, 30min after breakfast; and (c)standing for 20min, 30min after breakfast. Glucose and BP were assessed before and after breakfast. A generalized linear model revealed no significant differences for the incremental area under the curve of glucose between standing for 10min, 30min after breakfast, versus prolonged sitting after breakfast (β = -4.5mg/dl/2hr, 95% CI [-17.3, 8.4]) and standing for 20min, 30min after breakfast, versus prolonged sitting after breakfast (β = 0.9mg/dl/2hr, 95% CI [-11.9, 13.7]). There was no difference in area under the curve of systolic and diastolic BP among the sessions. Interrupting prolonged sitting time with 10 or 20min of standing 30min after breakfast does not attenuate postprandial glycemia or BP in middle-aged and older adults with Type 2 diabetes.

Association between gestational blood pressure and pregnancy induced hypertension or pre-eclampsia

Objective: To construct the gestational-age-specific blood pressure curve and percentile blood pressure values of pregnant women in Jiangsu Province, and to explore the clinic significance of the blood pressure changes in women whose blood pressure was less than 140/90 mmHg (1 mmHg=0.133 kPa) in each trimester and eventually developed pregnancy induced hypertension (PIH) or pre-eclampsia (PE). Methods: A prospective longitudinal cohort during pregnancy was built. Singleton pregnant women in the first trimester (11-13+6 weeks) were recruited from July 2017 to September 2020 in Nanjing Drum Tower Hospital, and were followed up in the second trimester (19-23+6 weeks), the third trimester (30-33+6 weeks) and approaching the expected date of delivery (35-38+6 weeks). The Viewpoint 6.0 software was used to record pregnancy-related information. The blood pressure was measured by standard methods in our clinic. Least mean square (LMS) function was performed to fit the gestational-age-specific blood pressure curve and percentile blood pressure values were calculated at every follow-up time point. Logistic regression was applied to calculate the OR for the groups with blood pressure ≥95th percentile (P95). Results: There were 3 728 singleton pregnant women invited in this study, including 3 490 normal pregnant women (93.62%, 3 490/3 728), and 238 pregnant women with PIH or PE (6.38%, 238/3 728). Gestational-age-specific blood pressure curve showed that systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) decreased in the second trimester, compared with those in the first and the third trimester, however the fluctuation of blood pressure was low, but regardless of the gestational age, P95 of SBP, DBP and MAP increased by 14, 11 and 11 mmHg respectively, compared with 50th percentile (P50). In the first trimester, the risk of developing PIH or PE finally in pregnant women with blood pressure ≥P95 was 4.36-fold (95%CI: 2.99-6.35) for SBP than women with SBP<P95, 5.22-fold (95%CI: 3.65-7.46) for DBP and 5.14-fold (95%CI: 3.61-7.32) for MAP. When approaching the expected date of delivery, the corresponding risks of the women with blood pressure ≥P95 were 16.76 times, 27.45 and 27.31 times respectively than those of the women with blood pressure <P95. In the first trimester, every 1 mmHg elevation of SBP the risk developing PIH or PE increased by 24% (OR=1.24, 95%CI: 1.15-1.33), 44% (OR=1.44, 95%CI: 1.31-1.59) for DBP and 47% (OR=1.47, 95%CI: 1.33-1.61) for MAP, respectively. The risk in the second trimester was similar to that in the first trimester, and in the third trimester, the risk was further increased. When approaching the expected date of delivery, DBP or MAP increased by 1 mmHg, the risk developing PIH or PE was double; while SBP increased by 1 mmHg, the risk increased by 58%. The areas under the receiver operator characteristic curves of SBP, DBP and MAP were similar for predicting PIH or PE, and the predictive efficiency were all poor. Conclusions: Construction of percentile blood pressure values for pregnant women is helpful in identification of high-risk women of developing PIH or PE. The risk of PIH or PE in pregnant women with blood pressure ≥P95 but <140/90 mmHg has significantly increased compared with women with blood pressure <P95.

Dicrotic Notch Identification: a Generalizable Hybrid Approach under Arterial Blood Pressure (ABP) Curve Deformations.

Dicrotic Notch (DN) is a distinctive and clinically significant feature of the arterial blood pressure curve. Its automatic identification has been the focus of many kinds of research using either model-based or rule-based methodologies. However, since DN morphology is quite variant following the patient-specific underlying physiological and pathological conditions, its automatic identification with these methods is challenging. This work proposes a hybrid approach that employs both model-based and rule-based approaches to enhance DN detection's generalizability. We have tested our approach on ABP data gathered from 14 pigs. Our result strongly indicates 36% overall mean error improvement with maximum 52% and -11% accuracy enhancement and degradation in extreme cases.

Influence of exercise type on maternal blood pressure adaptation throughout pregnancy

BACKGROUNDIt has been reported that 10% of all pregnancies are complicated by a hypertensive disorder of pregnancy. Previous research has shown that moderate-vigorous intensity exercise has a positive effect on maternal resting blood pressure. A research gap, however, exists related to how different types of exercise (resistance, aerobic, combined resistance and aerobic) affect maternal blood pressure. Most of the previous studies solely focused on aerobic exercise.OBJECTIVEThe aim of this study was to examine the effects of exercise types on maternal blood pressure throughout pregnancy.STUDY DESIGNThis study employed a secondary analysis using data from a randomized controlled prenatal exercise intervention trial. This study utilized 3 exercise intervention groups (aerobic, resistance, combination) and compared the results with those of a nonexercize control group. Participants completed 3 50-minute sessions weekly from 16 weeks of gestation until delivery. Maternal vital signs and physical measurements such as systolic blood pressure, diastolic blood pressure, and heart rate were measured every 4 weeks throughout the intervention period. Between-group mean differences in maternal measurements were assessed using Pearson's chi-square tests for continuous (age, prepregnancy body mass index, heart rate, systolic blood pressure, diastolic blood pressure, pulse pressure) variables. For gravida, exact Wilcox 2-sample tests were performed to determine between-group differences in mean values. Hierarchical linear growth curves were used to estimate maternal trajectories of systolic blood pressure and diastolic blood pressure from 16 weeks to 36 weeks’ gestation in each of the 4 groups (aerobic, combination, control, and resistance).RESULTSThere were no differences among the groups in maternal age or prepregnancy body mass index. Controlling for maternal body mass index, the lowest significant systolic blood pressure curve was noted throughout the pregnancy for women who participated in resistance exercise, followed by women in the aerobic exercise group all relative to the no exercise control group. At 36 weeks’ gestation, the systolic blood pressure was lower in the resistance group by 12.17 mm Hg (P<.001) and in the aerobic group by 7.90 mm Hg (P<.001) relative to controls. No significant change in systolic blood pressure was noted in the combination group in comparison with controls at 36 weeks’ gestation. Similarly, we demonstrated a significantly lower linear growth curve in diastolic blood pressure that was maintained throughout pregnancy in any exercise type relative to controls. After controlling for maternal body mass index, all 3 exercise types (combination, resistance, and aerobic) significantly predicted a similar decrease in diastolic blood pressure that was maintained throughout pregnancy. At 36 weeks’ gestation, the diastolic blood pressure was lower in the aerobic group by 7.30 mm Hg (P<.01), in the combination group by 6.43 mm Hg (P<.05), and in the resistance group relative to controls.CONCLUSIONOverall, all exercise types were beneficial in lowering maternal resting blood pressure throughout pregnancy. Resistance training was noted to be the most beneficial in improving systolic blood pressure, followed by aerobic exercise. All 3 exercise groups were noted to improve diastolic blood pressure equally. Further research needs to be done to determine if either resistance or aerobic exercise throughout pregnancy decreases the risk for hypertensive disorders of pregnancy and the associated morbidity and mortality.