Changes In Systolic Blood Pressure Research Articles

Changes in blood pressure associated with frailty and sarcopenia in elderly outpatients with cardiometabolic diseases.

We aimed to examine the relationship between changes in clinic blood pressure (BP) and frailty and sarcopenia in elderly outpatients with cardiometabolic disease. In 691 elderly outpatients with cardiometabolic diseases, the associations of frailty according to the modified Japanese Cardiovascular Health Study score (J-CHS) and Kihon Checklist (KCL) criteria with clinic BP were evaluated at baseline and followed up for 3 years. Among the patients (79.2 ± 6.3 years, male 35.6%), 30.4% had frailty by the J-CHS criteria and 38.0% by the KCL criteria. A J-curve relationship was observed between BP and frailty; the prevalence of frailty was the lowest in patients with systolic BP (SBP) 119.5-130.5 mmHg and in those with diastolic BP (DBP) 72.0-80.5 mmHg. Frailty by the J-CHS criteria correlated with lower DBP (OR = 0.892 per 5 mmHg increase, 95% confidence interval [CI] 0.819-0.972, P = 0.009), whereas that by the KCL criteria correlated with lower SBP (OR = 0.872 per 10 mmHg increase, 95% CI 0.785-0.969, P = 0.011) in multivariate-adjusted models. In patients with frailty by the J-CHS criteria at baseline, changes in DBP (OR = 0.921 per 1 mmHg change, 95% CI 0.851-0.996, P = 0.038) were associated with sustained frailty 1 year later. Changes in DBP were associated with progression to a slow walking speed 1 year later (OR = 0.939, 95% CI 0.883-0.999, P = 0.047). Changes in SBP (OR = 0.928, 95% CI 0.878-0.981, P = 0.008) and DBP (OR = 0.926, 95% CI 0.859-0.997, P = 0.042) were associated with progression to a weak hand grip strength 3 years later. A J-curve relationship was observed between frailty and BP, and a decline in BP was associated with progression to a slow walking speed and weak hand grip strength in elderly outpatients with cardiometabolic diseases. Geriatr Gerontol Int 2023; 23: 506-516.

Role of Meditation in Ameliorating Examination Stress Induced Changes in Cardiovascular and Autonomic Functions.

Examination stress is a very well-known model of psychological stress in students. It induces changes in systolic (SBP) and diastolic blood pressure (DBP), along with changes in heart rate variability (HRV) and baroreflex sensitivity (BRS), due to autonomic perturbations. To find out if Raj Yoga meditation (RYM) practice affects autonomic and cardiovascular function in healthy young subjects during periods of examination stress. Our primary objective was to evaluate the effect of one month of supervised RYM practice on ameliorating examination-induced changes in cardiovascular and autonomic function. The secondary objective was to measure the stress levels of medical students before and after RYM. Pre-training measurements of SBP, DBP, HRV, and BRS were done, and the Medical Student Stressor Questionnaire (MSSQ) was administered to 80 participants one month before examinations. They were then trained in RYM. Post-training assessment of the same parameters was done after examinations and also after two months. In our study, RYM training decreased DBP (p = 0.01) but not SBP. BRS showed a trend towards an increase after RYM practice, but it was not statistically significant (p = 0.44). The standard deviation of the NN interval (SDNN) (p = 0.03), low-frequency (LF) nu (0.003), and high-frequency (HF) nu (0.04) showed a statistically significant change. Average RR, median RR, average rate, square root of the mean squared differences of successive NN intervals (RMSSD), pRR, total power, LF (µs2), and LF/HF ratio were not statistically significantly different between the three groups. There was a statistically significant decline in MSSQ scores for MSSQ I (p = 0.04), MSSQ II (p = 0.04), and MSSQ IV (p = 0.03). Short-term practice of supervised RYM during stressful periods is protective for the cardiovascular and autonomic systems and decreases stress in medical students.

Site-specific effects of dobutamine on cardiac conduction and refractoriness.

Isoproterenol, a non-specific beta agonist, is commonly used during electrophysiology studies (EPS). However, with the significant increase in the price of isoproterenol in 2015 and the increasing number of catheter ablations performed, the cost implications cannot be ignored. Dobutamine is a less expensive synthetic compound developed from isoproterenol with a similar mechanism to enhance cardiac conduction and shorten refractoriness, thus making it a feasible substitute with a lower cost. However, the use of dobutamine for EPS has not been well-reported in the literature. To determine the site-specific effects of various doses of dobutamine on cardiac conduction and refractoriness and assess its safety during EPS. From February 2020 to October 2020, 40 non-consecutive patients scheduled for elective EPS, supraventricular tachycardia, atrial fibrillation, and premature ventricular contraction ablations at a single center were consented and prospectively enrolled to assess the effect of dobutamine on the cardiac conduction system. At the end of each ablation procedure, measures of cardiac conduction and refractoriness were recorded at baseline and with incremental doses of dobutamine at 5, 10, 15, and 20 mcg/kg/min. For the primary analysis, the change per dose of dobutamine from baseline to each dosing level of dobutamine received by the patients, comparing atrioventricular node block cycle length (AVNBCL), ventricular atrial block cycle length (VABCL) and sinus cycle length (SCL), was tested using mixed-effect regression. For the secondary analysis, dobutamine dose level was tested for association with relative changes from baseline of each electrophysiologic parameter (SCL, AVNBCL, VABCL, atrioventricular node effective refractory period (AVNERP), AH, QRS, QT, QTc, atrial effective refractory period (AERP), ventricular effective refractory period (VERP), using mixed-effect regression. Changes in systolic and diastolic blood pressures were also assessed. The Holm-Bonferroni method was used to adjust for multiple testing. For the primary analysis there was no statistically significant change of AVNBCL and VABCL relative to SCL from baseline to each dose level of dobutamine. The SCL, AVNBCL, VABCL, AVNERP, AERP, VERP and the AH, and QT intervals all demonstrated a statistically significant decrease from baseline to at least one dose level with incremental dobutamine dosing. Two patients (5%) developed hypotension during the study and one patient (2.5%) received a vasopressor. Two patients (5%) had induced arrhythmias but otherwise no major adverse events were noted. In this study, there was no statistically significant change of AVNBCL and VABCL relative to SCL from baseline to any dose level of dobutamine. As expected, the AH and QT intervals, and the VABCL, VERP, AERP and AVNERP all significantly decreased from baseline to at least one dose level with an escalation in dobutamine dose. Dobutamine was well-tolerated and safe to use during EPS.

Evaluation of the Efficacy and Tolerability of a Fixed Dose Combination of Amlodipine And Indapamide in Patients Older Than 55 Years

Background: There is very limited real-life data on hypertension management in Bangladeshi population. Considering this fact, this study evaluated the effectiveness of treatment with an indapamide/amlodipine single-pill combination (SPC) in Bangladeshi patients over the age of 55 years, in an OPD setting with uncontrolledsystolic hypertension in real-life clinical practice. Methods: This was a 3-month, multicenter, observational, open-label study conducted in 3 divisional cities of Bangladesh among patients with grade I or II hypertensions who were either uncontrolled on previous antihypertensive treatment or treatment-naïve. The effectiveness of indapamide/amlodipine SPC was assessed by the change in office systolic blood pressure (SBP) and the rate of target SBP (< 140 mmHg)achievement at 2 weeks, 1 month and 3 months, in four age groups: 55–59 years, 60–69 years, 70–79 years, and80 years or older. Results: The COMBINE study recruited 213 patients, of whom 185 took indapamide/amlodipine 1.5/5 mg SPC forafull three-month course of therapy.Mean age was 62.4±7.4 years, 76 men [41.1%] and 109 women [58.9%]. The absolute decrease of SBP during 3 months of taking indapamide/amlodipine single-pill combination (SPC) was 27.7 mm Hg, DBP - 10.2 mm Hg.After 3 months of treatment significant SBPdecreases from baseline were observed in each age group:”29.9 mmHg (from 156.7 to 126.8),”25.1 mmHg (from 152.7 to 127.6),”26.1 mmHg (from 152.8 to 126.7),and “ 24.5 mmHg (from 151.8 to 127.3)in the 55–59, 60–69, 70–79, and 80 years and older age groups, respectively. Conclusion: This COMBINE study results showed that indapamide/amlodipine SPC was associated with significant and rapid reductions in BP even in a different age range of Bangladeshi patients in routine clinical practice. This study result is consistent with already achieved data of this SPC globally. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 200

Effect of Adapted Mindfulness Training in Participants With Elevated Office Blood Pressure: The MB-BP Study: A Randomized Clinical Trial.

Background Hypertension is a leading risk factor for cardiovascular disease. Despite availability of effective lifestyle and medication treatments, blood pressure (BP) is poorly controlled in the United States. Mindfulness training may offer a novel approach to improve BP control. The objective was to evaluate the effects of Mindfulness-Based Blood Pressure Reduction (MB-BP) versus enhanced usual care control on unattended office systolic BP. Methods and Results Methods included a parallel-group phase 2 randomized clinical trial conducted from June 2017 to November 2020. Follow-up time was 6 months. Outcome assessors and data analyst were blinded to group allocation. Participants had elevated unattended office BP (≥120/80 mm Hg). We randomized 201 participants to MB-BP (n=101) or enhanced usual care control (n=100). MB-BP is a mindfulness-based program adapted for elevated BP. Loss-to-follow-up was 17.4%. The primary outcome was change in unattended office systolic BP at 6 months. A total of 201 participants (58.7% women; 81.1% non-Hispanic White race and ethnicity; mean age, 59.5 years) were randomized. Results showed that MB-BP was associated with a 5.9-mm Hg reduction (95% CI, -9.1 to -2.8 mm Hg) in systolic BP from baseline and outperformed the control group by 4.5 mm Hg at 6 months (95% CI, -9.0 to -0.1 mm Hg) in prespecified analyses. Plausible mechanisms with evidence to be impacted by MB-BP versus control were sedentary activity (-350.8 sitting min/wk [95% CI, -636.5 to -65.1] sitting min/wk), Dietary Approaches to Stop Hypertension diet (0.32 score [95% CI, -0.04 to 0.67]), and mindfulness (7.3 score [95% CI, 3.0-11.6]). Conclusions A mindfulness-based program adapted for individuals with elevated BP showed clinically relevant reductions in systolic BP compared with enhanced usual care. Mindfulness training may be a useful approach to improve BP. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03256890 and NCT03859076.

(046) Long-term Testosterone Pellet Insertion in Women with Low Libido Shows No Evidence of Erythrocytosis and a Minimal Side Effect Profile

Abstract Introduction Testosterone therapy for low libido in women has become more prevalent over recent years. While numerous testosterone formulations exist and have been studied in women, there has been little data assessing the safety and efficacy of subcutaneous testosterone pellet use in this population. Objective The aim of this study was to understand the biochemical effects and side effect profile of female patients who underwent testosterone pellet insertion by a single provider at an academic institution. Methods An Institutional Review Board approved retrospective chart review of all female patients undergoing testosterone pellet insertion from 2009-2022 was undertaken. Women taking 75 mg and 100 mg testosterone pellets were identified, and separately analyzed for biochemical and clinical data. Analysis of variance was performed to determine statistical significance of laboratory values over duration of testosterone pellet insertion. Results A total of 220 separate pellet insertion sessions were undertaken amongst the two cohorts. In the 75 mg cohort, the average number of pellets inserted per session was one. The average time between pellet insertion was 4.7 months (Standard error (SE) 0.1) over a five year period. There was no statistically significant change in testosterone trough levels over the duration of treatment (P=0.5105). There was also no statistically significant change in hematocrit levels from baseline (P=0.9696). In addition, no statistically significant change in systolic blood pressure was noted (P=0.8798). None of the patients in this cohort reported new or worsening acne. One patient reported mild increased facial hair growth. Two out of 19 (10.5%) patients reported vaginal bleeding during the study period, but both were also on systemic estrogen therapy at the time. In the 100 mg cohort, the average number of pellets inserted per session was one. The average time between pellet insertion was 4.3 months (SE 0.1) over an 18 month period. There was a statistically significant rise in testosterone trough levels over the duration of treatment (P=0.0168). There was no statistically significant change in hematocrit levels from baseline (P=0.7805). There was no statistically significant change in systolic blood pressure (P=0.7030). Two patients in this cohort were started on new blood pressure medications during the treatment course. None of the patients in this group reported new or worsening acne, changes in facial hair growth, or vaginal bleeding. Conclusions In both the 75 mg and 100 mg cohorts, testosterone pellet insertion lead to steady testosterone levels based on trough data, with a statistically significant rise amongst the 100mg cohort, and without any statistically significant rise in erythrocytosis rates, which is commonly seen with exogenous testosterone administration in the male population. In addition, no statistically significant changes in systolic blood pressure were noted in either cohort, along with minimal other side effects. This data suggests a relatively safe biochemical profile for regulated testosterone pellet administration in women with low libido, with a minimal side effect profile. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific

Machine Learning-Based prediction of Post-Treatment ambulatory blood pressure in patients with hypertension

Purpose. Pre-treatment prediction of individual blood pressure (BP) response to anti-hypertensive medication is important to determine the specific regimen for promptly and safely achieving a target BP. This study aimed to develop supervised machine learning (ML) models for predicting patient-specific treatment effects using 24-hour ambulatory BP monitoring (ABPM) data. Materials and Methods. A total of 1,129 patients who had both baseline and follow-up ABPM data were randomly assigned into training, validation and test sets in a 3:1:1 ratio. Utilising the features including clinical and laboratory findings, initial ABPM data, and anti-hypertensive medication at baseline and at follow-up, ML models were developed to predict post-treatment individual BP response. Each case was labelled by the mean 24-hour and daytime BPs derived from the follow-up ABPM. Results. At baseline, 616 (55%) patients had been treated using mono or combination therapy with 45 anti-hypertensive drugs and the remaining 513 (45%) patients had been untreated (drug-naïve). By using CatBoost, the difference between predicted vs. measured mean 24-hour systolic BP at follow-up was 8.4 ± 7.0 mm Hg (% difference of 6.6% ± 5.7%). The difference between predicted vs. measured mean 24-hour diastolic BP was 5.3 ± 4.3 mm Hg (% difference of 6.8% ± 5.5%). There were significant correlations between the CatBoost-predicted vs. the ABPM-measured changes in the mean 24-hour Systolic (r = 0.74) and diastolic (r = 0.68) BPs from baseline to follow-up. Even in the patients with renal insufficiency or diabetes, the correlations between CatBoost-predicted vs. ABPM-measured BP changes were significant. Conclusion. ML algorithms accurately predict the post-treatment ambulatory BP levels, which may assist clinicians in personalising anti-hypertensive treatment.

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

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

Central Hemodynamic Response to Activation of the Vestibular Sympathetic Reflex with Head Down Rotation in Healthy Young Adults.

The purpose of this study was to assess the effect of vestibular-sympathetic activation on estimated measures of central (aortic) hemodynamic load in young adults. Methods: 31 participants (n=14 female, 17 male) underwent radial tonometry and popliteal Doppler-ultrasound in the prone position with the head in a neutral position and during 10 minutes of head-down rotation (HDR) as a means of activating the vestibular sympathetic reflex. Subjective orthostatic intolerance was assessed utilizing a 10-item orthostatic hypotension questionnaire. Results: There was a reduction in brachial systolic BP during HDR (111±10 vs. 109±9 mmHg, p<0.05), but there was no change in aortic systolic BP (100±9 vs. 99±8 mmHg, p>0.05). Aortic augmentation index (-5±11 vs. -12±12%, p<0.05) and reservoir pressure (28±8 vs. 26±8mmHg, p<0.05) were reduced with a concomitant reduction in popliteal conductance (5.6±0.7 vs. 4.5±0.7 ml/min∙mmHg, p<0.05). Change in aortic systolic BP was associated with subjective orthostatic intolerance score (r = -0.39, p<0.05). Conclusions: Activation of the vestibular sympathetic reflex via HDR resulted in slight reductions in brachial BP concomitant with preservation of aortic BP. Despite peripheral vascular constriction during HDR, there was a reduction in pressure from wave reflections and reservoir pressure. Finally, there was an association between change in aortic systolic BP during HDR and orthostatic intolerance score suggesting that individuals that cannot defend against drops in aortic BP during vestibular sympathetic reflex activation may be more likely to experience higher subjective symptomatology of orthostatic intolerance.

Admission blood pressure and clinical outcomes in patients with acute ischaemic stroke treated with intravenous alteplase and endovascular treatment versus endovascular treatment alone: A MR CLEAN-NO IV substudy.

High systolic blood pressure (SBP) is associated with poor functional outcome. We analysed whether the association of SBP with outcomes after endovascular treatment (EVT) is modified by prior intravenous thrombolysis (IVT). This was a post-hoc analysis of MR CLEAN-NO IV, a randomised trial of IVT with alteplase followed by EVT versus EVT alone, within 4.5 h from stroke onset. SBP was recorded on hospital admission. The primary outcome was 90-day modified Rankin Scale (mRS) score and secondary outcomes included symptomatic intracranial haemorrhage (sICH) and successful reperfusion (eTICI 2b-3), analysed with (ordinal) logistic regression. Estimates were calculated per 10 mmHg change in SBP. We assessed whether IVT modified the associations of SBP with these outcomes using multiplicative interaction terms. Of 539 randomised patients, 266 received IVT. The association of SBP with mRS score was J-shaped, with an inflection point at 150 mmHg. Using 150 mmHg as a reference point, SBPs higher than 150 mmHg were associated with poor functional outcome (acOR: 1.23, 95% CI: 1.09-1.38), but lower SBPs were not (acOR: 1.14, 95% CI: 0.99-1.30). Higher SBP was not associated with the risk of sICH (aOR: 1.09, 95% CI: 0.93-1.27) nor with the probability of successful reperfusion (aOR: 1.00, 95% CI: 0.91-1.10). Our main result was that we found no effect modification by IVT (p-values for interaction, mRS = 0.94; sICH = 0.26; successful reperfusion = 0.58). There was no effect modification of IVT with SBP for any of the clinical outcomes. Therefore, the level of SBP (if ⩽185/110 mmHg) should not guide IVT decisions in patients otherwise eligible for both IVT and EVT within the 4.5-h time window. ISRCTN80619088, https://www.isrctn.com/ISRCTN80619088.

Metabolomic Profiles Associated With Blood Pressure Reduction in Response to the DASH and DASH-Sodium Dietary Interventions.

The DASH (Dietary Approaches to Stop Hypertension) diets reduced blood pressure (BP) in the DASH and DASH-Sodium trials, but the underlying mechanisms are unclear. We identified metabolites associated with systolic BP or diastolic BP (DBP) changes induced by dietary interventions (DASH versus control arms) in 2 randomized controlled feeding studies-the DASH and DASH-Sodium trials. Metabolomic profiling was conducted in serum and urine samples collected at the end of diet interventions: DASH (n=219) and DASH-Sodium (n=395). Using multivariable linear regression models, associations were examined between metabolites and change in systolic BP and DBP. Tested for interactions between diet interventions and metabolites were the following comparisons: (1) DASH versus control diets in the DASH trial (serum), (2) DASH high-sodium versus control high-sodium diets in the DASH-Sodium trial (urine), and (3) DASH low-sodium versus control high-sodium diets in the DASH-Sodium trial (urine). Sixty-five significant interactions were identified (DASH trial [serum], 12; DASH high sodium [urine], 35; DASH low sodium [urine], 18) between metabolites and systolic BP or DBP. In the DASH trial, serum tryptophan betaine was associated with reductions in DBP in participants consuming the DASH diets but not control diets (P interaction, 0.023). In the DASH-Sodium trial, urine levels of N-methylglutamate and proline derivatives (eg, stachydrine, 3-hydroxystachydrine, N-methylproline, and N-methylhydroxyproline) were associated with reductions in systolic BP or DBP in participants consuming the DASH diets but not control diets (P interaction, <0.05 for all tests). We identified metabolites that were associated with BP lowering in response to dietary interventions. URL: https://www. gov/ct2/show/NCT03403166; Unique identifier: NCT03403166 (DASH trial). URL: https://www. gov/ct2/show/NCT00000608; Unique identifier: NCT00000608 (DASH-Sodium trial).

Development and validation of a random forest model to predict functional outcome in patients with intracerebral hemorrhage.

To develop and validate a machine learning (ML)-based model to predict functional outcome in Chinese patients with intracerebral hemorrhage (ICH). This retrospective cohort study enrolled patients with ICH between November 2017 and November 2020. The follow-up period ended in February 2021. The study population was divided into training and testing sets with a ratio of 7:3. All variables were included in the least absolute shrinkage and selection operator (LASSO) regression for feature selection. The selected variables were incorporated into the random forest algorithm to construct the prediction model. The predictive performance of the model was evaluated via the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and calibration curve. A total of 412 ICH patients were included, with 288 in the training set, and 124 in the testing set. Twelve attributes were selected: neurological deterioration, Glasgow Coma Scale (GCS) score at 24 h, baseline GCS score, time from onset to the emergency room, blood glucose, diastolic blood pressure (DBP) change in 24 h, hematoma volume change in 24 h, systemic immune-inflammatory index (SII), systolic blood pressure (SBP) change in 24 h, serum creatinine, serum sodium, and age. In the testing set, the accuracy, AUC, sensitivity, specificity, PPV, and NPV of the model were 0.895, 0.964, 0.872, 0.906, 0.810, and 0.939, respectively. The calibration curves showed a good calibration capability of the model. This developed random forest model performed well in predicting 3-month poor functional outcome for Chinese ICH patients.

Associations of SGLT2 genetic polymorphisms with salt sensitivity, blood pressure changes and hypertension incidence in Chinese adults.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors lowers blood pressure (BP) and exert a salutary effect on the salt sensitivity of BP. This study aimed to examine the associations of SGLT2 genetic variants with salt sensitivity, longitudinal BP changes and the risk of incident hypertension in Baoji Salt-Sensitive Study. A total of 514 participants were recruited when the cohort was established in 2004, and 333 participants received a dietary intervention that consisted of a 3-day usual diet followed sequentially by a 7-day low-salt diet and a 7-day high-salt diet. The cohort was then followed up for 14 years to evaluate the longitudinal BP changes and development of hypertension. We found that SGLT2 SNP rs3813007 was significantly associated with the systolic BP (SBP) responses to the low-salt diet. Over the 14 years of follow-up, SNPs rs3116149 and rs3813008 were significantly associated with the longitudinal SBP changes, and SNPs rs3116149, rs3813008, rs3813007 in SGLT2 were significantly associated with incidence of hypertension. Furthermore, gene-based analyses revealed that SGLT2 was significantly associated with hypertension incidence. Our study suggests that SGLT2 genetic polymorphisms may be involved in salt sensitivity and development of hypertension.

Carotid artery corrected flow time and respiratory variation of blood flow peak velocity for prediction of hypotension after induction of general anesthesia in adult patients undergoing emergency laparotomy for peritonitis: A prospective, observational study.

Doppler waveform analysis of carotid artery has been found to predict fluid responsiveness in patients undergoing elective surgeries. We evaluated the role of carotid artery corrected flow time (FTc) and respiratory variation of blood flow peak velocity (ðVpeak) in predicting post induction hypotension in patients undergoing emergency laparotomy for peritonitis. Adult patients (n = 60) with perforation peritonitis undergoing emergency laparotomy under general anesthesia (GA) were recruited in this prospective, observational study. Carotid ultrasonography was performed pre-induction, to determine FTc and ðVpeak. Post-induction hemodynamic parameters were recorded for 5 minutes. Spearman's rank correlation coefficient was used to determine the relationship between hypotension and carotid artery measurements. Post-induction hypotension occurred in 48.3% of patients. The carotid artery FTc was significantly lower (P = 0.008) in patients who developed post-induction hypotension, but ðVpeak was statistically similar (P = 0.62) in both groups. Spearman's rank correlation coefficient revealed a statistically significant correlation between FTc and systolic blood pressure (SBP) change at one-minute post induction (r2 = -0.29, P = 0.03); however statistical significance were not achieved at 2 minutes and 3 minutes (P = 0.05 at both time points). Carotid artery FTc had an area under the receiver operating characteristic (AUROC) curve (95% CI) of 0.70 (0.57-0.84) to predict post-induction hypotension and best cutoff value of 344.8 ms with a sensitivity and specificity of 61% and 79%, respectively. Carotid artery ðVpeak had an AUROC curve (95% CI) of 0.54 (0.39-0.69) to predict post-induction hypotension and best cutoff value of 7.9% with a sensitivity and specificity of 62% and 55%, respectively. Carotid artery FTc and ðVpeak are not reasonable predictors of hypotension in patients undergoing emergency laparotomy for perforation peritonitis.

Associations of long-term exposure to air pollution, physical activity with blood pressure and prevalence of hypertension: the China Health and Retirement Longitudinal Study.

Long-term exposure to air pollution and physical activity (PA) are linked to blood pressure and hypertension. However, the joint effect of air pollution and PA on blood pressure and hypertension are still unknown in Chinese middle-aged and older adults. A total of 14,622 middle-aged and older adults from the China Health and Retirement Longitudinal Study wave 3 were included in this study. Ambient air pollution [particulate matter with diameter ≤ 2.5 μm (PM2.5), or ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbonic oxide (CO)] were estimated using satellite-based spatiotemporal models. PA was investigated using International Physical Activity Questionnaire. Generalized linear models were used to examine the associations of air pollution, PA score with blood pressure [systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)], and the prevalence of hypertension. Subgroup analysis was conducted to investigate the effects of air pollution on blood pressure and the prevalence of hypertension in different PA groups. The results showed that for each inter-quartile range (IQR) increase in PM2.5 (25.45 μg/m3), PM10 (40.56 μg/m3), SO2 (18.61 μg/m3), NO2 (11.16 μg/m3), CO (0.42 mg/m3) and PA score (161.3 MET/h-week), the adjusted odd ratio (OR) of hypertension was 1.207 (95% confidence interval (CI): 1.137, 1.281), 1.189 (95%CI: 1.122, 1.260), 1.186 (95%CI: 1.112, 1.266), 1.186 (95%CI: 1.116, 1.260), 1.288 (95%CI: 1.223, 1.357), 0.948 (95%CI: 0.899, 0.999), respectively. Long-term exposure to PM2.5, PM10, SO2, NO2, and CO was associated with increased SBP, DBP, and MAP levels. For example, each IQR increase in PM2.5 was associated with 1.20 mmHg (95%CI: 0.69, 1.72) change in SBP, 0.66 mmHg (95%CI: 0.36, 0.97) change in DBP, and 0.84 mmHg (95%CI: 0.49, 1.19) change in MAP levels, respectively. Each IQR increase in PA score was associated with -0.56 mmHg (95%CI: -1.03, -0.09) change in SBP, -0.32 mmHg (95%CI: -0.59, -0.05) change in DBP, and -0.33 mmHg (95%CI: -0.64, -0.02) change in MAP levels, respectively. Subgroup analysis found that the estimated effects in the sufficient PA group were lower than that in the insufficient PA group. Long-term exposure to air pollutants is associated with increased blood pressure and hypertension risk, while high-level PA is associated with decreased blood pressure and hypertension risk. Strengthening PA might attenuate the adverse effects of air pollution on blood pressure and hypertension risk.

Obesity Weight Loss Phenotypes in CKD: Findings From the Chronic Renal Insufficiency Cohort Study

Although people with chronic kidney disease (CKD) and obesity have important motivations to lose weight, weight loss is also associated with health risks. We examined whether patterns of change in systolic blood pressure (SBP), serum albumin level, and fat-free mass (FFM) can help to differentiate between healthy and high-risk weight loss in this population. Using data from the Chronic Renal Insufficiency Cohort Study (CRIC), we estimated a joint multivariate latent class model with 6 classes to identify distinct trajectories of body mass index (BMI), albumin, and SBP among participants with obesity (BMI≥30 kg/m2 at baseline), accounting for informative missingness from death. In a secondary analysis, we fit a 6-class model with BMI and FFM. Among 2831 participants (median baseline BMI 35.6, interquartile range [IQR] 32.4-40.0 kg/m2), median follow-up was 6.8 (IQR 4.8-12.9) years, median age was 61 (IQR 54-67) years, 53% were male, 50% were non-Hispanic Black, and 82% were trying to control or lose weight at baseline. Latent classes were associated with mortality risk (5-year cumulative incidence of mortality 6.8% and 1.5% in class 6 and 3, respectively). Class 6 had the highest mortality rate and was characterized by early, steep BMI loss, early serum albumin decline, and late SBP increase. In the secondary analysis, a class characterized by steep BMI and FFM loss was associated with the highest death risk. Among adults with CKD and obesity, BMI loss with concomitant serum albumin or FFM loss was associated with a high risk of death.

Blood pressure responses by fitness status following a physical activity intervention in sedentary adults

Background: Blood pressure and peak oxygen uptake (VO 2peak ) are strong independent predictors of all-cause and cardiovascular mortality. A VO 2peak of 8 METs or greater is associated with greater cardiovascular health and probability of survival, whereas individuals with a VO 2peak less than 8 METs are at greater risk for cardiovascular and all-cause mortality. Increasing physical activity in insufficiently active adults is associated with improvements in blood pressure (BP). Additionally, the relationship between an individual’s baseline VO 2peak and BP responses following a walking intervention are unknown. Therefore, we examined the change in BP in individuals stratified based on baseline VO 2peak (&lt; 8 METs &amp; ≥ 8 METs). We hypothesized that those with a VO 2peak &lt; 8 METs would see greater blood pressure responses compared to those with a VO 2peak ≥ 8 METs. Methods: Cross-sectional, secondary analyses were carried out on data from a previously conducted clinical trial that included insufficiently active (as determined by accelerometry) individuals (N=518). Subjects underwent BP measurements, anthropometric testing, and a treadmill-based VO 2peak test with ventilatory gas exchange assessment to determine VO 2peak . Subjects with missing data were excluded from analyses. Additionally, only valid VO 2peak tests (≥90% age-predicted HR max , RER &gt; 1.0) were included. Three hundred and sixty nine individuals had BP measured and met the criteria for a valid VO 2peak test. Subjects were then stratified based on baseline VO 2peak : low fit (&lt;8 METS), and high fit (≥8 METS). Linear mixed model analyses were carried out to examine main effects (time and VO 2peak category) of the walking intervention on BP. The interaction of time and VO 2peak category was examined as well. Data are presented as means ± SD with α set at 0.05. Results: Eighty-one individuals had a VO 2peak greater than or equal to 8 METs (age = 41.9±10.0 years; BMI = 28.8±4.8; VO 2peak = 31.1±3.1 mL/kg/min; Males/Females = 55/26). Two-hundred and eighty-eight individuals had a VO2peak less than 8 METs (age = 45.9±8.6 years; BMI = 34.4±6.5; VO 2peak = 22.4±3.2 mL/kg/min; Males/Females = 75/213). There was a significant group by time interaction effect for changes in systolic BP (≥ 8 METs: Pre = 120.8±1.4, Post = 123.0±1.6 mmHg, &lt; 8 METs: Pre = 122.1±0.7, Post = 120.4±1.0 mmHg) (p = 0.03). There was no significant effects found for DBP. Conclusions: These secondary analyses found that SBP significantly decreased following a 6-month walking intervention in individuals with low-fitness. These data suggest that those with lower baseline CRF are likely to have greater declines in SBP. Supported by NIH R01CA1989 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Inverse association between changes in systolic and diastolic blood pressure and risk of depression: A nationally representative cohort study

BackgroundDepression is one of complex mental disorders with diverse etiological factors but the association between blood pressure (BP) and depression is unknown. We aimed to investigate the association between changes in BP (systolic and diastolic) and incident depression. MethodsFrom the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS), 224,192 participants who underwent biennial health screenings from period I (2004–05) and II (2006–07) were included in the study. Systolic BP (SBP) and diastolic BP (DBP) categories were defined as follows: SBP into 5 categories (<90 mmHg, 90 mmHg −119 mmHg, 120 mmHg −129 mmHg, 130 mmHg −139 mmHg, ≥140 mmHg) and DBP into 4 categories (<60 mmHg, 60 mmHg −79 mmHg, 80 mmHg −89 mmHg, ≥90 mmHg). Also, BP levels were classified into 5 groups: normal, elevated BP, stage 1 BP, stage 2 BP, hypotension. Using the Cox proportional hazards regression, changes in SBP and DBP between two screening periods and the risk of depression were calculated by adjusted hazard ratio (aHR) and 95 % confidence interval (CI). ResultsThere were 17,780 depression events during 1.5 million person-year of follow-up. Compared to the participants with SBP ≥ 140 mmHg or DBP ≥ 90 mmHg from both periods, those who decreased SBP from ≥140 mmHg to 120 mmHg–129 mmHg (aHR 1.13; 95 % CI 1.04–1.24; P = 0.001) and those who decreased DBP from ≥90 mmHg to 60 mmHg–79 mmHg (aHR 1.10; 95 % CI 1.02–1.20; P = 0.020) showed a higher risk of depression, respectively. ConclusionsChanges in SBP and DBP showed an inverse relationship with depression risk.

Spontaneous Cardiac Baroreflex Sensitivity in Young, Healthy Black and White Adults: Influence of Race and Sex

Background: Black (BL) individuals living in the United States are more likely to develop hypertension and cardiovascular disease compared to their White (WH) counterparts. However, studies investigating racial differences in blood pressure regulation and baroreflex sensitivity (BRS) are limited and have reported equivocal results. Furthermore, despite BL females also having a high prevalence of hypertension and cardiovascular disease, sex differences are often not considered. Additionally, baroreflex effectiveness index (BEI) is a newer measure used to estimate baroreflex function, yet studies have not examined the influence of sex or race on BEI. Therefore, the purpose of this project was to investigate the effects of both race and sex on cardiac BRS and BEI. We hypothesized that BL individuals would have lower cardiac BRS and BEI than WH individuals. Methods: We studied 88 young healthy adults, 28 BL males (21 ± 3 years; mean ± SD), 17 WH males (24 ± 4 years), 15 BL females (21 ± 3 years), and 28 WH females (23 ± 4 years). Heart rate (ECG) and beat-to-beat arterial blood pressure (finger photoplethysmography) were continuously recorded during a five-minute resting baseline. Cardiac BRS was measured using the Sequence Method, by identifying the gain of the relationship between systolic blood pressure and RRI from sequence(s) of three or more consecutive heartbeats in which systolic blood pressure and RRI change in the same direction. BEI was quantified by baroreflex-driven ramps relative to all systolic blood pressure ramps. Results: Cardiac BRS was significantly higher in BL individuals (31 ± 15 ms/mmHg) compared to WH individuals (25 ± 11 ms/mmHg; main effect of race, p = 0.02). Interestingly, post hoc comparisons revealed that this was only true within the males (p = 0.03), but not females (p = 0.63). However, there was no difference in cardiac BRS between males and females (main effect of sex, p = 0.35) and no interaction between sex and race (p = 0.27). There were also no effects of race (p = 0.65) or sex (p = 0.15) on BEI. Conclusion: These preliminary data suggest that, in contrast to our hypothesis, young BL individuals have higher cardiac BRS compared to WH individuals; an effect that is only present in males. In contrast, BEI was not influenced by race or sex. Collectively, our findings do not suggest that lower cardiac BRS plays a major role in the higher prevalence of cardiovascular disease in BL individuals. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The effect of DASH diet on atherogenic indices, pro-oxidant-antioxidant balance, and liver steatosis in obese adults with non-alcoholic fatty liver disease: A double-blind controlled randomized clinical trial.

Background: The present clinical trial aimed to examine whether adherence to Dietary Approaches to Stop Hypertension (DASH) diet could improve lipid profile, the Pro-oxidant-antioxidant balance (PAB) as well as liver function in obese adults with non-alcoholic fatty liver disease (NAFLD). Methods: Sixty two patients with NAFLD were equally allocated into either DASH or low-calorie diet (LCD) group for 8 weeks. The primary and secondary outcomes were determined before and after the trial. Results: Forty patients completed the trial. Significant within group differences were found in dietary saturated fat, selenium, vitamins A and E as well as body weight and body mass index (BMI) and waist circumference (WC) after the intervention (P<0.05). DASH diet showed greater significant change in systolic and diastolic blood pressure without significant differences between the groups after 8 weeks. Apart from serum high-density lipoprotein cholesterol (HDL-C) and triglyceride/HDL-C, greater reductions were found not only in serum lipids and atherogenic indices (P<0.05) but also in serum aspartate aminotransferase (AST), AST to platelet ratio index (APRI) and lipid accumulation product (LAP) in DASH group in comparison to control group (P=0.008, P=0.019 and P=0.003, respectively). Nevertheless, there was not any difference in PAB level between the groups. Furthermore, adherence to DASH diet was more effective in alleviating liver steatosis compared with usual LCD (P=0.012). Conclusion: Adherence to DASH diet appears to be more effective in improving obesity, atherogenic and liver steatosis biomarkers but not oxidative stress (OS) than usual LCD.