DBP Changes Research Articles

A retrospective study of the safety and efficacy of peritoneal dialysis catheter placement under combined local infiltration anesthesia and monitored anesthesia care

ObjectiveGiven the lack of global consensus on anesthesia selection for peritoneal dialysis catheter (PDC) placement via open surgery, this study investigates the safety and efficacy of combining local infiltration anesthesia (LIA) with monitored anesthesia care (MAC) in patients with end-stage renal disease (ESRD).MethodsThis retrospective analysis of ESRD patients who underwent open surgical placement of PDC in the Department of Nephrology, the First Affiliated Hospital of the Army Medical University from 1 August 2020 to 31 May 2022. Patients were categorized into two groups based on anesthesia method: LIA group and LIA + MA group. MA was defined as preoperative sedation (0.2–0.7 µg/kg/h) with dexmedetomidine injection (Huidrican trade name, DEX), and intraoperative analgesia with dexrazoxane injection (Garonin trade name, DEZ) as appropriate according to the patients’ pain scores. We compared the general clinical data of the two groups of patients, the changes in blood pressure and heart rate during the whole operation, the intraoperative and postoperative pain, the total duration of the operation and the immediate postoperative complications.ResultsThe study included 123 patients (59 in the LIA + MAC group and 64 in the LIA group). The LIA + MA group exhibited lower pain scores measured by Visual Analogue Scale(VAS) during surgery (skin incision, subcutaneous adipose tissue dissection, anterior fascia, muscle traction, posterior fascia, peritoneum, and catheterization) compared to the LIA group(p<0.05). In terms of surgical incisions, to intraoperative pain scores (VRS), the LIA + MA group showed higher score level I and lower score level II compared to the LIA group (p = 0.002, 0.004, respectively). The LIA + MA group experienced lower postoperative resting pain (NRS) and VAS than the LIA group (p = 0.001,0.003, respectively). The surgical duration for the LIA + MA group was shorter than that of the LIA group (p<0.001). Preoperative systolic and diastolic blood pressures (SBP and DBP) were higher in the LIA + MA group compared to the LIA group (p<0.001,<0.001, respectively). Postoperative heart rate and DBP were lower in the LIA + MA group (p<0.001, 0.004, respectively). The LIA + MA group exhibited greater changes in heart rate, SBP, and DBP during and after surgery compared to the LIA group (p = 0.009, <0.001,<0.001, respectively). In terms of immediate postoperative complications, the proportion of patients requiring analgesics within 24 h post-surgery was significantly lower in the LIA + MA group (p = 0.031).ConclusionOpen surgery for PDC placement under LIA + MAC is both safe and effective.

Single-arm study of testosterone gel replacement therapy and ambulatory blood pressure outcomes in men with hypogonadism.

Studies examining ambulatory blood pressure (BP) response to testosterone replacement therapy are needed owing to inconsistent prior findings across formulations. This study assessed testosterone gel 1.62% and 24-h ambulatory BP. Single-arm non-inferiority trial (NCT04274894) conducted at 36 US sites enrolled 246 men with hypogonadism (mean age, 57.6 years; mean office systolic/diastolic BP [SBP/DBP], 129.8/79.5mm Hg) who were treated for 16weeks with once-daily testosterone gel treatment (starting dose, 40.5mg/day; min, max dose, 20.25, 81.0mg/day) to achieve testosterone concentration of 350-750ng/dL. Main outcome measures included mean change in 24-h average SBP (primary endpoint) and DBP from baseline to week 16. The non-inferiority threshold was a two-sided 95% confidence interval (CI) upper limit <3.0mm Hg for 24-h average SBP. Increase in mean±SD serum testosterone concentration to a physiologic level (baseline, 244.4±93.9ng/dL; week 16, 502.5±394.4ng/dL) was associated with a 1.9-mm Hg mean change in 24-h average SBP observed in the primary analysis (baseline, 123.5mm Hg; week 16, 125.4mm Hg; 95% CI, 0.63-3.13mm Hg; n=169). As the upper CI limit modestly exceeded the non-inferiority margin (3mm Hg), study drug effect on SBP could not be ruled out. Non-inferiority was observed in subgroups without hypertension or diabetes (95% CI, upper limit <3.0mm Hg) and was not observed in those with hypertension or diabetes. Daytime SBP and DBP changes were larger compared with nighttime. No clear cardiovascular adverse events or new safety signals were identified. While the effect of testosterone gel 1.62% on 24-h average SBP could not be ruled out based on the study's non-inferiority margin, the clinical relevance of the small-magnitude mean increase of 1.9mm Hg is anticipated to be minimal considering the results of the TRAVERSE study of testosterone gel 1.62% and major adverse cardiac events. ClinicalTrials.gov identifier: NCT04274894 (registered February 17, 2020).

Phase III randomized clinical trial of efficacy and safety of amlodipine and candesartan cilexetil combination for hypertension treatment

Effective antihypertensive therapy is essential for achieving optimal blood pressure (BP) control and reducing cardiovascular events. This double-blind, multicenter, randomized trial aimed to compare the antihypertensive efficacy and safety of a combination of amlodipine (AML) and candesartan cilexetil (CC) versus AML monotherapy in patients with essential hypertension (HTN). After a 4-week run-in period with AML 5 mg, patients whose HTN remained uncontrolled (diastolic BP [DBP]) ≥ 90 mmHg and < 120 mmHg) were randomized to receive either AML + CC or AML alone for 8 weeks. Efficacy was assessed by measuring changes in DBP and systolic BP (SBP). The primary safety measure was the incidence of adverse events (AEs). A total of 174 participants were included in the efficacy analysis. After 8 weeks, DBP decreased by -9.92 ± 0.86 mmHg in the AML + CC arm and - 2.08 ± 0.86 mmHg in the AML arm (p < 0.0001). SBP decreased by -14.27 ± 1.39 mmHg in the AML + CC arm versus - 2.77 ± 1.39 mmHg in the AML arm (p < 0.0001). AEs occurred in 11.24% of the AML + CC group and 5.62% of the AML group (p = 0.1773). AML + CC combination therapy demonstrated superior efficacy with good tolerance, making it a promising option for patients with inadequately controlled hypertension on amlodipine alone.

Caffeine Abstinence in Habituated Users: Cardiovascular Responses to Exercise With Blood Flow Restriction.

Blood flow restriction resistance exercise studies often require caffeine abstinence to avoid cardiovascular effects that could change the blood flow restriction stimulus. However, effects may be attenuated for habituated users. To compare cardiovascular responses to blood flow restriction resistance exercise when habituated users consume or abstain from caffeine. Thirty participants completed a 3-visit within-subject study beginning with familiarization and caffeine intake questionnaire. Visits 2 and 3 consisted of blood flow restriction resistance exercise (3 sets bicep curls to failure, 30% 1-repetition max, 40% arterial occlusion pressure [AOP]), following participants' normal caffeine consumption (CAFF) or abstaining (ABS). AOP, systolic (SBP) and diastolic (DBP) blood pressure, and heart rate were measured preexercise and postexercise. Prevalues and preexercise to postexercise change scores for SBP, DBP, AOP (all millimeters of mercury), heart rate (in beats per minute), and repetitions were compared between conditions. Results are represented as mean (SD). Preexercise AOP was similar for CAFF (137.8 [14.4]) and ABS (137.1 [14.9], BF10 = 0.2), although pre-SBP was higher for CAFF (115.4 [9.8]) than ABS (112.3 [9.4], BF10 = 1.9). Pre-DBP was similar between conditions. The exercise-induced change in AOP was greater for CAFF (18.4 [11.2]) than ABS (13.2 [14.9]), though evidence was anecdotal (BF10 = 0.7). Exercise-induced changes in SBP, DBP, and heart rate were similar between conditions (all BF10 ≤ 0.40). More repetitions were completed for CAFF (63 [26]) than ABS (57 [17], BF10 = 2.1). The findings of this study suggest that for habituated users, maintaining daily caffeine habits will not have substantial effects on common cardiovascular variables relevant to blood flow restriction.

A 4-week Randomized, Double-Blind, Placebo-Controlled Clinical Trial on the Use of Grape Seed Extract for Reducing Plasma Glucose, Lipid Profile, and Blood Pressure in Patients with Type 2 Diabetes Mellitus

: Diabetes mellitus (DM) is a common chronic disease that can significantly decrease life expectancy due to its complications. Grapes (Vitis Vinifera L.) and their byproducts, including seeds, have been used globally to treat various ailments. In this clinical trial, we investigated the effect of Iranian grape seed extract (GSE) on fasting blood sugar (FBS), lipid profile [including total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG)], as well as systolic and diastolic blood pressure (SBP and DBP, respectively) in patients with type 2 DM (T2DM). Seventy-four patients with T2DM were divided into two groups; 38 patients in the treatment group received 263.2 mg of GSE (standardized to contain 250 mg of proanthocyanidine) twice daily, and 36 patients in the placebo group received 263.2 mg of placebo twice daily for thirty days. At the end of the intervention, a statistically significant decrease was observed in SBP [from 125.83 ± 13.39 in the placebo group to 121.94 ± 7.49 in the treatment group (P = 0.002]), and FBS [from 144.75 ± 30.82 in the placebo group to 129.87 ± 31.79 in the treatment group (P = 0.001)]. There were no significant changes in total cholesterol, HDL, LDL, TG, and DBP between the two groups. Consuming Iranian GSE for a short duration can lower FBS and systolic blood pressure (BP), suggesting that GSE may play a key role in improving BP and fasting blood glucose in patients with T2DM.

Use of a novel algorithm to evaluate changes in diet quality following energy restriction

Dietary strategies for weight loss typically place an emphasis on achieving a prescribed energy intake. Depending on the approach taken, this may be achieved by restricting certain nutrients or food groups, which may lower overall diet quality. Various studies have shown that a higher quality diet is associated with better cardiovascular (CV) health outcomes1. This study aimed to evaluate the effect of an energy restricted diet on diet quality, and associated changes in cardiovascular risk factors. One hundred and forty adults (42 M:98 F, 47.5 ± 10.8 years, BMI 30.7 ± 2.3 kg/m2) underwent an energy restricted diet (30% reduction) with dietary counselling for 3 months, followed by 6 months of weight maintenance. Four-day weighed food diaries captured dietary data at baseline, 3 and 9 months and were analysed using a novel algorithm to score diet quality (based on the Dietary Guideline Index, DGI)2. Total DGI scores ranged from 0-120, with sub scores for consumption of core (0-70) and non-core foods (0-50). For all scores, a higher score or increase reflects better diet quality. The CV risk factors assessed included blood pressure (SBP and DBP) and fasting lipids (total (TC), high and low-density lipoprotein cholesterol (HDL-C, LDL-C) and triglycerides (TAG). Mixed model analyses were used to determine changes over time (reported as mean ± standard error), and Spearman rho (rs) evaluated associations between DGI score and CV risk factors. Dietary energy intake was significantly restricted at 3 months (−3222 ± 159 kJ, P&lt;0.001, n = 114) and 9 months (−2410 ± 167 kJ, P&lt;0.001, n = 100) resulting in significant weight loss (3 months −7.0 ± 0.4 kg, P&lt;0.001; 9 months −8.2 ± 0.4 kg, P&lt;0.001). Clinically meaningful weight loss (&gt;5% body mass) was achieved by 81% of participants by 3 months. Diet quality scores were low at baseline (scoring 49.2 ± 1.5), but improved significantly by 3 months (74.7 ± 1.6, P&lt;0.000) primarily due to reductions in the consumption of non-core i.e. discretionary foods (Core sub-score +4.0. ± 0.7, Non-core sub-score +21.3.1 ± 1.6, both P&lt;0.001). These improvements were maintained at 9 months (Total score 71.6 ± 1.7, P&lt;0.000; Core sub-score +4.4 ± 0.7 from baseline, P&lt;0.000; Non-core sub-score +17.9 ± 1.6 from baseline, P&lt;0.000). There were significant inverse relationships between changes in Total DGI score and changes in DBP (rs = −0.268, P = 0.009), TC (rs = −0.298, P = 0.004), LDL-C (rs = −0.224, P = 0.032) and HDL-C (rs = −0.299, P = 0.004) but not SBP and TG at 3 months. These data emphasise the importance of including diet quality as a key component when planning energy restricted diets. Automated approaches will enable researchers to evaluate subtle changes in diet quality and their effect on health outcomes.

Increased blood pressure after nonsevere COVID-19.

Various sequelae have been described after nonsevere coronavirus disease 2019 (COVID-19), but knowledge on postacute effects on blood pressure is limited. This is a cross-sectional analysis of blood pressure profiles in individuals after nonsevere COVID-19 compared with matched population-based individuals without prior COVID-19. Data were derived from the ongoing and prospective Hamburg City Health Study, a population-based study in Hamburg, Germany, and its associated COVID-19 program, which included individuals at least 4 months after COVID-19. Matching was performed by age, sex, education, and preexisting hypertension in a 1 : 4 ratio. Four hundred and thirty-two individuals after COVID-19 (mean age 56.1 years) were matched to 1728 controls without prior COVID-19 (56.2 years). About 92.8% of COVID-19 courses were mild or moderate, only 7.2% were hospitalized, and no individual had been treated on an intensive care unit. Even after adjustment for relevant competing risk factors, DBP [+4.7 mmHg, 95% confidence interval (95% CI) 3.97-5.7, P < 0.001] was significantly higher in individuals after COVID-19. For SBP, a trend towards increased values was observed (+1.4 mmHg, 95% CI -0.4 to 3.2, P = 0.120). Hypertensive blood pressures at least 130/80 mmHg (according to the ACC/AHA guideline) and at least 140/90 mmHg (ESC/ESH guideline) occurred significantly more often in individuals after COVID-19 than matched controls (odds ratio 2.0, 95% CI 1.5-2.7, P < 0.001 and odds ratio 1.6, 95% CI 1.3-2.0, P < 0.001, respectively), mainly driven by changes in DBP. Blood pressure is higher in individuals after nonsevere COVID-19 compared with uninfected individuals suggesting a significant hypertensive sequela.

Relationship between cerebral oxygenation, cardiac output, and blood pressure during transitional period in extremely low gestational age neonates.

To describe the relationship between cerebral oxygenation, cardiac output, arterial blood pressure (BP), and cerebral blood flow velocity in extremely low gestational age neonates (ELGANs) during transition. This study comprises secondary analyses from a prospective observational study conducted at a tertiary Neonatal Intensive Care Unit. Recruited ELGANs underwent cerebral saturation (CrSO2) monitoring and serial echocardiography during 72 h from birth. Correlative analyses of CrSO2 and cerebral fractional tissue oxygen extraction (CFTOE) with left (LVO) and right ventricular output (RVO), superior vena cava (SVC) flow, middle cerebral artery blood flow mean velocity (MCA.MV), systolic (SBP), diastolic (DBP), and mean (MBP) BP were conducted. Fifty ELGANs with median (range) gestational age of 25.9 (23.1-27.9) weeks were recruited. Echocardiography was performed sequentially at a median (range) age 5.0 (3.8-6.6), 17.3 (15.4-19.4), 31.0 (27.0-34.1), and 53.7 (49.3-58.3) hours. RVO, LVO, CrSO2, and SBP increased over time but no changes in MBP, DBP, CFTOE, MCA.MV or SVC flow were noted. A weak correlation was identified between CrSO2 and SBP (r2 = 0.11, p = 0.047) and MBP (r2 = 0.12, p = 0.04) at 17.3 (15.4-19.4) hours. No correlation of either CrSO2 or CFTOE with any measures of blood flow was identified. There is a weak correlation between measures of cardiac output, BP, and MCA.MV with both CrSO2 and CFTOE in ELGANs during transition. Whether this finding suggests intact cerebral autoregulation requires prospective evaluation in a cohort of sick ELGANs.

Effectiveness of multi-component modular intervention among adults with prehypertension in a village of Dakshina Kannada district - a community-based interventional study – protocol

Introduction: The Joint National Committee (JNC 7) report on Prevention, Detection, Evaluation, and Treatment of Hypertension, defined "prehypertension," as individuals with a Systolic Blood Pressure (SBP) in the range of 120–139 mmHg and a (diastolic blood pressure) DBP of 80–89 mmHg. Prehypertension is directly linked with hypertension which is a precursor of CVDs. Owing to its high conversion rate to hypertension, it is important to identify individuals with blood pressures in this category and bring about lifestyle modifications in them that can prevent them from being hypertensive and from developing cardiovascular diseases later in life. Methods: This randomized controlled trial will be done among the selected pre-hypertensive adults of all genders residing in Kateel Gram panchayat, Dakshina Kannada district, Karnataka. A baseline survey will be done initially to assess the level of prehypertension among the study population. To study the effectiveness of the intervention, 142 individuals will be randomly allocated using block randomization technique to intervention and control groups. A multi-component module (educational intervention) will be developed, validated, and administered to participants in the intervention group, while the control group receives standard care. Each participant will then be followed up once in four months till the end of the study period of one year to assess for changes in SBP, DBP, WHR, BMI, stress levels, and usage of tobacco and alcohol. Ethics and dissemination: Institutional Ethics Committee approval was obtained from Kasturba Medical College in Mangalore, India. The plans for dissemination of findings include presenting at scientific conferences and publishing in scholarly journals.

CLINICAL EFFICACY AND SAFETY OF TREATMENT WITH BISOPROLOL AND HYDROCHLOROTHIAZIDE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: To assess the blood pressure (BP) lowering effect and the safety profile of treatment with bisoprolol and hydrochlorothiazide in patients affected by hypertension. Design and method: The study was designed in according to guidelines of the 2020 preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. A systematic literature search was conducted in multiple electronic databases to identify the randomized controlled clinical studies investigating the effect of combined treatment with bisoprolol and hydrochlorothiazide on BP. Effect sizes for changes in SBP and DBP were expressed as mean differences (MDs) and 95% confidence intervals (95%CIs). For safety analysis, odds ratios (OR) and 95% CI intervals were calculated using the Mantel-Haenszel method. Results: Data were pooled from 5 clinical studies. Meta-analysis of available data showed that treatment with Bisoprolol / Hydrochlorothiazide significantly reduced SBP [MD: -8.35 mmHg, 95%CI (-11.44, -5.25) mmHg, P &lt;0.001, compared to control; MD: -9.88 mmHg, 95%CI (-12.62, -7.14) mmHg, P &lt;0.001, compared to placebo] and DBP [MD: -7.62 mmHg, 95%CI (-11.20, -4.04) mmHg, P &lt;0.001, compared to control; MD: -8.79 mmHg, 95%CI (-11.92, -5.67) mmHg, P &lt;0.001, compared to placebo]. Moreover, BP response rate and BP control rate after treatment with Bisoprolol / Hydrochlorothiazide were significantly greater compared to control [Response rate: OR: 4.86 mmHg, 95%CI (2.52, 9.37), P &lt;0.001; Control rate: OR: 1.67 mmHg, 95%CI (1.11, 2.51), P = 0.014]. Finally, treatment with Bisoprolol / Hydrochlorothiazide was associated with a reduced risk of any AE and peripheral edema compared to control. Conclusions: Our results show that treatment with Bisoprolol/Hydrochlorothiazide has favorable effects on BP and an good safety profile.

The COVID-19 pandemic and temporal change in metabolic risk factors for cardiovascular disease: A natural experiment within the HELIUS study

The coronavirus disease 2019 (COVID-19) pandemic, including the restrictive measures taken to reduce the spread of the virus, negatively affected people's health behavior. We explored whether the pandemic also had an effect on metabolic risk factors for cardiovascular disease (CVD) in women and men. We conducted a natural experiment, using data from 6962 participants without CVD at baseline (2011–2015) of six ethnic groups of the HELIUS study in Amsterdam, the Netherlands. We studied whether participants whose follow-up measurements were taken within the 11 months before the pandemic (control group) differed from those whose measurements were taken taken within 6 months after the first lockdown (exposed group). Using sex-stratified linear regressions with inverse probability weighting, we compared changes in baseline- and follow-up data between the control and exposed group in six metabolic risk factors: systolic and diastolic blood pressure (SBP, DBP), total cholesterol (TC), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and estimated glomerular filtration rate (eGFR). Next, we explored the mediating effect of changes in body-mass index (BMI), alcohol, smoking, depressive symptoms and negative life events at follow-up. We observed less favorable changes in SBP (+1.12mmHg for women, +1.38mmHg for men), DBP (+0.85mmHg, +0.80mmHg) and FPG (only in women, +0.12 mmol/L) over time in the exposed group relative to the control group. Conversely, changes in HbA1c (−0.65 mmol/mol, −0.84 mmol/mol) and eGFR (+1.06 mL/min, +1.04 mL/min) were more favorable in the exposed compared to the control group, respectively. Changes in SBP, DBP, and FPG were partially mediated by changes in behavioral factors, in particular BMI and alcohol consumption. Concluding, the COVID-19 pandemic, in particular behavioral changes associated with restrictive lockdown measures, may have negatively affected several CVD risk factors, in both women and men.

Incidence of hypertension and blood pressure changes in persons with HIV at high risk for cardiovascular disease switching from boosted protease inhibitors to dolutegravir: a post-hoc analysis of the 96-week randomised NEAT-022 trial.

Integrase inhibitors have been recently linked to a higher risk for hypertension. In NEAT022 randomized trial, virologically suppressed persons with HIV (PWH) with high cardiovascular risk switched from protease inhibitors to dolutegravir either immediately (DTG-I) or after 48 weeks (DTG-D). Primary endpoint was incident hypertension at 48 weeks. Secondary endpoints were changes in systolic (SBP) and diastolic (DBP) blood pressure; adverse events and discontinuations associated with high blood pressure; and factors associated with incident hypertension. At baseline, 191 (46.4%) participants had hypertension and 24 persons without hypertension were receiving antihypertensive medications for other reasons. In the 197 PWH (n=98, DTG-I arm; n=99, DTG-D arm) without hypertension or antihypertensive agents at baseline, incidence rates per 100 person-years were 40.3 and 36.3 (DTG-I) and 34.7 and 52.0 (DTG-D) at 48 (P=0. 5755) and 96 (P=0. 2347) weeks. SBP or DBP changes did not differed between arms. DBP (mean, 95% confidence interval) significantly increased in both DTG-I (+2.78 mmHg (1.07-4.50), P=0.0016] and DTG-D [+2.29 mmHg (0.35-4.23), P=0.0211] arms in the first 48 weeks of exposure to dolutegravir. Four (3 under dolutegravir, 1 under protease inhibitors) participants discontinued study drugs due to adverse events associated with high blood pressure. Classical factors, but not treatment arm, were independently associated with incident hypertension. PWH at high risk for cardiovascular disease showed high rates of hypertension at baseline and after 96 weeks. Switching to dolutegravir did not negatively impact on the incidence of hypertension or blood pressure changes relative to continuing protease inhibitors.

Attenuation of Hemodynamic Response to Laryngoscopy and Endotracheal Intubation with Two Different Doses of Labetalol in Controlled Hypertensive Patients

BACKGROUND&#x0D; In this study, we wanted to compare the efficacy of two different doses of Labetalol for controlling the hemodynamic responses to laryngoscopy and tracheal intubation under the same anaesthetic techniques in controlled hypertensive patients.&#x0D; &#x0D; METHODS&#x0D; This was a hospital-based prospective, randomized, and double-blinded study conducted among 96 patients who presented for a pre-anaesthetic check-up to the Department of Anaesthesiology and Critical Care, at Gauhati Medical College and Hospital, over a period of 1 year from 1st September 2021 to 31st August 2022 after obtaining clearance from the institutional ethics committee, and written informed consent from the study participants.&#x0D; &#x0D; RESULTS&#x0D; Intragroup comparison of mean SBP in patients receiving IV Labetalol 0. 15 mg/Kg and IV Labetalol 0. 3mg/Kg was statistically significant. In an intragroup comparison of mean DBP in patients receiving IV Labetalol 0. 15 mg/Kg, it was significant at 5 and 10 mins. In a comparison of changes in DBP and MAP at various predetermined time intervals i. e., at intubation, it was statistically significant. In an intragroup comparison of mean RPP in in patients receiving IV Labetalol 0. 3mg/Kg in comparison to the baseline, it was significant at 10 mins.&#x0D; &#x0D; CONCLUSIONS&#x0D; Both doses of IV Labetalol (0. 15 mg/Kg and 0. 3 mg/Kg), given 5 mins before endotracheal intubation are effective in attenuating the hemodynamic response to laryngoscopy and intubation in controlled hypertensive patients. In comparison to the IV Labetalol dose of 0. 15 mg/Kg, attenuation of hemodynamic response to laryngoscopy and endotracheal intubation was more in IV Labetalol 0. 3 mg/Kg.

52. The Association of Cardiovascular Risk Factors and Blood Pressure Changes after Exercise in Coronary Artery Disease Patients

Background: Changes in blood pressure after exercise and factors affecting it specifically in CAD patients were poorly studied. This study aimed at investigating the association of cardiovascular risk factors and changes of blood pressure among CAD patients after exercise. Methods: This retrospective study includes 87 CAD patients from cardiac rehabilitation center Dr. Hasan Sadikin General Hospital Bandung that have completed 12 sessions of moderate intensity exercise from December 2021 to November 2022. Blood pressure measured before and immediately after their training session. The change in blood pressure calculated as the mean of it during 12 sessions. Results: Among 86 patients (95.3% men; mean age 55.93 + 9.9) included in this study, 57% had hypertension, 29.1% had diabetes mellitus (DM), 9.3% had dyslipidemia, and 82.6% had history of smoking. All patients have received at least one antihypertensive therapy. From 970 blood pressure data, the mean SBP and DBP changes after exercise were decreased 8.13mmHg and 3.54mmHg, respectively. Most patients has decreased both SBP and DBP (66 patients; 77%); decreased SBP increased DBP (12.6%); increased both SBP and DBP (5.7%); and increased SBP decreased DBP (4.6%), Sex is the only factor that has association with category of blood pressure changes (p 0.007), while the others (age, hypertension, dyslipidemia, DM, history of smoking) were not. Conclusion: This study shows that most patients experience a decrease in blood pressure immediately after exercise. Men tend to have increasing blood pressure compared to women. However, other classic cardiovascular risk factors were not associated with the changes.

Comparative features of the morphometric correlates of blood pressure response to physical load of qualified athletes in some sports

Purpose: the purpose of this study was to establish morphometric parameters that correlate with the reactivity and recovery of blood pressure in response to a standard physical load in athletes of various game sports.&#x0D; Material &amp; Methods: to achieve the set goal, 101 qualified male athletes engaged in game sports were examined. All examined represented 3 game sports: 13 – water polo (average age 27.3±6.3 years), 59 – volleyball (average age 21.1±2.5 years), 29 – handball (average age 20.9±2.8 years). The morphometric study was carried out by traditional methods and included the determination of body length (BL, cm), body weight (BW, kg), chest circumference (CC, cm) with calculation of chest excursion (CE, cm), hand dynamometry, vital lung capacity (VLC, ml). Body mass index (BMI, kg×m–2), vital index (VI, ml×kg–1) and Erismann index (IE, c.u.) were calculated separately. The Martine test (20 squats in 30 seconds) was performed according to the traditional method.&#x0D; Results: changes in SBP in response to load were the significantly greater in handball players compared to water polo players (p=0.025) and compared to volleyball players (p=0.022). Changes in SBP during 3 minutes of recovery are not related to morphometric parameters and obey the general mechanisms of changes in hemodynamic support under the influence of physical load. Changes in DBP during 3 minutes of recovery are related to chest circumference (CC, cm) and proportionality of its development (IE, c.u.) in volleyball and water polo players, and with BW (kg) in handball players. Changes in PBP during 3 minutes of recovery in handball players are not differentiated, in volleyball players they are related to the proportionality of chest development (IE, c.u.), and in water polo players to the BW (kg), CC (cm), mobility and proportionality of chest development (CE, cm and IE, c.u.).&#x0D; Conclusions: the obtained results confirm that changes in DBP and PBP in response to physical load and during the recovery period after it are related to the morphometric parameters of the body, which can characterize the mechanisms of hemodynamic maintenance recovery and be useful in the selection and the organization of recovery measures in certain sports sport.

Potential Benefits of a Single Session of Remote Ischemic Preconditioning and Walking in Sedentary Older Adults: A Pilot Study.

Ischemic preconditioning (IPC) has shown positive effects in endurance-type sports among healthy young individuals; however, its effects in endurance-type exercises in older adults have not been explored. We aimed to examine the acute effects of a single session of IPC prior to an endurance-type exercise on cardiovascular- and physical-function-related parameters in sedentary older adults. A pilot study with a time-series design was carried out. Nine participants were enrolled consecutively in the following intervention groups: (i) SHAM (sham IPC + walking) and (ii) IPC (IPC + walking) groups. The main outcomes were resting systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), peripheral oxygen saturation (SpO2), maximum isometric voluntary contraction (MIVC), endurance performance, and perceived fatigue. After the intervention, the IPC group showed a significant reduction in SBP, whereas SpO2 decreased in the SHAM group. The IPC group maintained quadriceps MIVC levels, whereas these levels dropped in the SHAM group. No changes in DBP, resting HR, endurance, or fatigue in any group were observed. These findings are of interest for the promotion of cardiovascular and physical health in older people.

Factors Associated with the Antihypertensive Effect of Esaxerenone and Serum Potassium Elevation: A Pooled Analysis of Seven PhaseIII Studies.

This study investigated factors associated with the antihypertensive effects of esaxerenone and theincidence of serum potassium elevation in patients with hypertension. Using pooled data from seven phaseIII studies, the study analyzed factors associated with changes in office systolic (SBP) and diastolic (DBP) blood pressure from baseline to 12weeks, and factors associated with incidence of serum potassium levels ≥ 5.5mEq/L in esaxerenone-treated patients. Overall, 1466 and 1472 patients were included in the fullanalysis and safety analysis sets, respectively. Male sex (4.02/2.40mmHg), weight ≥ 78.4kg (4.62/2.09mmHg), hypertension duration ≥ 10years (2.66/1.71mmHg), prior antihypertensive treatment (2.38/1.40mmHg), plasma aldosterone concentration ≥ 120pg/mL (1.66/1.17mmHg), urinary albumin-to-creatinine ratio (UACR) ≥ 300mg/gCr (8.94/4.85mmHg) or 30-299mg/gCr (5.17/4.15mmHg), and smoking (2.62/1.27mmHg)were associated with mean changes in SBP andDBP. Fasting blood glucose ≥ 126mg/dL (- 2.73mmHg) was associated with the mean change in SBP only, and older age (65-74years, - 2.12mmHg; and ≥ 75years, - 3.06mmHg) with mean change in DBP only. Factors significantly associated with incidence of serum potassium levels ≥ 5.5mEq/L were higher baseline serum potassium (≥ 4.5mEq/L, odds ratio [OR] 6.702); lower estimated glomerular filtration rate (≥ 90mL/min/1.73m2, OR 0.148; 60-89mL/min/1.73m2, OR 0.331 vs 30-59mL/min/1.73m2, respectively); higher UACR (30-299mg/gCr, OR 7.317); higher DBP (≥ 100mmHg, OR 3.248); and gradeI hypertension (OR 2.168). Esaxerenone is effective in patients with a broad range of backgrounds, though some factors may predict increased benefit. Regarding elevated serum potassium, careful therapeutic management is recommended for patients with higher baseline serum potassium and reduced renal function. UMIN000047026.

Follow-up study on the relationship between changes in waist circumference and body weight and changes in blood pressure levels among high cardiovascular risk population

Objective: To investigate the relationship between changes in waist circumference, body weight, and blood pressure change in a high cardiovascular risk population and to provide a theoretical basis and reference for the prevention and treatment of hypertension and cardiovascular disease. Methods: A total of 12 931 patients with a high risk of cardiovascular disease participating in the follow-up survey in 2016 were selected as the study subjects, and their long-term follow-up data from 2017 to 2019 were included in the analysis. Statistical analysis was performed using a t-test, χ2 test, and generalized estimation equation (GEE). Results: Increased waist circumference, body weight, and BMI were associated with a higher risk of elevated blood pressure in people at high risk of cardiovascular disease. Waist circumference, weight, and BMI were reduced when blood pressure levels were lower. SBP and DBP increased by 0.200 (95%CI: 0.164-0.236) mmHg and 0.085 (95%CI: 0.066-0.105) mmHg for each 1 cm increase of waist circumference. SBP increased by 0.355 (95%CI: 0.289-0.421) mmHg and DBP increased by 0.182 (95%CI: 0.144-0.220) mmHg for each 1 kg increase in body weight. For each 1 kg/m2 increase in BMI, SBP increased by 1.100 (95%CI: 1.194-1.258) mmHg, and DBP increased by 0.365 (95%CI: 0.273-0.456) mmHg. Compared with urban residents, SBP changes more with waist circumference and body weight, and DBP changes more with waist circumference in high-risk cardiovascular disease groups (all P for interaction <0.05). SBP with waist circumference and BMI and DBP with BMI was greater in participants without hypertension than in those with hypertension (all P for interaction <0.05). Conclusion: There is a positive linear correlation between the changes in waist circumference, body weight, and BMI and the changes in blood pressure in a high-risk cardiovascular disease population.

The impact of telepharmacy on hypertension management in the United Arab Emirates.

To assess the effectiveness of telepharmacy services delivered by community pharmacies in hypertension management and examine its influence on pharmacists' ability to identify drug-related problems (DRPs). This was a 2-arm, randomised, clinical trial conducted among 16 community pharmacies and 239 patients with uncontrolled HTN in the U.A.E over a period of 12 months. The first arm (n=119) received telepharmacy services and the second arm (n=120) received traditional pharmaceutical services. Both arms were followed up to 12 months. Pharmacists self-reported the study outcomes, which primarily were the changes in SBP and DBP from baseline to 12-month meeting. Blood pressure readings were taken at baseline, 3, 6, 9, and 12 months. Other outcomes were the mean knowledge, medication adherence and DRP incidence and types. The frequency and nature of pharmacist interventions in both groups were also reported. The mean SBP and DBP differences were statistically significant across the study groups at 3-, 6-, and 9-month follow-up and 3-, 6-, 9-, 12- month follow-up, respectively. In detail, the mean SBP was reduced from 145.9 mm Hg in the intervention group (IG) and 146.7 mm Hg in the control group (CG) to 124.5, 123.2, 123.5, and 124.9 mm Hg at 3-, 6-, 9-, and 12-month follow-up in the IG and 135.9, 133.8, 133.7, and 132.4 mm Hg at 3-, 6-, 9-, and 12-month follow-up in the CG. The mean DBP was reduced from 84.3 mm Hg in IG and 85.1 mm Hg in CG to 77.6, 76.2, 76.1, and 77.8 mm Hg at 3-, 6-, 9-, and 12-month follow-up in the IG and 82.3, 81.5, 81.5, and 81.9 mm Hg at 3-, 6-, 9-, and 12-month follow-up in the CG. Medication adherence and knowledge of participants in the IG towards hypertension were significantly improved. The DRP incidence and DRPs per patient identified by pharmacists in the intervention and control groups were 2.1% versus 1.0% (p=0.002) and 0.6 versus 0.3 (p=0.001), respectively. The total numbers of pharmacist interventions in the IG and CG were 331 and 196, respectively. The proportions of pharmacist interventions related to patient education, cessation of drug therapy, adjustment of drug dose, and addition of drug therapy across the IG and CG were 27.5% versus 20.9%, 15.4% versus 18.9%, 14.5% versus 14.8%, and 13.9% versus 9.7%, respectively (all with p<0.05). Telepharmacy may have a sustained effect for up to 12 months on blood pressure of patients with hypertension. This intervention also improves pharmacists' ability to identify and prevent drug-related problems in community setting.

Effects of minimally and ultra-processed foods on blood pressure in Brazilian adults: a two-year follow up of the CUME Project.

To assess the association of food consumption according to degree of processing with changes in systolic (SBP) and diastolic (DBP) blood pressure in adult participants of a Brazilian cohort. Longitudinal study with 2496 adult participants of the Cohort of Universities of Minas Gerais (CUME Project). Food consumption was categorized by food groups according to degree of processing following the NOVA grading system: unprocessed/minimally processed foods/culinary ingredients (U/MPF&CI), processed foods (PFs) and ultra-processed foods (UPFs). unprocessed/minimally processed foods/culinary ingredients (U/MPF&CI), processed foods (PFs) and ultra-processed foods (UPFs). Changes in SBP and DBP were categorized (decreased, maintained, increased). Independent associations between exposure and outcomes were verified using multiple generalized ordered logistic models adjusted for potential confounders. After a two-year follow-up, the consumption of U/MPF&CI (% daily caloric intake) reduced the chance of increasing DBP (P for trend = 0.014), with a more evident effect among participants within the 5th quintile of this food group (odds ratio (OR) = 0.55; 95% confidence interval (CI): 0.34-0.97]. On the other hand, the consumption of UPFs (% daily caloric intake) raised the chance of increasing DBP (P for trend = 0.005) and was more evident among participants within the quintiles of higher consumption (4th quintile - OR = 1.97; 95% CI: 1.25-3.10; 5th quintile - OR = 1.79; 95% CI = 1.12-2.86). No associations were found between food consumption according to degree of processing and changes in SBP. Higher consumption of U/MPF&CI and UPFs were independently associated to lower and greater chances of increased DBP in adult participants from CUME Project.