Blood Pressure Response In Patients Research Articles

Progression of obstructive sleep apnoea after renal denervation is not associated with hypertension exaggeration

PurposeIn a cohort, observational prospective trial, we assessed the long-term dynamics of sleep-disordered breathing in patients with resistant hypertension after renal denervation and their association with blood pressure change at remote follow-up.Materials and methodsTwenty-eight patients with stable hypertension who were recruited for endovascular radiofrequency renal denervation in 2012–2019 and had valid both baseline and follow-up sleep study, were included in the analysis. All patients underwent physical examination, anthropometry, office and ambulatory blood pressure measurements, blood and urine tests, kidney visualization, and full polysomnography before and within 12–36 months after renal denervation.ResultsThe average follow-up comprised 30.1 ± 8.4 months. At long-term follow-up, no significant changes in creatinine level, estimated glomerular filtration rate, body mass index were registered. There was a significant increase in sleep apnea severity indices: the mean change in apnea-hypopnea index comprised 9.0(-21.1;25.2) episodes/h, in oxygen desaturation index 6.5(-16.8;35.9) episodes/h, in the average SpO2 -1.7(-5.6;1.9)%. Over 12-month follow-up, there were no significant differences in blood pressure response in patients with and without sleep apnea. The baseline apnea-hypopnea and oxygen desaturation indices and the mean SpO2 were associated with the circadian blood pressure profile at follow-up, but did not correlate with the blood pressure response.ConclusionsAlthough the severity of sleep apnea worsens at > 12 months follow-up after renal denervation, this is not associated with hypertension exaggeration.

Loop Gain as a Predictor of Blood Pressure Response in Patients Treated for Obstructive Sleep Apnea: Secondary Analysis of a Clinical Trial.

Rationale: Randomized trials have shown inconsistent cardiovascular benefits from obstructive sleep apnea (OSA) therapy. Intermittent hypoxemia can increase both sympathetic nerve activity and loop gain ("ventilatory instability"), which may thus herald cardiovascular treatment benefit. Objectives: To test the hypothesis that loop gain predicts changes in 24-hour mean blood pressure (MBP) in response to OSA therapy and compare its predictive value against that of other novel biomarkers. Methods: The HeartBEAT (Heart Biomarker Evaluation in Apnea Treatment) trial assessed the effect of 12 weeks of continuous positive airway pressure (CPAP) versus oxygen versus control on 24-hour MBP. We measured loop gain and hypoxic burden from sleep tests and identified subjects with a sleepy phenotype using cluster analysis. Associations between biomarkers and 24-h MBP were assessed in the CPAP/oxygen arms using linear regression models adjusting for various covariates. Secondary outcomes and predictors were analyzed similarly. Results: We included 93 and 94 participants in the CPAP and oxygen arms, respectively. Overall, changes in 24-hour MBP were small, but interindividual variability was substantial (mean [standard deviation], -2 [8] and 1 [8] mm Hg in the CPAP and oxygen arms, respectively). Higher loop gain was significantly associated with greater reductions in 24-hour MBP independent of covariates in the CPAP arm (-1.5 to -1.9 mm Hg per 1-standard-deviation increase in loop gain; P ⩽ 0.03) but not in the oxygen arm. Other biomarkers were not associated with improved cardiovascular outcomes. Conclusions: To our knowledge, this is the first study suggesting that loop gain predicts blood pressure response to CPAP therapy. Eventually, loop gain estimates may facilitate patient selection for research and clinical practice. Clinical trial registered with www.clinicaltrials.gov (NCT01086800).

Hyperoxia Exaggerates Systolic Blood Pressure Response in Patients with Peripheral Arterial Disease

It is well known that acute oxidative stress evokes different effects in patients with atherosclerotic disease and in normal subjects. The effects of acute hyperoxia, an important acute oxidative stressor, on hemodynamics have not been well studied in patients with peripheral arterial disease (PAD). We recruited 20 PAD patients (14M, 6F, 66 ± 6yrs), and 16 age-matched control subjects (10M, 6F, 65 ± 8yrs). The ankle-brachial pressure index (ABI) in the most affected limbs of the patients was 0.58 ± 0.15, compared to 1.04 ± 0.09 in the controls. Blood pressure and ECG were monitored at baseline and during hyperoxia (100% oxygen for 5 mins, as an acute oxidative stress test). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), heart rate (HR), and rate-pressure product (RPP) were averaged across the final minute of baseline and hyperoxia, and were compared across time and between groups using Repeated Measures Analyses of Variance (RMANOVA). Results indicated a significant interaction for SBP (F1,1=4.65, P=0.04), which was explained by a significant increase in SBP from baseline to hyperoxia in the PAD group (126 ± 13 mmHg vs. 137 ± 16 mmHg, respectively, P<0.001) that was not observed in the control group (115 ± 9 mmHg vs. 120 ± 7 mmHg at baseline and hyperoxia, respectively, P=0.06). In contrast, no significant interactions were observed for DBP (P=0.43), MBP (P=0.47), HR (P=0.71), or RPP (P=0.11). Considering 53% of PAD patients were on antihypertensive medicine, whereas none of the control subjects were on chronic antihypertensive agents, the likely effects of hyperoxia on systolic pressure may have been underestimated in our study.

Peripheral Revascularization Reverses The Decline In Active Muscle Oxygen Saturation In Peripheral Artery Disease

Peripheral artery disease (PAD) is a progressive atherosclerotic disease that limits blood flow to the skeletal muscles in the lower extremity. Reductions in blood flow may be more pronounced during ambulation or exercise and produce leg cramping or pain known as intermittent claudication. Recent studies have shown an exaggerated blood pressure response with lower muscle oxygen saturation (SmO2) during foot exercise in patients with PAD. However, it is unclear whether surgical and/or endovascular interventions normalize this response. PURPOSE: To examine whether revascularization procedures improve calf muscle SmO2 and reduce blood pressure responses during dynamic foot exercise in patients with PAD. We hypothesized that revascularization would improve SmO2 responses (indicating greater tissue perfusion) and that the blood pressure response would be attenuated during exercise. METHODS: Patients with symptomatic PAD (n = 6) performed incremental supine plantar flexion exercise, starting at 0.5 kg and increased by 0.5 kg every minute for up to 6 minutes, pre- and one-month post peripheral revascularization procedure. SmO2 was measured continuously from the gastrocnemius muscle, while heart rate and blood pressure were measured beat-by-beat. RESULTS: Reductions in SmO2 from baseline to end-exercise were attenuated post-revascularization (-6.5 ± 6.2% vs. -39.8 ± 22.5%, P < .05). The change in mean arterial blood pressure was reduced post-revascularization (4 ± 4 mmHg vs. 16 ± 12 mmHg P < .05). PAD patients exercised longer post-revascularization (5.8 ± 0.4 min vs. 4.0 ± 1.5 min P < .05). CONCLUSIONS: These data suggest that revascularization lessens the degree and rapidity of decline in SmO2 during exercise, and lowers the exaggerated blood pressure response in patients with PAD. Supported by NIH Grant P01 HL134609

Clinical application of stress echocardiography in valvular heart disease: an expert consensus of the Working Group on Valvular Heart Disease of the Polish Cardiac Society.

Valvular heart diseases (VHDs) constitute an increasing problem both as a consequence of population aging and as the sequelae of other heart diseases. Accurate diagnosis is essential for correct clinical decision‑making; however, in many patients, transthoracic and transesophageal echocardiography is insufficient. Stress echocardiography (SE) proved to be a useful tool allowing for simultaneous assessment of left ventricular contractile reserve and HVD hemodynamics under conditions of physiological or pharmacological stress. It is recommended for assessing the severity of VHD, guiding the choice of treatment, as well as for surgical risk stratification. It can be applied both in asymptomatic patients with severe VHD and in symptomatic individuals with moderate disease. In patients with VHD, SE can be performed either as exercise stress echocardiography (ESE) or dobutamine stress echocardiography (DSE). The first modality is recommended to unmask symptoms or abnormal blood pressure response in patients with aortic stenosis (AS) who report to be asymptomatic or in those with mitral stenosis with discordance between clinical symptoms and the severity of valve disease on transthoracic echocardiography. In asymptomatic patients with paradoxical low‑flow, low‑gradient (LFLG) AS, ESE can be used to assess the severity of stenosis. On the other hand, low‑dose DSE can be a useful diagnostic tool in classical LFLG AS, providing information on stenosis severity and contractile reserve. Moreover, SE is indicated in patients with prosthetic valve when there is discordance between symptoms and echocardiographic findings. It is also recommended in high‑risk surgical patients with VHD with poor functional capacity and more than 2 clinical risk factors. The present paper discusses in detail the use of SE in VHD.

BLOOD PRESSURE EFFECTS OF OBSTRUCTIVE SLEEP APNEA TREATMENT BY CONTINUOUS POSITIVE AIRWAY PRESSURE

Objective: Treatment of obstructive sleep apnoea (OSA) has been shown to reduce blood pressure (BP). However, the effect size is modest and treatment of OSA is not recommended as the only treatment target when treating hypertension. Despite the limited effect of continuous positive airway pressure (CPAP) therapy on BP, it is likely that certain phenotypes of OSA patients respond better to CPAP than others. The aim of the present systematic review and meta-analysis was to identify potential predictors for BP response in patients with OSA undergoing CPAP treatment.Design and method: A systematic search was conducted in three databases (MEDLINE, Embase and Web of Science) using terms exploring three domains (obstructive sleep apnoea, CPAP, clinical trial) based on the following inclusion criteria: i) randomised controlled clinical trials published between January 1st 1960 to December 31st 2017 including a reasonable control group; iii) OSA diagnosis using polysomnography; iv) age >18 years; v) OSA severity of at least 5 AHI/h. The random effect model was fitted to estimate the pooled BP reductions calculated as the difference between the BP change (end-treatment minus baseline) in the CPAP and control group. Moreover, the original estimates have been stratified according to selected patient characteristics. Results: Out of 2445 articles, 59 RCTs were included (n = 7,329 subjects) comparing CPAP with control groups. CPAP was associated with a net reduction in systolic BP of −2.12 (95% CI −2.82 to −1.42) mmHg and in diastolic BP of −1.97 (95% CI −2.46 to −1.48) mmHg, favouring treatment of OSA using CPAP (both p-values < 0.001). The subgroup analysis showed that systolic BP reduction was greater in subjects younger than 60 years (−2.88 fro age 40–50, −2.78 for age 50–60 and −0.61 for age more than 60 years, p = 0.007) and in patients with controlled BP at baseline versus uncontrolled BP (−1.45 vs −4.14, p = 0.002) (Figure 1). Conclusions: Younger patients (< 60 years) with uncontrolled blood pressure at baseline are more likely to experience significant BP reductions with CPAP therapy. Phenotypisation of specific cohorts of patients can guide clinicians to target OSA treatment and help to optimise patients’ cardiovascular risk.

Predictors for profound blood pressure response in patients undergoing renal sympathetic denervation.

Renal sympathetic denervation (RDN) as treatment for hypertension shows highly variable results. Although some patients do not show any blood pressure (BP) change and in most patients a BP reduction of at least 5 mmHg can be found, some show a reduction at least 20 mmHg. We sought to identify predictors for such a profound BP response. Profound BP response was defined as drop of at least 20 mmHg in daytime systolic ambulatory BP measurement (ABPM) 3 months after catheter-based RDN. Three different denervation devices were used for RDN, and pulse wave velocity was determined invasively in a subgroup of patients. One hundred and ninety consecutive patients were included in this analysis. Profound BP response was found in 33 patients. Patients with profound BP response were younger (P = 0.04), presented with higher baseline ABPM values (P < 0.001), were treated with ultrasound-based RDN and received more often a combined treatment with two different diuretics (P = 0.005 for both). After 3 months, a treatment target of daytime BP less than 135 mmHg could be achieved more frequently in patients with profound BP response (61 vs. 17%, P < 0.001). Age, use of ultrasound RDN, combined diuretic therapy and baseline BP independently predicted pronounced BP reduction. A second multivariate logistic regression model including pulse wave velocity if available identified baseline BP, pulse wave velocity and use of ultrasound denervation as independent predictors for profound BP response. Younger vascular age, higher baseline BP, treatment with ultrasound RDN and combined diuretic therapy were found as predictors for a pronounced BP reduction following RDN, improving BP control at follow-up.

Prognostic significance of blood pressure response during vasodilator stress Rb-82 positron emission tomography myocardial perfusion imaging

BackgroundA drop in blood pressure (BP) or blunted BP response is an established high-risk marker during exercise myocardial perfusion imaging (MPI); however, data are sparse regarding the prognostic value of BP response in patients undergoing vasodilator stress rubidium-82 (Rb-82) Positron Emission Tomography (PET) MPI. Methods and ResultsFrom the PET Prognosis Multicenter Registry, a cohort of 3413 patients underwent vasodilator stress Rb-82 PET MPI with dipyridamole or adenosine. We used multivariable Cox proportional hazard regression to analyze the association with mortality of four BP variables: stress minus rest systolic BP (∆SBP), stress minus rest diastolic BP (∆DBP), resting systolic BP (rSBP), and resting diastolic BP (rDBP). Covariates that had univariate P values <.10 were entered into the multivariable model. After median 1.7 years follow-up, 270 patients died. In univariate analyses, ∆SBP (P = .082), rSBP (P = .008), and rDBP (P < .001) were of potential prognostic value (P < .10), but ∆DBP was not (P = .96). After adjustment for other clinical and MPI variables, ∆SBP no longer independently predicted mortality (P = .082); only lower rSBP (P = .026) and lower rDBP (P = .045) remained independently prognostic. ConclusionsIn patients undergoing vasodilator stress MPI, only lower resting BP is an independent predictor of mortality along with other clinical and MPI variables; BP response does not appear to add to risk stratification in these patients.

Diagnostic Value Of Post Exercise Systolic Blood Pressure Response In Ischemic Heart Disease

Background: The normal decline in systolic blood pressure during recovery phase of treadmill exercise dose not occur in most patients with coronary artery disease, in others recovery values systolic blood pressure may even exceed the peak exercise value. Objectives: Treadmill exercise test parameters indicating the presence and extent of coronary artery disease have traditionally included such as exercise duration, blood pressure and ST-segment response to exercise. The three –minute systolic blood pressure ratio is another important indicator of presence and significance of coronary artery disease is useful and obtainable measure that can be applied in all patients who are undergoing stress testing for evaluation of suspected ischemic heart disease and this increase the sensitivity of exercise test . Type of the study: A prospective study. Methods: Between April 2011 and April 2012 ,all patients underwent treadmill exercise test , echocardiography coronary angiography in Ibn Ab-bitar Hospital Cardiac Surgery. Clinical and procedural data for patients undergoing treadmill and coronary angiography were prospectively collected and entered into database specially designed for the present study.To calculate mean systolic blood pressure ratio for each , Measurement of blood pressure in the 3rd minute of recovery time and divided by peak systolic blood pressure during exercise test ,after excluding patients . Coronary angiography was done for all patients who under went treadmill exercise test and multiple views were taken accordingly to clarify the lesion and critical lesion defined as &gt;50% stenosis in LMS and &gt;70% stenosis in LAD,LCX and RCA. Results: We studied 100 patients In the period from April 2011 to April 2012, 78(78%) male and 22 (22%) a female with a mean age 55.49±7.60 who undergone treadmill exercise testing and coronary angiography to assess the chest pain, 32 patient had normal blood pressure 68 had hypertension and 24 patients had normal coronary angiography and 76 patients had abnormal coronary angiography. SBP/3 minute recovery blood pressure ratio was significantly higher in patient with coronary artery disease than patient without coronary artery disease (mean ±SD O.92±0.09 VS 0.81 SBP/3 minute recovery blood pressure ratio was significantly related with the severity of coronary artery disease its higher in three vessels than one vessel disease 0.95±0.10 vs0. 91 ±0.01 p-value 0.0001. Conclusions: post exercise blood pressure response in patients with coronary artery diseaseis higher than patients with normal coronary artery .post exercise blood pressure is related to the severity of coronary artery disease

Predicting Fluid Responsiveness Using Bedside Ultrasound Measurements of the Inferior Vena Cava and Physician Gestalt in the Emergency Department of an Urban Public Hospital in Sub-Saharan Africa

BackgroundBedside inferior vena cava (IVC) ultrasound has been proposed as a non-invasive measure of volume status. We compared ultrasound measurements of the caval index (CI) and physician gestalt to predict blood pressure response in patients requiring intravenous fluid resuscitation.MethodsThis was a prospective study of adult emergency department patients requiring fluid resuscitation. A structured data sheet was used to record serial vital signs and the treating clinician’s impression of patient volume status and cause of hypotension. Bedside ultrasound CI measurements were performed at baseline and after each 500mL of fluid. Receiver operating characteristic (ROC) curve analysis was performed to characterize the relationship between CI and Physician gestalt, and the change in mean arterial pressure (MAP).ResultsWe enrolled 364 patients, 52% male, mean age 36 years. Indications for fluid resuscitation were haemorrhage (54%), dehydration (30%), and sepsis (17%). Receiver operating characteristic curve analysis found optimal CI cut-off values of 45%, 52% and 53% to predict a MAP rise of 5, 8 and 10 mmHg per litre of fluid, respectively. The sensitivity and specificity of CI of 50% for predicting a 10mmHg increase in MAP per litre were 88% (95%CI 81–93%) and 73% (95%CI 67–79%), respectively, area under the curve (AUC) = 0.85 (0.81–0.89). The sensitivity and specificity of physician gestalt estimate of volume depletion severity were 68% (95%CI 60–75%) and 86% (95%CI 80–90%), respectively, AUC = 0.83 (95% CI: 0.79–0.87). Those with a baseline CI ≥ 50% (51% of patients) had a 2.8-fold greater fluid responsiveness than those with a baseline CI<50% (p<0.0001).ConclusionUltrasound measurement of the CI can predict blood pressure response among patients requiring intravenous fluid resuscitation and may be useful in early identification of patients who will benefit most from volume resuscitation, and those who will likely require other interventions.

OP.1D.01] DIASTOLIC ORTHOSTATIC HYPERTENSION PREDICTS A FAVORABLE CARDIOVASCULAR PROGNOSIS IN TYPE 2 DIABETES

Objective: The primary aim was to determine the prognostic impact of the diastolic and systolic orthostatic blood pressure responses in patients with type 2 diabetes. We also evaluated associations between different orthostatic blood pressure responses and markers of subclinical cardiovascular organ damage. Design and method: Office blood pressures were measured in the sitting and in the standing position in 749 patients with type 2 diabetes who participated in the CARDIPP study (Cardiovascular Risk factors in Patients with Diabetes – a Prospective study in Primary care). Diastolic orthostatic hypertension was defined as a rise of diastolic blood pressure of 10 mmHg or more, diastolic orthostatic hypotension was defined as a drop of diastolic blood pressure 10 mmHg or more, systolic orthostatic hypertension was defined as a rise of systolic blood pressure of 20 mmHg or more, and systolic orthostatic hypotension was defined as a drop of systolic blood pressure of 20 mmHg or more. Recruitment took place between the years 2005 – 2008. Patients were followed until any of the primary outcome events (cardiovascular death or hospitalization for either myocardial infarction or stroke) occurred or until December 31st, 2014. Measurements of aortic pulse wave velocity and carotid intima-media thickness were performed at base-line. Results: Diastolic orthostatic hypertension was found in 140 patients (18.7%) and was associated with significantly lower risk of cardiovascular events (crude hazard ratio compared with patients without diastolic orthostatic hypertension: 0.438, 95% C.I. 0.201 – 0.953, P = 0.037). The association remained statistically significant after adjustment for traditional cardiovascular risk factors. Diastolic orthostatic hypotension (n = 31) had no impact on the cardiovascular prognosis, but was associated with increased arterial stiffness and increased carotid intima-media thickness at base-line. Systolic orthostatic hypertension (n = 45) had no impact on the risk of cardiovascular events, but was associated with increased arterial stiffness at base-line. Systolic orthostatic hypotension (n = 24) had no impact on cardiovascular prognosis and was not associated with markers of cardiovascular organ damage. Conclusions: Diastolic orthostatic hypertension is common in patients with type 2 diabetes, and may be a novel marker for decreased cardiovascular risk in these patients.

Pattern of Blood Pressure Response in Patients With Severe Asymptomatic Hypertension Treated in the Emergency Department

Severe asymptomatic hypertension (SAH) is a common cause of emergency department (ED) visits. Despite recommendations against using short-acting blood pressure (BP)-lowering drugs in the ED, it is still a common practice. The authors characterized BP response in the ED utilizing 24-hour ambulatory BP monitoring (ABPM). Patients with SAH who were not admitted to the hospital were recruited. All patients underwent 24-hour ABPM. A total of 21 patients (14 females) with a mean age of 58±16 years were studied. BP decreased from 199±16/101±17 mm Hg to 154±34/83±23 mm Hg after 5 hours but then rose to 174±25/94±17 mm Hg after 19 hours. In 17 patients, systolic BP was ≥180 mm Hg after 6.7±5.3 hours. Two patients experienced severe hypotension (systolic BP <90 mm Hg). Thus, data from a single site in Israel support the current recommendations for management of SAH in the ED.

GENDER SEGREGATION OF 24-H AMBULATORY BLOOD PRESSURE (ABPM) RESPONSE TO SWITCHING BETWEEN DIFFERING NIFEDIPINE OSMOTIC DELIVERY FORMULATIONS

Pharmacy initiated switches between “branded” and generic antihypertensive medications happen frequently. Regulatory approval of generic formulations does not require any time-based pharmacokinetic parameters. Therefore, timing of drug release is not evaluated in formulations with modified delivery. To assess clinical differences in blood pressure response in patients being switched between the two available nifedipine formulations: Mylan-nifedipine ER (MyN - labelled KU in Table) vs. “branded” Adalat XL (AdN - labelled GITS in Table), the clinical response was documented using 24-h Ambulatory Blood Pressure Monitoring (ABPM). A randomized crossover, block design was used to study 20 patients receiving daily morning-dosed AdN vs. MyN 60 mg. After each 2-week dosing period, 24-hr ABPM was done. Systolic (SBP) was compared for both 24 h and terminal 8 h (22:00 h - 06:00 h). Mean ± SE 24-h SBP was 133 ± 2.4 mmHg with AdN, vs. 135 ± 2.3 mmHg with MyN (p=0.03). For terminal 8 h, mean ± SE nocturnal SBP was 125 ± 3.3 mmHg with AdN vs. 129 ± 2.8 mmHg with MyN (p=0.018). However when only women were evaluated (see Table), SBP for 24-h was 133 ± 4.0 mmHg with AdN vs. 137 ± 3.3 mmHg with MyN (p=0.0002) and for terminal 8-h, was 124 ± 5.4 mmHg with AdN vs. 132 ± 4.0 mmHg with MyN (p=0.0003). Mean SBP for 24-h and terminal 8-h dosing were statistically significantly higher in patients when taking MyN, than when taking AdN. This is likely based on differences in delivery technology producing temporal differences in distribution of nifedipine concentrations. MyN’s first-order drug release profile is, by design and manufacture, different than AdN’s zero-order drug release. For a drug with only a 2-hour half-life, differences in both extent and timing of delivery could allow important concentration fluctuations in early and late partial AUC’s. Sensitivity to the difference in formulations appears greater in women, especially at the end of the dosing interval. The physiologic basis for this gender difference should be explored further. Arbitrary nifedipine switching by pharmacies may lead to unexplained variability in BP control, with unintended consequences in patient management.

PROGNOSTIC SIGNIFICANCE OF RESTING BLOOD PRESSURE AND BLOOD PRESSURE RESPONSE DURING VASODILATOR STRESS RB-82 POSITRON EMISSION TOMOGRAPHY MYOCARDIAL PERFUSION IMAGING

A drop in blood pressure (BP) or blunted BP response is an established high-risk marker during exercise myocardial perfusion imaging (MPI); however, data are sparse regarding the prognostic value of resting BP and BP response in patients undergoing vasodilator stress Rubidium-82 (Rb-82) Positron

Abstract 19100: Comparison of Exercise Blood Pressure Response in Patients With Coarctation of Aorta: Surgical Repair vs. Endovascular Stent

Background: Percutaneous stent placement has been shown to be a safe and effective treatment option for patients with coarctation of the aorta. Immediate post-procedural and short term hemodynamic assessments comparing stent placement to surgical correction show equivalency. Little is known about the effects of either treatment modality on blood pressure response during exercise. Methods: This study prospectively compares the hemodynamic response to exercise by treadmill testing in patients at least one year after intervention. Patients included were greater than seven years of age without complex congenital heart disease or single ventricle physiology. Patients underwent standard Bruce Protocol treadmill testing with periodic arm leg blood pressure and metabolic measurements. Results: Twenty-five patients underwent treadmill testing: 18 with surgical correction, 7 with stent placement. Median age was 13 years (IQR: 11-15.5yrs). The median arm-leg gradient prior to exercise was 12mmHg (IQR: 9.25-21.75mmHg) for surgical patients and 16mmHg (IQR: 3 - 25mmHg) for stented patients. The median peak exercise arm-leg gradient was 28mmHg (IQR:16 - 44mmHg) for surgical patients and 30mmHg (IQR:17.5 - 40mmHg) for stented patients. The median increase in the arm leg gradient with exercise was 16mmHg for surgical patients and 14mmHg for stented patients. Median Actual VO2Max/Predicted VO2Max was 100% for surgical patients compared to 96% for stented patients. Median Actual VO2Max/Predicted VO2Max was 100% for surgical patients compared to 96% for stented patients. Conclusions: Few studies have compared surgery and endovascular stenting for coarctation of the aorta, with only one prior study comparing the effects of exercise on blood pressure. Stenting and surgery offer excellent hemodynamic results acutely and at maximal exercise. Stent placement demonstrates equivalent results in blood pressure response during exercise testing when compared to surgical therapy.

Time related patterns of blood pressure response in patients with orthostatic hypotension during prolonged tilt testing

Introduction: Orthostatic hypotension (OH) is a common, frequently under diagnosed, disabling and treatable condition with prevalence up to 30%. OH is usually diagnosed with the tilt test (TT). The optimal duration of TT needed to detect OH, or whether standing longer than 3min/INS; contributes to diagnosis, remained unclear. We aimed to assess various time-related patterns of blood pressure (BP) responses in patients with OH.

Respuesta ortostática de la tensión arterial de pacientes con enfermedad de Parkinson inicial

To evaluate orthostatic blood pressure response in patients with early Parkinson's disease and mild to moderate disease treated at the National Institute of Neurology and Neurosurgery. A cross-sectional study with control group was carried out. Patients with Parkinson's disease with a disease duration of less than 5 years and mild to moderate severity along with healthy controls of the same age group were included. Those subjects with diabetes mellitus, hypertension or diagnosis of dysautonomia were excluded. Blood pressure was measured in supine position as well as after 3 and 5 min of standing. Seventy subjects with Parkinson's disease and 145 controls were included. There were no statistically significant differences in gender and age between both groups. There was no difference in systolic blood pressure change between groups at 3 minutes but at 5 minutes a statistically significant difference was found (P=.03). For diastolic blood pressure a difference between both groups was present at three and five minutes (P=.02 and P=.007). Patients with early Parkinson's disease have differences in orthostatic responses compared to healthy controls, these differences are more relevant at 5 minutes of standing.

Arousals Are Frequent and Associated With Exacerbated Blood Pressure Response in Patients With Primary Hypertension

Spontaneous arousals are relatively common during sleep, and induce hemodynamic responses. We sought to investigate the frequency and magnitude of blood pressure (BP) increases triggered by spontaneous arousals in patients with primary hypertension. We conducted a study in which we divided 18 nonobese, sedentary adults without sleep-disordered breathing into two groups, consisting of: (i) hypertensive (HT, n = 8) patients; and (ii) normotensive (NT, n = 10) controls. The groups were matched for age and body mass index. All subjects underwent full polysomnography with simultaneous monitoring of heart rate (HR) and beat-by-beat BP. Each subject's BP and HR were analyzed immediately before BP peaks triggered by spontaneous arousals during stage 2 of nonrapid eye movement sleep. The total sleep time, sleep efficiency, and sleep structure in the two study groups were similar. In contrast, the number of arousals was significantly higher in the HT than in the NT group, at 25 ± 5 vs. 12 ± 3 events/h, respectively (P < 0.05). The HR of the HT and NT groups was similar before arousal (65 ± 3 bpm vs. 67 ± 3 bpm, respectively, P < 0.01) and increased significantly and similarly in the two groups upon arousal (to 79 ± 6 bpm vs. 74 ± 4 bpm, respectively, P < 0.01). Systolic and diastolic BPs were significantly higher throughout sleep in the HT than in the NT group. During spontaneous arousals, BP increased in both groups (P < 0.05). However, the magnitude of the increase in systolic BP was significantly greater in the HT than in the NT group (22 ± 3 mm Hg vs. 15 ± 3 mm Hg, P < 0.05). Patients with hypertension who do not have sleep-disordered breathing have an increased cardiovascular burden during sleep, which may be due to the greater number of arousals and exacerbated systolic BP response that they experience during sleep. These novel findings may have cardiovascular implications in patients with hypertension.

Lack of relationship between success of angioplasty and blood pressure response in patients with renal artery stenosis

Mui, Kwok-Waia,b; Stassen, Patriciaa,b; Kouwenberg, Jan H.c; van den Hout, Huibc; Navis, Gerjan J.a; Woittiez, Arend J.J.b Author Information

Effect of CYP11B2 gene -344T/C polymorphism on renin-angiotensin-aldosterone system activity and blood pressure response to hydrochlorothiazide

To evaluate the effect of CYP11B2 gene -344T/C polymorphism on renin-angiotensin-aldosterone system (RAAS) activity and blood pressure in response to hydrochlorothiazide (HCTZ) treatment in Han Chinese patients with essential hypertension. Eight hundred and twenty-nine patients with mild/moderate essential hypertensive were enrolled. All subjects had their antihypertensive medications withdrawn. After two weeks of wash-out period with placebo, each patient was given 12.5 mg of HCTZ per day for the next six weeks. Physical, biochemical measurements, and the activity of RAAS were taken at the end of the wash-out period (baseline) and 6-week diuretic therapy period. Changes in systolic and diastolic blood pressure were analyzed for association with interaction between genotypes at CYP11B2 -344T/C polymorphism and gender. A total of 776 patients completed the study. 17.5% of subjects have achieved blood pressure normalization after six weeks treatment. For male patients, the aldosterone level with CC genotype was significantly higher than that of those with TT or TC genotype. Following the HCTZ treatment, the blood pressure response in patients with CC genotype was less obvious than that in others, whilst the increase of aldosterone level was greater. For female patients, no association was found between CYP11B2 -344T/C polymorphism and aldosterone level. Following the HCTZ treatment, the blood pressure response in patients with CC genotype was greater than others, whilst the increase of aldosterone activity was less apparent. In males, the -344T/C polymorphism of CYP11B2 gene is associated with aldosterone level, and the change of aldosterone level was greater, the blood pressure response was weaker after HCTZ treatment. In females, there was no association between this polymorphism and aldosterone level. The change of aldosterone level and blood pressure response to HCTZ were different from that in males.