Changes In Systolic Blood Pressure Research Articles

Increased Prevalence of Blood Pressure Instability Over Twenty-Four Hours in Chronic Spinal Cord Injury.

Spinal cord injury (SCI) leads to cardiovascular dysregulation, including persistent low blood pressure (BP), orthostatic hypotension, and autonomic dysreflexia, leading to daily BP instability that may not be adequately recognized. We compared mean systolic BP, diastolic BP, and heart rate from awake and asleep measurements over a 24-h period among persons with chronic SCI (n = 33; 30 cervical injuries and three upper thoracic injuries), ambulatory/non-injured (Ambulatory-NI; n = 13), and non-injured (NI) in a wheelchair (n = 9). Stability of awake BP was evaluated by deviation of systolic BP from 115 mmHg and percent of systolic BP measurement within and outside of 90-140 mmHg. Variability over 24 h was compared using coefficient of variation and average real variability. Awake hyper- and hypotensive events (change in systolic BP ±20 mmHg from the median) were compared to symptoms reported by the participants corresponding to BP events. Participants with SCI had a lower percentage of awake systolic BP measurements within 90-140 mmHg than Ambulatory-NI and a greater deviation below 115 mmHg. Coefficient of variation and successive differences of awake systolic and diastolic BP were greater in SCI than Ambulatory-NI. Finally, all SCI participants had hyper- and/or hypotensive events and 88% experienced the BP events asymptomatically. In conclusion, participants with SCI had significantly greater BP instability compared with NI, with many hyper- and hypotensive events occurring without symptoms. Clinical management of BP instability, regardless of symptoms, should be a priority after SCI to reduce the risk of cardiovascular disease and improve quality of life.

Association between Surgical Fibroid Removal and Blood Pressure: A Retrospective Case-Control and Prospective Cohort Study

<h3>Study Objective</h3> Fibroids, monoclonal proliferations of uterine smooth muscle cells, are common in women and have recently been associated with cardiometabolic risk factors including hypertension. The objective of this study is to determine whether fibroids are biomarker of systemic hypertension, and whether they may contribute to elevation in blood pressure. <h3>Design</h3> IRB-approved retrospective case-control study and prospective cohort study. <h3>Setting</h3> Single academic institution. <h3>Patients or Participants</h3> Retrospective chart review of 313 patients undergoing hysterectomy or myomectomy for fibroids and patients undergoing other surgical procedures for benign gynecological indications with similar demographic characteristics (control). Prospective cohort of 9 women undergoing myomectomy or hysterectomy for fibroids. <h3>Interventions</h3> Hysteroscopy, laparoscopy, open myomectomy or hysterectomy for fibroids (or non-fibroid indications as control). <h3>Measurements and Main Results</h3> In our retrospective cohort (n=294; mean age 41.9±10.6, 43.5% Black, 50% with fibroids), we found consistently that compared to patients without fibroids, patients with fibroids had significantly elevated systolic BP (pre-op 128 vs 122mmHg, p=0.0005; post-op 126 vs 122mmHg, p=0.02) but not diastolic BP (pre-op 77.6 vs 75.9mmHg, p=0.17; post-op 76.7 vs 75.0, p=0.19). Among patients with fibroids, surgical fibroid removal was associated with a small but not statistically or clinically significant drop in systolic (Δ=-2.21mmHg, p=0.062) but not diastolic BP (Δ=-0.93mmHg, p=0.39). The direction and magnitude of effect for change in systolic BP remained consistent after adjustment for age, race, and presence of diagnosed hypertension (β=-2.45, p=0.17). In our prospective cohort, there was a significant decrease in SBP of 9.9mmHg (pre- versus post-operatively), but no change in DBP following fibroid removal (p=0.03, p=0.14, respectively). Serum levels of Ang-II and ACE were not significantly altered following surgical fibroid removal (p=0.39, p=0.80, respectively). <h3>Conclusion</h3> Altogether, these findings demonstrate that fibroids are associated with hypertension and suggest that fibroid removal may lead to a clinically significant decrease in systolic blood pressure. These changes may occur by a mechanism independent of the renin-angiotensin-aldosterone system.

Effectiveness of a community-based education and peer support led by women’s self-help groups in improving the control of hypertension in urban slums of Kerala, India: a cluster randomised controlled pragmatic trial

BackgroundWith less than 20% of people with hypertension achieving their target blood pressure (BP) goals, uncontrolled hypertension remains a major public health problem in India. We conducted a study to...

ODP190 Efficacy of Esaxerenone on Hypertensive Patients with Type 2 Diabetes or Those with Impaired Glucose Tolerance

Abstract Patients with diabetes may develop mineralocorticoid receptor (MR) related hypertension due to abnormal activation of MR, thusMR blocker (MRB) is used for the treatment of hypertensionin patients with diabetes. Although theselective MRB esaxerenone (Esax)approved for hypertension, the effectiveness of Esax in daily clinical practice has not provenin hypertensive patients with type 2 diabetes (T2D) or those withimpaired glucose tolerance (IGT). The aim of this study is to clarifythe efficacy of Esax in these patients. In this retrospective study, patientswho initiated Esax from May 2019 to February 2020 and thosewho initiated amlodipine (Amlo) were screened. After excluding patients with a history of hypersensitivity to these drugs, K &amp;gt; 5. 0 mEq/L at the baseline and severe renal dysfunction (eGFR &amp;lt; 30 mL/min/1.73m 2), and patients receiving potassium preparations, 35 and 70 patients were enrolled in the Esax and Amlo group, respectively. After propensity score matching with the parameters including gender, age, body mass index (BMI), concomitant use of angiotensin receptor blocker, systolic blood pressure (SBP), diastolic blood pressure (DBP), K, AST, ALT, TG and eGFR, finally each 24 cases were analyzed. Primary endpoints were changes (Δ) in SBP and DBP from the baseline to 6 months after the initiation of the drugs. Secondary endpoints comprised changes in liver enzymes and those in lipid metabolism markers. Unpaired t-test was used for statistical analysis. The dose of Esax and Amlo were 2.2±0.5 mg and 4.1±1.2 mg at the baseline, and 3.4±1.3 mg and 5.3±1.2 mg at 6 months, respectively. SBP was more decreased in the Esax group compared with the Amlo group (ΔSBP: -27± 20 mmHg vs -11± 14 mmHg, p&amp;lt;0. 05). DBP was not significantly different between the two groups (ΔDBP: -11± 10 mmHg vs -9± 14 mmHg). In the Esax group, ALT and TG were significantly decreased (ΔAST: -7.3 ± 11.5 U/L vs +0.9 ± 9.5 U/L, p&amp;lt;0. 05,ΔTG: -14.3 ± 51. 0 mg/dL vs +33.5 ± 59.4 mg/dL, p&amp;lt;0. 05), and HDL-C significantlyincreased (ΔHDL: +1.8 ± 6.1 mg/dL vs -3.8 ± 4.8 mg/dL, p&amp;lt;0. 05). Severeadverse events were not observed in any subjects. These results suggest the efficacy of Esax for controlling blood pressure as well as the plausible benefit in liver disease and lipid metabolism in hypertensive patients with T2D or IGT. Presentation: No date and time listed

Changes in cardiovascular disease risk factors during menopausal transition in Japanese women: the Circulatory Risk in Communities Study (CIRCS).

We aimed to longitudinally clarify the changes in cardiovascular disease risk factors associated with menopause in Japanese women in the 2000s. Of the 4,596 women who underwent health examinations between 2007 and 2012 in three communities of the Circulatory Risk in Communities Study, 263 women who reported going through menopause during that period were included in the study. We randomly selected 1,665 men as control subjects who participated in a health examination at least once between 2001 and 2009 and at least once between 2010 and 2018 by 1:1 pair-matching for age, community, and examination year. The health examination data from 3 to 6 years before (2001-2009) and after menopause age (2010-2018) were compared in terms of body mass index, systolic and diastolic blood pressure levels, serum total cholesterol, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, triglycerides, uric acid, hemoglobin A 1c , hemoglobin, aspartate aminotransferase, alanine aminotransferase, and current smoker status. Compared with the men, the women showed a greater increase in serum total cholesterol (+16.7 vs -3.1 mg/dL, P < 0.001), non-high-density lipoprotein cholesterol (+15.9 vs -6.3 mg/dL, P < 0.001), fasting triglycerides (+1.2 vs +1.0 mg/dL, P = 0.027), triglycerides regardless of fasting status (+1.2 vs -0.9 mg/dL, P < 0.001), uric acid (+0.5 vs +0.2 mg/dL, P = 0.008), hemoglobin (+0.9 vs -0.3 g/dL, P < 0.001), aspartate aminotransferase (+2.9 vs -2.7 IU/L, P < 0.001), and alanine aminotransferase (+2.9 vs -2.6 IU/L, P < 0.001). No differences were found in the changes in body mass index, systolic and diastolic blood pressures, and hemoglobin A 1c between the women and the matched men. Menopause may be a crucial factor related to changes in serum total cholesterol, non-high-density lipoprotein cholesterol, triglycerides, uric acid, hemoglobin, and liver enzymes.

Upper-Arm SBP Decline Associated with Repeated Cuff-Oscillometric Inflation Significantly Correlated with the Arterial Stiffness Index.

We evaluated the clinical significance of the new non-invasive vascular indices to explore their potential utility using repeated cuff-oscillometric inflation. In 250 consecutive outpatients, we performed a cross-sectional, retrospective, single-center, observational study to investigate sequential differences in arterial stiffness using blood pressure, arterial velocity pulse index (AVI), and arterial pressure volume index (API) with repeated measurements. Males accounted for 62.7% of the patients, and the mean age was 68.1 ± 12.1 years. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the first reading in repeated measurements were 133.07 ± 21.20 mmHg and 73.94 ± 13.56 mmHg, respectively. The mean AVI and API were 23.83 ± 8.30 and 31.12 ± 7.86, respectively. In each measurement of these parameters, although DBP and AVI did not show significant changes throughout repeated measurements, SBP and API decreased significantly according to the measurement orders. Furthermore, changes in SBP and API were significantly correlated in several of the models. In this study, it was concluded that upper-arm SBP decline associated with repeated cuff-oscillometric inflation was significantly correlated with the arterial stiffness index. The findings of this study will allow clinicians to easily recognize the progression of atherosclerosis through regular, routine practice. In conclusion, this study suggests that changes in repeated SBP measurements may be predictive of arterial stiffness and atherosclerosis.

A comparative post hoc analysis of finerenone and spironolactone in resistant hypertension in moderate-to-advanced chronic kidney disease.

Mineralocorticoid receptor antagonists (MRAs) reduce systolic blood pressure (SBP) and increase serum potassium concentration ([K+]). This indirect comparison investigated any differences in SBP-lowering and hyperkalemia risk between finerenone, a nonsteroidal MRA, and the steroidal MRA spironolactone±a potassium binder. In FIDELITY (a pooled analysis of FIDELIO-DKD and FIGARO-DKD), a subgroup of patients with treatment-resistant hypertension (TRH) and chronic kidney disease meeting eligibility criteria of the AMBER trial were identified (FIDELITY-TRH). The main outcomes were mean change in SBP, incidence of serum [K+] ≥5.5mmol/L and hyperkalemia-associated treatment discontinuation. Results at ∼17weeks were compared with 12weeks from AMBER. In 624 FIDELITY-TRH patients and 295 AMBER patients, the least squares mean change in SBP (mmHg) from baseline was -7.1 for finerenone and -1.3 for placebo {between-group difference -5.74 [95% confidence interval (CI) -7.99 to -3.49], P<.0001} versus -11.7 for spironolactone+patiromer and -10.8 for spironolactone+placebo [between-group difference -1.0 (95% CI -4.4-2.4), P=.58]. The incidence of serum [K+] ≥5.5mmol/L was 12% for finerenone and 3% for placebo versus 35% with spironolactone+patiromer and 64% with spironolactone+placebo. Treatment discontinuation due to hyperkalemia was 0.3% for finerenone and 0% for placebo versus 7% for spironolactone+patiromer and 23% for spironolactone+placebo. In patients with TRH and chronic kidney disease compared with spironolactone with or without patiromer, finerenone was associated with a lower SBP reduction and lower risk of hyperkalemia and treatment discontinuation.Trial Registration: AMBER (NCT03071263), FIDELIO-DKD (NCT02540993), FIGARO-DKD (NCT02545049).

The Effects of Virtual Reality on Preoperative Anxiety in Patients Undergoing Colorectal and Abdominal Wall Surgery: A Randomized Controlled Trial

PurposeThe purpose of this study was to investigate the effects of a virtual reality (VR) application on preoperative anxiety (PA) in patients undergoing colorectal and abdominal wall surgery. DesignA prospective, parallel two-armed, randomized controlled trial. MethodsEighty six patients were divided into the control group (n = 43) and in the experimental group (n = 43). The experimental group received a preoperative VR application for 10 minutes. The routine preoperative procedure used at the clinic was used for the patients in the control group. The anxiety level was assessed using the Anxiety Specific to Surgery Questionnaire (ASSQ) and measured with physiological responses to anxiety, such as changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO2), before and after the VR application. FindingsThe VR application reduced PA levels in the experimental group (P < .001) and changes in the SBP (P < .001), DBP (P < .001), HR (P < .001), RR (P = .041) and SpO2(P = .019) values) compared to the levels in the control group. ConclusionsVR applications can reduce psychological and physiological responses to PA in patients undergoing colorectal and abdominal wall surgery.

Impact of pharmacist‐led chronic disease management in a Federally Qualified Health Center

AbstractIntroductionThere is growing interest in pharmacist‐led chronic disease management (CDM) for underserved populations such as those treated within Federally Qualified Health Centers (FQHCs).ObjectivesTo assess the impact of adding a pharmacist to the healthcare team within an FQHC for CDM.MethodsThis is a non‐randomized, 6‐month prospective pilot study whereby any member of the healthcare team could refer a patient to receive CDM from a pharmacist. The primary outcome is change in disease control as measured by primary clinical endpoint. Primary clinical endpoints for the most common disease states include glycated hemoglobin (A1C) for type 2 diabetes mellitus (T2DM), systolic blood pressure (SBP) for hypertension, Generalized Anxiety Disorder‐7 (GAD‐7) score for anxiety, and Patient Health Questionnaire‐9 (PHQ‐9) score for depression. Primary clinical endpoints are compared using a paired t test for the modified intention‐to‐treat population. Secondary outcomes include change in self‐reported health and healthcare utilization and difference in satisfaction with care between the primary care provider (PCP) and pharmacist.ResultsThree hundred patients were enrolled of whom 199 were included. Most patients were referred by their PCP. Statistically significant differences in the mean primary endpoint were observed for all disease states with at least 20 participants, including T2DM (n = 96, change in A1C ‐2.1%, P &lt; 0.001), hypertension (n = 32, change in SBP ‐29.7 mmHg, P &lt; 0.001), anxiety (n = 25, change in GAD‐7 score − 7, P &lt; 0.001), and depression (n = 22, change in PHQ‐9 score −11.1, P &lt; 0.0001). While statistically significant changes in self‐reported healthcare and healthcare utilization were not observed, patients were more satisfied with care.ConclusionWhen provided with prescriptive authority and working within an interdisciplinary primary care team, pharmacists were able to impact clinical and humanistic outcomes in the FQHC, leading to improved CDM for a variety of illnesses. More studies should be conducted to validate these results in other settings.

Blood pressure lowering and prevention of dementia: an individual patient data meta-analysis.

Observational studies indicate U-shaped associations of blood pressure (BP) and incident dementia in older age, but randomized controlled trials of BP-lowering treatment show mixed results on this outcome in hypertensive patients. A pooled individual participant data analysis of five seminal randomized double-blind placebo-controlled trials was undertaken to better define the effects of BP-lowering treatment for the prevention of dementia. Multilevel logistic regression was used to evaluate the treatment effect on incident dementia. Effect modification was assessed for key population characteristics including age, baseline systolic BP, sex, and presence of prior stroke. Mediation analysis was used to quantify the contribution of trial medication and changes in systolic and diastolic BP on risk of dementia. The total sample included 28 008 individuals recruited from 20 countries. After a median follow-up of 4.3 years, there were 861 cases of incident dementia. Multilevel logistic regression reported an adjusted odds ratio 0.87 (95% confidence interval: 0.75, 0.99) in favour of antihypertensive treatment reducing risk of incident dementia with a mean BP lowering of 10/4 mmHg. Further multinomial regression taking account of death as a competing risk found similar results. There was no effect modification by age or sex. Mediation analysis confirmed the greater fall in BP in the actively treated group was associated with a greater reduction in dementia risk. The first single-stage individual patient data meta-analysis from randomized double-blind placebo-controlled clinical trials provides evidence to support benefits of antihypertensive treatment in late-mid and later life to lower the risk of dementia. Questions remain as to the potential for additional BP lowering in those with already well-controlled hypertension and of antihypertensive treatment commenced earlier in the life-course to reduce the long-term risk of dementia. Class I evidence in favour of antihypertensive treatment reducing risk of incident dementia compared with placebo.

Intravesical injection of botulinum toxin type a may be an effective treatment option for autonomic dysreflexia in patients with high-level spinal cord injury

Objective To evaluate the efficacy of intravesical injection of botulinum toxin type A (BTX-A) for neurogenic detrusor overactivity (DO) in reducing the frequency and severity of autonomic dysreflexia (AD). Design A cross-sectional nonrandomized trial with before (baseline) and after (follow-up) assessments. Setting A single spinal cord injury (SCI) rehabilitation center in China. Participants Twenty-five patients with SCI at or above T6 and a history of AD who underwent urodynamic studies (UDS) before and 3 months after BTX-A injection. Interventions Received bladder injection treatment wtih 200 U BTX-A. Outcome Measures The maximum detrusor pressure(Pdetmax) and voume at first DO(VFIDC), baseline and overall maximum systolic blood pressure (SBP) during UDS, and scores of Incontinence Specific Quality of Life Instrument (IQoL) were recorded before and 3 months after the injection. The change in SBP (ΔSBP) from baseline to maximum SBP during UDS was calculated to assess the severity. The frequency of AD was recorded using ambulatory blood pressure monitoring during a 24 h period before and 3 months after the injection. Results BTX-A injection decreased the Pdetmax and increased the VFIDC and mean urine volume per catheterization increased. The maximum SBP and the ΔSBP during UDS decreased significantly decreased after the injection (151.44 ± 13.92 vs 133.32 ± 9.20 mmHg and 49.44 ± 12.81 vs 33.08 ± 9.11 mmHg respectively, P < 0.05). The frequency of bladder-related ADs (i.e. performed a clean intermittent catheterization or leakage) during a 24-h period significantly decreased from 11.04 ± 1.81–7.88 ± 2.15 (P < 0.001). Conclusions BTX-A decreases the severity of SBP increase and the number of AD episodes 3 months after intravesical injection.

Systolic blood pressure at age 40 and cognitive function 25 years later: the Akershus Cardiac Examination (ACE) 1950 Study.

Hypertension in midlife is a risk factor for cognitive impairment. Still, the ideal midlife blood pressure (BP) remains unknown. We examined associations between different systolic blood pressure (SBP) levels at the age of 40-43 years and change in SBP over a 25-year period with cognitive function at age 62-65 years. We included 2424 individuals born in 1950 who had participated both in the Age 40 Program (1990-1993) and the Akershus Cardiac Examination (ACE) 1950 Study (2012-2015). The exposure was SBP at age 40-43 years and the outcome was cognitive function at age 62-65 years, assessed with Montreal Cognitive Assessment, Delayed recall trial from the Consortium to Establish a Registry for Alzheimer's Disease Word List Memory Task, and Trail Making Test part B (TMT B). Participants were 40.1 ± 0.3 years old with mean SPB 128 ± 13 mmHg at the Age 40 Program, and 63.9 ± 0.6 years old with mean SPB 138 ± 18 at the ACE 1950 Study. Adjusted linear regressions showed no associations between SBP and subsequent cognitive function. In logistic regressions, individuals with SBP ≥140 mmHg, compared to individuals with SBP <120 mmHg (odds ratio 2.29, 95% confidence interval 1.28-4.10, P-value 0.005) had increased risk of an abnormal TMT B-score. Change in SBP during the 25-year follow-up was not associated with cognitive function. SBP ≥140 mmHg at age 40-43 was associated with reduced capacity on TMT B, a domain specific cognitive test sensitive to vascular impairment. No other associations were found between SBP, or change in SBP, and cognitive function.

Sex-specific time trends in incident atrial fibrillation and the contribution of risk factors: the Tromsø Study 1994-2016.

To explore sex-specific time trends in atrial fibrillation (AF) incidence and to estimate the impact of changes in risk factor levels using individual participant-level data from the population-based Tromsø Study 1994-2016. A total of 14 818 women and 13 225 men aged 25 years or older without AF were enrolled in the Tromsø Study between 1994 and 2008 and followed up for incident AF throughout 2016. Poisson regression was used for statistical analyses. During follow-up, age-adjusted AF incidence rates in women decreased from 1.19 to 0.71 per 1000 person-years. In men, AF incidence increased from 1.18 to 2.82 per 1000 person-years in 2004, and then declined to 1.94 per 1000 person-years in 2016. Changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI), physical activity, smoking and alcohol consumption together accounted for 10.9% [95% confidence interval (CI): -2.4 to 28.6] of the AF incidence decline in women and for 44.7% (95% CI: 19.2; 100.0) of the AF incidence increase in men. Reduction in SBP and DBP had the largest contribution to the decrease in AF incidence in women. Increase in BMI had the largest contribution to the increase in AF incidence in men. In the population-based Tromsø Study 1994-2016, AF incidence decreased in women and increased following a reverse U-shape in men. Individual changes in SBP and DBP in women and individual changes in BMI in men were the most important risk factors contributing to the AF incidence trends.

Estimation of systolic blood pressure by Random Forest using heart sounds and a ballistocardiogram

Cuffless blood pressure measurement enables unobtrusive and continuous monitoring that can be integrated with wearable devices to extend healthcare to non-hospital settings. Most of the current research has focused on the estimation of blood pressure based on pulse transit time or pulse arrival time using ECG or peripheral cardiac pulse signals as proximal time references. This study proposed the use of a phonocardiogram (PCG) and ballistocardiogram (BCG), two signals detected noninvasively, to estimate systolic blood pressure (SBP). For this, the PCG and the BCG were simultaneously measured in 21 volunteers in the rest, activity, and post-activity conditions. Different features were considered based on the relationships between these signals. The intervals between S1 and S2 of the PCG and the I, J, and K waves of the BCG were statistically analyzed. The IJ and JK slopes were also estimated as additional features to train the machine-learning algorithm. The intervals S1-J, S1-K, S1-I, J-S2, and I-S2 were negatively correlated with changes in SBP (p-val < 0.01). The features were used as explanatory variables for a regressor based on the Random Forest. It was possible to estimate the systolic blood pressure with a mean error of 3.3 mmHg with a standard deviation of ± 5 mmHg. Therefore, we foresee that this proposal has potential applications for wearable devices that use low-cost embedded systems.

Reducing ethnic and racial disparities by improving undertreatment, control, and engagement in blood pressure management with health information technology (REDUCE-BP) hybrid effectiveness-implementation pragmatic trial: Rationale and design

While racial/ethnic disparities in blood pressure control are documented, few interventions have successfully reduced these gaps. Under-prescribing, lack of treatment intensification, and suboptimal follow-up care are thought to be central contributors. Electronic health record (EHR) tools may help address these barriers and may be enhanced with behavioral science techniques. To evaluate the impact of a multicomponent behaviorally-informed EHR-based intervention on blood pressure control. Reducing Ethnic and racial Disparities by improving Undertreatment, Control, and Engagement in Blood Pressure management with health information technology (REDUCE-BP) (NCT05030467) is a two-arm cluster-randomized hybrid type 1 pragmatic trial in a large multi-ethnic health care system. Twenty-four clinics (>350 primary care providers [PCPs] and >10,000 eligible patients) are assigned to either multi-component EHR-based intervention or usual care. Intervention clinic PCPs will receive several EHR tools designed to reduce disparities delivered at different points, including a: (1) dashboard of all patients visible upon logging on to the EHR displaying blood pressure control by race/ethnicity compared to their PCP peers and (2) set of tools in an individual patient's chart containing decision support to encourage treatment intensification, ordering home blood pressure measurement, interventions to address health-related social needs, default text for note documentation, and enhanced patient education materials. The primary outcome is patient-level change in systolic blood pressure over 12 months between arms; secondary outcomes include changes in disparities and other clinical outcomes. REDUCE-BP will provide important insights into whether an EHR-based intervention designed using behavioral science can improve hypertension control and reduce disparities.

Changes of RV-PC coupling during negative for myocardial ischemia dobutamine stress echocardiography

Abstract Background Coupling between RV contractile function and pulmonary circulation (PC) reflects the comprehensive performance of the RV by integrating afterload and contractility. RV-PC coupling is nowadays frequently expressed by the non-invasively measured ratios TAPSE/RVSP and RVFWLS/RVSP. It has been shown that it decreases slightly during exercise, whereas no known data exist on how dobutamine does affect it. Purpose The aim of this study was to evaluate the changes in RV-PC coupling and RV mechanics during the different stages of dobutamine stress echocardiography (DSE) in cases without known coronary artery disease (CAD) and negative for myocardial ischemia DSE. Methods Patients with a low-to-intermediate risk for CAD were referred for and underwent DSE. RV systolic function was evaluated with TAPSE, S' and RV Free Wall (RVFW) Strain. The non-invasively measured RV-PC coupling was evaluated by indexing TAPSE and RV free wall longitudinal strain to right ventricular systolic pressure (RVSP) during baseline echocardiogram, low dose (inotropic dobutamine effect) and peak dose (chronotropic effect) stages of DSE. Results Initially, a total of 53 patients underwent DSE. Eight patients had a positive for ischemia response and were excluded. The remaining 45 patients {mean age 65±8.7, 28 (63%) male}, 24 (53%) had hypertension, 24 (53%) were smokers, 33 (74%) had dyslipidemia, 15 (34%) had family history of CAD and 7 (15%) had diabetes mellitus. TAPSE, S' and RVFW Strain increased from baseline to peak dose [23.55±2.91 vs 28.76±1.9 (p&amp;lt;0.001), 13.13±1.79 vs 23.83±4.87 (p&amp;lt;0.001) and 19.7±5.87 vs 23.46±5.42 (p=0.044) respectively]. TAPSE/RVSP showed a significant steady decrease between baseline and low dose (0.88±0.14 vs 0.79±0.19) and peak dose (0.88±0.14 vs 0.74±0.12) stages with a difference of 0.09 (p value 0.013) and 0.14 (p value 0.000) respectively. On the other hand, RVFW Strain/ RVSP exhibited a significant decrease (0.60±0.15, p value 0.000) only between baseline and peak dose. There was no significant correlation of the change in TAPSE/RVSP with the change in E/E' or change in Systolic Blood Pressure. Conclusions RV-PC coupling decreases during negative for ischemia DSE independently of LV dynamic changes and therefore, future studies should be oriented to evaluate the incremental role of this novel index not only for the assessment and evaluation of myocardial ischemia and RV disease that affects RV coupling, but also as a prognostic marker for patients with no evident ischemia. Funding Acknowledgement Type of funding sources: None.

Mesenchymal stromal cell therapy with early tacrolimus withdrawal prevents left atrial remodelling in renal transplant recipients: an analysis of the TRITON trial

Abstract Background After renal transplantation, there is a need for immunosuppressive regimens that effectively prevent allograft rejection, while minimizing cardiovascular side effects. The TRITON study is the first randomized clinical trial that tested a strategy with autologous bone marrow derived mesenchymal stromal cell (MSC) therapy and complete withdrawal of calcineurin inhibitors (CNIs). The combination of MSC therapy and CNIs discontinuation was associated with improved blood pression control and regression of left ventricular hypertrophy. Nevertheless, the impact of this immunosuppressive strategy on left atrial (LA) structural and functional remodelling, which has been proven as an independent predictor of cardiovascular outcomes, has not been investigated. Purpose To assess the effects of MSC therapy combined with CNIs withdrawal on longitudinal changes of LA structure and function, evaluated by two-dimensional transthoracic echocardiography. Methods The TRITON trial randomized renal transplant recipients to MSC therapy – infused at week 6 and 7 after transplantation, with complete withdrawal at week 8 of tacrolimus (MSC group) – or standard tacrolimus dose (control group). Patients who underwent transthoracic echocardiography with speckle-tracking analysis at week 4 and 24 after renal transplantation were included in this sub-analysis. Changes in echocardiographic variables between 4 and 24 weeks post-transplantation were evaluated and compared between randomization arms using an analysis of covariance model, adjusted for baseline variable. Results 54 patients (MSC group =27; control group =27) were included. Between 4 and 24 weeks after transplantation, an increase in indexed minimal LA volume (LAVImin) was observed in the control group, whereas in the MSC group there were no changes in LAVImin over the time, leading to a significant difference between groups (p=0.021). Moreover, patients randomized to MSC therapy showed a benefit in LA function, assessed by a significant interaction between changes in LA emptying fraction (LAEF) and LA reservoir strain and the treatment group (p=0.012 and p=0.027, respectively) (Table 1). The association between changes in LA structural and functional parameters and the randomization arm remained significant after adjustment for changes in systolic blood pressure, diastolic blood pressure and estimated glomerular filtration rate over the time (Figure 1). Conclusion The combination of MSC therapy and early CNIs withdrawal prevents LA structural and functional remodelling in the first six months after renal transplantation. MSC therapy appears a promising approach in renal transplant recipient, effective in the prevention of graft rejection, while exerting potential cardioprotective effects. Funding Acknowledgement Type of funding sources: None.

Continuous Intra-Arterial Blood Pressure Monitoring Improves the Efficiency of Percutaneous Balloon Compression of the Trigeminal Ganglion for Trigeminal Neuralgia.

Objective The aim of the study is to explore the characteristics of systolic blood pressure (SBP) and heart rate (HR) changes in patients undergoing percutaneous balloon compression (PBC) for trigeminal neuralgia and analyze the factors that influence the formation of the symbolic pear shape of the balloon, which signifies successful compression. Methods We retrospectively analyzed the changes in systolic blood pressure (SBP) and heart rate (HR) in 103 consecutive patients with trigeminal neuralgia (TN). Fifty-five patients who underwent operations with intermittent inflating cuff blood pressure (IICBP) monitoring were classified into the IICBP group. The other 48 patients who underwent continuous intra-arterial blood pressure (CIABP) monitoring were classified into the CIABP group. Results Among all the patients, there were more women than men and the patients in both the groups more commonly had TN on the right side and involving branch III. First, the balloon appeared as “pear-shaped” when the compression was effective, and the SBP increased an average of 59.04% in the CIABP group. CIABP provided us the precise range of the increase. Older patients had higher SBPs, especially patients with hypertension. Second, SBP was more sensitive and lasted much longer than HR in the process of puncturing the foramen ovale and compressing the ganglion. SBP fluctuated much more in the CIABP group than in the IICBP group. Third, the median time taken in the CIABP group was less than the IICBP group, and the prognosis of the CIABP group was better than the IICBP group. Conclusion Effective ganglion compression significantly increased SBP. CIABP can monitor SBP in real time and can also safeguard the compression process. CIABP is a safe and effective method in the PBC process that is worthy of promotion and application.

Noninvasive evaluation of coronary velocity reserve: need for correction of the sympathetic tone

Abstract Introduction Noninvasively Doppler estimated coronary velocity (as a surrogate of flow) reserve (CVR) by adenosine is a useful parameter for risk stratification in chronic coronary syndromes (CAD). However, baseline velocity fluctuation due to sympathetic drive, as in mental stress, may affect the evaluation of the actual CVR. Aim Aim of the study was to assess the effect of b blocker administration following adenosine infusion in the coronary velocity and thus the consequences in the estimated CVR. Patients and methods Sixty (females 8) patients (pts) with stable CAD (mean/SD: age 64/10, ejection fraction % 55/8) were studied before the performance of a dobutamine stress echo. Distal left anterior descending (LAD) velocity was estimated at rest (CVrest), at maximal adenosine infusion (140γ/kg/min: CVaden) and following esmolol infusion 3–5 min later (CVbbl). CVR was estimated using as baseline velocity either CVrest (CVRrest) or CVbbl (CVRbbl). Respective changes of heart rate (HR) and systolic blood pressure (SBP) were also estimated. Results CVbbl was smaller than CVrest (23/7 vs 29/13, p&amp;lt;0.0.01). Thus, CVRbbl was greater than CVRrest (3/0.9 vs 2.7/0.6, p&amp;lt;0.001) with an absolute difference (dCVR) of 0.46/0.84, a % difference (%dCVR) of 23/34%, with a modest linear relationship (R2=0.08, p=0.02 figure). The %dCVR was also linearly related to CVRrest (R2=0.13, p=0.003 figure) and it was independent from age, HR/BP changes and the dobutamine stress echo outcome. Differences between CVRbbl and CVRrest were greater in females (females/males: dCVR 1.2/0.9 vs 0.36/0.8, %dCVR 0.67/0.56 vs 0.36/0.26, both p&amp;lt;0.001). Conclusions Noninvasively estimated CVR is affected by the baseline sympathetic tone, irrespectively from the age in stable CAD. A gender effect is evident, reiterating the microvascular susceptibility in females. Thus, potential mental stress background must be considered, and b-blockade subsequently might be applied during CVR evaluation to overcome any sympathetic effect. Funding Acknowledgement Type of funding sources: None.

Blood Pressure and Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: DELIVER

BackgroundOptimizing systolic blood pressure (SBP) in heart failure (HF) with preserved ejection fraction carries a Class I recommendation but with limited evidence. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have antihypertensive effects across cardiovascular disease. ObjectivesThe authors examined the interplay between SBP and treatment effects of dapagliflozin on SBP and cardiovascular outcomes. MethodsThe authors analyzed 6,263 DELIVER (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure) participants and related baseline and mean achieved SBP categories (<120, 120-129, 130-139, ≥140 mm Hg) to the primary outcome (cardiovascular death or worsening HF), secondary outcomes, and safety events. They analyzed whether the blood pressure–lowering effects of dapagliflozin accounted for its treatment effects by adjusting for the change in SBP from baseline to 1 month. ResultsThe average age was 72 ± 10 years and 44% were women. SBP <120 mm Hg was associated with higher HF and mortality events, although amputation and stroke risk increased with higher SBP. Dapagliflozin reduced SBP by 1.8 (95% CI: 1.1-2.5) mm Hg compared with placebo at 1 month. The treatment effect of dapagliflozin on the primary outcome and Kansas City Cardiomyopathy Questionnaire total symptom score was consistent across SBP (interaction P = 0.15 and P = 0.98, respectively). Adverse events between arms were similar across SBP categories. The treatment effect was not accounted for by reducing blood pressure. ConclusionsIn DELIVER, risk by SBP was augmented in the lowest and highest categories and varied by endpoint examined. Dapagliflozin modestly decreased SBP compared with placebo. Dapagliflozin was similarly efficacious and safe across the range of baseline SBP. The beneficial effects of dapagliflozin were not accounted for the changes in SBP. (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213)