Decrease In Mean Blood Pressure Research Articles

Abstract P024: Longer Acting Antihypertensives Improve Blood Pressure Control

Introduction: Hypertension is a modifiable risk factor for cardiovascular and renal disease. It has been noted that blood pressure control has been decreasing over the past years throughout the US. In a quality improvement study, we are evaluating the effectiveness of longer acting antihypertensives in combination therapy with thiazide diuretic on blood pressure control in patients not sufficiently controlled. Methods: Participants included all clinic patients with diagnosed hypertension currently uncontrolled with BP >140/90. Their medications were modified to include a longer acting angiotensin II receptor blocker (ARB) and thiazide diuretic. Follow up visits were requested for 1 month and 3 months. Results: A total of 60 patients were started on longer acting ARB-thiazide therapy, of which 17 patients were included in analysis as follow up results were available. On follow-up visit, there was a mean decrease in blood pressure of 43.8 mmHg (95% CI 34.8 to 52.8, p <0.05) systolic and 18.9 mmHg (95% CI 11.9 to 25.9, p <0.05) diastolic. Of the 17 patients, 11 patients were switched from an ARB or an ARB-thiazide to a longer acting ARB-thiazide with a mean decrease in blood pressure of 41.0 mmHg (95% CI 30.5 to 51.5, p <0.05) systolic and 13.9 mmHg (95% CI 8.1 to 19.7, p <0.05) diastolic. Of the 11 patients, 7 were previously on an ARB-thiazide and switched to longer acting ARB-thiazide with a mean decrease in blood pressure of 33.5 mmHg (95% CI 24.7 to 46.2, p <0.05) systolic and 11.4 mmHg (95% CI 4.2 to 18.7, p <0.05). Conclusion: Including long-acting ARB and thiazide in antihypertensive regimen provided a statistically significant decrease in blood pressure.

Cardiovascular risk management in gout patients: do patients benefit from screening in secondary care?

To estimate the 10-year cardiovascular disease (CVD) risk in gout patients in secondary care and to evaluate the effect of CVD risk screening on the 10-year CVD risk after 1 year. A prospective cohort study was performed in patients with gout from Reade Amsterdam. Data on gout and CVD history, traditional risk factors, medication, and lifestyle were collected at baseline and 1 year. The 10-year CVD risk was calculated with the use of the NL-SCORE. A paired sample t-test and McNemar test was performed to test for differences between baseline and the 1-year visit. A very high prevalence of traditional CV risk factors was seen in our secondary care gout patients. Nineteen percent without previous CVD were categorised in the high-risk group according the NL-SCORE. The prevalence of CVD increased from 16% to 21% after 1-year follow-up. A decrease was seen in total- and LDL-cholesterol after 1 year. No decrease in mean BMI, waist-hip ratio, blood pressure or NL-SCORE was observed. The current need for CVD risk screening of gout patients in secondary care was illustrated by the high prevalence of traditional risk factors in this cohort. Recommendations to patients and the general practitioner (GP) alone did not result in overall improvement of traditional CVD risk factors nor the 10-year CVD risk. Our results indicate that a more prominent role of the rheumatologist is necessary to optimise the process of initiation and management of CVD risk in gout patients.

Assessment of the effect of two different doses of intranasal nitroglycerine spray on attenuation of haemodynamic stress response to pneumoperitoneum in laparoscopic surgeries: A randomised, double-blinded study.

Background and Aims:The stress response to pneumoperitoneum can be deleterious due to its effects on haemodynamics, thereby increasing the morbidity. We intended to compare different doses of nitroglycerine nasal spray to obtund these responses and to look for any side effects.Methods:After ethical committee clearance and clinical trials registration, 70 patients scheduled for laparoscopic cholecystectomy were recruited. Random allocation was done into two groups by a computer generated randomisation table. Group N4 (n = 35) received 400 μg nitroglycerine and group N8 (n = 35) received 800 μg nitroglycerine with an intranasal spray 2 min prior to pneumoperitoneum. All the haemodynamic parameters were monitored at regular intervals.Results:The heart rate was comparable between the groups except at 6 and 10 min of pneumoperitoneum but showed significant increase from baseline within the groups. Mean arterial pressure (MAP) was statistically significant between the groups, being higher in group N4. Within group N4, MAP was significantly low only at 2 min, 4 min of pneumoperitoneum (101.69 ± 12.34 at baseline versus 93.31 ± 8.07 at 2 min and 97.54 ± 9.07 mm Hg at 4 min) and increased significantly at 30 min of pneumoperitoneum (101.69 ± 12.34 at baseline versus 105.66 ± 12.35 mm Hg) and hence, MAP was observed to be around baseline throughout the rest of intraoperative period. Within group N8, there was a significant decrease in mean, systolic and diastolic blood pressure from baseline at most of the time intervals.Conclusion:800 μg of intranasal nitroglycerine effectively obtunds the hypertensive response associated with pneumoperitoneum as compared to 400 μg without significant side effects.

Observation of hemodynamic variability and level of blood cortisol while induction with propofol and etomidate: A prospective, randomized, double blind study

: To observe the effects of propofol and etomidate induction on patients undergoing laproscopic cholecystectomies regarding serum cortisol level, hemodynamic parameters, pain on injection, myoclonus, and apnea on induction.: It is a prospective, randomized, double blind study. After approval from Institute Ethics Committee, sixty patients of age between 18 and 60 years with ASA grade I and II scheduled for laproscopic cholecystectomy under general anesthesia were randomly divided into two groups: Group A (n=30) would receive injection propofol 2 mg/kg i.v., Group B (n=30) would receive injection etomidate 0.3 mg/kg i.v. as induction agent. Vital parameters at induction, laryngoscopy and thereafter recorded. Pain on injection, myoclonus, apnea on induction were carefully watched. Serum Cortisol is measured at 1 hour before induction and at 2 hours and 24 hours after induction.: Demographic variables and baseline parameters were comparable in both groups.Propofol group show significant decrease in heart rate and mean blood pressure after induction in comparison to etomidate group. Pain on injection was more in group A while myoclonus activity was higher in Group B. Serum cortisol level is significantly lower in Group B post induction compared to Group A which comes to above baseline after 24 hrs but in normal range. Etomidate is a better induction agent than propofol in view of hemodynamic stability but also led to chemical evidence of adrenocortical insufficiency in patients with ASA grade I & II undergoing elective laproscopic cholecystectomy under general anaesthesia which returns to normal in 24 hrs.

Esketamine as an Adjuvant to Ciprofol or Propofol Sedation for Same-Day Bidirectional Endoscopy: Protocol for a Randomized, Double-Blind, Controlled Trial With Factorial Design.

Background: Same-day esophagogastroduodenoscopy and colonoscopy procedures under sedation have been increasingly performed. This study aims to assess the effects of esketamine combined with ciprofol (a novel anesthetic/sedative agent) or propofol on respiratory and hemodynamic adverse events in patients undergoing same-day bidirectional endoscopy. Methods: This is a prospective, randomized, double-blind, placebo-controlled, 2 × 2 factorial trial. A total of 180 adult patients scheduled for same-day bidirectional endoscopy under sedation will be randomized, in a 1:1:1:1 ratio, to receive 1 of 4 sedation regimens: 1) ciprofol and esketamine, 2) propofol and esketamine, 3) ciprofol and normal saline placebo, or 4) propofol and normal saline placebo. The primary outcome is a composite of desaturation [peripheral oxygen saturation (SpO2) < 95%] and hypotension [mean blood pressure (MBP) < 65 mmHg or decrease in MBP ≥20% of baseline] during the sedation and in the recovery room. Secondary outcomes include episodes of desaturation, severe desaturation (SpO2 < 90%), hypotension, severe hypotension (decrease in MBP ≥30% of baseline), bradycardia, postoperative nausea and vomiting, dizziness or headache, hallucination or nightmare, injection pain, pain scores and fatigue scores, endoscopist satisfaction, and patient satisfaction. Data will be analyzed on the modified intention-to-treat basis. Discussion: We hypothesize that esketamine as an adjuvant to ciprofol or propofol sedation would improve cardiorespiratory stability. In addition, the potential interactions between interventions will be explored using the factorial design. The results of this trial will provide evidence for daily practice of sedation regimens for same-day bidirectional endoscopy. Clinical Trial Registration: Chinese Clinical Trials Registry, Identifier ChiCTR2100052523.

Chronic isoprenaline/phenylephrine vs. exclusive isoprenaline stimulation in mice: critical contribution of alpha1-adrenoceptors to early cardiac stress responses

Hyperactivity of the sympathetic nervous system is a major driver of cardiac remodeling, exerting its effects through both α-, and β-adrenoceptors (α-, β-ARs). As the relative contribution of subtype α1-AR to cardiac stress responses remains poorly investigated, we subjected mice to either subcutaneous perfusion with the β-AR agonist isoprenaline (ISO, 30 mg/kg × day) or to a combination of ISO and the stable α1-AR agonist phenylephrine (ISO/PE, 30 mg/kg × day each). Telemetry analysis revealed similar hemodynamic responses under both ISO and ISO/PE treatment i.e., permanently increased heart rates and only transient decreases in mean blood pressure during the first 24 h. Echocardiography and single cell analysis after 1 week of exposure showed that ISO/PE-, but not ISO-treated animals established α1-AR-mediated inotropic responsiveness to acute adrenergic stimulation. Morphologically, additional PE perfusion limited concentric cardiomyocyte growth and enhanced cardiac collagen deposition during 7 days of treatment. Time-course analysis demonstrated a diverging development in transcriptional patterns at day 4 of treatment i.e., increased expression of selected marker genes Xirp2, Nppa, Tgfb1, Col1a1, Postn under chronic ISO/PE treatment which was either less pronounced or absent in the ISO group. Transcriptome analyses at day 4 via RNA sequencing demonstrated that additional PE treatment caused a marked upregulation of genes allocated to extracellular matrix and fiber organization along with a more pronounced downregulation of genes involved in metabolic processes, muscle adaptation and cardiac electrophysiology. Consistently, transcriptome changes under ISO/PE challenge more effectively recapitulated early transcriptional alterations in pressure overload-induced experimental heart failure and in human hypertrophic cardiomyopathy.

An mHealth Intervention to Improve Medication Adherence and Health Outcomes Among Patients With Coronary Heart Disease: Randomized Controlled Trial.

BackgroundThe treatment of many chronic illnesses involves long-term pharmaceutical therapy, but it is an ongoing challenge to find effective ways to improve medication adherence to promote good health outcomes. Cardioprotective medications can prevent the enlargement of harmful clots, cardiovascular symptoms, and poor therapeutic outcomes, such as uncontrolled high blood pressure and hyperlipidemia, for patients with coronary heart disease. Poor adherence to cardioprotective medications, however, has been reported as a global health concern among patients with coronary heart disease, and it is particularly a concern in China.ObjectiveThis study aimed to evaluate the efficacy of a mobile health (mHealth) intervention using 2 mobile apps to improve medication adherence and health outcomes.MethodsA randomized, placebo-controlled, 2-arm parallel study was conducted in a major university-affiliated medical center located in Chengdu, China. Participants were recruited by flyers and health care provider referrals. Each participant was observed for 90 days, including a 60-day period of mHealth intervention and a 30-day period of nonintervention follow-up. The study coordinator used WeChat and Message Express to send educational materials and reminders to take medication, respectively. Participants used WeChat to receive both the educational materials and reminders. Participants in the control group only received educational materials. This study received ethics approval from the Duke Health Institutional Review Board (Pro00073395) on May 5, 2018, and was approved by West China Hospital (20170331180037). Recruitment began on May 20, 2018. The pilot phase of this study was registered on June 8, 2016, and the current, larger-scale study was retrospectively registered on January 11, 2021 (ClinicalTrials.gov).ResultsWe recruited 230 patients with coronary heart disease. Of these patients, 196 completed the baseline survey and received the intervention. The majority of participants were married (181/196, 92.4%), male (157/196, 80.1%), and lived in urban China (161/196, 82.1%). Participants’ average age was 61 years, and half were retired (103/191, 53.9%). More than half the participants (121/196, 61.7%) were prescribed at least 5 medications. The mean decrease in medication nonadherence score was statistically significant at both 60 days (t179=2.04, P=.04) and 90 days (t155=3.48, P<.001). Systolic blood pressure and diastolic blood pressure decreased in the experimental group but increased in the control group. The mean decrease in diastolic blood pressure was statistically significant at both 60 days (t160=2.07, P=.04) and 90 days (t164=2.21, P=.03). The mean decrease in systolic blood pressure was significantly different in the groups at 90 days (t165=3.12, P=.002).ConclusionsThe proposed mHealth intervention can improve medication adherence and health outcomes, including systolic blood pressure and diastolic blood pressure.Trial RegistrationClinicalTrials.gov NCT02793830; https://clinicaltrials.gov/ct2/show/NCT02793830 and ClinicalTrials.gov NCT04703439; https://clinicaltrials.gov/ct2/show/NCT04703439

Efektifitas Minuman Ritemjeri (Sari Tempe Jelly Seledri) Terhadap Tekanan Darah Pasien Hipertensi di Puskesmas Punti Kayu Kota Palembang

Background : Hypertension or high blood pressure is a condition which is characterized by an increase in systolic blood pressure ≥ 140 mmHg and diastolic blood pressure ≥ 90 mmHg at two measurements with an interval of five minutes in a state of sufficient rest or calm. One of the non-pharmacological therapies that can help lower blood pressure is by utilizing foods that contain high potassium and Apigenin namely tempe and celery. Purpose : To determine the effect of tempe juice and celery jelly on reducing blood pressure of hypertension sufferers at the Palembang Punti Kayu Health Center.Method : This study was a quasi-experimental study with a pre-test and post-test with control group design. The subjects of this study were 60 people with hypertension at the Punti Kayu Health Center who were willing and fulfilled the inclusion and exclusion criteria. Data analysis uses t-dependent and t-independent tests. Results : The study showed that there was an average decrease in systolic and diastolic blood pressure in the treatment group of 9,517 mmHg and 10,282 mmHg (p-value = 0,000 and p-value = 0,000). Whereas in the comparison group the mean decrease in systolic and diastolic blood pressure was 6,94 mmHg and 14,060 mmHg (p-value = 0.000 and p-value = 0,000). T-independent statistical test results for systolic blood pressure in the treatment and comparison groups obtained p-value 0.037 (p &lt;0.05) and diastolic blood pressure obtained p-value 0.046 (p &lt;0.05). Conclusion : There is an effect of giving tempe juice and celery jelly on the blood pressure of hypertension sufferers in Palembang Punti Kayu Health Center.

Hemodynamic and Metabolic Tolerance of Acetate-Free Biofiltration in Mechanically Ventilated Critically Ill Patients: A Real-Life Study.

Intradialytic hypotension can lead to superimposed organ hypoperfusion and ultimately worsens long-term kidney outcomes in critically ill patients requiring kidney replacement therapy. Acetate-free biofiltration (AFB), an alternative technique to bicarbonate-based hemodialysis (B-IHD) that does not require dialysate acidification, may improve hemodynamic and metabolic tolerance of dialysis. In this study, we included 49 mechanically ventilated patients requiring 4 h dialysis (AFB sessions n = 66; B-IHD sessions n = 62). Whereas more AFB sessions were performed in patients at risk of hemodynamic intolerance, episodes of intradialytic hypotension were significantly less frequent during AFB compared to B-IHD, whatever the classification used (decrease in mean blood pressure ≥ 10 mmHg; systolic blood pressure decrease >20 mmHg or absolute value below 95 mmHg) and after adjustment on the use of vasoactive agent. Diastolic blood pressure readily increased throughout the dialysis session. The use of a bicarbonate zero dialysate allowed the removal of 113 ± 25 mL/min of CO2 by the hemofilter. After bicarbonate reinjection, the global CO2 load induced by AFB was +25 ± 6 compared to +80 ± 12 mL/min with B-IHD (p = 0.0002). Thus, notwithstanding the non-controlled design of this study, hemodynamic tolerance of AFB appears superior to B-IHD in mechanically ventilated patients. Its use as a platform for CO2 removal also warrants further research.

Cerebral Autoregulation during Orthostatic Challenge in Congenital Central Hypoventilation Syndrome.

Rationale: Congenital central hypoventilation syndrome (CCHS) is a rare autonomic disorder with altered regulation of breathing, heart rate (HR), and blood pressure (BP). Aberrant cerebral oxygenation in response to hypercapnia/hypoxia in CCHS raises the concern that altered cerebral autoregulation may contribute to CCHS-related, variably impaired neurodevelopment. Objectives: To evaluate cerebral autoregulation in response to orthostatic challenge in CCHS cases versus controls. Methods: CCHS and age- and sex-matched control subjects were studied with head-up tilt (HUT) testing to induce orthostatic stress. Fifty CCHS and 100 control HUT recordings were included. HR, BP, and cerebral oxygen saturation (regional oxygen saturation) were continuously monitored. The cerebral oximetry index (COx), a real-time measure of cerebral autoregulation based on these measures, was calculated. Measurements and Main Results: HUT resulted in a greater mean BP decrease from baseline in CCHS versus controls (11% vs. 6%; P < 0.05) and a diminished increase in HR in CCHS versus controls (11% vs. 18%; P < 0.01) in the 5 minutes after tilt-up. Despite a similar COx at baseline, orthostatic provocation within 5 minutes of tilt-up caused a 50% greater increase in COx (P < 0.01) and a 29% increase in minutes of impaired autoregulation (P < 0.02) in CCHS versus controls (4.0 vs. 3.1 min). Conclusions: Cerebral autoregulatory mechanisms appear to be intact in CCHS, but the greater hypotension observed in CCHS consequent to orthostatic provocation is associated with greater values of COx/impaired autoregulation when BP is below the lower limits of autoregulation. Effects of repeated orthostatic challenges in everyday living in CCHS necessitate further study to determine their influence on neurodevelopmental disease burden.

Abstract 1122‐000070: Multiple Watershed Strokes Following Catheter Ablation Procedure

Introduction : Cerebral watershed strokes involve the junction of two non‐anastomosing arterial systems, which are hemodynamic zones at risk. Strokes occur in 3% to 9% of patients after cardiac procedures. The mechanism underlying post‐cardiac surgery watershed stroke involves a combination of hypoperfusion and embolization, but the role of hypoperfusion has not been well elucidated. Watershed strokes in the general population are usually secondary to global hypoperfusion, such as during cardiac arrest, but may also be attributable to stenosis of the carotid artery or other major vessel, leading to local hypoperfusion. Atrial fibrillation confers a threefold to fivefold increase in the risk of stroke, causing 15–20% of all thromboembolic events in the United States. Catheter ablation of atrial fibrillation is the treatment of choice, and currently one of the most commonly performed electrophysiology procedures in the United States. Successful catheter ablation in patients with atrial fibrillation is associated with a decrease in systolic blood pressure. One study showed that in patients with hemodynamically significant stenosis, the average decrease in mean blood pressure during TIA attack was 26.4. mm Hg. In addition, carotid artery stenosis is frequently associated with stenosis of the vertebral arteries, carotid siphon, and cerebral arteries. In these patients, cerebral blood flow is directly dependent on perfusion pressure, due to the loss of normal autoregulatory capacity in the cerebral circulation. Methods : Single Case Study Results : 84‐year‐old male patient with a past medical history of hypertension, gastrointestinal hemorrhage, coronary artery disease status post coronary artery bypass graft, prostate cancer, and atrial flutter on Apixaban status post recent catheter ablation performed five days prior to presentation at the hospital. Patient presented to the emergency room with complaints of spotty vision. The remainder of the neurologic exam was unremarkable. Patient’s vision changes started after the cardiac ablation procedure and progressively worsened. At the time of assessment, NIH score was 1 due to left eye hemianopsia. CT scan of the head without contrast was done and was negative for hemorrhage. CTA of the neck showed 60% stenosis of the left carotid artery. MRI of the brain was done and showed infarct zones between the right anterior cerebral artery and right middle cerebral artery, the right middle cerebral artery and right posterior cerebral artery, the left anterior cerebral artery and left middle cerebral artery, and in the area supplied by the right posterior cerebral artery. Interestingly, based on the radiologic features, all of these strokes happened at approximately the same time. Conclusions : This case demonstrates that even in asymptomatic patients with hemodynamically insignificant carotid stenosis, hypotensive episodes can elicit hemodynamically significant changes that may result in ischemic stroke. Current guidelines don’t include radiologic assessment of the carotid arteries before catheter ablation procedure in patients with known atherosclerotic disease. Based on our findings, in patients with known atherosclerotic disease, we recommend radiologic assessment of the carotid arteries prior to catheter ablation. Patient who undergo catheter ablation usually have an echocardiogram done prior to the procedure.

Effect of Intraveous Tranexamic Acid and Sublingual Misoprostol on Reducing Post Cesarean Section Bleeding

Background and Aim: Cesarean section rates are rising around the globe and are considered as the major surgical procedure conducted on females. Cesarean-related hemorrhage contributes to increasing mortality rates around the world. Due to the rise in cesarean rate and its associated complications, post-cesarean severe bleeding without proper management is a major concern. Therefore, the present study aimed to assess the intravenous tranexamic acid (TA) and sublingual misoprostol effect on reducing post-cesarean section bleeding. Materials and Methods: This cross-sectional study was conducted on 146 term pregnant women undergoing emergency or elective cesarean section at the Department of Obstetrics and Gynaecology, Qazi Hussain Ahmad Medical Complex, Noshehra during the period from 7th September 2020 to 6th March 2021. All the participants were randomly categorized into two groups. Each group comprised of 73 participants whereas groups I and II received sublingual misoprostol (600 µg) and 500 mg intravenous tranexamic at card clamping respectively. Both groups were administrated for postoperative 48 hours and blood loss was measured. The packed cell volume and postoperative Hb were evaluated and compared with initial values before surgery. The need for blood transfusion, drug side effects, and additional uterotonics was evaluated. SPSS version 20 was used for data analysis. Results: The mean age of groups I and II were 28.32±4.73 and 28.17±4.83 years whereas the overall mean age was 28.25±4.78years. A higher reduction of hemoglobin level was observed in an intravenous tranexamic group compared to the sublingual group (-2.39±0.93 versus -2.09±1.28g/dL) (p=0.001). Moreover, the intravenous tranexamic group had significantly higher blood suction and gauze usage than sublingual misoprostol (256.73± 83.25versus 189.68± 102.4 cubic centimeter (cc) and 4.59±1.43 versus 3.19±1.27) for a significant value of 0.001. The decrease in mean blood pressure during the cesarean section procedure was significant in intravenous tranexamic than sublingual misoprostol (p=0.001). Conclusion: Our study concluded that sublingual misoprostol significantly reduced total bleeding when compared to tranexamic acid. Furthermore, hemodynamic variables were stabilized more in the misoprostol group than in the tranexamic acid group. Keywords: Cesarean Section Bleeding; Intravenous Tranexamic acid; Sublingual misoprostol.

Hyperparathyroidism in patients with overt and mild primary aldosteronism.

Increased prevalence of hyperparathyroidism (HP) has been observed in primary aldosteronism (PA) patients. However, HP prevalence in milder forms of PA has not to date been evaluated. The objectives of this study were to assess the prevalence of primary and secondary HP in overt and milder misdiagnosed cases of PA and to investigate the effect of treatment on parathormone (PTH) secretion. Seventy PA patients with normal renal function were included prospectively. Specifically, patients with biochemically overt PA (increased basal aldosterone/renin ratio (ARR) and a positive diagnostic suppression test (DCVT)) and patients with mild PA (normal basal ARR and a positive DCVT) were analyzed. Mean blood pressure and mineral metabolism were evaluated at diagnosis and after treatment. Primary and secondary HP were found in 4.3% (3/70) and 51.4% (36/70) of patients, respectively, and biochemically overt and mild PA in 47.1% (33/70) and 52.9% (37/70) of patients, respectively. Sixty-three PA patients were followed up after treatment without receiving calcium or vitamin D. There was a decrease of mean blood pressure (p < 0.001), PTH (p < 0.001), and 24-h urinary calcium (p < 0.001), and an increase of serum potassium (p < 0.001) and calcium (p = 0.018) levels in secondary HP patients. There was no significant difference between biochemically overt and mild PA patients as concerned serum PTH, calcium, and 25-hydroxyvitamin-D levels either before or after treatment. Aldosterone levels before treatment were positively correlated with serum PTH levels. HP prevalence was high in both overt and mild PA patients, whereas the effect of treatment on serum and urinary calcium and PTH levels was similar in both groups.

Impact of self-monitoring of salt intake by salt meter in hypertensive patients: A randomized controlled trial (SMAL-SALT).

Salt intake over reference level would result in elevated blood pressure (BP) and long‐term morbidity. Salt meter is a device used to detect sodium content in daily food. This study aimed to evaluate the efficacy of salt‐meter addition to dietary education. The authors conducted a randomized‐controlled trial in hypertensive patients with uncontrolled BP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg). Patients were randomized to receive salt meter plus dietary education (group A) or education only (group B), and followed up for 8 weeks. The primary endpoint was change in 24‐h urinary sodium excretion. Changes in BP, salt taste sensitivity, cardio‐ankle vascular index (CAVI) were also analyzed. There were total number of 90 patients who had complete follow‐up, 45 in each group. Mean age was 62.9 years and 53% were females. Mean baseline 24‐h urine sodium was 151.6 mmol/24 h and mean SBP and DBP were 152.8 and 83.4 mmHg, respectively. Baseline characteristics were similar between two groups. At 8 weeks, mean change in urine sodium were –31.83 mmol/24 h and 0.36 mmol/24 h in group A and group B, respectively (p = .006). Mean decrease in BP were SBP, 14.44 versus 8.22 mmHg (p = .030), and DBP 5.53 versus 1.93 mmHg (p = .032). The salt sensitivity was improved more in group A. There was no different between change in CAVI. From this study, salt meter in conjunction with dietary education, for self‐monitoring of salt intake is superior to education alone in hypertensive patients, and provided better blood pressure control. Salt meter should be considered in uncontrolled hypertensive patients.

Comparison between methyldopa and combination of methyldopa and nifedipine in terms of mean change in blood pressure in pregnancy induced hypertension

Objective: Comparison between Methyldopa and combination of Methyldopa and Nifedipine in terms of mean change in blood pressure in pregnancy induced hypertension. Material and methods: This randomized controlled trial was conducted at Department of Obstetrics and Gynecology, Combined Military Hospital Bahawalpur from February 2020 to August 2020 over the period of 6 months. Total 80 patients with pregnancy induced hypertension as per operational definition having age 20-40 years and having gestational age ≥ 20 weeks assessed on LMP were selected. Results: Mean age of the patients was 30.81 ± 5.670 years, mean age of patients of group A was 31.50 ± 5.809 years and mean age of group B was 30.13 ± 5.515 years. Mean gestational age was 30.17 ± 5.981 weeks, mean gestational age of patients of group A was 29.70 ± 6.329 weeks and mean gestational age of patients of group B was 30.65 ± 5.65 weeks. In group A, mean diastolic blood pressure was decrease from 101.2250 ± 4.97938 to 84.5000 ± 3.26599 and in group B from 107.7750 ± 7.18434 to 82.5000 ± 2.25320. Comparison of mean decrease in diastolic blood pressure between group A (High dose Methyldopa) and group B (Low dose Low dose Methyldopa with Nifedipine) was done. Mean decrease in diastolic blood pressure in group A was 16.72 ± 3.935 and in group B was 25.28 ± 6.876. Statistically significant difference of mean decrease in diastolic blood pressure between the both groups was noted with p value 0.000. Conclusion: Results of this study showed that Low dose Methyldopa with Nifedipine combination is more effective as compared to High dose Methyldopa to reduce diastolic blood pressure in pregnant women suffering from pregnancy induced hypertension. Keywords: Diastolic blood pressure, Methyldopa, Nifedipine, Pregnancy induced hypertension, Systolic blood pressure

ROLE AND PROBLEMATICS OF THE EPIDURAL ANESTHESIA DURING EXTENSIVE LIVER RESECTIONS

Abstract. In the following article it was evaluated the coagulopathy and/or hypotension incidence rate in patients with the liver extensive resection, who were treated with the thoracal epidural anesthesia and pain management (TEA). Materials and methods. There were enrolled 55 subjects whom the liver extensive resection with TEA both in the intraoperative, and post-operative period was performed at the following site: National Institute of Surgery and Transplantology of the NAMS of Ukraine named after A.A. Shalimov. Influence on the haemodynamics was evaluated on the basis of the mean blood pressure (MBP) decrease lower than 65 mm Hg and appearance of the necessity of vasoactive substances’ administration. We determined the coagulation system’s alteration on the basis of changes of the indicators related to the prothrombotic time (PTT), prothrombotic index (PTI) and international normalization ratio (INR). Vascular platelet hemostasis was evaluated on the basis of the platelets level dynamics. Result. 80% of the 55 subjects required administration of noradrenaline with the aim of the objective MBP control. Execution of the liver extensive resection was characterized by the verifiable decrease of the platelets in the early post-operative period, but this decrease was not clinically significant. It was observed the verifiable increase of the PTT starting from the intraoperative period at the 16,5% (р=0,0001) in comparison with the baseline values, which correlated with the change of PTI and INR.Execution of the liver extensive resection was characterized by the decrease of the blood coagulation properties in early post-operative period, and which led to the verifiable increase of the prothrombotic time, INR and decrease of PTI. Conclusion. Now therefore, the influence of the TEA on the systemic hemodynamics and coagulation system requires of the alternative safe pain management methods’ search for this subjects’ group.

Effect of Patient Education Intervention on Medication Adherence and Blood Pressure of Hypertensive Filipino Patients: Systematic Review and Meta-analysis

Control of blood pressure because of poor adherence is a problem in the Philippines despite the implementation of medicine access programs. Patient education is utilized to address this problem; however, there is no published literature to evaluate this using a pooled data analysis. The objective of the study is to examine the effect of educational interventions on adherence and blood pressure. Eight databases were used to search for articles published from 2000–2020. Inclusion criteria specified the population as Filipino, 18 yr old and above, clinically diagnosed hypertension, and receiving treatment. Out of 1,514 articles, 10 articles were quality-assessed using the Cochrane risk of bias tool, systematically reviewed, and analyzed using a random-effects model. Patient education is estimated to increase the standardized self-reported adherence to 0.869 (p &lt; 0.05, I2 = 94.98%) and the proportion of adherent patients to 77.4% (p &lt; 0.001, I2 = 78.92%). The mean decrease in systolic blood pressure is estimated to be –14.568 (p &lt; 0.001, I2 = 0%) for studies with control group and –12.907 (p &lt; 0.001, I2 = 83.56%) for quasi-experimental studies. For diastolic blood pressure, the estimated mean decrease is –5.412 (p &lt; 0.001, I2 = 0%) for studies with control group and –5.592 (p &lt; 0.001, I2 = 58.6%) for quasi-experimental studies. Findings should be interpreted with caution because of the heterogeneity, low- to moderate-quality of evidence, and methodological limitations. Despite this, the result suggests that educational interventions should be incorporated in the existing programs for further research using longitudinal study design using objective measures for medication adherence.

Predicting hypotension during anesthesia: Variation in pulse oximetry plethysmography predicts propofol‐induced hypotension in children

The development of hypotension on administration of intravenous propofol is common and independently associated with adverse outcomes. Identifying patients with a high risk for anesthesia-induced hypotension may help anesthesiologists prepare for such an event. The authors hypothesized that propofol-induced hypotension is predictable by variables related to fluid responsiveness and investigated such variables to determine the factors which can predict hypotensive events. Patients 3-6years of age who underwent general were included. Intravenous midazolam 0.1mg kg-1 was administered as premedication, and preoperative noninvasive blood pressure, heart rate, perfusion index, pleth variability index, and respiratory variation of pulse oximetry plethysmographic waveform were measured. Intravenous propofol 2.5mg kg-1 was given, and blood pressure was measured 5 times at 1-min intervals. Subjects with significant hypotension (mean blood pressure decrease ≥20%) were allocated to the hypotensive group; those without significant hypotension were allocated to the relatively normotensive group. Of 77 patients, 50 (64.9%) developed significant hypotension. Patients in the hypotensive group exhibited significantly higher respiratory variation of pulse oximetry plethysmographic waveform (mean difference 11 [3.3] [95% confidence interval 4.9-18.1]; p=.001) and higher pleth variability index (mean difference 7.1 [2.8] [95% confidence interval 1.6-12.6]; p=.013) than the normotensive group. The areas under the receiver operating characteristic curve for respiratory variation of pulse oximetry plethysmographic waveform and pleth variability index were 0.722 and 0.649, respectively. High preoperative respiratory variation of pulse oximetry plethysmographic waveform and pleth variability index were both independently associated with propofol-induced hypotension in children.

Safety and efficacy of lacosamide versus phenytoin for refractory seizures in neurosurgical patients

BackgroundPostoperative neurosurgical patients have increased risk of seizures. Traditional anti-epileptics, such as phenytoin, are not always effective and cause adverse effects. Levetiracetam is the first-line therapy due to its similar...

Risk factors including preoperative echocardiographic parameters for post-induction hypotension in general anesthesia

BackgroundSevere hypotension immediately after induction of general anesthesia (post-induction hypotension) is a common complication and is associated with a poor postoperative outcome. We hypothesized that post-induction hypotension results from cardiac dysfunction which can be assessed by preoperative echocardiography. MethodsWe retrospectively enrolled 200 patients who had undergone elective surgery within 6 months after preoperative transthoracic echocardiography. The incidence of post-induction hypotension identified from anesthesia records was defined as a decrease in mean blood pressure to ≤50 mmHg after injection of induction anesthetics prior to surgery. Logistic regression analysis of patient characteristics and echocardiographic variables was used to identify the independent factors for post-induction hypotension. ResultsPost-induction hypotension was found in 63 of the 200 cases (incidence 32%). Independent risk factors for post-induction hypotension were the presence of a regional wall motion abnormality (RWMA) [odds ratio (OR), 6.65.; 95% confidence interval (CI), 1.76 - 25.10], an elevated E/e’ (OR, 1.13; 95% CI, 1.00 - 1.28), female gender (OR, 3.61; 95% CI, 1.37 - 9.56), and the use of an angiotensin II receptor blocker (OR, 3.17; 95% CI, 1.12 - 8.96). ConclusionsAssessment of RWMA and E/e' with preoperative transthoracic echocardiography might be helpful for stratification of patients at a risk of post-induction hypotension in general anesthesia.