Decline In Blood Pressure Research Articles

Effect of diltiazem on exercise tolerance in patients with stable coronary artery disease and hypertension.

The present study aimed to investigate the effect of diltiazem on cardiovascular risk and exercise tolerance in patients with stable coronary artery disease and hypertension. From 2016 to 2018, 80 patients with stable coronary artery disease (5 < Gensini score < 20) and hypertension were enrolled into the present study. These patients were randomly divided into two groups: diltiazem group (Dil, 90 mg, bid), and control group (angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB) for reducing blood pressure and β-receptor blockers for controlling heart rate). Liver and kidney function, heart rate variability (HRV), blood pressure variability (BPV) and bicycle exercise were measured at baseline and after six months. The incidence of cardiovascular events (re-hospitalization due to angina pectoris, acute myocardial infarction, and cardiogenic death) was also assessed. The differences in all indexes at baseline between these two groups were not statistically significant (P > 0.05, respectively). After six months of treatment, both groups of patients had significant improvements in HRV, BPV and exercise tolerance compared that before treatment (p < 0.05). The difference in the decrease in systolic blood pressure, improvement of HRV and BPV, and cardiovascular events between these two groups was not statistically significant (P = 0.588, 0.431, 0.152, 1.000, respectively). But the Dil group was significantly better than the control group in degree of heart rate decline, diastolic blood pressure decline, and improvement of ST segment depression (P < 0.001), and the improvement in exercise tolerance was also better than that of the control group. We found that diltiazem compared with ACEI/ARB and β-receptor blockers can further improve the exercise tolerance of patients with stable coronary artery disease and hypertension.

Seasonal variation and predictors of intradialytic blood pressure decline: a retrospective cohort study.

The risk factors for intradialytic systolic blood pressure decline remain poorly understood. We aimed to identify clinical and laboratory predictors of the intradialytic systolic blood pressure decline, considering its seasonal variation. In a retrospective cohort of 47,219 hemodialysis sessions of 307 patients undergoing hemodialysis over one year in three dialysis clinics, the seasonal variation and the predictors of intradialytic systolic blood pressure decline (predialysis systolic blood pressure--nadir intradialytic systolic blood pressure) were assessed using cosinor analysis and linear mixed models adjusted for baseline or monthly hemodialysis-related variables, respectively. The intradialytic systolic blood pressure decline was greatest and least in the winter and summer, respectively, showing a clear seasonal pattern. In both models adjusted for baseline and monthly hemodialysis-related parameters, calcium channel blocker use was associated with a smaller decline (-4.58 [95% confidence interval (CI), -5.84 to -3.33], P < 0.001; -3.66 [95% CI, -5.69 to -1.64], P < 0.001) and α blocker use, with a greater decline (3.25 [95% CI, 1.53-4.97], P < 0.001; 3.57 [95% CI, 1.08-6.06], P = 0.005). Baseline and monthly serum phosphorus levels were positively correlated with the decline (1.55 [95% CI, 0.30-2.80], P = 0.02; 0.59 [95% CI, 0.16-1.00], P = 0.007), and baseline and monthly normalized protein catabolic rates were inversely correlated (respectively, -22.41 [95% CI, -33.53 to -11.28], P < 0.001; 9.65 [95% CI, 4.60-14.70], P < 0.001). In conclusion, calcium channel blocker use, α blocker avoidance, and serum phosphorus-lowering therapy may attenuate the intradialytic systolic blood pressure decline and should be investigated in prospective trials.

Trajectory patterns of blood pressure change up to six years and the risk of dementia: a nationwide cohort study.

The present study aimed to investigate the associations between the trajectory of blood pressure (BP) change and the risk of subsequent dementia and to explore the differences in age, gender, and hypertension subgroups. We included 10,660 participants aged ≥ 60 years from 1998 to 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Latent growth mixture models were used to estimate BP trajectories. Cox-proportional hazard models were used to analyze the effects of BP trajectories on the risk of dementia. According to the results, stabilized systolic BP (SBP) was found to be associated with a higher risk of dementia compared with normal SBP [adjusted hazard ratio (aHR): 1.62; 95% confidence interval (CI): 1.27-2.07] and elevated SBP (aHR: 2.22; 95% CI: 1.51-3.28) in and only in the subgroups of the oldest-old, women, and subjects without hypertension at baseline. Similarly, stabilized pulse pressure (PP) was associated with a higher risk of dementia compared with normal PP (aHR: 1.52; 95% CI: 1.24-1.88) and elevated PP (aHR: 2.12; 95% CI: 1.48-3.04) in and only in the subgroups of the oldest-old, women, and subjects with hypertension at baseline. These findings suggest that stabilized SBP and PP have predictive significance for the occurrence of dementia in late life, and the factors of age, gender, and late-life hypertension should be considered when estimating the risk of BP decline on dementia.

Effects of renal denervation on the expression profile of circular RNA in the serum of patients with resistant hypertension

ObjectiveRenal denervation (RDN) is a new treatment option for resistant hypertension (RH), although it has been shown that reduced sympathetic nerve activity after RDN is the main cause of blood pressure decline. In view of the possible correlation between circRNA and hypertension and the metabolic state of the body after RDN, we investigated the potential role of circRNA in RDN treatment of RH. MethodsSerum samples of patients with RH were collected before and 48 h after RDN. We explored the mechanism underlying RDN with high-throughput integration of circRNA data. ResultsThere were 338 circRNAs that were differentiated before and after RDN; 170 were upregulated and 168 were downregulated (≥1.2-fold, P < 0.05), and the expression of five of them changed significantly (≥1.5-fold, P < 0.05). We used reverse transcription-quantitative polymerase chain reaction to confirm these results in 13 other patients with RH. hsa_circRNA_000367 was upregulated and hsa_circRNA_405119 was downregulated after RDN. We predicted their downstream miRNA–mRNA network and analyzed their putative function via the circRNA–miRNA–mRNA pathway. GO/KEGG analysis showed that their functional annotation may be related to nerve injury and hypertension. We used the Venn Diagram Generator to obtain the intersection of predicted target and sympathetic nerve-related genes (from GeneCards website). ConclusionThe mechanism underlying RDN may be closely related to upregulated hsa_circRNA_000367 or downregulated hsa_circRNA_405119 and involve regulated multiple pathways and multiple cellular and molecular biological processes. These circRNAs may potentially be used as treatment effect biomarkers in RDN.

Interaction between green tea and perindopril reduces inhibition of angiotensin-converting enzyme activity

Purpose: To investigate the blood pressure-lowering effect of green tea (GT) extract alone and in combination with an angiotensin converting enzyme (ACE) inhibitor, perindopril, on rats.&#x0D; Methods: The study consisted of four groups of five spontaneously hypertensive rats (SHR): negative control (2 % tragacanth mucilage), positive control group (perindopril, 0.36 mg/kg/day) and two treatment groups (green tea, 25 mg/kg/day; and combined green tea/perindopril). The treatments were given orally for 14 days. Systolic blood pressure was measured before and after treatment using the tail cuff technique. Angiotensin converting enzyme activity in the lung homogenate of the hypertensive rats was determined spectrophotometrically.&#x0D; Results: Green tea extract significantly reduced the rats’ systolic blood pressure (p &lt; 0.05) but did not inhibit the angiotensin-converting enzyme. The combination of green tea extract with perindopril also caused a significant decline in blood pressure (p &lt; 0.001). However, the green tea extract attenuated the inhibition of the angiotensin-converting enzyme activity by perindopril.&#x0D; Conclusion: Green tea extract produces anti-hypertensive activity in rats, but its mechanism of action is not via inhibition of angiotensin-converting enzyme. The interaction of GT extract with perindopril results in a reduction of ACE inhibitory activity.

Abstract P096: Association Of Accurately Measured Office, Self-measured Home, And Ambulatory Blood Pressure And Their Variability With Intracranial Arterial Stenosis

Background: Few studies have compared accurately measured office, self-measured home, and ambulatory blood pressure (BP) for asymptomatic intracranial artery stenosis (ICAS). Relationship of day-by-day or short-term variability in BP to asymptomatic ICAS remains unclear. Objectives: To examine the association of office, home (mean value and day-by-day variability), and ambulatory BP indices (24-hour/daytime/nighttime mean values, short-term variability, nocturnal decline, and morning pressor surge) with asymptomatic ICAS. Methods: Data on office and 7-day home BP and magnetic resonance angiography to assess ICAS were obtained in 677 men (mean age, 70.0 years) from a population-based cohort. Among them, 468 underwent 24-hour ambulatory BP monitoring. Mild- or severe-ICAS was defined as 1-49% or ≥50% stenosis, respectively, and any-ICAS as either mild or severe-ICAS. Results: We observed mild- and severe-ICAS in 153 (22.6%) and 36 (5.3%) participants, respectively. In multivariable Poisson regression with robust error variance, higher systolic BP at office, home, or ambulatory BP monitoring was associated with the presence of any- or severe-ICAS. The associations with ICAS were comparable between office, home, and ambulatory systolic BP (all heterogeneity Ps &gt;0.1). Independent of mean systolic BP, greater nocturnal decline or morning pressor surge in systolic BP was associated with higher burden of any- or severe-ICAS. Conclusion: The magnitude of association of BP accurately measured at office for asymptomatic ICAS was comparable with that of BP at home or ambulatory BP monitoring. Circadian BP variation based on ambulatory BP monitoring may be considered when assessing ICAS in apparently healthy individuals.

Compensatory depression of arterial pressure and reversal of ECG abnormalities by Annona muricata and Curcuma longa in hypertensive Wistar rats.

Increasing hypertension incidence in Sub-Sahara Africa and the current cost of management of the metabolic disorder has necessitated research on medicinal plants employed in African Traditional Medicine for hypertension. Thus, this study evaluated antihypertensive effect of Annona muricata leaves or Curcuma longa rhizomes in experimentally-induced hypertensive male Wistar rats (n=70) which were unilaterally nephrectomized and daily loaded with 1% salt. Cardiovascular and haematological changes, as well as urinalysis were determined. Rats were uninephrectomized and NaCl (1%) included in drinking water for 42days. Extract-treated hypertensive rats were compared to normotensive, untreated hypertensive and hypertensive rats treated with lisinopril (5mg/70kg) or hydrochlorothiazide (12.5mg/70kg). A.muricata extract or C.longa extract were administered at 100, 200 or 400mg/kg. Blood pressure (systolic, diastolic and mean arterial) and electrocardiogram was measured on day 41. Twenty-four-hour urine samples were collected from day 42. Blood samples were collected on day 43 for haematology (PCV, red cell indices, WBC and its differentials, and platelets). A.muricata or C.longa extracts caused a decline in elevated blood pressure of hypertensive rats. Heart rate and QT segment reduction coupled with prolonged QRS duration were reversed in extract-treated rats, with significant increases in hemogram parameters indicating increased blood viscosity. Also, leukocyturia, proteinuria and ketonuria with increased urine alkalinity, urobilinogen and specific gravity which are classical indicators of poor prognostic outcomes in hypertension were reversed in extract-treated rats. In conclusion, A.muricata and C.longa have cardioprotective effect with reversal of derangements in haemogram and urinalysis associated with hypertension.

013 Associations Between Rest-Activity Rhythms and Nocturnal Blood Pressure are Sex-Dependent in Apparently Healthy Emerging Adults

Abstract Introduction Misalignment between endogenous circadian rhythms and environmental signals – an emerging risk factor for cardiovascular disease (CVD) – can disrupt diurnal blood pressure (BP) rhythms, resulting in higher nocturnal BP and less-pronounced BP dipping (i.e., % decline in nighttime systolic BP [SBP] relative to daytime values). Daily patterns of rest and activity (‘rest-activity rhythms’ [RAR]) are a proxy for estimating circadian disruption in free-living settings and have been independently associated with elevated CVD risk. However, the relation between RAR and nocturnal BP is unclear. Thus, we aimed to quantify the associations between RAR and nocturnal BP characteristics in male and female emerging adults (18-25y). Methods Fifty healthy emerging adults (20±1y; 20M/30F) underwent 24-h ambulatory BP monitoring following 14 consecutive days of continuous wrist actigraphy. RAR variables of interdaily stability (IS; day-to-day consistency in RAR), intradaily variability (IV; within-day fragmentation of RAR), and relative amplitude (RA; difference between trough vs. peak activity) were computed. Bivariate correlations were used to quantify associations between RAR variables and nocturnal BP characteristics for all participants, and separately for males and females. Linear regression models of mean nocturnal SBP, nocturnal diastolic BP (DBP), and SBP dipping were also generated to test main and interactive effects of sex and RAR. Potential confounders (variables associated with outcomes at p&amp;lt;0.10) of daytime BP, race, body mass index, physical activity, sleep duration, alcohol, caffeine, and sodium intake were also included as indicated. Results Overall, IS and RA positively correlated with % SBP dipping (IS: r=0.33, p=0.02; RA: r=0.35, p=0.01). Among females only, correlations strengthened (IS: r=0.50, p&amp;lt;0.01; RA: r=0.52, p&amp;lt;0.01) and an inverse association between RA and mean nocturnal SBP emerged (r=-0.46, p=0.01). Conversely, among males, no significant associations were apparent. Multivariate regressions revealed a significant sex*RAR interaction, such that in females, every 1-standard deviation increase in IS and RA were associated with an average decrease in nocturnal SBP of 5.4 mmHg (95% CI: -10.0, -0.73) and 4.8 mmHg (95% CI: -9.2, -0.34), respectively. Conclusion Findings suggest that consistent and high-amplitude RAR associate with more favorable nocturnal BP characteristics, particularly in emerging female adults. Support (if any) Supported in part by NIH P20-GM113125.

Aortic stiffness is sympathetically mediated in fructose‐induced salt‐sensitive hypertension

Introduction Hypertension is one of the leading risk factors for major adverse cardiovascular events (MACE). Likewise, suboptimal dietary habits, including high fructose and sodium intake, are major leading causes of mortality. High dietary fructose alone predisposes to salt-sensitivity of blood pressure, which is an independent, significant cardiovascular risk factor. Aortic stiffness is now recognized as the most robust predictor of MACE and renal failure. Sympathoexcitation also imparts increased cardiovascular risk. Emerging data show that sympathetic inputs strongly impact aortic stiffness, and renal sympathetic denervation improves aortic distensibility. Recently published studies from our laboratory showed that with even short-term fructose in combination with high salt intake renal sympathetic nerve activity (RSNA) is significantly elevated prior to any increase in blood pressure and is responsible for activation of the renin-angiotensin-aldosterone system (RAS). Most recently, we also reported increased aortic stiffness in the fructose-induced salt-sensitive hypertension rat model. The present investigation was designed to assess the impact of acute blockade of RAS and/or sympathetic nervous activity on cardiovascular function in a rat model of fructose- induced salt-sensitive hypertension. Methods Sprague-Dawley rats were placed on a diet containing either 20% fructose or 20% glucose in their drinking water while consuming normal sodium. After one week, the fructose group was switched to a 4% sodium chow (FHS) and the rats were maintained on their respective diets for two additional weeks. At the beginning of week three, arterial and venous catheters were implanted and rats allowed to recover for one day. The following day, aortic pulsed wave velocity was measured using Vevo3100 ultrasound at two time points: 1) at baseline and 2) after intravenous injection of either sympatholytic agent clonidine, RAS inhibitor enalapril or diuretic hydrochlorothiazide (HCTZ). Blood pressure and heart rate were monitored throughout the entire experiment. Results Intravenous administration of clonidine, a central sympatholytic agent, reduced MAP and PWV in FHS rats significantly (by 23 ± 3 mmHg and by 212 ± 39 mm/s, respectively). A similar decline in blood pressure occurred in control rats (27 mmHg) but PWV did not change. The dose of enalapril used to inhibit RAS was chosen to provide a similar decline in MAP as clonidine. The reduction in MAP was slightly less profound (17 ± 4 mmHg); nonetheless, only a minimal change was observed in PWV in FHS (10 ± 6 mm/s) and no change in control rats. The diuretic HCTZ given acutely did not change either MAP or PWV. Conclusion Increase in aortic stiffness after two weeks of fructose and high salt diet appears to be sympathetically driven, since the abrogation of the sympathetic activity with clonidine decreased PWV in FHS rats. The effects of the RAS blockade may require a longer period of treatment to permit vascular remodeling and other cellular mechanisms and, thus, may not have been observable in an acute setting. Likewise, the intravascular volume changes due to the diuretic may also require longer exposure.

Salt sensitivity and timed drug therapy in arterial hypertension. Enhancing antihypertensive drug efficacy: a controlled randomised trial

Background. An elevated or inadequate sensitivity to salt intake is an important mechanism for maintaining high blood pressure in patients with arterial hypertension. Chronopharmacotherapy comprises an important approach to control arterial hypertension through personalised correction of blood pressure but requires a further proof of efficacy in salt-sensitive hypertensive patients.Objectives. An assessment of six-month dynamics of diurnal and nocturnal peripheral and central blood pressure in salt-sensitive patients with arterial hypertension under chronopharmacothe­rapy.Methods. A controlled randomised trial included 86 salt-sensitive patients with arterial hypertension. Salt sensitivity was estimated with a Kharchenko’s test. All patients had circadian monitoring of the peripheral and central blood pressure and glomerular filtration rate at baseline and in a six-month follow-up. The patients were randomised into 3 cohorts. Cohort A united patients received perindopril and amlodipine in morning, cohort B — perindopril in morning, amlodipine in evening, cohort C — perindopril in evening, amlodipine in morning. Statistica 12 (StatSoftInc, USA) was used for nonparametric statistical analyses.Results. In six months of chronopharmacotherapy a target arterial pressure was registered in 87.5% patients in cohort A, 96.4 and 96.2% patients in cohorts B and C, respectively. All cohorts exhibited a declining peripheral and central blood pressure over therapy. Cohort A had a greater decline in daytime, and cohorts B and C — both diurnally and nocturnally. Cohorts B and C had more patients with an adequate nocturnal blood pressure decline. Glomerular filtration rate also elevated with perindopril or amlodipine intake before bedtime.Conclusion. The perindopril or amlodipine intake before bedtime in a combined therapy for arterial hypertension provided for a target blood pressure in the overall majority of patients, effectively reduced peripheral and central blood pressure at all time intervals, contributed to optimising the circadian blood pressure profile and increased the glomerular filtration rate.

NOCTURNAL NON-DIPPING STATUS AND LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSIVE PATIENTS

Objective: Ambulatory Blood Pressure Monitoring (ABPM) is used to assess the dipping status in hypertensive patients according to the nocturnal blood pressure (NBP) decline: extreme dippers, dippers, non-dippers and inverted dippers. Increased NBP is currently regarded as a risk factor for cardiovascular (CV) events and hypertension-mediated organ damage (HMOD). One of the most common HMOD include left ventricular (LV) remodelling as chronic BP elevation may progressively increase LV thickness. The aim of this study is to determine if there is a higher prevalence of LVH in echocardiographic (ECHO) parameters in patients with increased NBP. Design and method: Prospective observational study. Inclusion criteria: subjects with treated hypertension undergoing ABPM performed in our Primary Health Care Unit and with ECHO in the last 3 years. Fisher's exact test was used whenever appropriate to assess independence and statistical significance of reported factors. Logistic regression analysis was performed to assess the effects and its statistical significance between established parameters. Statistical differences were indicated as p &lt; 0.05 and p &lt; 0.01. Statistical analysis was performed using R version 4.0.3. Results: For this study, 67 patients were screened, from which 44 were male and 23 females, average age of 55 years old. We obtained a distinct distribution of dipper and non-dipper profiles in a LVH dependent manner. The non-dipper presented higher significant effect with LVH (p &lt; 0.01) and the results obtained from the fisher test showcase a statistically significant relation between non-dippers and LVH (annex 1) Conclusions: The limitations of this study included the small sample size and the usage of a questionable diagnose of dipping status in a 24 h period since it is often highly variable. Based on the results, there seems to be an impact of NBP on LV structure since there is a statistically significant relation between non-dipper status and LVH. Hypertensive patients should be submitted to ECHO and other forms of HMOD screening, especially non-dippers, considering their increased CV risk, in order to improve CV risk stratification therapeutic strategies.

SYSTOLIC INTER-ARM BLOOD PRESSURE DIFFERENCE AND COGNITIVE DECLINE: FINDINGS FROM THE INTERPRESS-IPD COLLABORATION

Objective: Hypertension and dementia are associated with older age and each other. As the populations age, prevalence of dementia will rise, representing substantial costs and care burdens for society. Currently, no interventions halt established cognitive decline, therefore approaches focus on prevention. Systolic inter-arm differences (IAD) in blood pressure (BP) and cognitive decline are associated with cardiovascular disease. We recently published initial evidence for associations of IAD with prospective cognitive decline and now present findings from the INTERPRESS-IPD Collaboration, examining associations of IAD with mild cognitive impairment (MCI) development and dementia. Design and method: Individual participant data meta-analyses. We examined time-to-event data for new diagnoses of MCI and dementia, according to IAD status in univariable and multivariable regression models, stratified by study. Multivariable analyses were adjusted for systolic BP, age, sex and highest educational attainment. We also examined changes in Mental State Examination (MSE) scores, with adjustments as above, plus follow-up duration. Results: Mean age was 66.2 years, 55% were female, 84% were of White ethnicity and mean systolic IAD was 7.0 mmHg. During 10-year follow-up, 5.9% of 4,635 individuals, from 3 cohorts, had new diagnoses of MCI. In univariable analyses, MCI was associated with systolic IAD &gt;/=5mmHg [Hazard Ratio, 1.34 (95%CI 1.04 to 1.72); p=0.022] and &gt;/= 0mmHg [1.33 (1.03 to 1.73); p = 0.032]. After adjustment, associations with systolic IADs &gt;/ = 5mmHg [1.31 (1.02 to 1.67); p = 0.036] and &gt;/=10mmHg [1.29 (0.99 to 1.68); p = 0.056] remained. There were 95 new diagnoses of dementia during follow-up; no associations were observed between dementia diagnosis and IAD. MSE scores were recorded for 2,709 participants; 15.5% showed clinically meaningful reductions (&gt;/=5 points) during follow-up. Decreases were associated with IADs &gt;/=5mmHg (p=0.004) and &gt;/=10mmHg (p = 0.006) on univariable analyses. After adjustment, associations with IADs &gt;/=5mmHg remained (p = 0.033); age and educational attainment attenuated the association with IADs &gt;/ = 10mmHg (p = 0.11). Conclusions: We present the first time-to-event analyses of MCI development with IAD and demonstrate that systolic IADs &gt;/ = 5mmHg and &gt;/ = 10mmHg are associated with MCI onset. If confirmed, these findings could inform individualised treatment decisions to minimise risk of future cognitive decline.

Circadian Rhythm of Blood Pressure

Circadian rhythms synchronize human physiological changes with the day and night cycle. However, with the invention of artificial lighting, the consequences of disrupted rhythm also started showing in various areas of human health including vital parameters such as blood pressure. It is one of the strictly regulated variables in the cardiovascular system and thus understanding its variability is significant. The normal circadian variation in blood pressure is characterized by a 10%–20% reduction in the night recordings and the individuals with this decrease in the night-time blood pressure are termed “dippers,” a blunted decline in night-time blood pressure is seen in “nondippers.” Evidence suggests a relatively increased risk of cardiac and extracardiac morbidity in individuals with nondipping blood pressure patterns. The purpose of this review was to summarize the literature regarding various factors contributing to circadian variations in blood pressure and explore the role of chronotherapy in hypertension. We found that there is conflicting evidence to suggest the role of night time administration of antihypertensive drugs, but the understanding of these mechanisms can be utilized for strategic management of hypertension and suggests that if drugs are aligned with the circadian rhythm then may be useful in not only controlling hypertension but also improving cardiovascular outcomes.

276 Association of Systolic Blood Pressure and Residual Kidney Function Decline Among Hemodialysis Patients

276 Association of Systolic Blood Pressure and Residual Kidney Function Decline Among Hemodialysis Patients

Systemic mastocytosis with flushing and hypotension: A case report and literature review.

Systemic mastocytosis (SM) is a heterogeneous disease of the bone marrow, which is characterized by the abnormal proliferation and infiltration of mast cells in one or more organs, such as the skin, bone marrow, digestive tract, liver and spleen. Urticaria pigmentosa is a typical but infrequent manifestation of SM. Other clinical presentations are non-specific, varying from pruritus and hypotension to multiple organ dysfunction, which may be lethal when hemodynamic changes occur, such as the sharp decline in blood pressure observed in the present case. In patients who lack skin lesions, the diagnosis of SM is frequently challenging. The present study reported on a 58-year-old male who presented with episodic flushing and syncope. The patient demonstrated marked neutrophilia and reduced blood potassium concentrations soon after the onset of each episode, which was able to last several hours, ranging from once to four times a year. SM without skin lesions was suspected and confirmed after multifocal bone marrow aspiration, which revealed dense infiltrates of mast cells (≥15 mast cells), with positive toluidine blue and CD117 staining. The present case illustrates the significance of taking SM or mast cell activation syndrome into consideration when unexplained recurrent hypotension or even syncope are observed, care should be taken to exclude differential diagnoses, as some of them may have much poorer prognoses and require alternative treatments.

Prophylactic efficacy of intravenous atropine with crystalloid co-loading for hemodynamic stability in parturient undergoing cesarean delivery at Dilla University Referral Hospital. A randomized controlled trial

BackgroundThe main objective of this study is to assess the prophylactic efficacy of intravenous atropine for the prevention of hypotension after spinal anesthesia in a parturient who underwent cesarean delivery under spinal anesthesia. MethodA randomized controlled trial study was conducted at Dilla University hospital. Pregnant women scheduled for elective cesarean section were randomized to either atropine prophylaxis (n = 33) or active prophylaxis (n = 33) for prevention of post-spinal hypotension. Sample sizes were calculated using a G-power version 3.1.9.2 getting a total of 66 participants. Intraoperative blood pressure, heart rate, and incidence of postoperative nausea and vomiting were assessed. Paired sample t-test was used to compare each group change from baseline. Independent t-test and Manny Whitney tests were used based on the distribution of data. A statistically significant difference was determined at a p-value of ≤05. ResultBoth systolic and diastolic blood pressure declined from the baseline in both groups after spinal anesthesia. Atropine didn't prevent a decline in blood pressure from the baseline during the first 60 min of initiation of spinal anesthesia (p > 0.05). Heart rates at the 15th and 20th minute were higher in the atropine group (p < 0.05). There is no statistically significant difference between groups regarding mean Apgar score, and neonatal outcome. The total crystalloid fluid given during the perioperative period is higher in the active prophylaxis group with a mean of 2151.5 ml compared to 1651.52 ml in the atropine group p = 0.002. The incidence of intraoperative nausea and vomiting was higher in the active prophylaxis group compared to the atropine group but the difference is not statistically significant p > 0.05 as it was shown in the figure below. ConclusionProphylactic administration of atropine didn't prevent a decline in blood pressure from baseline. The incidence of nausea and vomiting was lower in the atropine group with no statistically significant difference.

Promotion of Aerobic Exercise Induced Angiogenesis Is Associated With Decline in Blood Pressure in Hypertension: Result of EXCAVATION-CHN1.

[Figure: see text].

Interrelationships between Survival, Sex, and Blood Pressure in Patients with Multiple System Atrophy

Objective: The aim of this study is to estimate survival among patients with multiple system atrophy-parkinsonian type (MSA-P) or cerebellar type MSA (MSA-C) in relation to blood pressure (BP) measurements, by sex. Methods: A cohort of 99 MSA patients was studied retrospectively. Their BP measurements were obtained during prolonged (40 min, vertical position) drug-free tilt testing. We used K-M survival curves and Cox regression to calculate adjusted (to age of onset) hazard ratios (HRs) of BP measurements on time to death by MSA subtype and sex. Results: Fifty-two MSA patients were males and 47 were females. Sixty-three of them had MSA-P and 36 had MSA-C. The mean age at motor symptom onset was 61.1 ± 10.4 years, and mean disease duration at the time of BP assessment was 8.0 ± 4.7 years. The 2 study groups (MSA-P and MSA-C) did not differ significantly in age at MSA onset, sex ratio, or disease duration. Survival time did not differ between the groups {medians: 12 years (95% confidence interval [CI]: 8–28) and 10 years (95% CI: 8–13), respectively}. The MSA-P group showed a trend towards better survival for males (log-rank p = 0.0925). The maximal diastolic orthostatic BP decline during tilt testing had a borderline positive association with death risk among MSA-C males (adjusted HR = 1.18, p = 0.0665), and systolic BP after 10 min in a supine position had a significant positive association with death risk among MSA-P males (adjusted HR = 1.06, p = 0.0354). Conclusions: The findings of a sex-based difference in the effect of BP on death risk may be important for adjusting the therapeutic approach to MSA patients.

Quantitative evaluation of white matter hyperintensities in patients with heart failure using an innovative magnetic resonance image analysis method: Association with disrupted circadian blood pressure variation.

White matter hyperintensities (WMHs) are risk factors for future cognitive impairment and are associated with an abnormal circadian blood pressure (BP) rhythm in patients with hypertension. However, whether this association exists in patients with heart failure (HF) is unclear. We performed a cross‐sectional study of hospitalized patients with HF who underwent ambulatory BP monitoring and brain magnetic resonance imaging (MRI). A non‐dipper BP pattern was defined as a < 10% nocturnal BP decline. WMHs on brain MRI scans were quantitated using a novel image analysis software (FUSION: FUsed Software for Imaging Of Nervous system). We enrolled 28 hospitalized patients with HF (age: 70.0 ± 9.8 years, 64.3% men). In the brain MRI analysis, the non‐dipper group had higher WMH volume (18.9 ± 19.8 vs. 7.7 ± 8.3 mL, P = .047) and percentage of WMH/total brain volume (1.31 ± 1.28% vs. 0.55 ± 0.58%, P = .04) than the dipper group. In conclusion, using the newly developed MRI analysis software, we successfully quantitatively measured the volume of WMHs and found that the WMH volume increased 2.4 times in patients with a non‐dipper pattern of nocturnal BP compared with those with a normal dipper pattern.

53 Postpartum blood pressure trajectories and risk of persistent hypertension following a hypertensive disorder of pregnancy

Women with hypertensive disorders of pregnancy (HDP) are at increased risk for chronic hypertension (cHTN). It is unclear whether postpartum blood pressures (BPs) differ among women who develop persistent HTN from those who do not. Among women with a HDP, we evaluated BP trajectories in the first 6 weeks postpartum, and compared women with persistent hypertension to those normotensive at 6-18 months postpartum. We used home BP data collected through a remote postpartum HTN monitoring program. Women who delivered between 2/2018-6/2019, without pre-pregnancy cHTN and with a follow up BP between 6-18 months postpartum were included. We compared BP trajectories and demographics by whether women had persistent hypertension (systolic BP ≥ 130 mmHg, diastolic BP ≥ 80 mmHg or anti-hypertensive medication use). We used repeated BP measures to fit mixed-effects linear regression models with participant identifier as random intercepts and weeks postpartum as a fixed effect expressed using restricted cubic splines. Adjusted models included pre-pregnancy body mass index (pBMI) and type of HDP. We included 368 women who contributed 5,958 BPs in the first 6 weeks postpartum. 182 (49.5%) were hypertensive at follow up, and 186 (50.5%) were normotensive at follow up a mean of 12.9 +/- 3.6 months postpartum. Women hypertensive at follow up had a higher pBMI. There was no difference by race, insurance status, maternal age or type of HDP. Despite no differences in BP at first prenatal visit, women with persistent hypertension had a slower decline in BP (p<0.01 for systolic and diastolic BP) in the first 6 weeks postpartum and had higher BPs at the postpartum visit. These differences persisted in multivariable models after adjustment for pBMI and type of HDP (p<0.01 for systolic and diastolic BP). BP trajectories in the first 6 weeks postpartum distinguish women with persistent hypertension at 6-18 months. Given insurance and long-term follow up limitations for many women, BP profiles in the first 6 weeks postpartum may identify women at higher risk for persistent hypertension.View Large Image Figure ViewerDownload Hi-res image Download (PPT)