Changes In Mean Blood Pressure Research Articles

Salt reduction as a population-based intervention for the prevention of coronary heart diseases: an economic assessment

<h3>Background</h3> The incidence of coronary heart diseases is increasing in the occupied Palestinian territory (oPt) and hence poses a growing challenge for treatment. Reduction in the intake of dietary salt is a potentially cost-effective approach to reduce the burden of coronary heart diseases. Here, we report the results of an economic assessment of three interventions of salt reduction in the oPt. <h3>Methods</h3> We did the analysis from a societal perspective of three salt-reduction interventions—population-wide health promotion campaigns, mandatory labelling of food packaging, and mandatory reduction of salt content of processed food. These interventions were assessed individually, and in combinations of two and all three together. We estimated the costs of policies using past experiences, expert opinion, and hospital records, and costs of health care with a standardised unit cost for treatments. We considered the financial implications for the food industry and public sectors. The total cost of implementation of each policy was compared with the do-nothing scenario. We used data reported in reviews of epidemiological studies as estimates of the expected reduction of the current sodium salt consumption attributable to each policy. The expected change in salt intake was then converted into a change in mean population blood pressure based on estimates reported in a meta-analysis. The change in blood pressure was used to estimate the number of deaths prevented or postponed in 10 years, using the Palestinian IMPACT policy model for coronary heart disease. The estimates were compared with the number of deaths from coronary heart disease that would have been expected in relation to the number in the baseline year. This policy model is an epidemiological model that was used to analyse mortality associated with coronary heart disease and risk factor trends in the West Bank, oPt, between 1998 and 2009, and project mortality trends for the future. We used Microsoft Excel 2010 for our analyses. <h3>Findings</h3> All policies resulted in a reduction in salt intake of 5–30%, leading to changes of 1–20 mm Hg in systolic blood pressure. All scenarios were cost effective compared with the do-nothing scenario. The cost-effectiveness of the scenarios for per life-year gained was $134·57–1430·62 (purchasing power parity at 2010 exchange rates). Policies for the labelling of food and use of the three interventions together were the most cost effective. These two scenarios were estimated to save costs ($9 million and $6 million) and resulted in 945 life-years gained and 2682 life-years gained, respectively. <h3>Interpretation</h3> Reduction of salt intake reduces the long-term burden of coronary heart diseases. In the oPt, population-based interventions to reduce salt intake are not only cost effective but also cost saving. We recommend a population-wide health promotion campaign, mandatory labelling of food packaging, and mandatory reduction of salt content of processed food. <h3>Funding</h3> European Community's Seventh Framework Programme.

Assessment of arterial stiffness during a five-years follow up in a general population in northern Italy

Background: Carotid-femoral pulse wave velocity (cfPWV) is an independent predictor of cardiovascular events and its measurement is recommended by current hypertension guidelines. Very few data are available on the progression of PWV over time. The aim of the present longitudinal study was to compare the progression of aortic stiffness over a 5-year period in a general population in Northern Italy (Vobarno Study). Methods: 227 subjects, 42% males (age 50 4 years and hypertension in 51% at baseline visit), underwent a baseline (BL) and a follow up (FU) visit, after 5.1 0.4 years. In all subjects laboratory examinations, measurement of clinic and 24 hours blood pressure (BP) and of PWV were performed at BL and at FU. Results: In the overall population cfPWV increased from 8.28 1.27 at BL to 8.51 3.2 m/s at FU (p<0.05), change: 0.22 1.25. cfPWV significantly increased from BL to FU in hypertensive subjects (HT) (from 8.61 1.41 to 8.90 1.40, p<0.01) but not in normotensives (NT) (from 7.97 1.03 to 8.11 1.11, p n.s). The absolute change in cfPWV from BL to FU progressively increased from -0.052 0.108 in NT, to 0.480 0.163 in treated HT and to 0.483 0.138 in untreated HT (p for linear trend<0.01); after adjustment for possible confounders (age, gender, BMI, baseline cfPWV and change in mean BP from baseline) the difference remained statistically significant. At multivariate analysis the variables independently related to the progression of cfPWV were age (beta 0.18, p<0.01) and cfPWV, mean BP at BL (beta -0.55, p<0.01, and beta 0.18, p<0.01, respectively) and the change in mean BP during follow-up (beta 0.20, p1⁄40.001). Conclusions: In a general population sample in Northern Italy the main determinants of the increase in arterial stiffness during a 5 years FU were age, cfPWV and mean BP at BL and change in mean BP over time.

Five-Year Change in Intraocular Pressure Associated with Changes in Arterial Blood Pressure and Body Mass Index. The Beijing Eye Study

PurposeTo examine a potential association between longitudinal changes in intraocular pressure (IOP), arterial blood pressure and body mass index (BMI) in a population-based setting.MethodsThe longitudinal population-based Beijing Eye Study included 2355 subjects with an age of 45+ years who were examined in 2006 and in 2011. The participants underwent a detailed ophthalmic examination including tonometry and measurement of arterial blood pressure and BMI.ResultsData on IOP, arterial blood pressure and BMI measured in 2006 and in 2011 were available for 2257 (95.8%) subjects with a mean age of 59.5±9.7 years. The mean change in IOP was −1.25±2.26 mm Hg, mean change in mean blood pressure −7.4±12.1 mmHg, and mean change in BMI was 0.01±2.04 kg/m2. In multivariate analysis, the 5-year change in IOP was significantly associated with a higher change in mean blood pressure (P<0.001; standardized regression coefficient Beta:0.11; regression coefficient B:0.02; 95% confidence interval (CI):0.01,0.03) after adjusting for younger age (P<0.001;Beta:−0.18;B:−0.04;95% CI:−0.05,−0.03), shorter body stature (P = 0.002;Beta:−0.06;B:−0.06;95% CI:−0.03,−0.01), thicker central corneal thickness (P<0.001;Beta:0.19;B:0.02;95% CI:0.01,0.02), deeper anterior chamber depth (P = 0.01;Beta:0.05;B:0.33;95% CI:0.07,0.60), and lower intraocular pressure at baseline (P<0.001;Beta:−0.56;B:−0.42;95% CI:−0.45,−0.39). If the analysis included only longitudinal parameters, the change in IOP was significantly associated with a higher change in mean arterial blood pressure (P<0.001;Beta:0.10;B:0.02;95% CI:0.01,0.03) and a higher change in body mass index (P<0.04;Beta:0.04;B:0.04;95% CI:0.01,0.09).ConclusionsIn the 5-year follow-up of our population-based sample, a change in IOP was associated with a corresponding change in arterial blood pressure and with a corresponding change in body mass index. These longitudinal data support the notion of a physiological relationship between arterial blood pressure, intraocular pressure and body mass index. These findings may be of interest for the discussion of the pathogenesis of glaucomatous optic neuropathy.

Abstract 550: Large Blood Pressure Variability Aggravates Arteriolosclerosis and Ischemic Changes in the Kidney in Hypertensive Rats

Background: Increased blood pressure (BP) variability (BPV) is a characteristic feature of hypertensive patients. Large BPV aggravates hypertensive target organ damage, such as left ventricular hypertrophy, carotid atherosclerosis, and microalbuminuria. We have shown that angiotensin II (AngII)-mediated inflammation plays a role in the aggravation of hypertensive cardiac remodeling in spontaneously hypertensive rats (SHR) with large BPV. However, little was known regarding renal damages induced by large BPV. The aims of this study were to investigate pathological changes of the kidney and to examine whether candesartan would prevent the renal damages in SHR with large BPV. Methods and Results: A model of a combination of hypertension and large BPV was created by bilateral sino-aortic denervation (SAD) in SHR at 12 weeks old. SAD increased BPV without changes in mean BP. At 19 weeks old, SAD induced patchy cortical interstitial lesions associated with ischemic changes of glomeruli and tubules and interstitial fibrosis. The interlobular or afferent arterioles around ischemic lesions showed remarkable arteriolosclerotic changes characterized by vascular smooth muscle cell proliferation and extracellular matrix deposition, leading to the luminal narrowing and occlusion (Figure). Chronic treatment with a subdepressor dose of candesartan prevented not only arteriolosclerotic changes but also interstitial fibrosis and ischemic changes in SHR with SAD. Conclusion: Large BPV aggravates renal arteriolosclerosis, which results in the cortical ischemic changes and fibrosis in the kidney of hypertensive rats through angII-mediated mechanisms.

Longitudinal Determinants of Left Ventricular Mass and Geometry

Background— The purpose of this study was to identify determinants of 20-year change in left ventricular (LV) mass (LVM) and LV geometry in black and white young adults in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Methods and Results— We studied 2426 black and white men and women (54.7% white) aged 43 to 55 years with cardiovascular risk factor data and echocardiograms from CARDIA year 5 and 25 examinations. In regression models, year 25 LVM or relative wall thickness was the dependent variable and with year 5 echo values, age, sex, race, body mass index, change in body mass index, mean arterial blood pressure, change in mean blood pressure, heart rate, change in heart rate, tobacco use, presence of diabetes mellitus, alcohol use, and physical activity score as independent variables. LVM and relative wall thickness increased, whereas prevalence of normal geometry declined from 84.2% to 69.7%. Significant determinants of year 25 LVM/m 2.7 were year 5 LVM, year 5 and change in body mass index, year 5 and change in mean arterial pressure, year 5 and change in heart rate, baseline diabetes mellitus, and year 5 tobacco and alcohol use (overall r 2 =0.40). Significant determinants of year 25 relative LV wall thickness were year 5 value, black race, change in body mass index, year 5 and change in mean arterial pressure, starting smoking, and year 5 diabetes mellitus (overall r 2 =0.11). Conclusions— Prevalence of abnormal LV hypertrophy and geometry increased from young adulthood to middle age. Both young adult cardiovascular risk traits and change in these traits predicted change in LV mass/geometry.

Home Blood Pressure Control After the Great East Japan Earthquake in Patients on Chronic Hemodialysis

At 14:46 on 11 March 2011, northeastern Japan was struck by a major earthquake measuring 9.0 on the Richter scale (the Great East Japan Earthquake). Several reports have suggested a transient blood pressure (BP) increase after a major earthquake, but its impact on BP in chronic dialysis patients has not been reported. In a retrospective review of 25 hemodialysis patients who were residents of Koriyama City, changes in the morning home BP after the earthquake were investigated. Home systolic and diastolic BPs were significantly elevated 1 week after the earthquake (158 ± 16 mm Hg vs. 151 ± 13 mm Hg, P < 0.01, for systolic; 81 ± 13 mm Hg vs. 78 ± 11 mm Hg, P = 0.01, for diastolic). Mean home BP 1 week after the earthquake was unchanged from baseline in patients treated with sympatholytics and/or renin-angiotensin system (RAS) inhibitors. BP values returned to baseline by 4 weeks after the earthquake, but percent changes in mean BP were significantly greater even 2 weeks, 4 weeks, and 6 weeks after the earthquake in patients not treated with RAS inhibitors than in those treated with RAS inhibitors (2 weeks 7.0% ± 4.5% vs. 0.2% ± 5.0%, P < 0.01; 4 weeks 4.4% ± 5.9% vs. -1.8% ± 5.3%, P = 0.02; 6 weeks 4.6% ± 4.9% vs. -1.9% ± 3.9%, P < 0.01). On multiple regression analysis, RAS inhibitor use had an independent relationship with percentage increases in mean BP during the 6 weeks after the earthquake. Home BP was significantly increased after a major earthquake in patients on chronic hemodialysis. Prolonged deterioration of BP control after the earthquake was associated with non-use of RAS inhibitors.

GW24-e1415 NE, Renin, Ang-II, ALD, ET-1, which one is the best indicator for renal denervation of treatment of resistant hypertension

ObjectivesTo explore the best indicator of catheter based renal sympathetic denervation (RSD) treatment of resistant hypertension, to choose the appropriate hypertensive patients undergo RSD, providing a theoretical basis.MethodsThirty patients with...

GW24-e1139 Vasorelaxant and antihypertensive effects of 7, 8-dihydroxyflavone in rats

Objectives7,8-Dihydroxyflavone (7,8-DHF) is a new potent agonist for TrkB receptors. 7, 8-DHF exerts protecting effects on neurons in Parkinson’s and Alzheimer’s diseases and stroke, improves memory and antagonises depression. Its...

Determinants of achieving early blood pressure control with monotherapy in a primary care setting.

This study sought to identify the determinants of early blood pressure (BP) control associated with monotherapy in hypertensive individuals being managed in the primary care setting. The Valsartan Intensified Primary Care Reduction of Blood Pressure (VIPER-BP) study, was a multicenter, randomized controlled trial of an intensive approach to BP management. During a standardized run-in, 2185 participants commenced monotherapy (valsartan 80mg/d) for 14 to 28days. A total of 1978 participants aged 59±12years (60% men) completed the run-in phase. Of these, 15.1%, 43.5%, and 41.4% participants had an initial BP target of ≤125/75, 130/80, and 140/90mmHg, respectively. A total of 416 of 2185 participants (19.0%) subsequently achieved their individual BP target during run-in with a mean BP change of -22.6±12.1/-12.9±8.2mmHg vs -4.2±16.2/-3.0±9.6mmHg for the rest (P<.001). These early responders were more likely to be women (adjusted odds ratio, 1.41; 95% confidence interval, 1.10-1.80), had lower BP at baseline, were less likely to have been treated previously (or for less time), and had a less stringent BP target. An initial period of monotherapy achieved BP control in a high proportion of hypertensive individuals with key groups (including women and de novo cases) more likely to show an early BP response.

Continuous veno-venous hemofiltration and intermittent hemofiltration in treatment of type 1 cardiorenal syndrome: a clinical research

Objective To compare the effects of continuous veno-venous hemofiltration(CVVH)and intermittent hemofiltration(IHF) on the hemodynamics and clinical outcomes of patients with type 1 cardiorenal syndrome.Methods From May 2008 to June 2011,34 patients diagnosed with type 1 cardiorenal syndrome were admitted to our hospital and received CVVH(19 cases) or IHF(15 cases).The general data,acute hemodynamic changes before and after hemofiltration and clinical outcomes at 28 days after hemofiltration were evaluated.Results There were no significant differences in the heart rates,diastolic blood pressure between the two groups before and after hemofiltration(P0.05).The systolic pressure was similar between the two groups before hemofiltration(P0.05),but that in the IHF group was significantly lower than that in the CVVH group after hemofiltration(P0.05).No significant difference was found in the maximal mean pressure or blood pressure changes between the two groups at 48 h after hemofiltration(P0.05),but the minimal mean pressure in IHF group was significantly lower than that in the CVVH group(P0.05).The improvement of cardiac function and the mortality rates at 28 d after hemofiltration were not significantly different between the two groups(P0.05).Multivariate analysis suggested that APACHE Ⅱ was the main influence factor of 28-day mortality of patients,and APACHE Ⅱ and net ultrafiltration were the main influence factor of the minimal mean pressure.Conclusion Compared with IHF,CVVH fails to greatly reduce the mortality of patients with type 1 cardiorenal syndrome.The severity of the disease is the main influence factor for the hemodynamic changes and the 28-day mortality of patients with type 1 cardiorenal syndrome.

Antihypertensive classes, cognitive decline and incidence of dementia

Prevention of cognitive decline and dementia with blood pressure lowering treatments has shown inconsistent results. We compared the effects of different classes of antihypertensive drugs on the incidence of dementia, and on cognitive function. We conducted a systematic review and included 19 randomized trials (18 515 individuals) and 11 studies (831 674 individuals) analysing the effects of antihypertensive treatment on cognition and on the incidence of dementia, respectively, in hypertensive patients without prior cerebrovascular disorders. Network meta-analysis was used for the comparison of antihypertensive classes. Antihypertensive treatment, regardless of the drug class, had benefits on overall cognition [effect size 0.05, 95% confidence interval (CI) 0.02-0.07] and all cognitive functions except language. Antihypertensive treatment reduced the risk of all-cause dementia by 9%, with reference to the control group (hazard ratio 0.91, 95% CI 0.89-0.94), when randomized trials and observationnal studies were combined (n = 15). Result was not significant with randomized trials alone (n = 4). Angiotensin II receptor blockers (ARBs) had larger benefits than placebo on overall cognition (adjusted effect size 0.60 ± 0.18, P = 0.02). ARBs were more effective than β-blockers (0.67 ± 0.18, P = 0.01), diuretics (0.54 ± 0.19, P = 0.04) and angiotensin-converting enzyme inhibitors (0.47 ± 0.17, P = 0.04) in rank. The mean change in blood pressure did not differ significantly between the different antihypertensive drug classes. Our results support the notion that antihypertensive treatment has beneficial effects on cognitive decline and prevention of dementia, and indicate that these effects may differ between drug classes with ARBs possibly being the most effective.

THU0136 Cardiovascular safety findings in rheumatoid arthritis patients treated with tofacitinib (CP-690,550), a novel, oral jak inhibitor

BackgroundTofacitinib is a novel, oral Janus kinase inhibitor being investigated as a targeted immunomodulator and disease-modifying therapy in rheumatoid arthritis (RA).ObjectivesTo evaluate the cardiovascular (CV) event rates and changes in...

Coronary Slow Flow and Abnormal Nocturnal Blood Pressure Profile in Normotensives

BackgroundAbnormal nocturnal blood pressure (BP) profile has been linked to microvascular function and autonomic dysfunction. However, no data were available regarding nocturnal BP profile in coronary slow flow (CSF).AimThe aim...

Significance of estimated salt excretion as a possible predictor of the efficacy of concomitant angiotensin receptor blocker (ARB) and low-dose thiazide in patients with ARB resistance

The purpose of this study was to assess the factors affecting the efficacy of combination therapy with losartan and thiazide, with a focus on the significance of salt excretion, via a multicenter observational study. Adult patients with essential hypertension showing therapy resistance to angiotensin receptor blocker (ARB) as a monotherapy or in combination with Ca channel blockers (CCB) were enrolled, and their previously administered ARBs were replaced with the combination tablet containing losartan (50 mg per day) and hydrochlorothiazide (12.5 mg per day). Blood pressure and biochemical parameters were monitored for a year. The baseline blood pressure (153.4±14.8/86.4±11.3 mm Hg) was significantly lowered at the 3rd month (137.3±17.4/78.2±11.1 mm Hg, n=93) and was maintained at this lower level until the 12th month (135.3±14.0/76.4±11.1 mm Hg, n=74). The baseline value of estimated salt excretion (eSE), calculated using Tanaka's formula, differed significantly between the high and low treatment response groups, which were defined by the average change in mean blood pressure (MBP-C, -11.3 mm Hg; eSE=10.8±2.9 g per day in high responders vs. 9.2±2.3 g per day in low responders, P=0.004). Univariate and multivariate analyses showed a significant correlation between eSE and MBP-C (R=-0.288, P=0.007) and indicated the clinical effectiveness of eSE as a possible predictor for MBP-C (P=0.021). In addition, the urine Na-to-Cr ratio (NCR) demonstrated significant correlations with eSE (R=0.848, P<0.001) and MBP-C (R=-0.344, P<0.001). These results suggest that eSE or NCR could, to a certain extent, predict the efficacy of combination therapy with losartan and low-dose thiazide in patients demonstrating ARB resistance. Combination therapy with losartan and thiazide might thus be suitable for patients with a large amount of salt excretion.

Efficacy and Safety of a Fixed Combination of Irbesartan/Hydrochlorothiazide in Chinese Patients with Moderate to Severe Hypertension

Background and ObjectivesIn a multi-center, single-arm, prospective study, we investigated the efficacy and safety of the fixed irbesartan/hydrochlorothiazide combination in Chinese patients with moderate to severe hypertension.MethodsEligible patients were aged 18–75 years, with a blood pressure of 160–199 mmHg systolic or 100–119 mmHg diastolic during a 1-week wash-out phase off antihypertensive medication. The enrolled patients started antihypertensive treatment with irbesartan/hydrochlorothiazide 150 mg/12.5 mg once daily, with the possible addition of irbesartan 150 mg once daily and up-titration to irbesartan/hydrochlorothiazide 300 mg/25 mg once daily at 4 and 8 weeks of follow-up, respectively. The primary efficacy variable was the goal blood pressure-attaining rate at 12 weeks of follow-up (<140/90 mmHg, or <130/80 mmHg in patients with diabetes mellitus).ResultsIn the intention-to-treat analysis (n = 501) at 12 weeks of follow-up, the goal blood pressure-attaining rate was 57.3 %, and the mean change in blood pressure from baseline was 27.8 mmHg [95 % confidence interval (CI) 26.4–29.1 mmHg; p < 0.001] systolic and 13.5 mmHg (95 % CI 12.6–14.4 mmHg; p < 0.001) diastolic. Similar findings were observed in the per-protocol analysis (n = 449). The prevalence of microalbuminuria and left ventricular hypertrophy significantly (p ≤ 0.01) decreased from 33.4 % (150/449) and 50.4 % (215/427) at baseline to 23.4 % (105/447) and 41.3 % (176/427) at the end of follow-up, respectively. Four patients (2.0 %) reported a serious adverse event.ConclusionThe fixed irbesartan/hydrochlorothiazide combination may control blood pressure to the target level in about 60 % of Chinese patients with moderate to severe hypertension, with an acceptable safety profile.

Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials

Objective To determine the effects of longer term modest salt reduction on blood pressure, hormones, and lipids.Design Systematic review and meta-analysis.Data sources Medline, Embase, Cochrane Hypertension Group Specialised Register, Cochrane...

Abstract 025: Urine Angiotensinogen and Salt-Sensitivity of Blood Pressure: The GenSalt Study

Urine excretion of angiotensinogen (AGT) has been proposed as a biomarker of intrarenal renin-angiotensin system activity, and therefore as a proxy for blood pressure regulation and sodium homeostasis. The association between urine levels of AGT and blood pressure response to dietary sodium intake has not been previously examined in the general population. We assessed the hypothesis that there is a direct relationship between urine levels of AGT and salt-sensitivity of blood pressure among participants of the Genetic Epidemiology Network of Salt Sensitivity (GenSalt) replication study. A 7-day low-sodium intervention, followed by a 7-day high-sodium intervention was carried out among 698 GenSalt-replication study participants from rural areas of north China. Absolute urine AGT excretion (μg/24 hours) and AGT-to-creatinine ratio (AGT/Cr, μg/g) were estimated at baseline for a random sample of 100 study participants. Nine blood pressure measurements were obtained at baseline and on the last three days of each intervention period. The absolute and percent changes in mean blood pressure from low-sodium to high-sodium intervention were used to assess salt-sensitivity. Median AGT and AGT/Cr were significantly (both p=0.01) reduced during the low-sodium intervention (AGT: 7.16 μg/24 hours, AGT/Cr: 8.36 μg/g) and increased during the high-sodium intervention (AGT: 8.84 μg/24 hours, AGT/Cr: 10.92 μg/g) compared to baseline (AGT: 8.28 μg/24 hours, AGT/Cr: 9.40 μg/g). Log-transformed AGT and AGT/Cr ratio at baseline was significantly and positively associated with blood pressure at baseline and at the end of each intervention. For example, one standard deviation higher log-transformed AGT/Cr ratio (1.2 μg/g) was associated with a 4.0 mm Hg (95% confidence interval: 1.3, 6.7) higher systolic blood pressure level at the end of the high-sodium intervention (p=0.004). One standard deviation higher log-transformed AGT/Cr ratio was associated with 1.58-times increased odds of high salt-sensitivity (≥5% change) of blood pressure (95% confidence interval: 1.00, 2.50; p=0.049). Log-transformed AGT/Cr ratio at baseline was positively associated with absolute and percent systolic blood pressure change from low- to high-sodium interventions (absolute: r=0.23, p=0.02; percent: r=0.20, p=0.047). In conclusion, elevated levels of urine AGT are associated with sodium-sensitivity of blood pressure. Augmentation of renal-angiotensin system activity may play an important role in the development of salt-sensitive hypertension.

Comparison of haemodynamic changes in patients undergoing unilateral and bilateral spinal anaesthesia.

To assess the haemodynamic changes in patients receiving unilateral and bilateral spinal anaesthesia with their pre-anaesthesia recordings. Quasi-experimental study. Main Operation Theater, Liaquat National Hospital, Karachi, from May 2006 to February 2007. Sixty patients meeting the inclusion criteria were randomly allocated in two groups of 30 patients each. One and a half ml of 0.75% hyperbaric bupivacaine was injected with free flow of cerebrospinal fluid using a 23 gauge quincke needle. Lumbar puncture was performed in the sitting position at 3 - 4 or 4 - 5 lumbar interspace. Patients were then assigned to the supine or lateral decubitus position for 10 minutes. Heart rate, systolic, mean and diastolic blood pressures of patients were recorded with their pre-anaesthesia readings in the 1st, 5th, 15th, 30th and then at every 15th minute till the end of procedure. Recovery room readings were also taken. The systolic, mean and diastolic blood pressure changes were significant in both groups. But from 1st minute to recovery room, statistically significant difference (p < 0.05) was found at each time interval, the unilateral groups (group A) being more stable with respect to pre-anaesthesia readings. The decrease in heart rate was comparable in both groups. Unilateral spinal anaesthesia was associated with a more stable cardiovascular profile, therefore, it is a valuable technique for high risk patients.

Cardiac baroreflex function and dynamic cerebral autoregulation in elderly Masters athletes

Cerebral blood flow (CBF) is stably maintained through the combined effects of blood pressure (BP) regulation and cerebral autoregulation. Previous studies suggest that aerobic exercise training improves cardiac baroreflex function and beneficially affects BP regulation, but may negatively affect cerebral autoregulation. The purpose of this study was to reveal the impact of lifelong exercise on cardiac baroreflex function and dynamic cerebral autoregulation (CA) in older adults. Eleven Masters athletes (MA) (8 men, 3 women; mean age 73 ± 6 yr; aerobic training >15 yr) and 12 healthy sedentary elderly (SE) (7 men, 5 women; mean age 71 ± 6 yr) participated in this study. BP, CBF velocity (CBFV), and heart rate were measured during resting conditions and repeated sit-stand maneuvers to enhance BP variability. Baroreflex gain was assessed using transfer function analysis of spontaneous changes in systolic BP and R-R interval in the low frequency range (0.05-0.15 Hz). Dynamic CA was assessed during sit-stand-induced changes in mean BP and CBFV at 0.05 Hz (10 s sit, 10 s stand). Cardiac baroreflex gain was more than doubled in MA compared with SE (MA, 7.69 ± 7.95; SE, 3.18 ± 1.29 ms/mmHg; P = 0.018). However, dynamic CA was similar in the two groups (normalized gain: MA, 1.50 ± 0.56; SE, 1.56 ± 0.42% CBFV/mmHg; P = 0.792). These findings suggest that lifelong exercise improves cardiac baroreflex function, but does not alter dynamic CA. Thus, beneficial effects of exercise training on BP regulation can be achieved in older adults without compromising dynamic regulation of CBF.

Systemic and microcirculatory effects of dobutamine in patients with septic shock

PurposeThe aim of this study was to characterize the cardiovascular responses to dobutamine and their predictors. Our hypotheses were that dobutamine mainly produces tachycardia and vasodilation and fails to improve the microcirculation of patients with septic shock. Materials and MethodsSystemic hemodynamics and sublingual microcirculation were evaluated with dobutamine (0, 2.5, 5.0, and 10.0 μg kg−1 min−1) in 23 patients with septic shock. ResultsDobutamine increased heart rate, cardiac index, and stroke volume index (SVI). Mean blood pressure was unchanged, and systemic vascular resistance decreased. Individual responses were heterogeneous. Stroke volume index increased in 52% of the patients. These patients showed lower changes in mean blood pressure (3 ± 16 mm Hg vs −10 ± 6 mm Hg, P < .05) and higher increases in cardiac index (1.47 ± 0.93 L m−1 m−2 vs 0.20 ± 0.5 L m−1 m−2) than did nonresponders. Changes in SVI significantly correlated with echocardiographic left ventricular ejection fraction (r = 0.55). In the whole group, perfused capillary density remained unchanged (14.0 ± 4.3 mm/mm2 vs 14.8 ± 3.7 mm/mm2), but improved if basal values were 12 mm/mm2 or less (9.1 ± 4.3 mm/mm2 vs 12.5 ± 4.8 mm/mm2). ConclusionsDobutamine produced variable hemodynamic effects. Systolic dysfunction was the only variable associated with increases in SVI. Finally, dobutamine only improved sublingual microcirculation when severe alterations were found at baseline.