Blood Pressure sBP Research Articles

Refractory and resistant hypertension in patients with type 2 diabetes mellitus: differences in metabolic profile and endothelial function

To determine the prevalence of refractory hypertension (RfH) in patients with and without type 2 diabetes mellitus (DM), as well as to evaluate whether diabetic patients with RfH significant differ from those with uncontrolled resistant hypertension (RH) in clinical phenotype, metabolic profile and endothelial function. The study included 193 patients with RH: RH 74 patients with diabetes and 119 patients without DM. Uncontrolled RH and RfH were defined by the presence of uncontrolled blood pressure BP (140 and/or 90 mm Hg) despite the use of 3 but 5 antihypertensive drugs (for RH) and 5 antihypertensive drugs, including a mineralocorticoid receptor antagonist (for RfH). Clinical examination, lab tests were performed. Flow-mediated dilation (FMD) and vasoreactivity of middle cerebral artery (MCA) using both breath-holding and hyperventilation test were measured by high-resolution ultrasound. The prevalence of refractory hypertension in patients with and without DM was similar (30% vs 28%, respectively). No differences in BP levels, data of echocardiography and clinical phenotype were found between the diabetic groups, but value of HOMA index, plasma resistin level and postprandial glycaemia were higher in patients with RfH. FMD and MCA reactivity to the breath-holding test were worse in patients with RfH, and they had a more pronounced vasoconstrictor response of MCA to the hyperventilation test compared to patients with RH. The prevalence of RfH is the same in patients with and without diabetes. Diabetic patients with refractory hypertension have a more unfavorable metabolic profile and greater impairment of endothelial function than patients with uncontrolled resistant hypertension.

Visceral Adiposity Index and Lipid Accumulation Product as diagnostic markers of Metabolic Syndrome in South Indians with Polycystic Ovary Syndrome.

Background:Cardiovascular disease (CVD) is one of the debilitating consequences of polycystic ovary syndrome (PCOS). Early diagnosis of metabolic syndrome (MetS) with a simple but accurate method can reduce the risk of progression to CVD in PCOS.Aims:This study aimed to determine the accuracy of various anthropometric indices and lipid accumulation product (LAP), in assessing the risk of MetS in PCOS.Settings and Design:This is a cross-sectional study including 150 PCOS women and 100 control subjects.Materials and Methods:Anthropometric parameters were measured and calculated. Lipid profile, fasting plasma glucose (FPG), and insulin were estimated. MetS was detected according to the International Diabetes Federation criteria.Statistical Analysis:Logistic regression and receiver operating characteristic curve analysis were applied to determine the potential association of anthropometric indices such as body mass index, waist circumference (WC), waist-to-hip ratio, waist-to-height ratio, conicity index (CI), visceral adiposity index (VAI), abdominal volume index (AVI), body adiposity index (BAI), and a body shape index (ABSI) and LAP with MetS.Results:In our study of PCOS women of the south Indian population, the prevalence of MetS was 59.3%, which was higher than other populations and the cutoff values of VAI and LAP were 6.05 and 53, respectively. VAI showed the strongest association with MetS, followed by diastolic blood pressure BP, FPG, and LAP.Conclusions:We recommend VAI and LAP as new indices for MetS diagnosis. As these indices exhibit population specificity, it is imperative that independent cutoffs are determined for every demographic population.

PECULIARITIES OF HEMODYNAMIC AND METABOLIC INDICATORS IN PATIENTS WITH ARTERIAL HYPERTENSION AND CONCOMITANT OBESITY DEPENDING ON PLASMA RENIN ACTIVITY

The aim of the research: to evaluate the effect of plasma renin activity on the state of hemodynamic and neurohumoral parameters in obese hypertensive patients. Anthropometric, biochemical, automated methods of immune analysis, spectrophotometric, instrumental, statistical methods were used to examine 200 hypertensive patients with class I–II obesity aged 45–55 years. Patients were divided into two groups depending on plasma renin activity: the first group included 21 patients with low-renin hypertension, the second – 179 patients with high-renin hypertension. Patients with HRAH had higher blood pressure BP (DBP, p = 0.004, SBP and mean blood pressure, p<0.001 for both indicators), higher CIMT bifurcation (p = 0.003) and cPWV (p = 0.023), larger size of the left ventricle and its MM (p = 0.039) compared with patients with LRAH. The HRAH was associated with a more pronounced imbalance of the oxidative stress system – antioxidant protection, higher levels of leptin, total cholesterol and LDL cholesterol. In the absence of differences in glycemic levels, patients with HRAH had significantly higher insulin levels and more pronounced IR, as assessed by the HOMA index. Patients with low plasma renin activity had significantly lower serum aldosterone levels with significantly higher ARR levels than patients with high plasma renin activity. Features of cardiovascular remodeling and neurohumoral status depending on the phenotype of hypertension in patients with concomitant obesity have been established.

Blood pressure excursions in acute ischemic stroke patients treated with intravenous thrombolysis.

To investigate the association of blood pressure BP excursions, defined as greater than 185 SBP or greater than 105 DBP, with the probability of intracranial hemorrhage (ICH) and worse functional outcomes in patients with acute ischemic stroke (AIS) treated with tissue plasminogen activator (tPA). We performed a post hoc analysis of the CLOTBUST-ER trial. Serial BP measurements were conducted using automated cuff recording according to the recommended BP protocol guidelines for tPA administration. The outcomes were prespecified efficacy and safety endpoints of CLOTBUST-ER. The mean number of serial BP recordings per patient was 37. Of the 674 patients, 227 (34%) had at least one BP excursion (>185/105 mmHg) during the first 24 h following tPA-bolus. The majority of BP excursions (46%) occurred within the first 75 min from tPA-bolus. Patients with at least one BP excursion in the first 24 h following tPA bolus had significantly lower rates of independent functional outcome at 90 days (31 vs. 40.1%, P = 0.028). The total number of BP excursions was associated with decreased odds of 24-h clinical recovery (OR = 0.88, 95% CI:0.80-0.96), 24-h neurological improvement (OR = 0.87, 95% CI: 0.81-0.94), 7-day functional improvement (common OR = 0.92, 95% CI: 0.87-0.97), 90-day functional improvement (common OR = 0.94, 95% CI: 0.88-0.98) and 90-day independent functional outcome (OR = 0.90, 95% CI: 0.82-0.98) in analyses adjusted for potential confounders. DBP excursions were independently associated with increased odds of any intracranial hemorrhage (OR = 1.26, 95% CI: 1.04-1.53). BP excursions above guideline thresholds during the first 24 h following tPA administration for AIS are common and are independently associated with adverse clinical outcomes.

The Role of Hyperglycemia and Coexisting Hypertension in The Development of Diabetic Nephropathy in Type II Diabetes Mellitus

Background: diabetic nephropathy (D.N) is an important cause of morbidity and mortality and now the most common cause of end stage renal failure ESRF worldwide but especially in developed countries.Objectives: the aim of the study is to know the role of hyperglycemia and co-existing hypertension HTN in the development of D.N. among patients with type II Diabetes Mellitus(DM).Patients and Method: one hundred and twenty one diabetic patients were enrolled in a prospective observational study. Sixty six patients were females and fifty five were males. Besides full history and physical examination data were collected according to a format. At the end, these data were collected and analyzed statistically.Results: the average age was (54± 2.1) year , female to male ratio 66 to 55 (1.2:1) the number of patients with hyperglycemia was 90. Average random blood sugar R.B.S was 259± 1.6 mg/dL. number of patients with hypertension was 71, the average of systolic blood pressure BP was 158± 6.1mmHg and diastolic was 10.2±1.1, the average duration of D.M. was (10.5± 4.2) year, the average of glycosylated hemoglobin HbA1c was 9.8± 2.1. the number of patients with D.N was 77.Conclusion: the data showed that hyperglycemia and co-existing of hypertension were major risk factors in the development of D.N. among patient with type II D.M.

The Effects of Different Degrees of Carbohydrate Restriction and Carbohydrate Replacement on Cardiometabolic Risk Markers in Humans-A Systematic Review and Meta-Analysis.

Low-carbohydrate diets (LCDs) often differ in their diet composition, which may lead to conflicting results between randomized controlled trials. Therefore, we aimed to compare the effects of different degrees of carbohydrate (CHO) restriction on cardiometabolic risk markers in humans. The experimental LCDs of 37 human trials were classified as (1) moderate-low CHO diets (<45–40 E%, n = 13), (2) low CHO diets (<40–30 E%, n = 16), and (3) very-low CHO diets (<30–3 E%; n = 8). Summary estimates of weighted mean differences (WMDs) in selected risk markers were calculated using random-effect meta-analyses. Differences between the LCD groups were assessed with univariate meta-regression analyses. Overall, the LCDs resulted in significant weight loss, reduced diastolic blood pressure BP, and increased total cholesterol and high-density lipoprotein cholesterol (HDL-C), without significant differences between the three LCD groups. Higher low-density lipoprotein cholesterol (LDL-C) concentrations were found with the very-low CHO diets compared to the moderate-low CHO diets. Decreases in triacylglycerol (TAG) concentrations were more pronounced with the low and very-low CHO diets, compared to the moderate-low CHO diets. Substitution of CHO by mainly saturated fatty acids (SFAs) increased total cholesterol, LDL-C, and HDL-C concentrations. Except for LDL-C and TAGs, effects were not related to the degree of CHO restriction. Potential effects of nutrient exchanges should be considered when following LCDs.

Moderate intensity endurance exercise: a beneficial intervention for relative cardiovascular parameters of primary and secondary hypertensive patients. Randomised controlled trial

Background Hypertension remains one of the most important preventable contributors to morbidity and mortality. Physical activity of moderate intensity has been recommended for the prevention and complementary treatment of hypertension and to improve longevity. We hypothesised that moderate-intensity aerobic exercise would result in improving relative cardiovascular parameters of primary and secondary hypertensive patients. Method This study was a multi-centre randomised controlled trial. In this study, a 6-weeks programme of moderate-intensity exercise using cycle-ergometer was administered to both primary and secondary hypertensive experimental groups compared with primary and secondary hypertensive control groups. The outcome measures (Systolic Blood Pressure―SBP, Diastolic Blood Pressure―DBP, and Heart Rate―HR) were assessed at baseline and 6 weeks. Analyses were conducted using two-way analysis of variance (ANOVA) for between groups comparison. Paired t-test was used to determine within group differences. Result Sixty nine (69) participants with a mean ± SD age of 40.89 ± 8.23 years completed the study. Significant positive reduction in SBP 9.91–9.36 mmHg and DBP 10.5–9.94 mmHg were observed between baseline and 6 weeks in the experimental groups. However, the reduction in SBP and DBP were observed in the experimental groups compared with the control groups. No positive change in HR across the groups was observed. Conclusion These results demonstrate the possible benefits of short-term moderate-intensity aerobic exercise training on both primary and secondary hypertension. Trial Registration PACTR201902490588010

Effects of High Intensity Interval Training on Physiological Variables of University Students

The purpose of this study was to evaluate the effects of high-intensity interval training (HIIT) on university students’ physiological variables. 40 male sports science students with an age range between 18-25 years were randomly assigned to the HIIT group (n=20) and control (C) group (n=20). The experiment group underwent eight weeks of HIIT, whereas, C group do not. Pre and posttest measurements of physiological variables like resting heart rate (RHR), respiratory rate (RR), recovery heart rate (RcHR), breath holding time (BHT), VO2 max and blood pressure BP) were made for all subjects before and after the intervention. To compare the mean physiological variables between the experiment and control groups, an independent sample t-test was employed. The statistical significance was set at p<0.05. Following the exercise intervention, the experiment group shows significantly better improvements than the control group in, RHR, RR, BHT, VO2 max, and systolic blood pressure (p<0.05). Thus, it was concluded that eight weeks of HIIT show a significant improvement in the physiological variables of university students.

The Role of Hyperglycemia and Coexisting Hypertension in the Development of Diabetic Nephropathy in Type II Diabetes Mellitus

Background: diabetic nephropathy (D.N) is an important cause of morbidity and mortality and now the most common cause of end stage renal failure ESRF worldwide but especially in developed countries.Objectives: the aim of the study is to know the role of hyperglycemia and co-existing hypertension HTN in the development of D.N. among patients with type II Diabetes Mellitus(DM).Patients and Method: one hundred and twenty one diabetic patients were enrolled in a prospective observational study. Sixty six patients were females and fifty five were males. Besides full history and physical examination data were collected according to a format. At the end, these data were collected and analyzed statistically.Results: the average age was (54± 2.1) year , female to male ratio 66 to 55 (1.2:1) the number of patients with hyperglycemia was 90. Average random blood sugar R.B.S was 259± 1.6 mg/dL. number of patients with hypertension was 71, the average of systolic blood pressure BP was 158± 6.1mmHg and diastolic was 10.2±1.1, the average duration of D.M. was (10.5± 4.2) year, the average of glycosylated hemoglobin HbA1c was 9.8± 2.1. the number of patients with D.N was 77.Conclusion: the data showed that hyperglycemia and co-existing of hypertension were major risk factors in the development of D.N. among patient with type II D.M.

P047: Prevalence and severity of hypertension presenting to Calgary area emergency departments

Introduction: Hypertension is common and a major cause of morbidity and mortality. Because it is asymptomatic, its diagnosis is often delayed. For many Canadians the Emergency Department (ED) is the only point of entry to the health care system, and therefore the recognition of undiagnosed and untreated hypertension in the ED is increasingly important. This study sought to evaluate the prevalence and severity of hypertension in patients presenting to Calgary area EDs, as well as to determine whether medical therapy was initiated and if patients had primary care providers for follow-up. Methods: Multi-centre electronic medical record (EMR) review of all adult patients presenting to Calgary area EDs from January 1, 2016 to December 31st, 2016. Hypertension was coded electronically by triage nurses and defined as systolic blood pressure SBP 140 mmHg and/or diastolic blood pressure DBP 90 mmHg. Hypertensive urgency was defined as SBP 180 mmHg and/or DBP 120 mmHg. Descriptive data was used to show patient demographics and hypertension prevalence. Primary care provider status, previous diagnosis of hypertension, chief complaint, and ED diagnoses were extracted and the EMRs were manually searched to determine whether treatment was initiated in the ED. Results: Of 304392 patients presenting to all Calgary sites, 43055 (14%) were found to have hypertension; mean age 52 (range 18 to 104), female 42%. Of these, 32986 (77%) had no known previous hypertension and 31% lacked a primary care provider. 0.2% had documentation of treatment initiated in the ED. 16% met criteria for hypertensive urgency. Conclusion: Many patients presenting to the ED have hypertension, often previously undiagnosed and at times severe. Many lack access to primary care. EDs may play an important role in the early recognition of hypertension. Dedicated management and follow-up pathways are indicated for this high-risk population.

Aegle marmelos leaf juice as a complementary therapy to control type 2 diabetes – Randomised controlled trial in Gujarat, India

ObjectiveTo compare the clinical efficacy of Aegle marmelos (L.) Correa (AMLC) leaf juice (supplementation (20g/100ml) for 60 days among type 2 diabetes mellitus subjects. DesignRandomised-controlled trial. SettingVeraval. Gir-Somnath, Gujarat, India. InterventionConfirmed type 2 diabetes mellitus subjects (n=60), were randomly divided to experimental (n=30) AMLC leaf juice supplementation (20g/100ml) and control group (n=30) for 8 weeks. Main outcome measures: body-mass-index (BMI), body-fat-percent (BF%), systolic and diastolic blood pressure (BP), fasting blood glucose, glycosylated haemoglobin and post prandial blood glucose (FBG, HbA1c and PPBG), total, high, low and very low density lipoproteins and triglycerides (TC, HDL, LDL-cholesterol and TG), C-reactive protein (CRP), liver enzyme tests serum glutamate oxaloacetate transaminase and, serum glutamate pyruvate transaminase (SGPT and SGOT), kidney function tests (creatinine), total protein (TP, albumin, globulin) and serum ferric reducing antioxidant potential (serum FRAP). ResultsAt 4 weeks, significant reduction was recorded in blood pressure SBP – 6.45%; DBP – 4.6%, FBG & HbA1c-20%; PPBG-15%; total cholesterol (TC-8%), LDL-15%), triglycerides (TG-11%), liver functions SGOT-19% and, SGPT-13%, increase in serum (FRAP-18%) in the subjects of EG post supplementation compared to baseline. When compared to control group, it reduced BF%, FBG, HbA1c, cholesterol, TG, LDL-cholesterol, CRP and raised HDL-cholesterol as well as improved antioxidant activity. ConclusionAMLC leaf juice supplementation (20g/100ml) for 60 days showed improvement in all bio-chemical parameters of type 2 diabetes mellitus, with enhanced efficacy and negligible adverse-effects. This juice can therefore, be supplemented along with oral hypoglycemic drugs to keep the above parameters in control. AMLC leaf being easily available and low cost, can be used as complementary therapy in the management of diabetes possibly due to presence of active components, aegelin 2, scopoletin and sitosterol in the leaf.

Random forest based thermal comfort prediction from gender-specific physiological parameters using wearable sensing technology

Prior knowledge of occupants’ thermal comfort can facilitate informed control decision of ambient thermal-conditioning in a building environment. This paper investigates the possibility to predict human thermal state (Comfort/Discomfort) from the information of physiological parameters. As gender difference has been widely linked with thermal comfort perception, a four-fold objective is adopted: first, investigating gender differences in subjective thermal perception; second, investigating gender differences in physiological response under different thermal states; third, identifying those physiological features that have the potential to predict thermal state, and fourth, establishing a data-driven thermal state prediction model for each gender group using the identified features. Human subject experiments were conducted, during which five physiological responses (hand skin temperature STh, hand skin conductance SCh, pulse rate PR, blood oxygen saturation SpO2, blood pressure BP) and four subjective responses (thermal comfort, thermal preference, humidity sensation, airflow sensation) were recorded in conjunction with a thermal sensation survey while environmental conditions varied from cold/cool to neutral levels (18°C−27∘C). Additionally, derivative features namely change rate (FOG) and mean squared gradient (MSG) of each physiological parameter were examined. Rigorous statistical analysis and subsequent predictive modeling utilizing Random Forest algorithm were implemented. Results demonstrate significant gender difference in several subjective and physiological responses. The features identified for males (SpO2-MSG/STh/STh-FOG/STh-MSG/SCh/SCh-FOG/SCh-MSG) and females (STh-FOG/STh-MSG/SCh/SCh-MSG/PR/PR-MSG) could accurately predict 92.86% and 94.29% of thermal states, respectively. This study indicates that the thermal state of a person can be identified by monitoring physiological parameters from non-intrusive body locations using wearable sensing technology.

LB.02.17]OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AND ARTERIAL HYPERTENSION

Objective: Optical coherence tomography angiography (OCTA) is a novel, non-invasive OCT technique able to identify and characterize retinal vascular patterns. Aim of our cross-sectional study was to evaluate the correlation between retinal microvascular modifications detected with OCTA and arterial hypertension (AH). We also evaluated the role of OCTA as an useful tool for early diagnosis of subclinical organ damage in hypertensive patients. Design and method: We enrolled 70 subjects: 35 hypertensive and 35 normotensive (NT) patients matched for age, sex and BMI. Hypertensive patients was divided into two groups: mild (Blood Pressure-BP < 160/100 mmHg MH) and severe (BP >180/110 mmHg, SH). OCTA was performed applying different analysis protocols for macula and optic disk, using SD-OCTA Avanti Optovue by SSADA algorithm. OCT angiograms were studied with corresponding OCT B scans and retinal maps, to assess accuracy and clinical utility. Morphological data were correlated to office BP (OBP), central systolic blood pressure (c-SBP) and microalbuminuria (MI) to evaluate the predictive value of OCT analysis. Results: We observed a lower mean foveal choroidal thickness in hypertensive patients vs normotensive (NT 319,68 ± 61,72 mm, MH 251,04 ± 63,1 mm SH 262,65 ± 51,08 mm p = 0.003). Deep vascular layer resulted similar in the three groups (NT: 59,2 ± 1,5%; MH: 59,2 ± 2.2%; SH: 57,8 ± 2,6%) as well as deep foveal avascular zone area (NT: 0,34 ± 0,09 mm2; MH 0,36 ± 0,07 mm2; SH: 0,39 ± 0,1 mm2). Our preliminary data didn’t show a significant correlation between morphological retinal parameters and OBP, c-SBP and microalbuminuria. Conclusions: Our data show how OCTA could highlight some vascular modifications in hypertensive patients, suggesting a potential usefulness of OCTA to assess ocular damage. We need largest studies to estabilish a predictive role of this technique.

Some Biochemical Risk Factors for Myocardial Infarction in Babylon City

The present comprehensive study was designed to investigate the changes in some biochemical parameters and determine the risk factors in sera samples of patient with myocardial infarction (MI) [history of diabetes mellitus (DM) type 1, hypertension (blood pressure BP), and DM+ BP+smoking].Sixty four patients with MI attending to Merjan Teaching Hospital in Hilla City, were included in the present study. Also thirty two healthy individuals of matched age and gender were utilized as control.The main measurements included the following biochemical measurements:-Ceruloplasmin (CP), copper(Cu),total protein(TP) ,albumin(Alb.),globulin(Glo),total cholesterol(TC), triglyceride(TG), and total bilirubin(TB) concentrations, also Alb./Glo. ratio, TC/Alb ratio, CP oxidase activity, CP oxidase specific activity and Cu conc. / CP oxidase activity ratio in sera of healthy (control) and patients with MI (history of DM , BP and DM+BP+smoking).The results revealed a highly significant increase(p&lt;0.001) in the CP, TP, Glo, TG, TB concentrations, Alb./Glo. ratio, CP oxidase activity, specific activity and Cu conc./CP oxidase activity ratio in sera of patients with MI (DM+ BP+smoking),while the same parameter referred significant increase(p&lt;0.01) in patients with MI(DM or BP) in comparisom with control group. But Alb. concentration show significant decrease in the all groups (p&lt;0.001), (p&lt;0.01) respectively. An important finding in this study is that biochemical risk factors appeared to occur in patients with DM+BP+smoking more the patients with DM or BP. This observation suggests that DM+BP+smoking may be more prominent risk factor for MI. Hypertriglyceridemia, but not hypercholesterolemia, is associated with MI. TC/Alb ratio is considered a better index of cardiovascular risk than serum cholesterol. CP conc., CP activity and specific activity and Cu Conc. / CP oxidase activity anew biochemical parameters and risk factors, therefore this results it is regarded us a primary indicator to MI.

Medicinal Plants Used in the Management Hypertension

Hypertension or high blood pressure BP is a chronic medical condition and is a worldwide epidemic High percentage of the world hypertensive population use herbal medicines for primary health care because of their low cost better acceptability and lesser side effects Naturally occurring medicinal plants herbs having antihypertensive potential so several ethnobotanical studies performed in different parts of world showed that hundreds of plants are used worldwide for empirical hypertension treatment This work provides basic knowledge from medicinal plants used for high blood pressure treatment to support future pharmacological and phytochemical investigation

Associations of human skeletal muscle fiber type and insulin sensitivity, blood lipids, and vascular hemodynamics in a cohort of premenopausal women.

Cardiometabolic disease remains a leading cause of morbidity and mortality in developed nations. Consequently, identifying and understanding factors associated with underlying pathophysiological processes leading to chronic cardio metabolic conditions is critical. Metabolic health, arterial elasticity, and insulin sensitivity (SI) may impact disease risk, and may be determined in part by myofiber type. Therefore, the purpose of this study was to test the hypothesis that type I myofiber composition would be associated with high SI, greater arterial elasticity, lower blood pressure, and blood lipids; whereas, type IIx myofibers would be associated with lower SI, lower arterial elasticity, higher blood pressure, blood lipids. Muscle biopsies were performed on the vastus lateralis in 16 subjects (BMI=27.62±4.71kg/m2, age=32.24±6.37years, 43% African American). The distribution of type I, IIa, and IIx myofibers was determined via immunohistochemistry performed on frozen cross-sections. Pearson correlation analyses were performed to assess associations between myofiber composition, SI, arterial elasticity, blood pressure, and blood lipid concentrations. The percentage of type I myofibers positively correlated with SI and negatively correlated with systolic blood pressure SBP, diastolic blood pressure, and mean arterial pressure (MAP); whereas, the percentage of type IIx myofibers were negatively correlated with SI and large artery elasticity, and positively correlated with LDL cholesterol, SBP, and MAP. These data demonstrate a potential link between myofiber composition and cardiometabolic health outcomes in a cohort of premenopausal women. Future research is needed to determine the precise mechanisms in which myofiber composition impacts the pathophysiology of impaired glucose and lipid metabolism, as well as vascular dysfunction.

Peripheral and Central Blood Pressure Response to Handgrip Exercise Coupled with Blood Flow Restriction

Low intensity exercise coupled with blood flow restriction (BFR) produces comparable strength gains and skeletal muscle hypertrophy, compared to non-BFR training at higher intensities. However, the cardiovascular response (e.g., blood pressure-BP) to this type of exercise remains controversial. PURPOSE: To examine peripheral and central BP responses to low and high-intensity, unilateral handgrip exercise performed with and without BFR. METHODS: Eight college-aged males (Age=24±5 yrs; BMI=30±7 kg/m2, handgrip max voluntary contraction-MVC=52±8 kg) underwent three 5-minute bouts (counter-balanced, 10 mins rest) of rhythmic handgrip (1–2 sec duty cycle, 20 squeezes/min) performed at a low (40% MVC) and high-intensity (60% MVC) with and without proximal occlusion (80-100 mmHg, 50-80% arterial occlusion assessed via radial artery Doppler-ultrasound). Peripheral BP’s (brachial artery) were obtained using the oscillometric method, and a proprietary transfer function was applied to the pulse waveform to estimate central aortic BP’s [systolic, diastolic, mean arterial pressure (MAP) and rate-pressure product (RPP=heart rate x systolic BP)]. RESULTS: Peripheral systolic and diastolic BP, MAP and RPP were greater than central pressures at BL (e.g., peripheral systolic BP=130±6 vs. central systolic BP=113±5 mmHg; P<0.001), and across each handgrip bout (P<0.05). Compared to BL, both peripheral and central MAP increased, with the greatest change occurring during high-intensity handgrip with BFR (+17±4, P<0.001). Similar findings were observed for peripheral and central systolic and diastolic BP, and RPP (e.g., central RPP at BL=7296±621, vs. 40% BFR=8217±612, vs. 60% with BFR=9441±686, vs. 60% without BFR=9237±629; P<0.001). CONCLUSION: These preliminary findings indicate that low intensity, unilateral handgrip exercise performed with BFR produces a comparable BP response (i.e., magnitude increase for MAP) as high intensity handgrip without BFR; however, RPP was greater during high intensity handgrip both with and without BFR, compared to low intensity with BFR.

Effects of blood-pressure-lowering treatment on outcome incidence in hypertension: 10 - Should blood pressure management differ in hypertensive patients with and without diabetes mellitus? Overview and meta-analyses of randomized trials.

Type 2 diabetes mellitus is associated with an increased risk of hypertension, and cardiovascular and renal disease, and it has been recommended that management of hypertension should be more aggressive in presence than in absence of diabetes mellitus, but the matter is controversial at present. Meta-analysing all available randomized controlled trials (RCTs) to compare the effects on cardiovascular and renal outcomes of blood pressure BP lowering to different systolic BP (SBP) and diastolic BP (DBP) levels or by different drug classes in patients with and without diabetes mellitus. The database consisted of 72 BP-lowering RCTs (260 210 patients) and 50 head-to-head drug comparison RCTs (247 006). Among these two sets, RCTs or RCT subgroups separately reporting data from patients with and without diabetes mellitus were identified, and stratified by in-treatment achieved SBP and DBP, by drug class compared with placebo, and drug class compared with all other classes. Risk ratios and 95% confidence intervals, and absolute risk reductions of six fatal and non-fatal cardiovascular outcomes, all-cause death, and end-stage renal disease (ESRD) were calculated (random-effects model) separately for diabetes mellitus and no diabetes mellitus, and compared by interaction analysis. We identified 41 RCTs providing data on 61 772 patients with diabetes mellitus and 40 RCTs providing data on 191 353 patients without diabetes mellitus. For achieved SBP at least 140 mmHg, relative and absolute reductions of most cardiovascular outcomes were significantly greater in diabetes mellitus than no diabetes mellitus, whereas for achieved SBP below 130 mmHg, the difference disappeared or reversed (greater outcome reduction in no diabetes mellitus). Significant ESRD reduction was found only in diabetes mellitus, but it was greatest when achieved SBP was at least 140 mmHg, and no further effect was found at SBP below 140 mmHg. All antihypertensive drug classes reduced cardiovascular risk vs. placebo in diabetes mellitus and no diabetes mellitus, but angiotensin-converting enzyme inhibitors were the only class more effective in diabetes mellitus than in no diabetes mellitus. When compared to other classes, renin-angiotensin system blockers were equally effective in cardiovascular prevention in no diabetes mellitus, but moderately, though significantly, more effective in diabetes mellitus. BP-lowering treatment significantly and importantly reduces cardiovascular risk both in diabetes mellitus and no diabetes mellitus, but evidence for reduced ESRD risk is available only in diabetes. Contrary to past recommendations, in diabetes mellitus there is little or no further benefit in lowering SBP below 130 mmHg, whereas continuing benefit is seen in no diabetes mellitus also at SBP below 130 mmHg. Although all BP-lowering drugs can beneficially be prescribed in hypertensive patients with diabetes mellitus, the current recommendation to initiate or include a renin-angiotensin system blocker is supported by the evidence here presented.

Efficacy and Safety of Dexmedetomidine for Conscious Sedation During Endoscopic Submucosal Dissection

Introduction: Although diazepam DZP and pentazocine Hydrochloride (PTZ) is widely used for sedation during ESD in Japan, there are frequent cases found where the total amount of DZP usage is quite large due to ineffectiveness of sedation. Recently dexmedetomidine (DEX) has become used for sedation during ESD in Japan. DEX has an advantage over DZP in that it does not cause respiratory depression. Therefore, also in our institution DEX has been introduced for sedation during ESD since 2014. In the present study we aimed to investigate the efficacy and safety of DEX for sedation during ESD. Methods: We checked our electronic medical records and extracted 114 cases of ESD between 19th March 2014 and 7th April 2016. These 114 cases were divided into two groups: Group A DEX DPZ and PTZ used concomitantly; Group B, DPZ and PTZ used (without DEX). As the indicator of sedative effectiveness, we investigated the number of body movement which required additional administration of DPZ or PTZ. And we checked adverse events during sedation, such as bradycardia. Results: There were 80 cases extracted in group A, and 34 cases in group B. In group A, the number of body movement was significantly fewer than in group B (A 1.14/h, B 1.18/h). Moreover, the incidence of nausea or vomiting during or three hours after ESD was significantly lower in group A than in group B (2.5% vs 23%, P< 0.001). Whereas, low blood pressure sBP < 80mmHg or bradycardia < 60bpm occurred more frequently in group A than in group B (35% and 28% vs 2% and 0%, respectively; P < 0.001). In 6 cases of low blood pressure we required ephedrine hydrochloride injection. The rest cases of low blood pressure (23 cases) and all the bradycardia cases recovered spontaneously after the end of DEX injection. Conclusion: We concluded that DEX is effective in that it can reduce the number of body movement compared to a DPZ/PTZ method. Although low blood pressure and bradycardia are important adverse events related to DEX, it can be usually managed safely. DEX should be recommended for a sedative agent for ESD.

Chronic Reno-Cardial Continuum in Glomerulonephritis

To elucidate main risk factors contributing to development of cardiovascular pathology at the predialysis stage of chronic glomerulonephritis. We examined 173 patients (90 men, 83 women, age 15-70, mean age 36.8+/-12.9 years) at predialysis stage of chronic glomerulonephritis. Cardiovascular pathology (coronary heart disease, disturbances of cardiac rhythm, left ventricular hypertrophy, chronic heart failure) was found in 88 patients. Clinical examination included history taking, physical examination with measurement of blood pressure BP and anthropological parameters, laboratory and instrumental investigation for diagnosis verification. Biochemical parameters studied were blood serum levels of cholesterol (Ch), high-density lipoprotein Ch, low-density lipoprotein Ch, fibrinogen, C-reactive protein, total protein, and creatinine. ECG and echocardiography were also performed. Presence of cardiovascular pathology was associated with higher concentration of calcium in blood serum (1.7+/-0.6 vs. 1.4+/-0.5 mmol/l, p<0.05), anemia with lower hemoglobin content, number and volume of erythrocytes, higher creatinine (150 [76-179]) vs. 100 [70-117] mcmol/l; p<0.05) and lower glomerular filtration rate (GFR) (80 [41-104] vs. 100 [69-122] ml/min; p<0.05). Main factors, contributing to development of cardiovascular pathology in patients at the predialysis stage of chronic glomerulonephritis were anemia, hypercalcemia, and lowering of GFR with increased serum creatinine.