Blood Pressure Index Research Articles

Health outcomes of an ambulatory exercise-based cardiac rehabilitation program across patient risk categories

Abstract Background Exercise-based cardiac rehabilitation is recommended after an ST-segment elevation myocardial infarction (STEMI) to improve prognosis, quality of life and control of cardiovascular risk factors. Ambulatory training has been proposed as an alternative if in-hospital training is unavailable. Purpose To study the health outcomes of an ambulatory exercise-based Cardiac Rehabilitation Program (aCRP) in STEMI patients across different patient risk profiles. Methods A Phase 2 aCRP aimed to STEMI patients was implemented in our hospital in 2022. Conventional or cardiopulmonary exercise testing (C/CPET) was performed, patient risk was stratified as low risk or intermediate/high risk, and a 3-month, individualized aerobic and strength ambulatory training program was provided. C/CPET was repeated at the end of Phase 2 and peak oxygen consumption (peak VO2) was measured. Questionnaires were used to analyse quality of life (SF-36), depression (PHQ-2), anxiety (GAD-2), adherence to Mediterranean diet (PREDIMED) and weekly physical activity (IPAQ). Comparisons were performed between patients at low risk and patients at intermediate/high risk. A p<0.05 was considered statistically significant. Results The cohort comprised 41 patients who completed Phase 2 of aCRP (mean age 60.1±10.2 years, 82.9% male and 53.7% smokers) and were stratified as low risk (n=15, 36.6%) or intermediate/high risk (n=26, 63.4%). Reductions in systolic blood pressure (-7.9±15.7mmHg), LDL cholesterol (-59.5±35mg/dL), weight (-3±6.5kg) and body mass index (BMI, -1±2.2) were attained (all p<0.05). Smoking abstinence was accomplished in 90.9% of smokers and most patients achieved an LDL<55mg/dL target (75.6%). Quality of life improved (+8.4±23.7 points in SF-36, p=0.03) and anxiety symptoms diminished (-0.6±1.8 points in GAD2, p=0.04). A median 4.1±4.7ml/kg/min peak VO2 increase was achieved (+17.9% from baseline, p<0.001) and patients increased their reported weekly physical activity in 2681.1±3385.3 METS/week (+156.2% from baseline, p<0.001). No significant differences were noted between low risk and intermediate/high risk patients, except lower LDL<55mg/dL (65.4% vs. 93.3%, p=0.045) and higher weight loss and BMI reduction (-4.2±7.7 vs. -0.8±3kg, p=0.05 and -0.16±1.1 vs. -1.54±2.5, p=0.02, respectively) in intermediate/high risk patients. No readmissions for cardiovascular causes or complications of ambulatory training were registered. Conclusions In STEMI patients, a Phase 2 ambulatory Cardiac Rehabilitation Program can provide excellent control of cardiovascular risk factors, improve quality of life, and significantly increase functional capacity and reported weekly physical activity. Results are comparable in patients at low risk and intermediate/high risk of cardiac rehabilitation, which could support the inclusion of intermediate/high risk patients in ambulatory exercise-based cardiac rehabilitation programs if in-hospital supervised training is unavailable.Health outcomes of aCRP.

Effect of initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy on ambulatory blood pressure indices

Abstract Background The QUARTET trial showed that a combination of four ultra-low-dose blood pressure (BP) medications lowered mean unattended office BP more effectively than initial monotherapy. Purpose To investigate the effects of a combination of four ultra-low-dose blood pressure (BP) medications on ambulatory BP changes. Methods Australian adults (≥18 years) with hypertension who were untreated or on monotherapy were eligible for participation in the QUARTET study. Overall, 591 participants were randomly assigned to receive either the quadpill (containing irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg) or an indistinguishable monotherapy control (irbesartan 150 mg). The difference in 24-hour, daytime and night-time systolic and diastolic ambulatory BP at 12 and 52 weeks were pre-defined secondary outcomes. Reported parameters for this analysis were derived from ambulatory BP recordings of 576 participants that fulfilled pre-defined validation criteria. Results Of 576 participants, 289 were randomized to the quadpill group and 287 to the monotherapy group. At baseline, 24-h systolic/diastolic BP was 139.2/81.0 mmHg in the monotherapy vs. 139.8/81.3 in the quadpill group, daytime BP was 142.5/83.5 vs 143.4/84.0 mmHg, and night-time BP was 125.1/70.7 vs. 125.4/70.7 mmHg. At 12 weeks, mean 24-h ambulatory systolic and diastolic BP were 7.7 (95%CI: 9.6, 5.8) and 5.3 (95%CI: 6.5, 4.1) mmHg lower in the quadpill versus monotherapy group (p<0.001 for both). Similar reductions were observed for daytime (8.1/5.7 mmHg lower in quadpill compared to montherapy group) and night-time (6.3/4.0 mmHg lower in quadpill compared to monotherapy group) BP (all p<0.001) at 12 weeks. The reduction in systolic and diastolic ambulatory BP variability were more pronounced in the quadpill group at 12 weeks, the 24-h standard deviation was reduced by -1.2 (-1.8, -0.5) mmHg for systolic and -0.9 (-1.5, -0.4) mmHg diastolic BP. The rate of BP control (24 hours BP ≥130 and/or ≥80 mmHg) at 12 weeks was higher in the quadpill group (77% vs 50%; p<0.001). These effects were maintained at 52 weeks. Conclusion A quadruple quarter-dose combination compared to monotherapy resulted in greater ambulatory BP lowering across the entire 24-hour period with higher ambulatory BP control rates at both 12 and 52 weeks. These findings further substantiate the efficacy of an ultra-low-dose quadpill-based BP lowering strategy – which has been previously shown not to increase the rate of side effects - and extends it to ambulatory BP measurements.

Efficacy of azilsartan medoxomil in patients with hypertension and stable coronary artery disease in combination with type 2 diabetes

Aim. To study the effect of azilsartan medoxomil (AZL-M) on the 24-hour blood pressure (BP) profile in patients with hypertension (HTN), type 2 diabetes (T2D) and stable coronary artery disease (CAD).Material and methods. A total of 183 patients with CAD in combination with HTN and T2D took part in the study (100 men (54,64%), 83 women (45,36%)). All patients were previously prescribed a statin, antiplatelet therapy, a beta-blocker, and an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). At baseline, the proportion of people taking ARBs and ACEIs was 30% and 70%, respectively. All study participants were discontinued from a previously prescribed ARBs or ACE inhibitors and were prescribed 6-month AZL-M (Edarbi®) therapy. During this period, according to the study plan, patients visited the medical center to assess the effectiveness and safety of therapy and blood pressure changes.Results. The mean age of the patients was 65,0 years (60-69 years), while the mean body mass index (BMI) — 31,24 kg/m2. The mean age of female participants was higher than the mean age of males: 66,35±6,59 vs 62,72±8,82 years (p=0,002). The mean BMI in women was higher and was 33.08 kg/m2, while in men it was 30,74 kg/m2 (p=0,001). Six-month AZL-M therapy decreased 24-hour BP values. Thus, the time index of systolic blood pressure (SBP) hypertension in the daytime decreased from 63% to 12%, while at night from 70% to 10%, and the time index of diastolic blood pressure (DBP) hypertension in the daytime from 18% to 10%, and at night from 44% to 8%. The main result is confirmation of AZL-M effectiveness in relation to BP control, as well as good drug tolerability. At the visit after 1-month AZL-M therapy, target BP values were recorded in 45,4% of participants, and after six months — the proportion of people with normal 24-hour BP values was 69,9%.Conclusion. Edarbi® therapy in patients with HTN in combination with T2D and stable CAD leads to 24-hour BP normalization. At the same time, the drug has a good safety profile, since the reported adverse events were not related to the drug.

Abstract 13565: Long-Term Prognostic Value of the Combination of Systemic Immune-Inflammation Index and AHEAD Score and in Patients Admitted for Acute Decompensated Heart Failure

Backgrounds: Systemic inflammation plays a critical role in the outcomes of heart failure patients. A newly defined index, which is named as systemic immune-inflammation index (SII), had been reported to have prognostic value in patients with cardiovascular disease. On the other hand, comorbidities are strongly associated with poor clinical outcome in heart failure patients (pts). AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score was known to be related to clinical outcomes in acute decompensated heart failure (ADHF) patients. We sought to investigate the prognostic value of the combination of SII and AHEAD in patients admitted for ADHF. Methods and Results: We studied 263 patients admitted for ADHF and discharged with survival. At the discharge, we obtained SII, which is computed as neutrophils x platelets / lymphocytes, and AHEAD score (range 0-5, atrial fibrillation, hemoglobin <13 mg/dL for men and 12 mg/dL for women, age >70 years, creatinine >130 μmol/L, and diabetes mellitus). During a follow-up period of 5.0±4.2 yrs, 67 patients had cardiovascular death (CVD). At multivariate Cox analysis, SII and AHEAD score were significantly independently associated with CVD, independently of prior heart failure hospitalization, systolic blood pressure and left ventricular dimension index. The patients with both greater SII (≥571 determined by ROC analysis: AUC 0.632[0.553-0.712]) and AHEAD score (≥3: AUC 0.635[0.562-0.707]) had a significantly increased risk of CVD than those with either and none of them (51% vs 28% vs 16%, p<0.0001, respectively). Conclusion: The combination of SII and AHEAD score would be useful for stratifying patients at risk for cardiovascular-renal poor outcome in ADHF patients.

Abstract 14509: Life’s Simple 7 Predicts Mild Cognitive Impairment and Dementia in an Older Adult Population

Introduction: The American Heart Association’s Life’s Simple 7 (LS7) is a metric used widely in cardiovascular disease research. Lower scores on Life's Simple 7 predicts a lower performance on measures of cognitive functioning in young and middle-aged adults. Whether this is the case in older adults, however, is unclear. Hypothesis: Higher LS7 scores at baseline will be associated with a reduced risk of mild cognitive impairment (MCI) or dementia in older adults. Methods: Data from the Health and Retirement Study (HRS) between 2010 to 2018 was used in the analysis. The respondents were older than 50 years old and free from dementia and MCI at baseline. A survival-analysis was used and failures were defined as having MCI or dementia as determined by a 27-point Telephone Interview for Cognitive Status (TICS). LS7 scores were computed using smoking status (current and former), physical activity, diet, blood pressure, total cholesterol, blood glucose, and body mass index (BMI). A cox proportional hazard model was used to evaluate hazard ratio of developing mild cognitive impairment (MCI) and dementia in older adults. Results: There were 1,604 respondents with complete data included in this analysis. Of these respondents, 563 (35.1%) were male and 1,041 (64.9%) were female. 1,224 (76.3%) were white, 236 (14.7%) were black, and 143 (8.9%) were of another race. The average age of the respondents at baseline was 62.3±10.6 years. In 7,505 person-years, there were 1,197 events of MCI or dementia. After adjusting for age, gender, and educational attainment, a LS7 score less than 5 was associated with a 1.51 times higher risk of MCI or dementia than a LS7 score greater than 8 (p < 0.005). However, LS7 scores between 7 or 8 was not significantly associated with increased risk of MCI or dementia compared to a LS7 score greater than 8 (HR: 1.12, p = 0.09). Conclusions: Lower LS7 score is associated with significantly lower performance on a measure of global cognitive functioning. As in young and middle-aged adults, maintaining a heart-healthy lifestyle may be important in preventing cognitive decline in older adults.

Abstract 17653: Neighborhood Deprivation and Cardiovascular Health in US Adolescents, National Health and Nutrition Examination Survey 2007-2018

Introduction: AHA “Life’s Essential 8” scores cardiovascular health (CVH) as good, intermediate or poor based on diet, physical activity, sleep, tobacco exposure, cholesterol, blood pressure, blood glucose, and body mass index. CVH of the US population remains suboptimal, and the relationship between neighborhood deprivation and CVH in youth has not been fully explored. Hypothesis: We hypothesize that high neighborhood deprivation is associated with intermediate/poor CVH in adolescents. Methods: Using 2007-2018 National Health and Nutrition Examination Survey data, we examined the relationship between neighborhood deprivation index (NDI) and CVH status in adolescents. NDI was created from 2010 US Census data and reflects neighborhood level income, housing, education, and poverty status. Higher NDI indicates greater neighborhood deprivation. NDI values were divided into tertiles for analysis. We used proc survey logistic to assess the odds of poor/intermediate CVH status among youth living within high and intermediate compared to low deprivation communities. The model was adjusted for age, sex, ethnicity-race, household reference education and marital status, family poverty, rural vs urban residence and Citizenship status. All analyses were conducted using SAS 9.4, p<0.05 . Results: We evaluated data from 3894 individuals, representative of 57,195,556 US adolescents 13 to 18 years of age. Most adolescents were non-Hispanic white (67%), male (51%), US Citizens (96%), mean age of 15 years, with an even distribution of youth living within low, intermediate and high deprivation neighborhoods (Table 1). We identified 31% greater odds of intermediate/poor CVH status among youth living within the most deprived communities (Table 2). Conclusions: Greater NDI associates with worse CVH in US adolescents. Public health initiatives should consider using NDI to tailor efforts in designing intervention strategies to preserve CVH status in US adolescents.

Effect of Preoperative Oral Carbohydrate Loading on Perioperative Hemodynamic in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Study

Background: Conventional preoperative fasting is associated with intravascular volume contraction, increased stress, hyperglycaemia in the perioperative period. Recently, the concept of preoperative carbohydrate loading is introduced. This study was conducted to reveal the relation between use of carbohydrate-rich fluid and perioperative hemodynamic, perfusion index, and glucose control of the patients, who were undergoing elective laparoscopic cholecystectomy under general anesthesia. Methods: This study is a double-blinded prospective randomized control study. The patients, who met the inclusion criteria were randomly divided into 2 groups of 43 each with the help of computer-generated randomization method. Patients who received preoperative carbohydrate loading and patients who follow conventional preoperative fasting for surgery were labelled as Group E and Group S respectively. Incidence of hypotension was the primary outcome; variation in blood pressure, heart rate, perfusion index, and blood glucose level were the secondary outcomes. Results: Intraoperative hypotensive episodes were significantly lower in the carbohydrate loading group in comparison to the conventional fasting group, p=0.023. The systolic, diastolic blood pressure and perfusion index were significantly lower in the conventional fasting group. Also, the heart rate was significantly higher in the conventional fasting group. Numeric rating scale, the score for pain taken at 1 hour postoperatively was significantly lower in the carbohydrate loading group. Blood glucose level postoperatively after 24 hours was significantly more in the conventional fasting group. Conclusion: The carbohydrate loading group has better hemodynamic stability and optimal intravascular volume after induction and intraoperatively. Also, the carbohydrate loading group had better glycaemic control and better pain relief postoperatively.

Anthropometric indexes for predicting high blood pressure in Turkish adults.

It is controversial which anthropometric indexes are the best in predicting the risk of hypertension and how anthropometric measurements are related to blood pressure (BP). This study aimed to evaluate the relationship between BP and anthropometric indexes and to determine the best predictors for hypertension risk. This cross-sectional study was conducted with 415 consecutive participants (161 men, mean age: 33.4 years) aged 18-88 years in Istanbul, Turkey. Weight, height, waist circumference (WC), and neck circumference (NC) and BP were measured by well-trained personnel. Waist-to-height ratio (WHtR) and body mass index (BMI) were calculated. Pearson correlation, linear regression, and multivariate analyses were used to assess the relationship between anthropometric measurements and SBP, DBP, using the Statistical Package for the Social Sciences version 23.0. The systolic BP (SBP) and diastolic BP (DBP) were related to weight, WC, NC, BMI, and WHtR (P < 0.05). Linear regression analyses showed BMI and WC as independent risk factors for SBP with an increase by 1.11 mmHg in men (P = 0.036) and 1.59 mmHg in women (P = 0.001) in SBP when BMI increased 1 unit, while SBP increases by 0.2 mmHg when WC increases by 1 unit regardless of gender (P = 0.013). Our results showed that BMI and WC are related to BP and important predictors of hypertension risk. Therefore, the uses of BMI and WC are recommended as screening tools for the prediction of hypertension risk among Turkish adults.

The impact of the Prime Time Sister Circles® (PTSC) on blood pressure of low-income mid-life African American women in the United States

There is a pressing need to develop and evaluate culturally tailored, community-based interventions that address hypertension management among low-income African American women. We employed a randomized controlled trial to test the effectiveness of the Prime Time Sister Circles® Program in reducing blood pressure and body mass index among low-income African American women ages with hypertension. Study participants (N = 339) were African American women aged 40–75 years who were diagnosed with hypertension and received their primary care at government funded health centers in Washington, D.C. Compared to the usual care group, Prime Time Sister Circles® participation was associated with a reduction in systolic BP by − 2.45 (CI − 6.13, 1.23) mmHg, a reduction in diastolic BP by − 3.66 mmHg (CI − 6.32, − 0.99), and a change in BMI by − 0.26 (CI − 2.00, 1.48) from baseline to 15 months. The results suggest that culturally tailored community-based interventions can improve hypertension management in low-income women.

Characterising diabetes in Kazakhstan: a cluster analysis

Abstract Background Diabetes is a global pandemic, affecting 537 million adults worldwide in 2021. Diabetes is much more complex than the classification into type 1 diabetes and type 2 diabetes suggests. We aimed to identify homogeneous groups of patients with diabetes based on routinely collected measurements using unsupervised, data-driven cluster analysis. Methods We analyzed the data from Electronic Medical Records of 558 patients with newly diagnosed diabetes from 4 outpatient clinics in Astana. We performed a k-means cluster analysis of 9 routinely measured variables using the KMeans function (iterations=3 million) from the Scikit-Learn Python library. Results Cluster 1, consisting of 176 (31,5%) patients, was defined by late-onset diabetes, relatively low blood pressure (BP) and body mass index (BMI), moderate metabolic derangements, and comparably low glomerular filtration rate (GFR). The 83 (14,9%) patients in cluster 2 were characterized by a late manifestation of diabetes, high BP and BMI, relatively poor glycemic control, moderate dyslipidemia, and comparably low GFR. Cluster 3, including 98 (17,6%) patients, was represented by a low age at onset, comparably low BP and BMI, moderately poor glycemic and lipid controls, and high GFR. The 110 (19,7%) patients in cluster 4 had late-onset diabetes, high BP and BMI, subcompensated diabetes, poor lipid control, and relatively low GFR. Cluster 5, which involved 91 (16,3%) patients, was characterized by comparably low BP and BMI, poor glycemic control, modest dyslipidemia, and high GFR. Conclusions We intend to continue the project for further conducting a prospective study with dynamic monitoring of study participants, tracking specific patterns in the development of diabetic complications in each cluster. The results of this work will contribute to the development of a model for identifying patients with an initially predictable course of diabetes and a high risk of its complications at the time of diagnosis. Key messages • We identified five clusters of patients with diabetes with clinically significant characteristics in each cluster. • Identification of subgroups of patients with an initially predictable course can be useful for recognizing those at highest risk of complications and applying personalized treatment strategies.

Sonographic evaluation of maternal blood loss after childbirth using postpartum inferior vena cava diameter among parturients in Kano Metropolis, Nigeria

Postpartum hemorrhage has been a major cause of maternal morbidity and mortality globally every year. Sonographic measurement of inferior vena cava diameter is a cheap, safe, non-invasive method and an indicator of blood loss after childbirth. The study was aimed to establish normal range values of postpartum inferior vena cava (IVC) among parturients in Kano metropolis, Nigeria. A prospective and longitudinal study from September, 2021 to September, 2022 was adopted and a minimum sample size of 210 measurements of IVC intraluminal diameter was calculated for the study using G Power sample size software. The sample comprised of two sets measurements obtained from 105 parturients before delivery and after delivery. The maternal heart rate and systolic blood pressure were measured. Blood samples from all subjects were collected. The data was analyzed using IBM Statistical Software. The range value of IVC diameter on inspiration of the subjects before childbirth was 13.2 mm – 20.3 mm, after childbirth was 9.1 mm – 16.7 mm. The IVC diameter range on expiration before childbirth was 17.3 mm – 24.8 mm, after childbirth was 12.6 mm – 21.4 mm. The Packed Cell Volume (PCV) range of the subjects before childbirth was 35% – 40%, after childbirth was 18% – 33%. The heart rate before childbirth was 64 bpm – 100 bpm, after childbirth was 70 bpm – 100 bpm. The systolic blood pressure before childbirth was 110 mmHg – 120 mmHg, after childbirth was 90 mmHg – 120 mmHg. The shock index before childbirth was 0.5 – 0.9 and after childbirth was 0.6 – 0.9. A statistical significant (p&lt;0.001) difference in IVC was observed. Furthermore, a statistical significant (p&lt;0.001) difference was obtained in PCV, maternal heart rate, systolic blood pressure and shock index. There was a statistical significant strong positive correlation between IVC and PCV during inspiration and expiration before and after childbirth.

Evaluation and Comparison of Changes in Blood Pressure and ECG After Hormone Therapy in Hypothyroid Patients

Background: Hypothyroidism is one of the disorders that is associated with an increased risk of cardiovascular disease. One of the first responses to thyroid hormone administration is to reduce systemic vascular resistance and increase cardiac output and heart contraction.&#x0D; Methods: In this study, which was performed as a quasi-experimental study (before and after), 50 patients were referred to the endocrinology and internal medicine clinic of Towhid Hospital in Sanandaj (in two groups of 25 patients receiving medication and the group that did not receive medication) They were included in the study based on inclusion and exclusion criteria. Blood pressure, heart rate, and ECG were performed by a cardiologist after recording them.&#x0D; Results: The mean age of patients participating in the study was 48.0 ± 7.74 years. Compared the patients receiving the drug and the other group, in terms of sex distribution and age, showed results; There was no statistically significant difference between the two groups (p value &gt; 0.05) However, in terms of comparing blood pressure and heart rate indices in the before and after stages, the two groups showed a statistically significant difference between patients receiving medication and patients who did not receive medication in terms of systolic and diastolic blood pressure in the previous phase of hormone therapy (p value &lt; 0.01).&#x0D; Conclusion: Special attention to hypothyroid patients according to the obtained results, Control, follow-up, and planning for these patients, by those involved in the matter and those responsible for the health sector, seems important and necessary and should be taken into consideration.

Association between ankle-brachial blood pressure index with all-cause and cardiovascular mortality in adults without arterial stiffness

PurposeTo explore the relationship between ankle-brachial blood pressure index (ABPI) and all-cause or cardiovascular mortality in adults without arterial stiffness.MethodsA total of 6784 participants without arterial stiffness were enrolled from National Health and Nutrition Examination Survey 1999–2004. The hazard ratio (HR) and 95% confidence interval (CI) of ABPI associating with the risk of all-cause and cardiovascular mortality was calculated by Cox proportional regression models adjusted for demographic and traditional risk factors. Dose-response relationship was explored with restricted cubic spines.ResultsAfter an average follow-up of 12.1 years, 1844 all-cause deaths and 299 cardiovascular deaths occurred. Compared with the lowest ABPI quartile, the second quartile was associated with the lowest risk of all-cause mortality (HR 0.89, 95%CI 0.79–0.98; p = 0.036) and cardiovascular mortality (HR 0.75, 95%CI 0.56–0.98; p = 0.048). Besides, dose-response analysis revealed that ABPI was nonlinearly correlated to all-cause mortality (p for nonlinearity < 0.001) and linearly correlated to cardiovascular mortality (p for nonlinearity = 0.459).ConclusionsThe relationship between ABPI and all-cause and cardiovascular mortality followed a L-shape curve. A lower ABPI was independently associated with an increased risk of all-cause and cardiovascular mortality in adults without arterial stiffness.

Predicting metabolic syndrome using machine learning - Analysis of commonly used indices.

Determining the factors that contribute to making a reliable prediction of the metabolic syndrome will provide a deeper understanding of the medical indices involved in the prediction and assist in early diagnosis and treatment of patients. The study examined the optimal number of National cholesterol education program adult treatment panel (NCEP ATP) III indices needed to make a reliable prediction of the syndrome, whether each of the five NCEP ATP III indices for predicting the syndrome is equally important and whether a reliable prediction can be made using calculated blood pressure indices - estimated mean arterial pressure and pulse pressure - instead of NCEP ATP III blood pressure indices. The results show that NCEP ATP III indices for determination of the syndrome are not equally important. Moreover, the indices importance and their prediction quality vary according to gender. Optimal results are obtained by using all five NCEP ATP III indices for prediction.

Saponins of Panax japonicus ameliorates cardiac aging phenotype in aging rats by enhancing basal autophagy through AMPK/mTOR/ULK1 pathway

Heart disease is a significant health concern for elderly individuals, with heart aging being the primary cause. Recent studies have shown that autophagy can play a protective role in preventing cardiac aging. Our previous research confirmed that Chikusetsu saponin IVa, a fundamental component of Saponins of Panax japonics (SPJ), can enhance basic autophagy levels in cardiomyocyte of isoproterenol induced cardiac fibrosis mice. However, it remains unclear whether SPJ possesses a protective effect on cardiac dysfunction during the natural aging process. Rats were randomly divided into four groups: adult control group (6 months old), aging group (24 months old), aging group treated with 10 mg/kg SPJ, and aging group treated with 30 mg/kg SPJ. The heart function, blood pressure, and heart mass index (HMI) were measured. Hematoxylin and eosin staining (H&E) and Wheat Germ Agglutinin (WGA) staining were used to observe the changes in morphology, while Masson staining was used to examine collagen deposition in the rat hearts and CD45 immunohistochemistry was conducted to examine the macrophage infiltration in heart tissues. TUNEL kit was used to detect apoptosis level of cardiomyocyte, and western blot was used to evaluate autophagy-related proteins as well as AMPK/mTOR/ULK1 pathway-related markers. SPJ treatment improved the cardiac function, reduced HMI, attenuated myocardial fiber disorder, inhibited inflammatory cell infiltration, and decreased collagen deposition and cardiomyocyte apoptosis in aging rats. Additionally, SPJ treatment decreased the expression of aging-related proteins and restored the expression of autophagy-related markers. SPJ activated autophagy through the activation of AMPK, which in turn increased the phosphorylation of ULK1(Ser555), while inhibited the phosphorylation of mTOR and ULK1(Ser757). Our study demonstrates that SPJ improves the cardiac function of aging rats by enhancing basal autophagy through the AMPK/mTOR/ULK1 pathway. These results offer a theoretical foundation and empirical evidence to support the clinical advancement of SPJ in enhancing age-related cardiac dysfunction.

OC19.05: ASPRE trial: effects of aspirin on mean arterial blood pressure and uterine artery pulsatility index trajectories in pregnancy

OC19.05: ASPRE trial: effects of aspirin on mean arterial blood pressure and uterine artery pulsatility index trajectories in pregnancy

Immune Markers, Blood Pressure Severity, and Cardiac Remodeling 1 to 2 Years After Hypertensive Disorders of Pregnancy.

Background Cardiovascular dysfunction and hypertension can persist postpartum following hypertensive disorders of pregnancy (HDPs). This study hypothesized that activin A, proinflammatory markers and concentric remodeling by echo would be higher 1-2 years postpartum following HDP with persistent hypertension compared to HDP with normalized blood pressure (BP). We further hypothesized correlations between biomarkers with BP and echocardiographic indices. Methods and Results This study enrolled participants with HDPs but no prepregnancy hypertension followed 1 to 2 years after delivery. Activin A and inflammatory cytokines, BP, and echocardiograms were obtained. Biomarker concentrations and echocardiographic parameters were compared between HDP with and without persistent hypertension. Individuals with persistent hypertension at a mean of 1.6 years postpartum had significantly higher activin A concentrations (median[interquartile range 25-75] 230.6 [196.0-260.9] versus 175.3 pg/mL [164.3-188.4]; P<0.01), more concentric left ventricular concentric remodeling (relative wall thickness >0.42, 48% versus 7%; P<0.01), and worse peak left atrial strain (33.4% versus 39.3%; P<0.05) as compared with those whose BP normalized. Higher activin A and interleukin-6 concentrations correlated with higher systolic (activin A: r=0.43, P=0.01) and diastolic BP (activin A: r=0.58, P<0.01; interleukin-6: r=0.36; P<0.05), as well as greater left ventricular thickness (activin A and interventricular septal thickness: r=0.41, interleukin-6 and interventricular septal thickness: r=0.36; both P<0.05). Conclusions Individuals with HDPs and persistent hypertension had significantly higher activin A and greater concentric remodeling compared with those with HDPs and normalized BP at 1 to 2 years postpartum. Activin A was positively correlated with both BP and echocardiographic indices (left ventricular thickness), suggesting overlapping processes between persistent hypertension and cardiac remodeling.

Effects of Continuous Non-Invasive Blood Pressure Monitoring on Intraoperative Hemodynamics and Postoperative Myocardial Injury in Craniotomy: Comparison Between Groups Based on Self-Control and Propensity Score Matching

Objective: To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy. Methods: 120 cases of elective craniotomy were divided into the self-control group (continuous non-invasive blood pressure monitoring and intermittent cuff non-invasive blood pressure monitoring, CNAP group) and propensity score matching group (only intermittent cuff non-invasive blood pressure measurement in previous craniotomy, PSM group); Goal-directed hemodynamic management in CNAP group included heart rate (HR), blood pressure (BP), stroke volume (SV), stroke variability (SVV), and systemic vascular resistance index (SVRI). The main index is to compare the troponin level within 72 hours after operation between the CNAP group and the PSM group; The secondary indicators are the comparison of the hemodynamic conditions between the CNAP group and the PSM at 10 specific time points. Results: The incidence of postoperative myocardial injury in the CNAP group was significantly lower than that in the PSM group (12% vs. 30%, P = 0.01); in the CNAP group hypotensive episodes (6 vs. 3, P = 0.01), positive balance of fluid therapy (700 vs. 500 mL, P &lt; 0.001), more use of vasoactive drugs (29 vs. 18, P = 0.04), more stable hemodynamics medical status (P = 0.03) were recorded. Conclusion: The hemodynamic management strategy based on continuous non-invasive blood pressure monitoring can reduce the incidence of myocardial injury after elective craniotomy and maintain a more stable hemodynamic state.

A Proposed Pediatric Clinical Cardiovascular Health Reference Standard

Clinical cardiovascular health is a construct that includes 4 health factors-systolic and diastolic blood pressure, fasting glucose, total cholesterol, and body mass index-which together provide an evidence-based, more holistic view of cardiovascular health risk in adults than each component separately. Currently, no pediatric version of this construct exists. This study sought to develop sex-specific charts of clinical cardiovascular health for age to describe current patterns of clinical cardiovascular health throughout childhood. Data were used from children and adolescents aged 8-19 years in six pooled childhood cohorts (19,261 participants, collected between 1972 and 2010) to create reference standards for fasting glucose and total cholesterol. Using the models for glucose and cholesterol as well as previously published reference standards for body mass index and blood pressure, clinical cardiovascular health charts were developed. All models were estimated using sex-specific random-effects linear regression, and modeling was performed during 2020-2022. Models were created to generate charts with smoothed means, percentiles, and standard deviations of clinical cardiovascular health for each year of childhood. For example, a 10-year-old girl with a body mass index of 16 kg/m2 (30th percentile), blood pressure of 100/60 mm Hg (46th/50th), glucose of 80 mg/dL (31st), and total cholesterol of 160 mg/dL (46th) (lower implies better) would have a clinical cardiovascular health percentile of 62 (higher implies better). Clinical cardiovascular health charts based on pediatric data offer a standardized approach to express clinical cardiovascular health as an age- and sex-standardized percentile for clinicians to assess cardiovascular health in childhood to consider preventive approaches at early ages and proactively optimize lifetime trajectories of cardiovascular health.

The effect of Dexmedetomidine on suppression of the bispectral index score and hemodynamic response during laryngoscopy and intubation in addicted patients in supratentorial brain tumor surgery, a randomized double-blinded controlled trial

BackgroundDexmedetomidine is an α2-adrenoceptor agonist with good sedative effects with no cardiovascular instability or respiratory depression, and it might help facilitate endotracheal intubation and inhibit hemodynamic responses. AimThe current study assessed how intravenous Dexmedetomidine affected cardiovascular response and endotracheal intubation in opium-addict patients. Materials and methodsThis study is a clinically randomized, double-blind, controlled trial. One hundred patients diagnosed with supratentorial brain tumors undergoing tumor resection surgery with general anesthesia entered this study. One group received Dexmedetomidine (1/μg/kg for 10 min) before induction of anesthesia. The exact amount of normal saline (placebo) was administered in the second group. The two groups were analyzed statistically regarding blood pressure, heart rate, and bispectral index score, recorded 1 min before and 1 min after intubation. The statistical tests used for analysis are the student T-test, Mann-Whitney non-parametric test, the chi-square test, and Fisher's exact test. ResultsThe intervention group's heart rate, systolic blood pressure, and bispectral index score decreased 1 min after anesthesia induction and intubation compared to the control group. Diastolic blood pressure after induction of anesthesia was not significantly different between the two groups; however, it decreased following the intervention after intubation (p > 0.05). ConclusionCompared to the control group, Dexmedetomidine suppressed hemodynamic response and bispectral index score in opium-addict patients.