Changes In SBP Research Articles

Xanthine oxidase gene variants and their association with blood pressure and incident hypertension: a population study.

The enzyme xanthine oxidoreductase (XOR) generates uric acid in the terminal steps of the purine metabolism; meanwhile reactive oxygen species are formed. We hypothesized that uric acid production, as assessed indirectly from XOR variants, is associated with hypertension. Among 2769 participants (48.3% men; mean age 40.7 years) randomly recruited from European populations, we genotyped 25 tagging XOR SNPs and measured blood pressure (BP) at baseline and follow-up (median 8.8 years). The relation between variants of the XOR gene with changes in pulse pressure and mean arterial pressure over time; and incidence of hypertension, were analyzed. Compared with nonminor allele carriers, pulse pressure increased approximately 2 mmHg more in minor allele carriers of rs11904439 (P = 0.01), whereas mean arterial pressure and DBP increased approximately 1 mmHg less in minor allele carriers of rs2043013 (P = 0.01). In 2050, participants normotensive at baseline, hazard ratios contrasting risk of hypertension in minor allele carriers vs. nonminor allele carriers were 1.31 (95% confidence interval 1.03-1.68; P = 0.02) and 1.69 (95% confidence interval 1.11-2.57; P = 0.01) for rs11904439 and rs148756340, respectively. With the false discovery rate set at 0.25, the aforementioned associations retained significance. The changes in SBP from baseline to follow-up and the serum levels of uric acid at baseline (n = 1949) were not associated with XOR. Pending confirmation, our findings suggest that variation in uric acid production, as captured by genetic variation in XOR, might be a predictor of changes in BP and in the risk of hypertension.

Subchondral Bone Plate Changes More Rapidly than Trabecular Bone in Osteoarthritis.

Osteoarthritis (OA) is the most common joint disorder, characterised by focal loss of cartilage and increased subchondral bone remodelling at early OA stages of the disease. We have investigated the temporal and the spatial relationship between bone remodelling in subchondral bone plate (Sbp) and trabecular bone (Tb) in Dunkin Hartley (DH, develop OA early) and the Bristol Strain 2 (BS2, control which develop OA late) guinea pigs. Right tibias were dissected from six male animals of each strain, at 10, 16, 24 and 30 weeks of age. Micro-computed tomography was used to quantify the growth plate thickness (GpTh), subchondral bone plate thickness (SbpTh) and trabecular bone thickness (TbTh), and bone mineral density (BMD) in both Sbp and Tb. The rate of change was calculated for 10–16 weeks, 16–24 weeks and 24–30 weeks. The rate of changes in Sbp and Tb thickness at the earliest time interval (10–16 weeks) were significantly greater in DH guinea pigs than in the growth-matched control strain (BS2). The magnitude of these differences was greater in the medial side than the lateral side (DH: 22.7 and 14.75 µm/week, BS2: 5.63 and 6.67 µm/week, respectively). Similarly, changes in the BMD at the earliest time interval was greater in the DH strain than the BS2, again more pronounced in the disease prone medial compartment (DH: 0.0698 and 0.0372 g/cm3/week, BS2: 0.00457 and 0.00772 g/cm3/week, respectively). These changes observed preceded microscopic and cellular signs of disease as previously reported. The rapid early changes in SbpTh, TbTh, Sbp BMD and Tb BMD in the disease prone DH guinea pigs compared with the BS2 control strain suggest a link to early OA pathology. This is corroborated by the greater relative changes in subchondral bone in the medial compared with the lateral compartment.

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.

PS 05-08 A COMPARATIVE STUDY OF ANEROID BLOOD PRESSURE MEASURING DEVICE AND DIGITAL BLOOD PRESSURE MONITOR VERSUS MERCURY SPHYGMOMANOMETER

Objective: To compare accuracy of aneroid and digital blood pressure instrument in comparison to mercury sphygmomanometer in supine as well as in standing position. To check postural changes in BP by aneroid and digital BP instrument in comparison to mercury sphygmomanometer. Design and method: This study has been enrolled patients visiting OPD and IPD patients department of medicine of KGMU Lucknow. Patients of age >12 years, of either gender were included in study. B.P of patient first measured with a mercury device using same arm. Blood Pressure in supine and standing position by mercury sphygmomanometer then aneroid and then digital Blood Pressure instrument. Results: Mean SBP in supine position are 127.44 + 12.25, 132.91 + 13.09 and 141.01 + 14.35 mmHg respectively and mean SBP finding in standing position are 122.75 + 12.34, 127.42 + 14.20 and 133.82 + 14.37 mmHg respectively by mercury, aneroid and digital manometer. Mean DBP in supine position are 80.49 + 8.80, 85.56 + 9.69 and 90.65 + 12.50 mmHg respectively and mean DBP in standing position are 78.79 + 8.82, 82.05 + 11.49 and 86.03 + 11.96 mmHg by mercury, aneroid and digital manometer respectively. The postural change in SBP (Supine Vs standing) are −8.43 + 4.27, −9.16 + 5.95 and −10.12 + 7.65 mmHg respectively and in DBP are −4.88 + 5.36, −6.39 + 6.54 and −6.98 + 8.98 mmHg by mercury, aneroid and digital manometer respectively. Conclusions: Compared to mercury, both aneroid and digital sphygmomanometers provided significantly higher mean values for both sitting and supine positions on overall evaluation (p < 0.001).

PP.27.20] EFFECTIVENESS AND SAFETY OF VALSARTAN/AMLODIPINE/ HYDROCHLOROTHIAZIDE IN EGYPTIAN PATIENTS WITH HYPERTENSION UNCONTROLLED ON ANY DUAL THERAPY

Objective: To assess the effectiveness, safety and tolerability of amlodipine/valsartan/hydrochlorothiazide (Aml/Val/HCT) single pill combination (SPC) in Egyptian patients with hypertension who were not controlled on any dual therapy. Design and method: Prospective, open label, multicenter, observational, cohort study conducted in patients with hypertension from Egypt, who were uncontrolled on any dual antihypertensive therapy and to whom Aml/Val/HCT SPC was indicated. Patients were treated with Aml/Val/HCT (5/160/12.5 mg or 10/160/25 mg; the only two available forms in Egypt) for 12 weeks. The primary endpoint was mean change in systolic and diastolic blood pressure (SBP and DBP) at week 12. Secondary endpoints included mean change in SBP and DBP at week 2, BP goal (<140/90 mmHg), safety and tolerability, change in heart rate, and compliance with SPC at week 12. Results: A total of 1080 patients completed the study. The mean baseline BP was 165.5/100.8 mmHg. Significant reduction in SBP/DBP -35.9/-20.3 mmHg (P < 0.0001) from baseline was observed at week 12. Similarly, the reduction in SBP/ DBP −28.0/−15.7 mmHg (P < 0.0001) was significant after 2 weeks of treatment. Majority of patients (76.85%) reached the BP goal of <140/90 mmHg. The most common adverse events were ankle edema (10.92%), lower limb edema (5.88%), and palpitation (5.88%). Physician's evaluation showed that 61.76% (667/1080) of the patients had excellent tolerability to study medication. The sitting pulse significantly reduced from 80.3 bpm at baseline to 77.2 bpm (P < 0.0001). Compliance was better for patients taking Aml/Val/HCT 5/160/12.5 mg as compared to 10/160/25 mg (60.56% vs 39.35%). Conclusions: In this observational study conducted in Egypt, Aml/Val/HCT (5/160/12.5 mg or 10/160/25 mg) SPC significantly reduced BP in patients not controlled on any previous dual therapy. It also showed significant improvement in BP control and good safety profile.

Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry.

AimsCatheter-based renal artery denervation (RDN) has been shown to lower blood pressure (BP) in certain patients with uncontrolled hypertension. Isolated systolic hypertension (ISH) (systolic BP [SBP] ≥140 mmHg and diastolic BP <90 mmHg), characterized by increased vascular stiffness, is the predominant hypertensive phenotype in elderly patients. This study compared baseline characteristics and SBP change at 6 months between patients with ISH and combined systolic–diastolic hypertension (CH).Methods and resultsThis study pooled data from 1103 patients from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry. A total of 429 patients had ISH, and 674 had CH. Patients with ISH were significantly older than those with CH (66 vs. 55 years), had more type 2 diabetes mellitus (52.9 vs. 34.6%), and a lower estimated glomerular filtration rate (71.8 vs. 78.6 mL/min/1.73 m2); all P < 0.001. At 6 months, the SBP drop for CH patients was −18.7 ± 23.7 mmHg compared with a reduction of −10.9 ± 21.7 mmHg for ISH patients −7.8 mmHg, 95% confidence interval, CI, −10.5, −5.1, P < 0.001). The change in 24-h SBP at 6 months was −8.8 ± 16.2 mmHg in patients with CH vs. −5.8 ± 15.4 mmHg in ISH (−3.0 mmHg, 95% CI −5.4, −0.6, P = 0.015). Presence of ISH at baseline but not age was associated with less pronounced BP changes following the procedure. The strongest predictor of office SBP reduction at 6 months was CH, followed by aldosterone antagonist use and non-use of vasodilators.ConclusionThe reduction in BP among patients with ISH following RDN was less pronounced than the reduction in patients with CH.Clinical.Trials.gov identifiersNCT01534299 and NCT01418261.

Impact of Acute Energy Drink Consumption on Blood Pressure Parameters: A Meta-analysis.

Hospitalizations associated with energy drinks have increased in the past decade. Whereas energy drinks are suspected to cause hemodynamic effects, the magnitude of risk remains controversial. We evaluated the effects of acute energy drink consumption on systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR). A search in PubMed, Cumulative Index of Nursing and Allied Health Literature, and Cochrane database through December 31, 2015, was performed. Prospective clinical studies assessing the effects of commercially available energy drinks on BP and HR were included. A weighted mean change from baseline was calculated using the DerSimonian and Laird random-effects model for all end points. In all, 15 studies were included, encompassing a total of 340, 322, and 340 individuals for SBP, DBP, and HR, respectively. SBP and DBP increased significantly by 4.44 mm Hg (95% CI = 2.71 to 6.17; Cochrane Q P = 0.001) and 2.73 mm Hg (95% CI = 1.52 to 3.95; Cochrane Q P = 0.050), respectively. HR changed nonsignificantly by 0.80 beats per minute (95% CI = -1.26 to 2.87; Cochrane Q P < 0.001). The largest change in SBP was seen with drinks administering ≥200 mg of caffeine (6.44 mm Hg, 95% CI = 4.62 to 8.27). Our results indicate that acute consumption of caffeinated energy drinks significantly raises SBP and DBP. Further investigation of the ingredients in energy drinks and the impact of chronic energy drink consumption is warranted.

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.

Direct comparisons of commercial weight-loss programs on weight, waist circumference, and blood pressure: a systematic review.

BackgroundObesity is common in the U.S. and many individuals turn to commercial programs to lose weight. Our objective was to directly compare weight loss, waist circumference, and systolic and diastolic blood pressure (SBP, DBP) outcomes between commercially available weight-loss programs.MethodsWe conducted a systematic review by searching MEDLINE and the Cochrane Database of Systematic Reviews from inception to November 2014 and by using references identified by commercial programs. We included randomized, controlled trials (RCTs) of at least 12 weeks duration that reported comparisons with other commercial weight-loss programs. Two reviewers extracted information on mean change in weight, waist circumference, SBP and DBP and assessed risk of bias.ResultsWe included seven articles representing three RCTs. Curves participants lost 1.8 kg (95%CI: 0.1, 3.5 kg) more than Weight Watchers in one comparison. There was no statistically significant difference in waist circumference change among the included programs. The mean reduction in SBP for SlimFast participants was 4.5 mmHg (95%CI: 0.4, 8.6 mmHg) more than that of Atkins participants in one comparison. There was no significant difference in mean DBP changes among programs.ConclusionsThere is limited evidence that any one of the commercial weight-loss programs has superior results for mean weight change, mean waist circumference change, or mean blood pressure change.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3112-z) contains supplementary material, which is available to authorized users.

Prevalence and correlates of new-onset left ventricular geometric abnormalities in a general population: the PAMELA study.

We sought to evaluate new-onset abnormal LV (left ventricle) patterns and their correlates over a 10-year period in members of the general population enrolled in the Pressioni Arteriose Monitorate e Loro Associazioni study. The study included 817 patients with normal LV geometry at baseline evaluation having a readable echocardiogram at the end of follow-up. Cut-points for abnormal LV geometric patterns were derived from reference values of the healthy fraction of the Pressioni Arteriose Monitorate e Loro Associazioni population. Over a 10-year period 39% of participants progressed to abnormal LV geometric patterns as follows: LV concentric remodelling (15.2%), eccentric dilated left ventricular hypertrophy (LVH) (8.4%), concentric LVH (7.9%), eccentric nondilated LVH (6.8%), and concentric dilated LVH (0.7%). Age [odds ratio (OR): 1.039; 95% confidence interval (CI) 1.023-1.056, P < 0.0001], LV mass index (OR: 1.039; 95% CI 1.026-1.052, P < 0.0001), night-time SBP (OR: 1.024; 95% CI 1.005-1.043, P = 0.01), office SBP changes during follow-up (OR: 1.017 95% CI 1.007-1028, P = 0.001), and BMI (OR: 1.067; 95% CI 1.017-1.120, P = 0.009) emerged as key correlates of new-onset abnormal LV geometry. Age and LV mass index turned out to be strong determinants of all sub-types of LVH; whereas blood pressure, BMI, and sex exhibited a different predictive value across the various LV geometric patterns. Our study provides the first evidence that long-term changes from normal cardiac morphology toward abnormal LV geometry represent a clinically relevant phenomenon at the community level. From a practical perspective this finding reinforces the concept that life-style changes and pharmacologic treatment aimed to reduce over-weight/obesity and optimize blood pressure are of paramount importance for prevention of subclinical cardiac damage.

Hemodynamic Changes Following Routine Fluid Resuscitation in Patients With Blunt Trauma.

BackgroundThe management of trauma patients is often difficult. The American college of surgeons suggests using advanced trauma life support (ATLS) measures. ATLS is regarded as the gold standard for the resuscitation of cases with acute life threatening injuries.ObjectivesTo assess the change in base excess (BE) values and central venous pressure (CVP) one and six hours after injection of 1000 cc normal saline in trauma patients admitted to the ICU.Patients and MethodsAccording to the inclusion and exclusion criteria, patients were randomly selected to participate in the project. Inclusion criteria included trauma patients admitted to the ICU with a CVP line and who had indication for hydration. In trauma patients, at the zero time period, BP, PR, RR and CVP were measured, and a blood gas test was used to assess Hb, pH, BE, PO2, HCO3 and PCO2. Then 1000 cc of normal saline was injected, and after one and six hours, the same values were re-evaluated.ResultsThe mean age of the patients was 38.1 ± 3.9 (range 15 - 60). The mean duration of hospitalization was 7.4 ± 4.4 (range 1 - 21) days. The mean ISS for these patients was 14.33 ± 5.3. BE changes in both groups of patients, based on Hb primary division, showed a significant difference (P ≤ 0.05). The results showed that there was no significant relation between the measured ISS and the changes in base values (P ≥ 0.05).ConclusionsAccording to our results, the infusion of one liter normal saline will cause a statistically significant decrease only in BD, after one hour, in patients with moderate to severe ISS. The changes in SBP, PR, CVP and also pH, HCO3 and Hb were not statistically remarkable.

Longitudinal genome-wide methylation study of Roux-en-Y gastric bypass patients reveals novel CpG sites associated with essential hypertension.

BackgroundEssential hypertension is a significant risk factor for cardiovascular diseases. Emerging research suggests a role of DNA methylation in blood pressure physiology. We aimed to investigate epigenetic associations of promoter related CpG sites to essential hypertension in a genome-wide methylation approach. MethodsThe genome-wide methylation pattern in whole blood was measured in 11 obese patients before and six months after Roux-en-Y gastric bypass surgery using the Illumina 450 k beadchip. CpG sites located within 1500 bp of the transcriptional start site of adjacent genes were included in our study, resulting in 124 199 probes investigated in the subsequent analysis. Percent changes in methylation states and SBP measured before and six months after surgery were calculated. These parameters were correlated to each other using the Spearman’s rank correlation method (Edgeworth series approximation). To further investigate the detected relationship between candidate CpG sites and systolic blood pressure levels, binary logistic regression analyses were performed in a larger and independent cohort of 539 individuals aged 19–101 years to elucidate a relationship between EH and the methylation state in candidate CpG sites.ResultsWe identified 24 promoter associated CpG sites that correlated with change in SBP after RYGB surgery (p < 10−16). Two of these CpG loci (cg00875989, cg09134341) were significantly hypomethylated in dependency of EH (p < 10−03). These results were independent of age, BMI, ethnicity and sex.ConclusionsThe identification of these novel CpG sites may contribute to a further understanding of the epigenetic regulatory mechanisms underlying the development of essential hypertension.

Gender difference in the response to valsartan/amlodipine single-pill combination in essential hypertension (China Status II): An observational study.

Background:The China STATUS II is a prospective, multicentre, open-label, post-marketing, observational study including Chinese adults (aged ⩾ 18 years) with essential hypertension who were prescribed once-daily valsartan/amlodipine (Val/Aml 80/5 mg) single-pill combination. In order to examine gender differences in treatment response to Val/Aml, we further analysed data from the China STATUS II study.Methods:A total of 11,312 patients (6456 (57%) men and 4856 (43%) women) received the Val/Aml treatment for 8 weeks. After the treatment, we compared the proportion of patients not achieving the target systolic blood pressure (SBP: < 140 mm Hg) or diastolic blood pressure (DBP: < 90 mm Hg) in different age groups (by Fisher exact probability test) and estimated the changes in blood pressure (BP) according to age and gender, using a mixed model.Results:At enrolment, mean SBP was higher in the female versus the male patients (160.0 ± 12.71 versus 159.3 ± 12.31 mm Hg; p = 0.003), whereas the mean DBP was higher in the male versus the female patients (96.4 ± 10.65 versus 94.5 ± 10.72 mm Hg; p < 0.001). The overall proportion of women not achieving the target BP was less than that of men (57.41% versus 59.59%; p < 0.05) at 4 weeks and (22.22% versus 23.78%; p < 0.05) at 8 weeks after the Val/Aml treatment. Among both men and women, the proportion of patients not achieving the target SBP increased with age; however, the proportion not achieving the target DBP decreased with age. The mixed-model analysis showed that the changes in SBP were closely related to gender, indicating that the SBP-lowering effect after Val/Aml treatment might be better in women. In addition, the changes in DBP were closely related to age.Conclusions:Gender might be a factor for consideration in the decision-making process of individualised antihypertensive therapy, in the future.

Medication adherence and activity patterns underlying uncontrolled hypertension: Assessment and recommendations by practicing pharmacists using digital health care

ObjectivesThis report summarizes the first use of a digital health feedback system (DHFS) by practicing pharmacists to establish evidence-based blood pressure (BP) management recommendations. SettingFifteen commercial pharmacies and 39 patients in the Isle of Wight participated. Practice descriptionThe pharmacists were experienced in providing New Medicine Services to patients in their communities. Practice innovationThe pharmacists utilized a commercially available DHFS. The DHFS utilized FDA-cleared and CE-marked class 2 medical devices passively captured and shared information about medication-taking using an ingestible sensor, and daily patterns of rest, activity, and exercise using a wearable patch that incorporates an accelerometer. InterventionsPharmacists provided targeted counselling for BP management as guided by the digital information. EvaluationBlood pressure was measured serially, and patient and provider experiences with DHFS use were assessed using satisfaction surveys. ResultsThe mean change in SBP over the 2-week evaluation period was -7.9 ± 22.1; mean change in DBP was -2.8 ± 12.9. A root cause for persistent hypertension was determined for all of these 34 patients: 68% had pharmaceutical resistance, and 32% had inadequate medication use. Specifically, 29% were found to be capable to achieving blood pressure control on their currently prescribed medications, 68% were found to have a need for additional pharmacological treatment, and 3% needed additional adherence support. Pharmacists found that the DHFD helped in targeting specific recommendations, and to create a collaborative experience with their patients. Patients found the experience to be positive and helpful. ConclusionDHFS that provides confirmation of medication taking and objective measures of lifestyle patterns can help pharmacists to identify specific factors contributing to uncontrolled hypertension, to make evidence-based prescribing and lifestyle recommendations for achieving treatment goals, and to create a collaborative experience for patients in the management of their self-care.

Autonomic response during bladder hydrodistention reflects the severity of symptoms in patients with bladder pain syndrome/interstitial cystitis.

To evaluate the correlation between symptom severity of bladder pain syndrome/interstitial cystitis (BPS/IC) and autonomic nervous system activity, we examined autonomic responses during bladder hydrodistention. Medical records were collected from a prospective database for patients who underwent bladder hydrodistention with a fixed protocol from March 2012 to December 2013. A total of 40 patients (16 males, 24 females) were included for the analysis. Hydrodistention was performed under general anesthesia (31 patients), spinal anesthesia (six patients), and both types of anesthesia (three patients) at different times. Twenty-five patients who underwent holmium laser enucleation of the prostate served as controls. Pulse rate (PR), systolic (SBP), and diastolic blood pressure (BP) were measured pre-hydrodistention, during hydrodistention, and after drainage. The spinal anesthesia and control groups exhibited little change in BP and PR during hydrodistention, while a significant increase was demonstrated in the general anesthesia group (e.g., ΔSBP 4.89 ± 4.80, 10.40 ± 19.03, and 56.26 ± 30.38 mm Hg, respectively, P < 0.001). Under general anesthesia, autonomic response during hydrodistention was more prominent in patients with preoperative visual analogue scale (VAS) pain score ≥7, Hunner's lesion, and glomerulation grade 4. Preoperative maximal cystometric capacity negatively correlated with changes in SBP during hydrodistention (R2 = 0.294, P = 0.009), while VAS score and interstitial cystitis problem index demonstrated a positive correlation with the changes (R2 = 0.208, P = 0.012; R2 = 0.173, P = 0.015). Under general anesthesia, exaggerated autonomic responses to bladder hydrodistention were demonstrated in BPS/IC patients, which reflected the severity of symptoms. These results support the hypothesis of altered activity of autonomic system in BPS/IC. Neurourol. Urodynam. 36:677-682, 2017. © 2016 Wiley Periodicals, Inc.

Abstract P168: Evaluation of the American Heart Association’s “Check Change ControlTM”- Blood Pressure Control Program

Background: Blood pressure (BP) awareness, treatment and control remains suboptimal among US adults with hypertension. In response, the AHA has developed the “Check. Change. Control. TM” (CCC) BP program to reduce BP in those with elevated BP. We evaluated the efficacy of this program as implemented in a sample of Asian and Hispanic senior citizens in Southern California. Methods: We studied 122 participants aged &gt;62 years (93% Chinese and 7% Hispanic) who participated in the CCC program in Los Angeles and Orange Counties, California. Systolic (SBP) and diastolic blood pressure (DBP) was recorded over the CCC program resulting in 8 readings over 4 months during which participants learned self-monitoring, tracking BP, the use of the Heart360 TM digital tool, and self-management skills. Participants in this analysis were required to have baseline, final, and at least two interim BP measures. BP changes from baseline to mid-study and final visit were examined by the paired t-test among the whole cohort and in those with elevated BP (&gt;=140 SBP and/or &gt;=90 DBP) at baseline. Results: Average baseline SBP was 136.8 (19.4) mm Hg and DBP was 76.0 (12.0) mm Hg. At baseline, 46.7% of the participants had elevated BP, which was reduced to 41% by the final visit. The figure depicts the change in SBP and DBP from baseline to mid visit and final visit for the overall cohort and those with elevated BP at baseline. There were significant reductions in both SBP and DBP overall and especially among those with elevated BP at baseline. Further, 36.1% of participants had a SBP drop of &gt;10 mm Hg from baseline to final visit. Conclusion: In conclusion, the AHA’s CCC program had a significant impact in reducing BP in our AHA CCC participants, especially among those with elevated BP at baseline. Further study should investigate the specific program and patient factors that best predict blood pressure reduction.

Digital interventions to promote self-management in adults with hypertension systematic review and meta-analysis.

Objective:To synthesize the evidence for using interactive digital interventions (IDIs) to support patient self-management of hypertension, and to determine their impact on control and reduction of blood pressure.Method:Systematic review with meta-analysis was undertaken with a search performed in MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Cochrane Library, DoPHER, TROPHI, Social Science Citation Index and Science Citation Index. The population was adults (>18 years) with hypertension, intervention was an IDI and the comparator was usual care. Primary outcomes were change in SBP and DBP. Only randomized controlled trials and studies published in journals and in English were eligible. Eligible IDIs included interventions accessed through a computer, smartphone or other hand-held device.Results:Four out of seven studies showed a significantly greater reduction for intervention compared to usual care for SBP, with no difference found for three. Overall, IDIs significantly reduced SBP, with the weighted mean difference being −3.74 mmHg [95% confidence interval (CI) −2.19 to −2.58] with no heterogeneity observed (I-squared = 0.0%, P = 0.990). For DBP, four out of six studies indicated a greater reduction for intervention compared to controls, with no difference found for two. For DBP, a significant reduction of −2.37 mmHg (95% CI −0.40 to −4.35) was found, but considerable heterogeneity was noted (I-squared = 80.1%, P = <0.001).Conclusion:IDIs lower both SBP and DBP compared to usual care. Results suggest these findings can be applied to a wide range of healthcare systems and populations. However, sustainability and long-term clinical effectiveness of these interventions remain uncertain.

Effect of Etomidate Versus Combination of Propofol-Ketamine and Thiopental-Ketamine on Hemodynamic Response to Laryngoscopy and Intubation: A Randomized Double Blind Clinical Trial.

Background:Laryngoscopy and intubation frequently used for airway management during general anesthesia, is frequently associated with undesirable hemodynamic disturbances.Objectives:The aim of this study was to compare the effects of etomidate, combination of propofol-ketamine and thiopental-ketamine as induction agents on hemodynamic response to laryngoscopy and intubation.Patients and Methods:In a double blind, randomized clinical trial a total of 120 adult patients of both sexes, aged 18 - 45 years, scheduled for elective surgery under general anesthesia were randomly assigned into three equally sized groups. Patients in group A received etomidate (0.3 mg/kg) plus normal saline as placebo. Patients in group B and C received propofol (1.5 mg/kg) plus ketamine (0.5 mg/kg) and thiopental sodium (3 mg/kg) plus ketamine (0.5 mg/kg), respectively for anesthesia induction. Before laryngoscopy and tracheal intubation, immediately after, and also one and three minutes after the procedures, hemodynamic values (SBP, DBP, MAP and HR) were measured.Results:A repeated measurement ANOVA showed significant changes in mean SBP and DBP between the time points (P < 0.05). In addition, the main effect of MAP and HR were statistically significant during the course of study (P < 0.05). Furthermore, after induction of anesthesia, the three study groups had significantly different SBP, DBP and MAP changes overtime (P < 0.05). However, HR changes over time were not statistically significant (P > 0.05). Combination of propofol-ketamine had superior hemodynamic stability compared to other induction agents.Conclusions:Combination of propofol-ketamine may be recommended as an effective and safe induction agent for attenuating hemodynamic responses to laryngoscopy and intubation with better hemodynamic stability. Although, further well-designed randomized clinical trials to confirm the safety and efficacy of this combination, especially in critically ill patients or patients with cardiovascular disease, are warranted.

Association of late-life changes in blood pressure and cognitive status.

BackgroundDisagreement exists on the association between changes in blood pressure and cognitive impairment. We aimed to examine whether 4-year changes in systolic and diastolic blood pressure (SBP and DBP) are associated with cognitive status in a representative sample of older men and women.MethodsAnalysis of longitudinal data from 854 participants of a population-based German sample (aged 60–87 years) was performed with standard cognitive screening and blood pressure measurements. Effects of changes in SBP and DBP (10 mmHg and 5 mmHg respectively as unit of regression effect measure) on cognitive status were evaluated using non-parametric and linear regression modeling.ResultsNo clear associations were seen between changes in SBP or in DBP and cognitive scores. Small effects were found after stratification for sex and hypertension awareness. Specifically, larger decreases in SBP were associated with higher cognitive scores in those men aware of their hypertension (10 mmHg decrease in SBP, β = −0.26, 95% CI: −0.51 to −0.02) and men with controlled hypertension (10 mmHg decrease in SBP, β = −0.44, 95% CI: −0.92 to −0.03). Additionally larger increases in DBP were associated with higher cognitive scores in men with controlled hypertension (5 mmHg increase in DBP, β = 0.67, 95% CI: 0.19–1.15). For women aware of their hypertension, larger decreases in DBP were associated with higher cognitive scores (5 mmHg decrease in DBP, β = −0.26; 95%CI: −0.51 to −0.01).ConclusionsChanges in blood pressure were only weakly associated with cognitive status. Specifically, decreases in SBP were associated with higher cognitive scores in men aware of their hypertension and especially those that were medically controlled.

Postural blood pressure electrocardiographic changes are associated with falls in older people

To determine the magnitude of postural blood pressure change, differences in ECG between fallers and non-fallers were measured. Postural blood pressure change is associated with symptoms of dizziness, presyncope, and syncope. In this cross-sectional study were included participants from The Malaysian Falls Assessment and Intervention Trial: fallers, aged 65 years or older with two or more falls or one injurious fall in 12 months, from a teaching hospital; and non-fallers, aged 65 years and older found through word-of-mouth and advertising. Noninvasive beat-to-beat blood pressure was measured at 10 min supine rest and 3 min standing. The maximal drop in systolic and diastolic pressure was calculated from a 12-lead ECG interpreted by a cardiologist. Basic demographics, medical history, and symptoms of dizziness, presyncope, and syncope were recorded for all patients. We recruited 155 fallers and 112 non-fallers. Fallers had a significantly longer PR interval (179 ± 32 vs. 168 ± 27 ms, p = 0.013) and a longer corrected QT interval (449 ± 41 vs. 443 ± 39 msec, p = 0.008), and larger change in SBP (28 ± 14 vs. 19 ± 9 mmHg, p < 0.001) with posture change. SBP drop of ≥30mmHg associated with recurrent and injurious falls [odds ratio [95 % confidence interval] = 7.61 (3.18-18.21)]. The changes remained significant after adjustment for symptoms of dizziness, presyncope and syncope. Older individuals with recurrent and injurious falls have significantly longer PR and QT intervals and larger SBP reduction with posture change as compared to non-fallers, and these are not explained by the presence of dizziness, presyncope, or syncope. SBP cut-off of ≥30mmHg considered for postural measurements using continuous BP monitors, the significance of this value needs to be evaluated.