DBP Changes Research Articles

Mechanical somatosensory stimulation decreases blood pressure in patients with Parkinson's disease.

The current study aimed to assess the effects of five cycles of automated mechanical somatosensory stimulation (AMSS) of the fore-feet on blood pressure (BP) and cardiovascular autonomic control in Parkinson's Disease patients. Out of 23 patients, 16 underwent an AMSS session every 72 h, for a total of five sessions per patient. Electrocardiogram, noninvasive beat-to-beat blood pressure and respiratory activity were recorded for 20 min in supine position at baseline and after the AMSS sessions. Main outcomes were the changes in SBP and DBP, in the spectral indices of cardiac sympathetic (LFRRn.u.) and vagal (HFRR) modulatory activities, cardiac sympathovagal relationship (LF/HF), vascular sympathetic modulation (LFSAP) and arterial baroreflex sensitivity (sequence technique). Symbolic analysis of heart rate variability provided additional indices of cardiac sympathetic (0V%) and vagal (2UV%) modulation to the sinoatrial node. After five AMSS trials a reduction in SBP (baseline: 131.2 ± 15.5 mmHg; post-AMSS: 122.4 ± 16.2 mmHg; P = 0.0004) and DBP (baseline: 73.2 ± 6.1 mmHg; post-AMSS: 68.9 ± 6.2 mmHg; P = 0.008) was observed. Post-AMSS, spectral and symbolic indices of cardiovascular sympathetic control decreased and arterial baroreflex sensitivity increased (baseline: 5.7 ± 1.3 ms/mmHg; post-AMSS: 11.27 ± 2.7 ms/mmHg). AMSS sessions were effective in reducing BP, increasing baroreflex sensitivity and decreasing cardiovascular sympathetic modulation in Parkinson's disease patients. AMSS might be useful to control supine hypertension in Parkinson's disease.

Do treatment-induced changes in arterial stiffness affect left ventricular structure? A meta-analysis

Vascular research demonstrated that pulse wave velocity (PWV), a measure of arterial stiffness, is inherently blood pressure dependent. Considering the hypothesized pathophysiological chain of increased arterial stiffness leading to increased blood pressure load with consequent left ventricular hypertrophy (LVH) development, we conducted a systematic review of antihypertensive and lifestyle intervention studies to determine the association between, on the one hand, changes in arterial stiffness and blood pressure, and, on the other hand, changes in left ventricular mass (LVM). Using PubMed, EMBASE, Cochrane and Web of Science, we identified 23 studies, containing 2573 patients. Studies reported changes in arterial stiffness (assessed by means of PWV), SBP, DBP and LVM index (LVMI), respectively. Statistically significant reductions in SBP, PWV and LVMI were reported in 16, 14 and 20 studies, respectively. Pooled analysis of studies showed that the proportion in SBP reduction did not correlate significantly to the proportion in reductions of the other two variables. On the contrary, we found a significant positive correlation (r = 0.61, P = 0.003) between arterial stiffness and reduction of LVM, expressed as a relevant reduction in LVMI of 6.9 g/m per 1.0 m/s reduction in PWV. Our findings provide evidence that a decrease in arterial stiffness is associated with reduction of LVM. To investigate whether there exists a causal relation between LVH due to arterial stiffness increases and in turn blood pressure load increases, future studies should strive for a multiple follow-up design and use of blood pressure independent or corrected stiffness indices.

Effects of Peripheral Cold Application and Antipyretics on Hemodynamic Parameters in Febrile ICU Patients Diagnosed with Hospital-Acquired Infections

Background: Accurately assessing hemodynamic parameters plays an important role in preventing complications during and after interventions related to a fever in febrile patients. There are not enough studies related on the effects of peripheral cold application (PCA) and antipyretics (APs) on hemodynamic parameters in febrile patients. Objectives: The aim was to determine the effects of PCA and APs on hemodynamic parameters in febrile ICU patients diagnosed with hospital-acquired infections (HAIs). Methods: In this retrospective study, the archive documents of the 346 adult ICU patients diagnosed with HAIs of a university hospital in Turkey were evalauted. Body temperature (BT), systolic/diastolic blood pressure (SBP/DBP), pulse rate (PR), respiratory rate (RR), and arterial O2Sat (aO2sat) changes one hour before, during, and one hour after application of PCA or APs were evalauted. Results: The incidence of HIAs was 4.16%. A total of 46% of the patients had a bacteremia infection and causative microorganisms in 16.8% were Acinetobacter spp. BT, DBS, PR, and aO2Sat changes one hour before, during, and one hour after PCA were significantly different. In addition, BT, RR, and aO2Sat changes one hour before, during, and one hour after APs were also significantly different (P < 0.05). More decrease in SBP and DBP were observed between during and one hour after APs compare with PCA. Conclusions: BT and hemodynamic parameters, especially SBP and DBP changes, were higher in APs compared with PCA. Knowledge regarding the effects of APs on BT and hemodynamic parameters will be of benefit to the ICU staff in terms of quality of care in febrile patients. The ICU staff should be proactive in ensuring that they have an evidence-based management plan for the prevention of HIAs and management of fever that conforms to the relevant clinical guidelines and integrates multidisciplinary care.

Predictors for progressions of brachial-ankle pulse wave velocity and carotid intima-media thickness over a 12-year follow-up: Hanzhong Adolescent Hypertension Study.

Objective:Atherosclerotic diseases are the leading cause of death worldwide. This study aimed to investigate the predictors of brachial–ankle pulse wave velocity (baPWV) and carotid intima–media thickness (CIMT) progression in a Chinese cohort over a 12-year follow-up period and to determine whether these predictors differ by follow-up time.Methods:A total of 202 participants were recruited from a previously established cohort in Shaanxi Province, China. Both baPWV and CIMT were measured in 2013 and 2017. Multivariable regression was used to determine the predictors of CIMT and baPWV progression.Results:Men had higher CIMT and baPWV and a higher rate of CIMT progression during two follow-ups than women. A 4-year change in SBP was associated with baPWV progression, whereas a 12-year change in DBP was associated with baPWV progression. The increased progression of baPWV presented a linear trend when subgrouping all the participants according to SBP and DBP changes over 4 and 12 years, respectively. In addition, heart rate (HR) change over 4 and 12 years was consistently associated with CIMT progression, and a linear trend was also seen when subgrouping the population.Conclusion:Our study demonstrated that SBP and DBP contributed differently in different stages to the progression of arterial stiffness in this Chinese cohort. Moreover, HR was consistently involved in the increased progression of CIMT in all periods. These findings underline the importance of early detection and control of blood pressure and resting HR for the prevention of arterial stiffness progression.

Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs

BackgroundSpinal block is a common procedure for lower limbs surgery. Fentanyl, a synthetic opioid and dexmedetomidine, a selective α2 agonist have been used as adjuvants in spinal anesthesia to prolong intraoperative and postoperative analgesia. The aim of current study is to compare the efficacy of dexmedetomidine and fentanyl added to intrathecal bupivacaine in orthopedic procedures in lower limbs.MethodsIn this randomized clinical trial, 90 patients undergoing elective lower limb surgeries were randomly allocated to three groups. Via intrathecal approach, the patients received 2.5 ml hyperbaric bupivacaine 0.5% plus 5 micrograms dexmedetomidine (BD group), 25 micrograms fentanyl (BF group) or 0.5 ml normal saline (BN group), respectively. Time to reach the complete motor block, the highest sensory level, regression from block, analgesic request and duration of the drug effect, hemodynamic changes and side effects were compared between the groups.ResultsThere was no significant difference between the groups regrading time to reach complete motor block, but time to reach the highest sensory level was shorter in group BD than group BF (6.28 ± 1.75 vs. 7.17 ± 1.45, p = 0.03). Group BD had significantly lower mean of NRS 6 h after operation (1.90 ± 0.84 vs. 6.16 ± 1.44 vs. 6.30 ± 1.17, p < 0.001) and longer duration to regress to Bromage 0 (331.60 ± 73.96 vs. 185.56 ± 35.87 vs. 147.03 ± 33.05 min, p < 0.001), to analgesic request (496.63 ± 70.19 vs. 296.33 ± 44.83 vs. 221.83 ± 22.26 min, p < 0.001), to regress two sensory levels (149.00 ± 23.17 vs. 88.90 ± 12.85 vs. 69.33 ± 6.67 min, p < 0.001) and to regress to S1 (560.53 ± 81.86 vs. 329.83 ± 44.10 vs. 241.83 ± 22.26 min, p < 0.001). Serial changes in SBP (p = 0.006), DBP (p = 0.03) and HR (p = 0.002) in group BF were significantly higher than the other two groups. The three groups had comparable side effects.ConclusionsUsing dexmedetomidine as an adjuvant to bupivacaine for spinal anesthesia in lower limb surgeries has longer duration of sensory and motor block and longer postoperative analgesia.Trial registrationIRCT registration number: IRCT2017041010599N15, 24 May 2017.

Initiation of Disease-Modifying Therapies in Rheumatoid Arthritis Is Associated With Changes in Blood Pressure.

This study reports the effect of disease-modifying therapies for rheumatoid arthritis (RA) on systolic and diastolic blood pressure (SBP, DBP) over 6 months and incident hypertension over 3 years in a large administrative database. We used administrative Veterans Affairs databases to define unique dispensing episodes of methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, tumor necrosis factor inhibitors, and prednisone among patients with RA. Changes in SBP and DBP in the 6 months before disease-modifying antirheumatic drug initiation were compared with changes observed in the 6 months after initiation. The risk of incident hypertension within 3 years (new diagnosis code for hypertension and prescription for antihypertensive) was also assessed. Multivariable models and propensity analyses assessed the impact of confounding by indication. A total of 37,900 treatment courses in 21,216 unique patients contributed data. Overall, there were no changes in SBP or DBP in 6 months prior to disease-modifying antirheumatic drug initiation (all P > 0.62). In contrast, there was a decline in SBP (β = -1.08 [-1.32 to -0.85]; P < 0.0001) and DBP (β = -0.48 [-0.62 to -0.33]; P < 0.0001) over the 6 months following initiation. The greatest decline was observed among methotrexate and hydroxychloroquine users. Methotrexate users were 9% more likely to have optimal blood pressure (BP) after 6 months of treatment. Patients treated with leflunomide had increases in BP and a greater risk of incident hypertension compared with patients treated with methotrexate (hazard ratio, 1.53 [1.21-1.91]; P < 0.001). Blood pressure may improve with treatment of RA, particularly with methotrexate or hydroxychloroquine. Leflunomide use, in contrast, is associated with increases in BP and a greater risk of incident hypertension.

CHANGING ARTERIAL STIFFNESS GRADIENT BY NITROGLYCERIN AND ITS RELATION TO CENTRAL PRESSURE WAVE ANALYSIS

Objective: We have previously shown that administration of nitroglycerin (NTG) reduced femoral pulse wave velocity without affecting aortic stiffness, which results in an increase in aortic-femoral (AF) PWV ratio (a measure of arterial stiffness gradient). In this study, we examined the impact of post-NTG changes of AF-PWV ratio on wave reflection using wave separation analysis. Design and method: In 20 treated hypertensive subjects with or without kidney disease, carotid-femoral (CFPWV) (aortic) and femoral-distal (FDPWV) were determined as respective measures of aortic and femoral stiffness. Aortic-femoral PWV ratio (AF PWV ratio) was used as a measure of arterial stiffness gradient. Aortic pressure waveform was obtained through generalized transfer function applied to the radial artery pressure waveform after calibration with systolic and diastolic blood pressures (SBP and DBP). Using GEE, we examined the extent of association between changes in aortic-femoral (AF) PWV ratio, and augmentation index (Aix), pressure forward (Pf), pressure backward (Pb) and reflection magnitude (RM). Results: After administration of NTG, SBP and mean BP (area under the curve) decreased (114 ± 19 vs 107 ± 15 and 89 ± 11 vs 85 ± 9 mm Hg, p < 0.01) without changes in DBP. The CFPWV remained unchanged (12.2 ± 2.2 vs 12.3 ± 2.9 m/s), whereas FDPWV decreased (8.7 ± 1.5 vs 7.2 ± 1.1 m/s, p < 0.001). Accordingly, AF PWV ratio increased (1.42 ± 0.25 vs 1.73 ± 0.41). Aix declined as expected (20.1 ± 11.9 vs 7.7 ± 12.8 %, p < 0.001). There was a slight but not statistically significant reduction in Pf (27.7 ± 10.7 vs 25.4 ± 7.9 mmHg, p = 0.068), while Pb decreased (17.2 ± 8.1 vs 13.4 ± 6.6 mmHg), resulting in a reduction in RM from 0.61 ± 0.10 to 0.51 ± 0.13 (p < 0.001). There was a significant association between the extent of changes in AF PWV ratio and changes in Aix (β = −15, p < 0.001), Pb (β = −9.5, p < 0.001) and RM (β = −0.21, p < 0.001). Conclusions: This study shows that alteration of arterial stiffness gradient with nitroglycerin is associated with changes in arterial wave reflection indices.

A community health worker intervention to improve blood pressure among Filipino Americans with hypertension: A randomized controlled trial

Behavioral interventions utilizing community health workers (CHWs) have demonstrated effectiveness in improving hypertension disparities in ethnic minority populations in the United States, but few have focused on Asian Americans. We assessed the efficacy of a CHW intervention to improve hypertension management among Filipino Americans with uncontrolled blood pressure (BP) in New York City (NYC) from 2011 to 2013. A total of 240 Filipino American individuals (112 in the treatment group and 128 in the control group) with uncontrolled hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg) were recruited from community-based settings in NYC. Using a community-based participatory research approach, treatment participants received 4 educational workshops and 4 one-on-one visits with CHWs over a 4-month period, while control group participants received 1 educational workshop. Main outcome measures included BP control, changes in SBP and DBP, and changes in appointment keeping at 8-months. At 8-months, BP was controlled among a significantly greater percentage of treatment group participants (83.3%) compared to the control group (42.7%). The adjusted odds of controlled BP for the treatment group was 3.2 times the odds of the control group (P < 0.001). Both groups showed decreases in SBP and DBP, with greater decreases among treatment participants. Significant between-group differences were also demonstrated in adjusted analyses (P < 0.001). Individuals in the treatment group showed significant changes in appointment keeping. In conclusion, a community-based intervention delivered by CHWs can help improve BP and related factors among Filipino Americans with hypertension in NYC.

Associations of Pulse and Blood Pressure with Hippocampal Volume by APOE and Cognitive Phenotype: The Alzheimer’s Disease Neuroimaging Initiative (ADNI)

Background: It is increasingly evident that high blood pressure can promote reduction in global and regional brain volumes. While these effects may preferentially affect the hippocampus, reports are inconsistent. Methods: Using data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI), we examined the relationships of hippocampal volume to pulse pressure (PPR) and systolic (SBP) and diastolic (DBP) blood pressure according to apolipoprotein (APOE) ɛ4 positivity and cognitive status. The ADNI data included 1,308 participants: Alzheimer disease (AD = 237), late mild cognitive impairment (LMCI = 454), early mild cognitive impairment (EMCI = 254), and cognitively normal (CN = 365), with up to 24 months of follow-up. Results: Higher quartiles of PPR were significantly associated with lower hippocampal volumes (Q1 vs. Q4, p = 0.034) in the CN and AD groups, but with increasing hippocampal volume (Q1, p = 0.008; Q2, p = 0.020; Q3, p = 0.017; Q4 = reference) in the MCI groups. In adjusted stratified analyses among non-APOE ɛ4 carriers, the effects in the CN (Q1 vs. Q4, p = 0.006) and EMCI groups (Q1, p = 0.002; Q2, p = 0.013; Q3, p = 0.002; Q4 = reference) remained statistically significant. Also, higher DBP was significantly associated with higher hippocampal volume (p = 0.002) while higher SBP was significantly associated with decreasing hippocampal volume in the EMCI group (p = 0.015). Conclusion: Changes in PPR, SBP, and DBP differentially influenced hippocampal volumes depending on the cognitive and APOE genotypic categories.

Blood Pressure Seasonality in Hemodialysis Patients from Five European Cities of Different Latitudes

Background/Aims: Climate influences the regulation of blood pressure (BP). Our objective was to precisely estimate BP seasonality in hemodialysis (HD) patients from five European cities with marked climate differences. Methods: Stable prevalent HD patients from 5 European facilities (Santa Cruz de Tenerife (Spain), Seville (Spain), Montpellier (France), Ottignies (Belgium), Umea (Sweden)) present over the years 1995-1999 were included in this historical longitudinal observational study. Individual monthly averages of pre-dialysis BP level were computed from all facility BP measurements (> 90 000 observations). The association between BP level and location, seasons and meteorological measurements was analyzed by mixed models. Results: 261 patients were included and followed-up for a median duration of 2 years (6903 monthly observations). Pre-dialysis SBP and DBP were minimal in summer (July) and maximal in winter (November and December), and mean changes were respectively 4.2 [3.0; 5.4] and 2.0 [1.3; 2.7] mmHg. Seasonality was confirmed in 4 locations (P_season≤0.001 for SBP and DBP), but not in Umea (both P_season> 0.05). Seasonal changes in DBP were larger in southern locations (P_interaction=0.02). BP level was associated with climate parameters: in a positive manner with humidity or rainfall, and inversely with sunshine duration or temperature. The effects of temperature and rainfall on DBP varied with latitude (P_interaction< 0.02) and were greater in southern locations. Conclusion: BP varies with seasons and climate in different European areas and seasonality can be more important in southern locations. These changes in BP deserve attention as they may be responsible for a significant increase in cardiovascular risk which may be preventable.

OP.7C.01] CENTRAL-TO-PERIPHERAL DIASTOLIC BLOOD PRESSURE ATTENUATION IN HEALTHY ADOLESCENT AND THE EFFECTS OF HEART RATE. THE MACISTE STUDY

Objective: Heart rate (HR) is directly associated to central-to-peripheral pulse wave amplification. We aimed at evaluating the associations between heart rate and each BP component in a cohort of healthy adolescents. Design and method: 470 healthy adolescents (17 ± 1.4 years, 56% boys, brachial BP 123/67 ± 11/7 mmHg, HR 72 ± 12 bpm) were enrolled in the present study. Brachial BP was measured on 3 occasions by validated devices. Central BP was estimated by radial and brachial applanation tonometries, and calibrated to brachial MAP/DBP (SphygmoCor). Results: Brachial and central BP were 123/67 ± 11/7 mmHg and 105/69 ± 9/8 mmHg. SBPamp was 1.17 ± 0.04, PPamp was 1.57 ± 0.13, while DBP amplification was 0.97 ± 0.01 (DBP ’attenuation’). HR had a direct correlation with brachial and central DBP (r = 0.38 and r = 0.46, both p < 0.01) and central SBP (r = 0.09, p = 0.04), but not with peripheral SBP (p = 0.59), and a negative one with brachial and central PP (r = −0.24 and r = −0.37, both p < 0.01). HR had a positive association with PPamp (r = 0.38, p < 0.01), and a negative one with SBPamp (r = −0.14, p < 0.01) and DBPamp (r = −0.55, p < 0.01). The slope of BP change for each 10-bpm HR increase was steeper for central DBP (2.8 ± 0.3 mmHg), than for peripheral DBP (2.2 ± 0.3 mmHg, p for difference between regression coefficients < 0.01), and for central and brachial DBP than for central SBP (0.7 ± 0.3 mmHg, both p < 0.01). Conclusions: HR is associated with more pronounced changes in DBP than in SBP, and in central than peripheral DBP. Increasing HR may attenuate DBP from centre to periphery. The assumption that DBP is constant along the arterial tree may not be valid during dynamic conditions.

The Effect of Posture on Intraocular Pressure and Systemic Hemodynamic Parameters in Treated and Untreated Patients with Primary Open-Angle Glaucoma.

To assess intraocular pressure (IOP), systolic, diastolic, and mean arterial blood pressure (SBP, DBP, MAP) changes in the sitting, supine, and 20° head-down (Trendelenburg) position in treated (tPOAG) and untreated (uPOAG) primary open-angle glaucoma patients and healthy controls. All participants underwent IOP and systemic BP measurements in the sitting, supine, and Trendelenburg positions during office hours. IOP and BP readings in the sitting, supine, and Trendelenburg positions were analyzed. Twenty-one tPOAG patients, 17 uPOAG patients, and 21 controls were enrolled in the study. Compared to controls, eyes in the tPOAG and uPOAG groups had significantly larger posture-induced IOP elevation upon changing from the sitting to the supine position (P = 0.020 and P = 0.032, respectively). Compared to controls, the IOP elevation in the Trendelenburg position was statistically higher for the tPOAG (P = 0.003), but not the uPOAG group (P = 0.840). All 3 groups had a similar pattern of SBP, DBP, and MAP changes. Compared to controls, posture-induced IOP changes are more pronounced in treated and untreated POAG patients.

Oral potassium supplementation for management of essential hypertension: A meta-analysis of randomized controlled trials.

ImportanceIncreased dietary potassium intake is thought to be associated with low blood pressure (BP). Whether potassium supplementation may be used as an antihypertensive agent is a question that should be answered.ObjectiveTo assess the effect of oral potassium supplementation on blood pressure in patients with primary hypertension.Search methodsWe searched Medline, Web of Science, Scopus, Cochrane Central Register of Controlled Trials until October 2016. We also screened reference lists of articles and previous reviews. We applied no language restrictions.Selection criteriaWe included randomized placebo-controlled clinical trials addressing the effect of potassium supplementation on primary hypertension for a minimum of 4 weeks.Data collection and analysisWe extracted data on systolic and diastolic BP (SBP and DBP) at the final follow-up. We explored the heterogeneity across studies using Cochran's test and I2 statistic and assessed the probability of publication bias using Begg's and Egger's tests. We reported the mean difference (MD) of SBP and DBP in a random-effects model.ResultsWe found a total of 9059 articles and included 23 trials with 1213 participants. Compared to placebo, potassium supplementation resulted in modest but significant reductions in both SBP (MD -4.25 mmHg; 95% CI: -5.96 to -2.53; I2 = 41%) and DBP (MD -2.53 mmHg; 95% CI: -4.05 to -1.02; I2 = 65%). According to the change-score analysis, based on 8 out of 23 trials, compared to baseline, the mean changes in SBP (MD -8.89 mmHg; 95% CI: -13.67 to -4.11) and DBP (MD -6.42 mmHg; 95% CI: -10.99 to -1.84) was significantly higher in the intervention group than the control group.ConclusionsOur findings indicated that potassium supplementation is a safe medication with no important adverse effects that has a modest but significant impact BP and may be recommended as an adjuvant antihypertensive agent for patients with essential hypertension.

Abstract MP041: Time Course of Change in Blood Pressure From the DASH Diet and Sodium Reduction

Background: The time course of change in BP from lifestyle interventions, particularly sodium reduction, is uncertain. Hypotheses: (1) The DASH diet and sodium reduction will lower BP rapidly (within 1 wk), and (2) BP effects will be sustained over time. Methods: In the DASH-Sodium trial, adults without cardiovascular disease, not using antihypertensive medications, were randomly assigned to either a control diet or the DASH diet. With either diet, participants were fed each of three sodium levels in random order in 4-wk periods separated by 5-day breaks. The three sodium levels were: low (50 mmol/d), medium (100 mmol/d), and high (150 mmol/d). BP was measured during the run-in period and weekly over 12 wks of the trial. Differences in BP were determined at the end of each wk. Trends in differences were modeled via linear regression. Results: The trial enrolled 412 participants (57% women, 57% black, mean age was 48 yrs, mean SBP/DBP was 135/86 mmHg). Compared with the control diet, DASH lowered SBP at wk 1 (-4.36; -6.96,-1.77) and wk 12 (-3.82; -6.03,-1.61); corresponding changes in DBP were -1.07 (-2.66, 0.53) and -0.99 (-2.32, 0.33) ( Figure ). From wk 1 to 12, there was no trend in the difference between DASH and control diets for either SBP ( P -trend = 0.91) or DBP ( P -trend = 0.99). In the context of the control diet, reducing sodium from high to low, changed SBP by -4.03 (-6.66,-1.39) and DBP by -0.80 (-2.50, 0.89) after 1 wk, and SBP by -6.66 (-8.84,-4.47) and DBP by -3.43 (-4.72,-2.13) after 4 wks. Trends in differences from wk 1 to 4 were significant for SBP ( P -trend = 0.02) and non-significant for DBP ( P -trend = 0.1). There was no trend over time in SBP or DBP from reducing sodium while on the DASH diet ( P -trend for SBP = 0.71 and for DBP = 0.25). Conclusions: The DASH diet lowers SBP and DBP early and its effects were maintained with dietary adherence over time. Meanwhile, the effects of sodium reduction on SBP were not fully realized by 4 wks in the context of a typical American diet, suggesting that the effect of lowering sodium on SBP continues to increase over time.

Antazoline-insights into drug-induced electrocardiographic and hemodynamic effects: Results of the ELEPHANT II substudy.

Antazoline is an old antihistaminic and new antiarrhythmic agent with unknown mechanisms of action which recently has been shown to effectively terminate atrial fibrillation. The aim of study was to examine the effects of antazoline on hemodynamic and ECG parameters. Antazoline was given intravenously in three 100mg boluses to 10 healthy volunteers (four males, mean age 40+11years). Hemodynamic and ECG parameters were measured using impedance cardiography [systolic (sBP), diastolic (dBP), mean (mBP) blood pressure, stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR) and heart rate (HR), P wave, PR interval, QRS complex, QT and corrected QT (QTcF) interval]. Plasma concentration of antazoline was also measured. Antazoline caused significant prolongation of P wave, QRS as well as QT and QTcF (101±10 vs 110±16ms, p<.05, and 101±12 vs 107±12ms, p<.05, 399±27 vs 444±23ms, p<.05, and 403±21 vs 448±27ms, p<.05, respectively). Also, a significant decrease in SV was noted (94.9±21.8 vs 82.4±19.6 ml, p<.05). A significant correlation between changes in plasma drug concentration and changes in CO, HR, and dBP was found. Antazoline impairs slightly hemodynamics, significantly reducing SV. Significant prolongation of P wave and QRS duration corresponds to drug-induced prolongation of conduction, whereas QT prolongation represents drug-induced prolongation of repolarization.

Declining blood pressure and intensification of blood pressure management among people over 80 years: cohort study using electronic health records.

Background:Management of high blood pressure (BP) in people over 80 years is controversial, but there is limited information available concerning the uptake of hypertension treatment at this age.Objective:To evaluate use of antihypertensive drugs and changes in SBP and DBP from 2001 to 2014 in men and women aged 80 years and over.Methods:Cohort study using primary care electronic health records of 265 225 participants from the UK Clinical Practice Research Datalink. Records of BP and antihypertensive medications were analysed. Linear trends were estimated by frailty category in multiple regression models.Results:Data were analysed for 116 401 men and 148 824 women. The proportion with BP recorded increased from 51% in 2001 to 78% in 2014. The proportion of patients prescribed antihypertensive medications increased from 64 to 76%. Mean SBP declined from 150 (SD 20) mmHg in 2001 to 135 (16) mmHg in 2014. In ‘fit’ participants, the decline in SBP was 12.4 (95% confidence interval 11.9–13.0) mmHg/decade in those treated for hypertension and 8.5 (7.8–9.1) mmHg in those not treated. The decline in SBP was smaller as frailty increased. The proportion of all participants with BP less than 140/90 mmHg increased from 14 to 44% in the study period.Conclusion:In octogenarians, BP treatment has intensified between 2001 and 2014. BP values have declined in both treated and untreated participants, with a substantial increase in the proportion achieving conventional BP targets.

The role of initial and longitudinal change in blood pressure on progression of arterial stiffness among multiethnic middle-aged men.

A few studies have examined the longitudinal association of blood pressure (BP) with arterial stiffness progression, and the results were inconsistent. The objective of this study was to investigate the roles of initial BP and its longitudinal change on the progression of arterial stiffness measured using brachial-ankle pulse wave velocity (baPWV). Study participants (n = 656) were from population-based samples of healthy men aged 40-49 years at baseline (213 White Americans, 47 African-Americans, 152 Japanese Americans and 244 Japanese in Japan). BP measures, baPWV and other factors were examined at baseline and 4-7 years later. General linear regression was applied for statistical analyses. Annual change in SBP (standardized coefficient: 0.33, P < 0.001), but not its baseline level (standardized coefficient: 0.03, P = 0.495), had a positive significant association with the progression of baPWV after adjusting for a wide range of standard cardiovascular risk factors. Similarly, annual changes in DBP (standardized coefficient: 0.35, P < 0.001), pulse pressure (standardized coefficient: 0.15, P = 0.001) and mean arterial pressure (standardized coefficient: 0.37, P < 0.001) were positively associated with the progression of baPWV. None of the baseline measures were related to the progression of baPWV. Our findings imply that, regardless of initial BP, effective monitoring and controlling of BP is important to slow down arterial wall stiffening and hence reduce cardiovascular risk.

PP.28.12] 24-HOUR PATTERNS OF CENTRAL AORTIC AND BRACHIAL SYSTOLIC BLOOD PRESSURE IN THE VERY ELDERLY

Objective: The aim of current study was to investigate and compare 24-hour profiles of central and peripheral blood pressures in the very elderly via their simultaneous ambulatory monitoring. Design and method: Parallel 24-h ambulatory aortic and brachial blood pressure monitoring was performed in 67 treated hypertensive subjects older than 80 years (mean age 84,1 ± 3,1 years, 25,5% male, mean clinic brachial SBP 134,8 ± 23,2 mmHg) with an oscillometric cuff-based device BPLab Vasotens («Petr Telegin», Russia). Patients with ejection fraction < 40%, atrial fibrillation and severe comorbidities were not included. 24-h, awake and sleep-time systolic, diastolic and pulse blood pressure in aorta and brachial artery were compared in subgroups divided according to the diurnal pattern of brachial systolic blood pressure (SBP). Results: The diurnal profiles of central systolic and pulse BPs run in parallel with those of peripheral BPs in patients with all types of diurnal pattern and SBP amplification at night did not change significantly comparing to day-time values. Non-dipping or reverse-dipping SBP patterns appeared to be typical and were observed in 82,1% patients, while 50,7% participants had inadequate DBP dip < 10%. The proportionality of night-time SBP and DBP changes varied in different types of SBP diurnal profile. SBP and DBP decreased proportionally in dippers (ratio of DBP/SBP night-time reduction was 1,18) and disproportionately in non-dippers (the ratio was 2,6). In those patients with reverse-dipping pattern SBP and DBP changed in opposite directions at night. This disproportion in SBP and DBP night-time changes resulted in different intensity of PP night-time rise that was most evident in reverse-dippers. Relative nocturnal reduction of PP was 9,3 ± 4,72% in dippers, whereas non-dippers and reverse-dippers had relative PP increase of 6,2 ± 8,6 and 22,9 ± 12,3 %, respectively. Conclusions: The diurnal patterns of central and brachial BPs observed in very elderly treated hypertensives were almost parallel. PP amplification is similar in the day- and nighttime and this finding is different from previously described diurnal PP amplification behavior in younger subjects. Proportionality of SBP and DBP sleep-time changes depends on dipping status and results in nocturnal PP increase in non- and reverse-dippers.

Abstract PR359

Background & Objectives: Several techniques have been proposed to attenuate the pressor response following laryngoscopy and intubation.Clonidine has been shown to be effective for preoperative sedation, analgesia and perioperative haemodynamic stability. More recently gabapentin has been used for attenuation of pressor response to laryngoscopy and intubation. Primary Objective: To compare the efiicacy, saftey and utility of clonidine and gabapantin in attenuation of pressor response to laryngoscopy and tracheal intubation. Materials & Methods: STUDY DESIGN:Prospective, double-blind, randomized control. Toatal 90 patients, divided in 3 groups of 30 each. Inclusion Criteria: ASA grade I and II patients in the age group 20 to 60 years of both sexes. Study drug was administered as follows on day of surgery - GROUP I – Tab. Diazepam 5 mg at 6:00 am with sips of water. GROUP II – Cap. Gabapentin 900 mg at 6:00 am with sips of water. GROUP III – Tab. Clonidine 0.2 mg at 6:00 am with sips of water. Results: The rise of heart rate was longest in diazepam group and shortest in clonidine group. The pattern of changes in SBP, DBP and MAP were same in all the three groups following laryngoscopy and intubation. Hence the changes in MAP are taken as a reflection of drugs following ‘laryngoscopy and intubation. Both clonidine and gabapentin groups required statistically significant reduced analgesia intraoperatively as compared to diazepam. The attenuation of heart rate was better in gabapentin and clonidine group, as compared to diazepam group. Also the rise of heart rate was longest in diazepam group and shortest in clonidine group. The pattern of changes in SBP, DBP and MAP were same in all the three groups following laryngoscopy and intubation. Hence the changes in MAP are taken as a reflection of drugs following ‘laryngoscopy and intubation. Both clonidine and gabapentin groups required statistically significant reduced analgesia intraoperatively as compared to diazepam. However no such difference was noted between gabapentin and clonidine groups Conclusion: Clonidine was effective in attenuating pressor response (SBP, DBP, MAP) to laryngoscopy and intubation and was better than diazepam but less effective than gabapentine. Patients who were premedicated with clonidine and gabapentin have longer duration of post operative analgesia as compared to diazepam.

Influence of geomagnetic activity and atmospheric pressure on human arterial pressure during the solar cycle 24

We performed a study of the systolic (SBP) and diastolic (DBP) arterial blood pressure behavior under natural variables such as the atmospheric pressure (AtmP) and the horizontal geomagnetic field component (H). We worked with a sample of 304 healthy normotense volunteers, 152 men and 152 women, with ages between 18 and 84years in Mexico City during the period 2008–2014, corresponding to the minimum, ascending and maximum phases of the solar cycle 24. The data was divided by gender, age and day/night cycle. We studied the time series using three methods: Correlations, bivariate and superposed epochs (within a window of three days around the day of occurrence of a geomagnetic storm) analysis, between the SBP and DBP and the natural variables (AtmP and H). The correlation analysis indicated correlation between the SBP and DBP and AtmP and H, being the largest during the night. Furthermore, the correlation and bivariate analysis showed that the largest correlations are between the SBP and DBP and the AtmP. The superposed epoch analysis found that the largest number of significant SBP and DBP changes occurred for women. Finally, the blood pressure changes are larger during the solar minimum and ascending solar cycle phases than during the solar maximum; the storms of the minimum were more intense than those of the maximum and this could be the reason of behavior of the blood pressure changes along the solar cycle.