Blood Pressure Readings Research Articles

Inherited Stanford A DeBakey I Aortic Dissection: Unveiling Genetic Predispositions and Surgical Management

BACKGROUND: Aortic dissection refers to the disruption of the medial layer of the aorta caused by intramural hemorrhage. This leads to the separation of the layers of the aortic wall, resulting in the establishment of a true lumen and a false lumen, which may or may not be connected. The prevalence of aortic dissection ranges from 0.2% to 0.8%. Additionally, a notable percentage, surpassing 20%, of individuals exhibit a familial inclination towards thoracic aorta dissection. CASE PRESENTATION: A male patient in his middle age, 41 years old, with risk factors of uncontrolled hypertension, obesity, and a familial propensity to aortic dissection, presented to the emergency department exhibiting symptoms of chest pain. It characterized the sensation as having a tearing quality and indicated that it extended towards the abdomen region. The results of the test revealed several notable findings. A blood pressure reading of 235/133, a wider mediastinum and cardiomegaly on the chest X-ray, a slight increase in Hs-Troponin levels, and an electrocardiogram showed sinus rhythm with left ventricular hypertrophy. He underwent a computed tomography scan, which revealed the existence of an aortic dissection that extended from the ascending to the descending aorta without any aortic valve involvement. He was assessed with a Stanford A. DeBakey I aortic dissection, and underwent successful therapy for aortic arch replacement with the elephant trunk procedure, and plans to undertake an endovascular procedure for the descending aorta in the upcoming period. CONCLUSION: Aortic dissection is a pathological disorder that may exhibit hereditary inheritance, and the choice of surgical technique is dependent on the specific underlying disease.

Efficacy and Safety of Pharmacist-Managed NSAIDs Deprescribing: A Jordanian Outpatient Study

Background. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage pain, including chronic pain conditions. However, their prolonged use is associated with significant risks, particularly gastrointestinal (GI) adverse events. This study aimed to evaluate the effectiveness and safety of a pharmacist-managed deprescribing program for NSAIDs in a Jordanian outpatient population. Methods. A convenience sample of 100 participants who had been using NSAIDs for pain management was recruited. Participants underwent a structured deprescribing intervention in collaboration with physicians. Various effectiveness and safety outcomes were assessed before and after deprescribing. Descriptive statistics and chi-square test were used for data analysis. Results. The majority of participants reported chronic pain conditions, with rheumatoid arthritis (24%) and osteoarthritis (22%) being the most prevalent. Ibuprofen (28%) and diclofenac (22%) were the most commonly used NSAIDs. The deprescribing program was associated with a significant reduction in heartburn, stomach ulcer, kidney problems and fluctuation in blood pressure readings (p<0.05), and pain exacerbation. Notably, the reduction in pain exacerbation was evident (p=0.003) in the 4-month follow-up. Conclusion. A pharmacist-managed NSAIDs deprescribing program demonstrated effectiveness in reducing the risk of GI adverse events and fluctuation in blood pressure readings without causing harm during a short-term follow-up. These findings support the feasibility of implementing such programs in outpatient settings. Further long-term investigations are necessary to confirm these results.

Using 15-Minute Serial Blood Pressures as an Alternative to Measuring a Single Blood Pressure.

Thirty-minute office blood pressure (OBP-30) is an alternative to ambulatory blood pressure (BP) measurement, yet is impractical to implement. This study aimed to determine whether unattended BP readings over 15 minutes would result in a similar probability of obtaining a BP of <140/90. Sixty-seven adults self-described as having high BP were analyzed. BP was measured at baseline and every 5 minutes for 15 minutes with the initial reading compared to the average of the last three readings (OBP-15). Compared to baseline, there was a decline in both average systolic (4.2 points) and diastolic (2.8 points) BP. The probability of BP control predicted by multivariate model was 71.6% at baseline and 78.0% using OBP-15 (p=0.011). The increase in BP control from initial to OBP-15 measurement was significant for indigenous or persons of color compared to whites, and men compared to women. OBP-15 is convenient and results in lower BP readings and higher probability of BP control compared to the initial reading.

Electronic Health Record-based Surveillance of Hypertension Prevalence

Background:Public health officials require timely, accurate data to guide decision-making. The Behavioral Risk Factor Surveillance System (BRFSS), a nationwide telephone survey of U.S. adults conducted by the CDC, serves as a primary source for chronic disease prevalence data. However, limitations like small sample sizes and publication delays exist. A promising alternative is Electronic Health Record-based (EHR) surveillance. Under the CDC-funded Multi-state Electronic Health Record-based Network for Disease Surveillance (MENDS) project, the Regenstrief Institute utilizes EHR data from the Indiana Network for Patient Care database to detect hypertension using algorithms based on a combination of blood pressure measurements, diagnostic codes, and antihypertensive prescriptions.&#x0D; Methods:We compared hypertension prevalence estimates between BRFSS and MENDS using 2015 data from Indiana residents. BRFSS included individuals who positively reported a diagnosis of hypertension or antihypertensive medication use. MENDS included individuals based on clinical diagnosis, abnormal blood pressure readings, and medication history. Gestational hypertension and end-stage renal disease cases were excluded. Equivalence was empirically tested using the two one-sided t-tests (TOST) statistical method.&#x0D; Results:TOST analysis revealed the two methods were not equivalent overall (p &lt; 0.0001) or in any strata measured. The EHR-based model produced a lower estimate of 18.7% (95% CI ± 7.1 x 10-6, n=10,800,076), while BRFSS produced a higher estimate of 28.4% (95% CI ± 3.8, n=934).&#x0D; Conclusion:BRFSS might overestimate (i.e., too sensitive) hypertension prevalence due to survey methodology, while the EHR-based model might underestimate (i.e., too specific) due to its more complex hypertension-detection algorithm. Nevertheless, the EHR-based model provides a reliable and more timely method for estimating hypertension prevalence.&#x0D; Implications:MENDS provides estimates for other chronic disease risk measures such as diabetes, smoking, and obesity. Participating health departments receive updated data each month and can monitor trends. By providing reliable and timely data, public health officials can make well-informed decisions to serve their communities.

Impact of COVID-19 restrictions on diabetes mellitus management in Qatari primary care settings

IntroductionIn 2019, Coronavirus Diseases 2019 (COVID-19) emerged as a pandemic making diabetic patients among the most vulnerable to this virus. Previous studies showed contradicting evidence for the impact of “lockdown” on the management of diabetic patients. New models of service delivery were introduced in Primary Health Care Corporation (PHCC) (Qatar’s largest primary care provider) to ameliorate the risk of infection to both patients and health care workers including converting face to face chronic disease appointments (NCD, antenatal, and preventive visits) to telephone and video consultations. This study aimed to compare access and outcomes of PHCC registered diabetics pre-COVID and during the COVID-19 lockdown period.MethodsThe study was conducted as a 3 year historic cohort using PHCC’s electronic health record system. Individuals with an established diagnosis of diabetes mellitus (DM) before January 2019 and having at least one clinical encounter per year in a PHCC health center during the study period starting Jan 2019 to Dec 2021 were recruited. Pre-COVID-19 period was defined as the interval between January 2019 and February 2020, while the COVID-19 lockdown period was defined as the interval between February 2020 to December 2021. The study used a paired observation approach on selected process indicators on delivery of health services in line with PHCC’s diabetes management guidelines (at least two HbA1C tests done per year and at least one each of the following per year—low-density lipids (LDL) test, ophthalmology screening, podiatry assessment, health education and dietetics clinic consultations) and outcome indicators (blood pressure readings and the results of two laboratory tests: blood HbA1c and serum LDL level).ResultsCOVID-19 was associated with an overall mean reduction of 0.9 per year of consultations. Similarly, the delivery of annual assessments as per guidelines were also impacted. Of these, the probability of achieving the designed target for two HbA1C tests per year was reduced by almost a half (paired OR=0.47) during COVID-19 compared to pre- COVID-19 period. Conversely, a significant increase in the probability of having at least one each of LDL test, ophthalmology screening and dietetics consultation was observed (paired OR=1.84, 1.62 and 1.94 respectively) during COVID-19. The probability of having inadequate glycemic control (HbA1C > =7%) was significantly increased by 32% during COVID-19 period. Likewise, the probability of experiencing inadequately controlled blood pressure was significantly increased by 47% during the pandemic. Conversely, the probability of having Inadequately controlled blood lipids (LDL 2.6 mmol/L+) was significantly reduced by 9%.ConclusionsThe impact of the COVID-19 pandemic on the primary health care services in Qatar has highlighted PHCC’s resilience by the introduction of virtual consultations during COVID-19 restrictions. Only one process indicator was significantly impacted during COVID-19 restrictions, namely having at least two HbA1C tests per individual with diabetes per year. However, the control of the disease according to HbA1c and blood pressure measurements showed a noticeable deterioration during COVID-19.

Lidocaine, Esmolol, and Beyond: A Comprehensive Analysis of Hemodynamic Stress during Laryngoscopy and Intubation

Aim: To evaluate the haemodynamic stress response in combination of lidocaine and esmolol versus lidocaine or esmolol alone during laryngoscopy and intubation Methods: This research comprised 60 patients who provided written permission and met the inclusion and exclusion criteria. Selected patients were randomly assigned to one of three groups based on a computer-generated random number: lignocaine 1.5 mg/kg (n=40), esmolol 2mg/kg (n=40), or lignocaine 1mg/kg and esmolol 1mg/kg (n=40). This research comprised patients aged 20 to 42 who had elective procedures under general anaesthetic and had ASA I and II. Patients with contraindications to beta blockers, such as bronchial asthma, COPD, a basal heart rate of 60 beats per minute, respiratory impairment, and documented reactions to local anaesthetics. Results: There were no significant variations in age, preoperative heart rate, or blood pressure between the groups. Males and females were approximately equally dispersed throughout all groupings. Following the delivery of the test medicines, all three groups saw a substantial drop in heart rate (Group E 61.23±3.64, Group L 73.25±5.36, Group LE 72.23±5.36) (p&lt;0.001). Four Group E patients developed bradycardia. (HR &lt;60). Although both Group LE and Group L showed near baseline values, Group L showed near baseline values until the third minute, whereas Group LE showed a continuous reduction in heart rate rates. After 30 minutes, all three groups' heart rates were statistically insignificant. Following induction and administration of the test medicines, systolic, diastolic, and hence mean arterial blood pressure lowers gradually in all three groups (p&lt;0.001). (This is for systolic blood pressure.). Group E 97.36±5.69, Group L 125.39±6.36, Group LE 116.78±4.78) Group E 60.034.69, Group L 82.935.36, Group LE 72.034.78) (Group E 72.10±3.69, Group L 96.90±3.85, Group LE 86.44±2.87) Before intubation, patients in Group E experienced substantial decreases in systolic, diastolic, and mean arterial blood pressure (less than 20% of baseline). Following intubation, blood pressure levels in Group LE were near baseline until the 30th minute (p&lt;0.001). Group E had a consistent fall in all three blood pressure readings following intubation until the fifth minute. Group E's blood pressures were likewise around baseline at the 15th and 30th minutes. Until the 15th minute, Group L had a considerable rise in all three blood pressures. Conclusion: As a result, esmolol and lidocaine together are a safe and effective strategy to minimise laryngoscopy responses to intubation and extubation, lowering myocardial oxygen consumption and the risk of myocardial ischemia under general anaesthesia.

Effect of nadanusandhana on heart rate variability in individuals with insomnia – A randomized controlled trial

ABSTRACT Background: Insomnia is a common sleep disorder characterized by difficulty initiating or maintaining sleep or sleep that is unrefreshing or of poor quality. It is a serious public health concern where pharmacological insomnia treatments are often only advised for short term. Nadanusandana relaxation can be a safe, simple, and most effective treatment for insomnia as an adjuvant yogic treatment. Aim: The aim of this study was to assess the effect of Nadanusandana relaxation on autonomic variables in patients with insomnia. Settings and Design: A prospective randomized controlled trial conducted on subjects who fulfilled the inclusion criteria were divided equally into two groups. Group 1 along with naturopathy and yogic intervention practiced Nadanusandana relaxation (n = 50) and Group 2 underwent only naturopathic and yogic practices (n = 50). Subjects and Methods: Subjects were assessed for heart rate variability (HRV), blood pressure, and Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) scores before and after treatment. Statistical Analysis Used: SPSS 21.0 was used for statistical analysis. Results: The Nadanusandana relaxation group observed a significant increase in average RR interval, the square root of the mean squared difference between adjacent N-N intervals, the fraction of consecutive RR intervals that differ by more than 50 ms, and high frequency (HF), and a significant decrease in low frequency (LF) and LF/HF ratio was observed in HRV.. A very substantial drop in both the diastolic and systolic blood pressure during blood pressure readings. Sleep quality questionnaire analyzed a significant decrease in ISI score and in PSQI. Conclusion: Nadanusandana relaxation reduces sympathetic tone and shifts sympathovagal balance toward vagal dominance in regular practice. Hence, the result claims that this technique can be effective in reducing sleep disturbances, lowering blood pressure, and improving sleep quality in insomnia.

Prevalence and risk factors associated with uncontrolled blood pressure in rural areas in Settat City, Morocco.

high blood pressure, commonly known as hypertension, is one of the most widespread chronic diseases in the world. It is a serious problem whose management is essential to maintain stable blood pressure levels in the short term, and to prevent neuro-cardio-vascular complications in the long term. This study aims firstly to explore the characteristics of uncontrolled blood pressure among patient´s residents of rural areas in Settat City, and secondly to determine its prevalence and identify associated risk factors. this is a cross-sectional, descriptive, and analytical study which took place between March and August 2023, and targeted a population of hypertensive patients following up at primary healthcare facilities in rural areas in Settat City. A questionnaire was developed and evaluated to ensure its reliability before being administered to study participants, anthropometric measurements and blood pressure readings were also taken. four hundred hypertensive patients were surveyed, 53% (212) of whom had uncontrolled blood pressure, with a mean age of 56.94 (±13.10 years), and a marked female preponderance, illustrated by 72.3% (289) were female. The risk factors associated with uncontrolled blood pressure were: male gender (aOR: 2.53, 95% CI 1.13-5.65), monthly income (aOR: 5.64, 95% CI 3.04-10.46), diabetes (aOR: 3.16, 95% CI 1.77-5.63), monotherapy (aOR: 8.42, 95% CI 2.85-24.90), poor compliance with medication (aOR: 7.48, 95% CI 4.21-13.29), and stress (aOR: 2.22, 95% CI 1.14-4.33). the level of blood pressure control was unsatisfactory in this population, underscoring the imperative of educating hypertensive patients about management measures and reinforcing the quality of primary health services.

Impact of Preanesthetic Blood Pressure Deviations on 30-Day Postoperative Mortality in Non-Cardiac Surgery Patients.

Blood pressure readings taken before anesthesia often influence the decision to delay or cancel elective surgeries. However, the implications of these specific blood pressure values, especially how they compare to baseline, on postoperative in-hospital 30-day mortality remain underexplored. This research aimed to examine the effect of discrepancies between the baseline blood pressure evaluated in the ward a day before surgery, and the blood pressure observed just before the administration of anesthesia, on the postoperative mortality risks. The study encompassed 60,534 adults scheduled for non-cardiac surgeries at a tertiary care center in Seoul, Korea. Baseline blood pressure was calculated as the mean of the blood pressure readings taken within 24 hours prior to surgery. The preanesthetic blood pressure was the blood pressure measured right before the administration of anesthesia. We focused on in-hospital 30-day mortality as the primary outcome. Our research revealed that a lower preanesthetic systolic or mean blood pressure that deviates by 20 mmHg or more from baseline significantly increased the risk of 30-day mortality. This association was particularly pronounced in individuals with a history of hypertension and those aged 65 and above. Higher preanesthetic blood pressure was not significantly associated with an increased risk of 30-day mortality. We found that a lower preanesthetic blood pressure compared to baseline significantly increased the 30-day postoperative mortality risk, whereas a higher preanesthetic blood pressure did not. Our study emphasizes the critical importance of accounting for variations in both baseline and preanesthetic blood pressure when assessing surgical risks and outcomes.

Left Ventricular Dysfunction in Hypertensive Patients and Inter-arm Pressure Difference

Background: Systolic inter-arm pressure difference (SIAD) is considered as cardiovascular risk. We aimed to ascertain whether the presence of (SIAD) is associated with impaired left ventricular (LV) functions or not. Methods: Blood pressure (BP) was measured on both arms of 81 participants, echocardiographic parameters of LV functions; ejection fraction, mitral E, A, eˋ, aˋand tricuspid regurgitant velocities, left atrial volume index, E/A and E/eˋ ratio, LV stiffness index and myocardial performance index (MPI) were measured, and global longitudinal strain (GLS) was assessed. Results: Higher SIAD level had good positive correlations with age, body mass index (BMI), duration of hypertension (HTN), MPI, and LV end-systolic volume. SIAD had good negative correlations with mitral E wave velocity, E/A ratio, eˋ and sˋ wave velocities, and with the average GLS. Impaired LV average GLS is independently associated with: Years from HTN discovery followed by BMI, gender, and age. Conclusion: BP reading in both arms on the first visit is not sufficient; hypertensive patients need evaluation of the SIAD on follow up. We need to consider the SIAD on risk stratification and BP control. This will be simple to follow in primary care and areas with low resources.

Emergency hypertension and hypertensive crisis prevalence and associated factors

Objective: The purpose of this study was to determine the prevalence of emergency hypertension in patients who had been diagnosed with hypertensive crisis. Methods: An analysis of adult patients with complete medical records who were hospitalized to King Saud Medical City in Riyadh, Saudi Arabia between September 2022 and September 2023 and diagnosed with hypertensive crisis was carried out. Results: The study subsequently gathered 151 patient records. Patients were diagnosed with a hypertensive crisis when their systolic blood pressure and diastolic blood pressure (SBP/DBP) readings were more than 180 / 120 mmHg. The average age of the patients was 61.2 years, with females making up 54.3% patients. Around 66.6% had a history of using antihypertensive medications. History of hypertension was shown to be the most prevalent medical risk factor (72.8%). Stroke was the most common complication (n=32, 21.2%). Additionally, headache was the most common complaint at admission (41.1%). Further, 92.7% patients were discharged after showing improvement, and 6.6% patients reported deaths. Conclusion: Multivariate logistic regression analysis revealed that the gender of the patient and the presence of a history of hypertension were independently associated factors with hypertensive emergency. Monitoring and counselling hypertensive persons is crucial, and screening for hypertension might help prevent or minimize damage to target organs.

Comparison of the Efficacy of Labetalol and Nifedipine in Preeclampsia: A Prospective Interventional Study

Introduction: Hypertensive disorders of pregnancy constitute the most widely analysed conditions in pregnancy. Previously, methyldopa was the most commonly used drug, which nowadays has been largely replaced by T. labetalol and T. nifedipine due to the slower onset of action of methyldopa. Chronic hypertension is associated with more maternal and perinatal adverse events, so it is important to determine the optimal antihypertensive therapy. Aim: To compare drug side effects, obstetric complications, and mode of delivery between Group A (T. labetalol administered) and Group B (T. nifedipine administered). Materials and Methods: A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology, Dhiraj Hospital and SBKS Medical Institute and Research Centre, Vadodara, Gujrat, India from December 2022 to May 2023 at Dhiraj Hospital, involving 200 pregnant women with hypertension or Blood Pressure (BP) readings ≥140 mmHg Systolic Blood Pressure (SBP) or ≥90 mmHg Diastolic Blood Pressure (DBP) after 20 weeks gestation. They were randomly divided into two groups: Group A (n=100) with T. labetalol administered and Group B (n=100) with T. nifedipine. The two groups were compared with variables like age, side effects of respective drugs, pregnancy complications, and outcomes, including vaginal or caesarean delivery. The Chi-square and t-test were used to compare variables between the two groups. Results: The mean age in Group A was 25.52±4.10 years, and in Group B, it was 25.95±4.47 years. In Group A (T. labetalol), the majority of cases, i.e., 34 (34%), required a 200 mg dose, followed by 300 mg in 26 (26%) of cases. In Group B (T. nifedipine), the majority of cases, i.e., 48 (48%), required a 30 mg dose, followed by 20 mg in 28 (28%) and 40 mg in 24 (24%) of cases. In Group A (T. labetalol), 2 (1%) cases had Intrauterine Growth Restriction (IUGR), 4 (2%) had oligohydramnios, and 2 (1%) had Intrauterine Demise (IUD). In Group B (T. nifedipine), 6 (3%) cases had IUGR, 6 (3%) had oligohydramnios, and 0 (0%) mmHg had IUD. No significant difference was found between Group A and B (p=0.213). In Group A (T. labetalol), 76 (38%) cases had vaginal delivery, 14 (7%) had emergency caesarean sections, and 10 (5%) had elective caesarean sections. In Group B (T. nifedipine), 70 (35%) cases had vaginal delivery, 18 (9%) had emergency caesarean sections, and 12 (6%) had elective caesarean sections. No significant difference was found between groups A and B (p=0.628). Post-intervention SBP in Group A was 126.06±6.6 mmHg, and in Group B, it was 126.96±8.17 mmHg with no statistically significant difference (p=0.3925). Post-intervention DBP in Group A was 80.6±2.38 mmHg, and in Group B, it was 80.2±1.40 mmHg with no statistically significant difference (p=0.14). Conclusion: Both T. labetalol and T. nifedipine were found to be equally effective. However, with respect to drug side effects and tolerability, T. labetalol was found to be significantly better compared to T. nifedipine.

Prevalence of type 2 diabetes mellitus and hypertension in patient's visiting the conservative dentistry and endodontics department: a cross-sectional study in Surabaya City.

This descriptive cross-sectional study focuses on the prevalence of hypertension (HTN) and type 2 diabetes mellitus (T2DM) amongst patients who visited the Conservative Dentistry and Endodontics department. Recognizing these incidence statistics is critical for improving endodontic therapy delivery and assuring high-quality dental care with positive treatment outcomes. In advance of getting dental care, all patients visiting the department were advised to get their blood sugar and blood pressure levels checked at random. Measurements were taken with digital equipment, and individuals with high levels were encouraged to seek medical advice before undergoing dental procedures. The obtained data was imported into Excel and analyzed with IBM SPSS software (version 21). The investigation had 1,100 participants (55.8% female and 44.2% male), with an average age of 44.58 ± 12.77 years. Of the individuals, 40.6% were referred for type 2 diabetes, 12.6% for hypertension, and 24.0% for both diseases. There was a significant correlation (p<0.05) between referral status and gender. The average blood pressure and random blood sugar readings were 141.02 mmHg ± 56.28 mmHg (systolic), 79.83 mmHg ± 10.68 mmHg (diastolic), and 126.68 mg/dL ± 15.36 mg/dL, respectively. There was a substantial (p<0.05) difference in mean systolic blood pressure between men and women. Furthermore, age was strongly connected with random blood sugar levels (p<0.05) and systolic and diastolic blood pressure (p<0.05). There were significant (p<0.05) variations in mean blood pressure and blood sugar levels between referred and non-referred individuals. Age had a relationship with higher random blood sugar levels, systolic blood pressure, and diastolic blood pressure. Dentists should consider patient age while planning treatment, as type 2 diabetes mellitus and hypertension require unique techniques to emphasize patient safety and produce excellent outcomes.

Prevalence of High Blood Pressure, Risks Factors, and Knowledge Deficit in Apparently Healthy College Students

Background: College students are assumed to be generally healthy, thus, elevated blood pressure can be easily missed in this population. However, recent research on college students has demonstrated increasing rates of elevated blood pressure. Situations that increase risk of elevated BP include higher levels of stress related to college education as well as other common stress producing events in life. Additionally, college students may engage in behaviors that increase risk such as eating poor diets, drinking alcohol, and not exercising regularly. The purpose of this study was to assess the prevalence of elevated blood pressure and risk factors in undergraduate college students and develop a campus wide educational initiative. Methods: Undergraduate students at a faith-based, Midwestern university (n = 138) participated in a cross-sectional study. Demographic data, standardized BP measurements, risk factors, and perceived stress levels were collected via a Google form and in-person assessments. Results: Fifty-two percent of college students had an elevated systolic blood pressure, and 30% had elevated diastolic blood pressure. Male students had significantly higher systolic (X2 = 101.343, p = .005) and diastolic blood pressure readings (X2 = 144.44, p &lt; .001) compared to female students. There was no association between year in school and stress levels (X2 = 315.83, p = .102). Stress and systolic blood pressure were not correlated (r = .121, p = .180) nor were stress and diastolic blood pressure (r = .075, p = .408). Following the educational initiative, 96% of students (n = 91) were able to accurately define elevated blood pressure, risk factors for hypertension, and strategies to lower blood pressure. Conclusions: It is vital that blood pressure assessments become a priority for college students. These assessments must be followed by interventions aimed at reducing blood pressure levels, stress, and risk factors related to hypertension to prevent the long-term effects of cardiovascular disease. Healthcare providers on college campuses, including and perhaps most effectively students in health-related fields, should be involved in working with this population to increase awareness and screening efforts.

Use of amlodipine in the treatment of cats with systemic hypertension in Japan.

An increase in systemic blood pressure causes bleeding and ischemia owing to peripheral vascular breakdown, leading to various forms of organ damage. The brain, eyes, kidneys, and cardiovascular system are known target organs for hypertension. To our knowledge, no reports in Japan describe, in detail, the types of antihypertensive drugs used to treat hypertension in cats or its underlying causes. Therefore, we aimed to investigate the use of antihypertensive drugs in domestic cats with hypertension in Japan, the causes of hypertension, and the vital prognosis of these patients. In the present survey, we found that amlodipine was used alone (60/80 cats) or concomitantly (20/80 cats) in all cat patients with hypertension in Japan. We also determined that blood pressure measurements were not yet routinely performed on cats at veterinary clinics in Japan. Furthermore, we have new information suggesting that amlodipine administration in cats with hypertension, which lowers systolic arterial pressure levels to within the normal range (<140 mmHg), may have a negative impact on their survival. Routine blood pressure measurements for cats during their regular health checkups can help identify hypertension, and proper interpretation of blood pressure readings can facilitate suitable treatment measures.

Are aneroid and digital sphygmomanometers as reliable and accurate as mercury sphygmomanometers?

Background: The accurate measurement of blood pressure (BP) is crucial for effectively treating hypertension, which stands as a primary risk factor for both cardiovascular disease and premature mortality. The shift from mercury to nonmercury sphygmomanometers in developing countries due to environmental concerns prompts an evaluation of the accuracy of these alternatives. Aims and Objectives: The objectives of this study were to evaluate the precision of non-mercury instruments in diagnosing hypertension and to analyze interarm differences in both systolic and diastolic BP using three different sphygmomanometers. Materials and Methods: Sixty subjects aged 18–25 were included. BP measurements were taken from both arms using different types of sphygmomanometers. Statistical analysis involved paired t-tests, Chi-square tests for correlations, and a significance threshold of P &lt; 0.05. Results: Significant differences in systolic BP readings were observed between the gold standard (mercury manometer) and digital/aneroid devices (P = 0.00). Compared to the mercury manometer, both digital and aneroid devices showed limited accuracy in detecting hypertension. Kappa agreement was moderate at 0.57. Despite high specificity (100%), sensitivity was lower at 44.4%, indicating a risk of missing true positive cases. Both devices exhibited a sensitivity of 25%, with fair to poor agreement (kappa values) in identifying cardiovascular risk compared to the mercury reference. Conclusion: This study underscores the diminished reliability of both aneroid and digital devices in detecting hypertension and assessing cardiovascular risk using specified interarm BP criteria. These findings emphasize the crucial need for further research and caution when relying on non-mercury devices in clinical settings.

Electrocardiography, Blood Pressure Measurements, Vital Parameters and Anaesthetic Indices in the African Giant Rat (Cricetomys Gambianus Waterhouse) Immobilized with Diazepam or Ketamine.

In spite of the increasing use and importance of the African giant rat (Cricetomys gambianus Waterhouse) in research, and other fields, like location of landmines, there is still not enough information on their physiology. In this study, we assessed the electrocardiogram, blood pressure, vital parameters and anaesthetic indices of the African giant rat (Cricetomys gambianus Waterhouse), both genders, using diazepam or ketamine as chemical restraints. A total of 24 adult African Giant Rats (AGR), 12 males and 12 females were used in this experiment. The animals were divided into two groups of twelve animals each (6 males and 6 females). One group was assessed for the effect of diazepam, and the other group ketamine. Diazepam (Roche®, Switzerland) was administered intraperitoneally at a dose rate of 7.5 mg/kg, while ketamine was administered intraperitoneally at a dose rate of 45 mg/kg. Parameters measured were recorded from the time desirable sedation was achieved, and every 15 minutes till the animal was awake. Animals administered diazepam took a longer time to sleep or achieve desirable sedative state, a longer time to respond to stimuli before waking up fully and a longer time to be fully awake, relative to ketamine-induced sedation. Ketamine caused a continuous increase in respiratory rate and blood pressure, while diazepam caused a continuous decrease in the respiratory rate. The electrocardiogram showed tachycardia throughout the experiment with the use of both drugs, although this was more pronounced with the use of diazepam, causing a decrease in QRS interval and a decrease in QT interval. Gender differences were observed in most parameters measured. The results obtained gave baseline values for electrocardiogram and blood pressure readings, while also detailing the changes and gender differences observed with sedation. In addition, results indicated ketamine is best used for short procedures and diazepam at a higher dose used for procedures requiring longer time in the African giant rat.

Comparing preoperative fasting and ultrasound-measured intravascular volume status in elective surgery, enhanced recovery patients versus inpatient, urgent surgery patients and the ability of IVC collapsibility to predict post-induction hypotension.

Hypotension following induction of general anaesthesia has been shown to result in increased complications and mortality postoperatively. Patients admitted to the hospital undergoing urgent surgery are often fasted from fluids for significant periods compared to elective patients subject to Enhanced Recovery After Surgery protocols despite guidelines stating that a two-hour fast is sufficient. The aim of this prospective, observational study was to compare fasting times and intravascular volume status between elective surgery patients subject to enhanced recovery protocols and inpatient, urgent surgery patients and to assess differences in the incidence of post-induction hypotension. Fasting data was obtained by questionnaire in the preoperative area in addition to inferior vena cava collapsibility index, a non-invasive measure of intravascular volume. Blood pressure readings and drug administration for the ten minutes following induction were obtained from patients' charts. Inpatients undergoing urgent surgery were fasted significantly longer than enhanced recovery patients and had lower intravascular volume. However, no difference was found in the incidence of post-induction hypotension.

Comparison of Home and Office Blood Pressure Devices in the Clinical Setting.

Self-measured blood pressure (SMBP) monitoring is increasingly used for remote hypertension management, but the real-world performance of home blood pressure (BP) devices is unknown. We examined BP measurements from patients' home devices using the American Medical Association's (AMA) SMBP Device Accuracy Test tool. Patients at a single internal medicine clinic underwent up to five seated, same-arm BP readings using a home device and an automated BP device (Omron HEM-907XL). Following the AMA's three-step protocol, we used the patient's home device for the first, second, and fourth measurements and the office device for the third and fifth (if needed) measurements. Device agreement failure was defined as an absolute difference in systolic BP >10 mm Hg between the home and office devices in either of two confirmatory steps. Performance was examined by brand (Omron vs. non-Omron). Moreover, we examined patient factors associated with agreement failure via logistic regression models adjusted for demographic characteristics. We evaluated 152 patients (mean age 60 ± 15 years, 58% women, 31% Black) seen between October 2020 and November 2021. Device agreement failure occurred in 22.4% (95% CI: 16.4%, 29.7%) of devices tested, including 19.1% among Omron devices and 27.6% among non-Omron devices (P = 0.23). No patient characteristics were associated with agreement failure. Over one-fifth of home devices did not agree based on the AMA SMBP device accuracy protocol. These findings confirm the importance of office-based device comparisons to ensure the accuracy of home BP monitoring.

CONSEQUENCES OF PERCEIVED STRESS ON COGNITIVE DECLINE AND BLOOD PRESSURE AS A MODERATOR IN OLDER BLACK AMERICANS

Abstract Previous research suggests that perceptions of stress shape cognitive health outcomes. However, few studies have explored this association longitudinally. The aim of this study was to determine whether perceived stress is associated with cognitive changes over time and if blood pressure (BP) acts as a moderator in a sample of older Blacks 48 to 95 years of age, who were enrolled in the Baltimore Study of Black Aging—Patterns of Cognitive Aging and interviewed at two time points, approximately 3 years apart (N = 450). Cognition included 5 domains: working memory, processing speed, verbal memory, vocabulary, and inductive reasoning. Three readings of orthostatic BP were collected and mean systolic (range = 82-230.3 mmHg) and diastolic BP (range = 51-136.7 mmHg) values were calculated for each participant. Results from the linear regression model showed no direct effect of perceived stress on cognitive decline. Systolic (F(3,426)= 4.37, p= 0.0048) and diastolic (F(3,426) = 3.26 p=0.0215) BP modified the relationship between stress and inductive reasoning at follow-up but was not related to any other cognitive domains, adjusting for age, sex, education, depressive symptoms, comorbidities, and baseline cognition. These important findings demonstrate the joint effects of stress and BP on cognition, highlighting the need for more research documenting the underlying processes and risk factors for domain-specific cognitive decline. The potential benefits of this approach provide a basis for developing cognitive interventions for this population of Black Americans.