Delta Systolic Blood Pressure Research Articles

Prehospital Post-Resuscitation Vital Sign Phenotypes are Associated with Outcomes Following Out-of-Hospital Cardiac Arrest

Objectives The use of machine learning to identify patient ‘clusters’ using post-return of spontaneous circulation (ROSC) vital signs may facilitate the identification of patient subgroups at high risk of rearrest and mortality. Our objective was to use k-means clustering to identify post-ROSC vital sign clusters and determine whether these clusters were associated with rearrest and mortality. Methods The ESO Data Collaborative 2018–2022 datasets were used for this study. We included adult, non-traumatic OHCA patients with >2 post-ROSC vital sign sets. Patients were excluded if they had an EMS-witnessed OHCA or were encountered during an interfacility transfer. Unsupervised (k-means) clustering was performed using minimum, maximum, and delta (last minus first) systolic blood pressure (BP), heart rate, SpO2, shock index, and pulse pressure. The assessed outcomes were mortality and rearrest. To explore the association between rearrest, mortality, and cluster, multivariable logistic regression modeling was used. Results Within our cohort of 12,320 patients, five clusters were identified. Patients in cluster 1 were hypertensive, patients in cluster 2 were normotensive, patients in cluster 3 were hypotensive and tachycardic (n = 2164; 17.6%), patients in cluster 4 were hypoxemic and exhibited increasing systolic BP, and patients in cluster 5 were severely hypoxemic and exhibited a declining systolic BP. The overall proportion of patients who experienced mortality stratified by cluster was 63.4% (c1), 68.1% (c2), 78.8% (c3), 84.8% (c4), and 86.6% (c5). In comparison to the cluster with the lowest mortality (c1), each other cluster was associated with greater odds of mortality and rearrest. Conclusions Unsupervised k-means clustering yielded 5 post-ROSC vital sign clusters that were associated with rearrest and mortality.

Post-spinal hypotension management for cesarean section in low resource settings: efficiency and safety of two very low-dose boluses of norepinephrine, a randomized double-blinded controlled trial

Spinal anesthesia is the gold standard anesthetic technique for cesarean section. However, its major complication is hypotension. Norepinephrine has recently been described as an efficient and safe alternative to Phenylephrine. The aim of this study was to determine the effective target bolus of Norepinephrine to prevent and treat post-spinal anesthesia hypotension. We conducted a prospective controlled randomized study including 126 parturients scheduled for cesarean delivery under spinal anesthesia. We compared two groups that received a prophylactic bolus of either 1μg/kg or 0.5μg/kg of Norepinephrine without fluid loading. The rescue intravenous bolus of Norepinephrine was half the dose of the prophylactic bolus. The main outcomes were the percentage of decrease in systolic and mean blood pressure. The secondary outcomes included the timing of the first hypotension, duration of hypotension, number of rescue boluses, total Norepinephrine consumption, incidence of hypotension and maternal adverse effects and fetal outcomes. Our primary outcome has shown similarities between groups; delta systolic blood pressure before delivery was 19.4% in group 1µg/kg versus 20.5% in group 0.5µg/kg. Both groups were similar for all secondary outcomes, except that the higher dose of Norepinephrine resulted in more hypertension. Fetal outcomes were similar in both groups. Bolus of 0.5μg/kg followed by rescue doses of 0.25μg/kg of Norepinephrine was efficient in preventing and treating spinal anesthesia-induced hypotension. These doses may be recommended for routine use in healthy parturients.

Abstract TP87: Predictors Of Diffusion-weighted Imaging Lesion Burden In Patients After Minimally Invasive Surgery For Intracerebral Hemorrhage

Introduction: The etiology of diffusion-weighted imaging (DWI) lesions in patients after minimally invasive surgery (MIS) for acute intracerebral hemorrhage (ICH) remains unclear. Methods: Postoperative brain MRIs of patients with spontaneous ICH from 2016-2021 who underwent imaging within one month of MIS were reviewed. DWI lesions were quantified. Lesions within 10 mm of the hematoma were excluded. Siderosis and microbleeds were identified. Leukoaraiosis was quantified using the Fazekas score. Univariate analyses were conducted to determine predictors of DWI lesion burden, and variables with P≤0.1 were included in multivariate analyses. Results: DWI lesions were present in 84 (49%) postoperative MRIs. The average number of DWI lesions was 2.11 (range 0-74, SD 6.50). Factors associated with DWI burden in univariate analyses included increased presenting systolic blood pressure (SBP) (P=0.003), Fazekas score (P=0.004), delta SBP on day of admission (P=0.034), preoperative angiogram (P=0.062), microbleeds on MRI (P=0.065), increased presenting National Institutes of Health Stroke Score (P=0.066), presence of intraventricular hemorrhage (P=0.069), and decreased presenting Glasgow Coma Scale (P=0.076). Upon multivariate analysis, increased Fazekas score (OR 2.04, 95% CI 1.21-3.43, P=0.008), presenting SBP (OR 1.04, 95% CI 1.00-1.06, P=0.014), and preoperative angiogram (OR 10.35, 95% CI 1.44-74.36], P=0.020) were predictive of DWI burden. Conclusions: In this unique postoperative ICH cohort, white matter changes, presenting SBP, and preoperative angiogram predicted DWI lesion burden. Larger studies are needed to understand the implications of DWI burden after MIS for ICH recovery.

The Association Among Post-hemodialysis Blood Pressure, Nocturnal Hypertension, and Cardiovascular Risk Factors.

Most hemodialysis (HD) patients suffer from hypertension and have a heightened cardiovascular risk. While blood pressure (BP) control is essential to end-stage kidney disease (ESKD) patients, overly stringent control can lead to intradialytic hypotension (IDH). This study aimed to examine BP variations during and after HD to determine whether these variations correlate with IDH risk. BP measurements during dialysis were taken from 28 ESKD patients, and ambulatory BP monitoring was applied post-dialysis. Laboratory parameters and risk factors, including diabetes, coronary disease, and LV mass index, were compared between IDH and non-IDH groups using an independent t-test. Of the 28 patients with an average age of 57.4 years, 16 (57.1%) had diabetes, 5 (17.9%) had coronary artery disease, and 1 (3.6%) had cerebrovascular disease. The mean systolic blood pressure (SBP) during and post-HD was 142.26 mmHg and 156.05 mmHg, respectively (p=0.0003). Similarly, the mean diastolic blood pressure (DBP) also demonstrated a significant increase, from 74.59 mmHg during HD to 86.82 mmHg post-HD (p<0.0001). Patients with IDH exhibited a more substantial SBP difference (delta SBP, 36.38 vs. 15.07 mmHg, p=0.0033; age-adjusted OR=1.58, p=0.0168) and a lower post-dialysis BUN level (12.75 vs. 18.77 mg/dL, p=0.0015; age-adjusted OR=0.76, p=0.0242). No significant variations were observed in daytime and nocturnal BP between the IDH and non-IDH groups. Hemodialysis patients exhibited a marked increase in post-dialysis BP and lacked a nocturnal BP dip, suggesting augmented cardiovascular risks. This highlights the importance of more stringent BP control after hemodialysis.

PRELIMINARY REPORT: BLOOD PRESSURE TRAJECTORIES OVER TIME IN A MULTI-ETHNIC POPULATION

Objective: Objective: Hypertension remains the leading cause of cardiovascular diseases worldwide. Major interethnic differences in the prevalence of hypertension exist. Exploring blood pressure (BP) levels in a large prospective multi-ethnic population provides insight in interethnic differences in blood pressure trajectories across the life course. Design and method: Design and method: We examined BP course over time in participants from the HEalthy Life in an Urban Setting (HELIUS) study. Participants aged 18–70 years from Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin with BP data at baseline and follow-up were included. BP levels were corrected for the use of antihypertensive medication. BP change over time was expressed as delta systolic blood pressure (delta SBP) and delta diastolic blood pressure (delta DBP). Multivariate regression analyses were performed to assess the association between ethnicity and BP levels at follow-up, with correction for sex, age, follow-up time, change of BMI and blood pressure levels at baseline. Results: Results: In total 8.053 participants (mean age 46.2 (12.4) years, 43.8% female) were included. Median follow-up time was 6.2 (5.3–7.1) years. Overall there was a slight increase in SBP over time (129.41 mmHg at baseline vs. 129.87 at follow-up), while diastolic blood pressure levels tended to decrease (delta DBP = -0.59 mmHg) (Figure 1). The highest SBP increase was found in the Ghanaian population (+1.84 mmHg), while the largest decrease was observed in in the Dutch population (-0.28 mmHg). The lowest DBP decrease was found in the Ghanaian population (-0.02 mmHg) and the highest decrease in the South-Asian Surinamese population (-1.31 mmHg). Multivariable regression analysis showed a strong association between ethnicity and SBP at follow-up, especially for the Ghanaian population (β = 5.51 (95%CI 4.42 – 6.61), p = 2.2e-16) compared to the Dutch reference population. For DBP these interethnic differences were also present, but less pronounced. Conclusions: Conclusions: Major interethnic differences in the course of blood pressure over time were found, with substantially higher SBP levels in the Ghanaian population compared to the reference Dutch population.

Differences in oscillometric blood pressure readings between unsupported and supported back conditions.

Appropriate body posture is important for accurate blood pressure (BP) measurement. However, the impact of an unsupported back on BP readings is currently controversial. This study included 224 subjects (18-86 years old, 54.5 ± 15.5 years old, 105 males). BP was measured with an oscillometric BP device randomly following one of two protocols for back support conditions: (1) supported-unsupported-supported-unsupported, or (2) unsupported-supported-unsupported-supported. The average of the two systolic BP (SBP) and diastolic BP (DBP) readings in the same position was recorded as the final BP value. The differences in BP between the unsupported and supported back conditions were calculated as delta BP. Moreover, the percentage variation in BP (PV) was calculated with the formula delta BP/BP with an unsupported back. Multivariable regression analysis evaluated the impact of age, sex, hypertension history and supported BP level on PV. The SBP/DBP levels measured with an unsupported back were slightly higher than those when the back was supported (132.7 ± 19.5/79.6 ± 12.9 mmHg vs. 130.3 ± 20.0/78.5 ± 14.3 mmHg), and the delta SBP (2.3 mmHg) was statistically significant. The multivariable regression analysis showed that age was a positive factor but supported SBP level as a negative factor for systolic PV, while age and supported DBP level were positive factors, but hypertension history was a negative factor for diastolic PV. For a group participant, the mean difference in oscillometric SBP/DBP in the unsupported back position was 2.3/1.0 mmHg higher than that in the supported back position.

Autonomic functions in focal epilepsy: A comparison between lacosamide and carbamazepine monotherapy

ObjectiveSome antiepileptic drugs (AEDs), like sodium channel blockers are significantly associated with autonomic dysfunction in patients with epilepsy. Unlike other sodium-blockers AEDs, lacosamide (LCM) is a third generation AEDs which enhances the slow inactivation of voltage-gated sodium channels. So far, data about LCM on autonomic nervous system are still unknown. This study was designed to investigate cardiovascular autonomic and sudomotor function in patients affected by focal epilepsy on LCM monotherapy, compared to patients treated with carbamazepine (CBZ) monotherapy and healthy subjects. MethodsPatients on LCM underwent autonomic function tests including head up tilt test (HUTT), Valsalva maneuver, deep breathing, hand grip, and cold face. Heart rate variability (HRV) analysis was performed in rest condition and during HUTT. Sudomotor function was assessed through Sudoscan. All results were compared with patients on carbamazepine (CBZ) monotherapy and with healthy subjects. ResultsFourteen patients on LCM monotherapy, 12 patients on CBZ monotherapy and 16 healthy controls were studied. At cardiovascular function tests, delta systolic blood pressure (∆SBP) at 3 min of HUTT and ∆SBP early phase II-late phase II at Valsalva maneuver were significantly lower in CBZ group compared to LCM patients. Spectral analysis of HRV showed no significant differences among LCM, CBZ and control groups. No difference in sudomotor function was found in all three groups. ConclusionsIn conclusion, our findings suggest that LCM and CBZ on monotherapy do not affect autonomic cardiovascular and sudomotor functions compared to controls. Nevertheless, patients on CBZ showed a lower sympathetic reactivity with respect to LCM.

3-9SYSTOLIC BLOOD PRESSURE, MEAN ARTERIAL BLOOD PRESSURE RELATED TO CLINICAL OUTCOMES IN HEMORRHAGIC STROKE WITH EMERGENCY HYPERTENSION

Introduction: Stroke is a leading cause of mortality and disability in Indonesia. According to classification, 15–20% are hemorrhagic stroke, and 80% are due to hypertension. Many of them with emergency hypertension. Several studies have demonstrated a strong association between an increased level of blood pressure (BP) with poor outcomes. Comprehensive management of emergency hypertension could decrease mortality and disability. Objective: To study about the relationship of initial systolic blood pressure (SBP) and initial mean arterial pressure (MAP) with outcome in the patient having a hemorrhagic stroke and emergency hypertension. Method: This is an analytic observational study using medical records.The study investigated the association between SBP and MAP with clinical outcome based on The National Institutes of Health Stroke Scale (NIHSS) in living patients and deceased Result: We collected 60 subjects. Mean SBP initial 191.22 mmHg, MAP initial 134.26. We found a decrease in BP. Mean SBP at discharge 140.56 mmHg and MAP at discharge 103.0 mmHg. We observed decreasing in NIHSS from 12.89 at initial to 9.5 at discharge. Statistical analysis using Pearson's for delta SBP and MAP with NIHSS initial and discharge was not significant. The average of SBP and MAP of the patient who died is higher than the survived patient; however, it was not statistically significant. Conclusion: We could not find the relationship between initial systolic blood pressure, initial mean arterial pressure, and NIHSS in survived and deceased patients.

Improved Sleep Quality Improves Blood Pressure Control among Patients with Chronic Kidney Disease: A Pilot Study

Background: Despite the abundance of data documenting the consequences of poor sleep quality on blood pressure (BP), no previous study to our knowledge has addressed the impact of sleep improvement on resistant hypertension among patients with chronic kidney disease (CKD). Methods: The aim of this pilot study was to determine whether improved sleep quality and duration will improve BP control in patients with resistant hypertension and CKD. It was a prospective single-center cohort study that involved 30 hypertensive subjects with CKD presenting with primary resistant hypertension and poor sleep quality or duration <6 h/night. Sleep quality and duration were modified using either sleep hygiene education alone or adding sleep medication. The cohort’s BP was followed every 3 months for 6-month duration. The average home and clinic BPs were collected at each follow-up visit. The primary outcome baseline change in systolic BP (SBP) and diastolic BP (DBP; home and clinic) at 3 and 6 months after documented sleep improvement. Secondary outcomes included change from baseline in mean arterial pressure, and delta SBP after sleep improvement. Results: African American patients represented 50% of the cohort. All patients had evidence of CKD with GFR ≤60 mL/min and were obese with 40% having type 2 diabetes mellitus. The primary endpoint of change in clinic SBP and DBP was significantly reduced at 3 months, baseline 156 ± 15/88 ± 8 vs. 3 months 125 ± 14/73 ± 7 (p < 0.0001). This difference persisted at 6 months. However, there was no further reduction in-home or clinic BPs between the 3- and 6-month periods. Home and clinic average delta SBP change at 3 months from baseline was –34.4 ± 15 and –30.8 ± 19 mm Hg respectively. Delta SBP change was associated with sleep improvement of >6 h/night, that is, gaining an extra 3–4 h’ sleep duration, home; R² = 0.66, p < 0.0001 and clinic; R² = 0.49, p < 0.0001. Conclusion: Optimizing sleep quality and duration to >6 h/night improved BP control and was associated with a significant delta change in SBP within 3 months of follow-up. Physicians should obtain a sleep history in patients with CKD who present with resistant hypertension.

The relationship between hypoalbuminemia and intradialytic hypotention in hemodialysis patients

Objective The aim of this study was to evaluate the relationship between serum albumin and intradialytic hypotension (IDH). Background Hypoalbuminemia and IDH are common complications during hemodialysis (HD) session. Hypotension is a risk factor for mortality and morbidity in HD patients. Patients and methods We conducted a cross-sectional study on 50 patients with end-stage renal disease who received regular HD session three times weekly for more than 3 months (from April to July 2017) at Ashmoun General Hospital. They were divided into two groups: group 1 included patients who developed recurrent attacks of IDH (24 patients) and group 2 included patients who did not develop IDH (26 patients). Data collected from each patient included the following: (i) demographic features and clinical features (blood pressure (BP) changes during session, ultrafiltration rate, intradialytic weight gain, duration of dialysis, cause of end-stage renal disease, surface area of dialyzer, and blood flow of the machine); (ii) blood chemistry (creatinine level, urea, hemoglobin, hematocrit value, albumin, triglycerides, cholesterol, aspartate aminotransferase, alanine aminotransferase, Na*, K*, and KT/V); (iii) echocardiographic assessment of left ventricular geometry; and (iv) inferior vena cava-guided ultrasonography. Results Serum albumin level among group I ranged between 2.4 and 4.7 mg/dl, with mean ± SD of 3.1 + 0.53 mg/dl, whereas in group II, serum albumin level ranged between 2.6 and 4.6 mg/dl with mean ± SD of 3.6 ± 0.48 mg/dl, with P value of 0.002, indicating there was a high significant difference between both groups. There was a highly significant positive correlation between delta systolic BP and IVC collapsibility index (IVCC). There was a highly significant negative correlation between serum albumin and IVCC, and there was a highly significant negative correlation between delta systolic BP and IVC diameter. Conclusion We concluded that serum albumin is a parameter that is associated with IDH and found that bedside measurements of IVCC and IVC diameter are easy and good markers for prediction of IDH.

ASSOCIATION BETWEEN BLOOD PRESSURE VARIABILITY AND EARLY NEUROLOGICAL DETERIORATION IN ACUTE ISCHEMIC STROKE PATIENTS

Background: Variability in blood pressure is a predictor of stroke severity and causes of poor functional outcome. Blood pressure variability is one of the main predictor of the prognosis acute ischemic stroke. Blood pressure variability were independently and linearly associated with the development of early neurologic deterioration (END) in acute ischemic stroke Objective: To determine the association between blood pressure variability and END in acute ischemic stroke patients. Method: This study uses a cross sectional design. Sampling was conducted at H. Adam Malik General Hospital Medan. Samples were taken as many as 40 subjects consecutively. Blood pressure checks were perform every hour for 72 hours then an assessment of the National Institute of Health Stroke Scale (NIHSS) score at admission and the third day of treatment. Data analysis used fisher’s exact test. Results: The demographic characteristics of the study subjects were an average age of 56-&lt;71 years, high school education level, housewife occupation and Batak ethnicity. The mean of maximum systolic blood pressure (SBP) was 151±12.16 mmHg, minimum SBP 123.15±18 mmHg, delta SBP 25.35±10.66 mmHg, maximum diastolic blood pressure (DBP) 79.7±6.01 mmHg, minimum DBP 61.77±7.32 mmHg and delta DBP 17.97±8.48 mmHg. The NIHSS day 1 score had an average of 9.55±6.73, the NIHSS day 3 score was 11.25±7.93. Most subjects experienced END. There is a significant relationship between blood pressure variability and END with a p of 0.03 (p&lt;0.05). Conclusion: There is a significant relationship between blood pressure variability and END in patients with acute ischemic stroke.

Long term metabolic and renal outcomes of kidney donors compared to controls with excellent kidney function

BackgroundOnly few studies of living kidney donors have included controls that were similarly healthy, including excellent kidney function.MethodsIn this study, we aimed to estimate long term metabolic and renal outcome in a cohort of 211 living donors compared to two control groups: paired-matched controls, and another control group of 2534 healthy individuals with excellent kidney function.ResultsDonors presented with higher estimated Glomerular Filtration Rate (eGFR): (97.6 ± 15.2 vs 96.1 ± 12.2 vs 94.5 ± 12.4 ml/min/1.73m2) and lower urine albumin to creatinine ratio (UACR) (4.3 ± 5.9 vs 5.9 ± 6.1 vs 6.1 ± 6.9 mg/g) for donors, matched controls and healthy controls, respectively (p < 0.001). In a mean follow up period of 5.5 for donors, donors presented with positive eGFR slopes during the first 3 years post donation, followed by negative slopes, compared to constantly negative slopes presented in the control group (p < 0.05). The variables related to the slope were being a donor, baseline eGFR, Body Mass Index (BMI) and age but not eGFR on the last day of follow-up or increased delta UACR. There was a significant increase in UACR in donors, as well as a higher rate of albuminuria, associated with a longer time since donation, higher pre-donation UACR and higher pre-donation BMI. Healthy controls had a lower BMI at baseline and gained less weight during the follow up period. Donors and controls had similar incidence of new onset diabetes mellitus and hypertension, as well as similar delta systolic and diastolic blood pressure. Donors were more likely to develop new onset metabolic syndrome, even after adjustment for age, gender and BMI. The higher incidence of metabolic syndrome resulted mainly from increased triglycerides and impaired fasting glucose criteria. However, prevalence of major cardiovascular events was not higher in this group.ConclusionsDonors are at increased risk to develop features of the metabolic syndrome in addition to the expected mild reduction of GFR and increased urine albumin excretion. Future studies are needed to explore whether addressing those issues will impact post donation morbidity and mortality.

Assessing Extracellular Volume in Hemodialysis Patients Using Intradialytic Blood Pressure Slopes

Background/Aims: Extracellular volume (ECV) overload is a mortality risk factor in hemodialysis patients, but no standard approach exists to objectively assess this clinically. We aimed to quantify relationships between slopes of repeated intradialytic blood pressure (BP) measurements and ECV. Methods: In a cross-sectional study of 71 hemodialysis patients, we calculated BP slopes from all intradialytic measurements using Gaussian regression. We measured extracellular and total body water (TBW) with bioimpedance spectroscopy. We analyzed unconditional and conditional associations between BP slope and volume metrics with mixed linear models and sensitivity analyses using non-linear intradialytic BP trajectory. Results: Mean systolic intradialytic BP slope (IBPS) was –0.06 (0.1) mm Hg/min. Post-dialysis extracellular water (ECW)/weight was the volume metric mostly strongly associated with slope (r = 0.34, p = 0.007 for unconditional analysis; β = 1.45, p = 0.001 for conditional analysis). Among subjects with post-dialysis systolic BP ≥130 mm Hg, the association strengthened (r = 0.40, p = 0.006; β = 1.42, p = 0.003). ECV was more strongly associated with the BP slope than with pre-dialysis, post-dialysis, or delta systolic BP (r = –0.07, 0.19, 0.28; p = 0.6, 0.1, 0.03). In nonlinear models, BP trajectory also had the strongest association with post-dialysis ECW/body weight (p < 0.001). Conclusions: In hypertensive hemodialysis patients, measurements of ECV excess are more strongly associated with IBPSs than with pre-dialysis, post-dialysis, or change in systolic BP. Among varying volume metrics, post-dialysis ECW/weight has the strongest association with these slopes. Determining IBPS is a novel method to optimize clinical assessment of ECV in hemodialysis patients.

Longitudinal prospective observational type study about determinants of renal resistive index variations in chronic renal failure patients treated with conventional medical and dietetic therapy.

This longitudinal prospective observational type study was conceived with the aim to examine the impact on renal resistive index (RRI) of the variables that we can manipulate with therapeutic and or dietetic interventions in a chronic kidney disease population in order to known which of these variables was statistically related to changes in RRI and therefore could become the object of the greatest therapeutic effort. This study was undertaken between May 2016 to May 2017 in the outpatient nephrology and urology clinic of San Donato Hospital in Arezzo. The study population (84 patients: 47 males and 37 females) was randomly selected among the chronic kidney patients (with various degrees of renal impairment) affected by hypertension and or diabetes mellitus. After a comprehensive medical examination these patients were submitted to determination of serum creatinine, glycated hemoglobin, 24-hour urinary albumin excretion and finally renal Doppler ultrasonography. Then the patients were submitted to a full therapeutic and dietetic intervention to ameliorate the renal impairment by a wide range of actions and after on average a one-year interval were submitted again to a new medical examination and a second determination of serum creatinine, glycated hemoglobin, 24-hour urinary albumin excretion and a new renal Doppler ultrasonography too. The comparison between basal and final data revealed a slight reduction in the mean of bilateral renal resistance indices (Delta RRI: -0.0182 ± 0.08), associated to a slight increase in the mean glomerular filtration rate (Delta GFR: 0.8738 ± 10.95 ml/min/1.73 m2), a reduction in mean body weight (Delta weight: -1.9548 ± 5.26 Kg) and mean BMI (Delta BMI: -0.7643 ± 2.10 Kg/m2) as well as a reduction in the mean systolic blood pressure (Delta systolic blood pressure: -8.8333 ± 25.19 mmHg). Statistical analysis showed statistically significant correlations (p < 0.05) between Delta RRI and Delta weight (p < 0.03), Delta BMI (p < 0.02) and Delta systolic blood pressure (p < 0.05). Despite the many limitations the our study clearly identifies the targets (yet widely known) to act on to prevent kidney alterations related to RRI and provides further evidence, if any, of the utility of RRI as a key parameter in monitoring patients with chronic renal failure and as a valuable tool to drive the clinical efforts to contrast the kidney disease.

Intra-dialytic hypotension: Identifying patients most at risk.

Intra-dialytic hypotension (IDH) remains a frequent but serious complication of haemodialysis. We performed a retrospective observational analysis of our prevalent dialysis population extracting data from an online database. Four hundred and thirty-two patients underwent 21 consecutive outpatient dialysis sessions during the study period: Of the 9,072 dialysis sessions studied, 438 were complicated by episodes of IDH (4.8%). 266/432 patients were asymptomatic whilst 166/432 experienced at least one episode of IDH. Symptomatic patients had significantly lower pre-dialysis systolic blood pressures (137 mmHg compared with 146 mmHg p < 0.0001) and demonstrated a greater per cent drop in their systolic blood pressure (delta systolic) before and after dialysis (9.7% vs. 4.1% p < 0.0001). Patients taking either a single or no anti-hypertensive agents had a significantly higher delta systolic than those on two or more anti-hypertensive agents (7.6% vs. 2.2% p < 0.01) and were almost 50% more likely to suffer from IDH (RR = 1.48, p = 0.017). Using logistical regression we identified pre-dialysis systolic blood pressure and delta systolic blood pressure as strong predictor variables for IDH (p < 0.0001). We constructed a model able to calculate the risk of an individual patient suffering with IDH using delta systolic and pre-dialysis systolic blood pressure. A ROC analysis suggests this to be an accurate model (AUC = 0.79). Delta systolic blood pressure is clinically useful in identifying patients most at risk of IDH. Anti-hypertensive medication use is associated with a lower delta systolic and a lower risk of IDH.

Diferentes ordens do exercício combinado: efeitos agudos de 24 horas sobre a pressão arterial de atletas

Resumo Verificar as respostas de 24 horas da pressão arterial (PA) em jovens adultos após diferentes ordens de execução do exercício aeróbio (EA) e resistido (ER). Participarão do estudo dez homens saudáveis (22,6 ± 70,3; 3.7 anos ± 5,8 kg; 175,9 ± 5,8 centímetros). O estudo consistiu em quatro sessões experimentais realizadas de forma aleatórias: EA + ER (AR); ER + EA (RA); Circuito Concorrente (CC) e controle (CO). Todas as sessões tiveram a mesma duração e intensidade, EA: 15 min a 90% do limar de lactato mínimo indireto; ER: 15min a 90% de 12 RM com 12 repetições (seis exercícios). A PA foi medida antes, durante e 1 h (Microlife® BP3A1C) após a realização de exercícios em laboratório e 23 h durante as atividades diárias, utilizando a medição da pressão arterial ambulatorial (Dyna-MAPA®). A pressão arterial sistólica (PAS) no período de 24 horas e de vigília, e a diastólica (PAD), no período de 24 horas, o sono e de vigília, e a média da PA no período de vigília foram menores na sessão RA em comparação com a sessão CO apresentando um tamanho do efeito de moderado a alto (d de Cohen = -0,46 / -0,78). A área sob a curva da PAD na sessão AR foi menor do que na sessão CO no período de vigília (1004 ± 82 vs. 1065 ± 107; p &lt; 0,047) e 24 h (1456 ± 103 vs 1528 ± 132; p &lt; 0,026) períodos. A sessão RA apresentou maiores pontos de redução da PA durante 24 horas em relação ao outros protocolos.

Abstract TP377: Predictors of Diffusion-weighted Imaging Lesions and One-year Case-fatality in Intracerebral Hemorrhage

Introduction: Diffusion-weighted imaging (DWI) lesions in intracerebral hemorrhage (ICH) have been associated with vasculopathy, blood pressure (BP) lowering, and poor functional outcomes. We sought to identify predictors of DWI lesion formation and one-year case-fatality in ICH. Methods: In this retrospective study of primary ICH at our institution from 2009-2011, cases were identified by ICD-9 code and verified by physician review. Only subjects undergoing brain MRI within 72 hours of presentation were included. In addition to standard chart review, we abstracted all BPs available prior to MRI. Vasculopathy severity was assessed by white matter disease score and microbleed burden. Univariate analysis was stratified by DWI lesion presence; logistic regression analyses assessed predictors of DWI lesions and all-cause one-year case-fatality. Results: Of 500 subjects in the overall ICH cohort 98 met inclusion criteria for this analysis, of which 20 (20.4%) had DWI lesions. Selected univariate analysis is shown in the Table. In the best clinical model fit, intraventricular extension (OR 5.63 (1.60, 19.85), p=0.007), microbleeds (OR 3.43 (0.95, 12.34), p=0.06), and delta systolic BP lowering (((max systolic BP-min systolic BP)/max systolic BP)*100) (OR 0.97 (0.95, 0.99), p=0.0005) were associated with DWI lesion presence. Overall one-year case-fatality was 16.3%; age (OR 1.04 (1.00, 1.07), p=0.05), GCS (OR 1.30 (1.09, 1.56), p=0.004), and DWI lesions (OR 3.80 (1.14, 12.61), p=0.03) were independently associated. Conclusions: Predictors of DWI lesions in ICH include underlying vasculopathy but the impact of BP lowering on DWI lesion formation remains unclear. Further investigation of BP effects on DWI lesion formation is warranted with larger cohorts given the association with DWI lesions and one-year case-fatality. Future trials of BP control in ICH should consider stratifying by imaging biomarkers for underlying vasculopathy.

Autonomic cardiovascular control and sports classification in Paralympic athletes with spinal cord injury

Purpose To investigate the relationship between the classification systems used in wheelchair sports and cardiovascular function in Paralympic athletes with spinal cord injury (SCI). Methods 26 wheelchair rugby (C3–C8) and 14 wheelchair basketball (T3‐L1) were assessed for their International Wheelchair Rugby and Basketball Federation sports classification. Next, athletes were assessed for resting and reflex cardiovascular and autonomic function via the change (delta) in systolic blood pressure (SBP) and heart rate (HR) in response to sit-up, and sympathetic skin responses (SSRs), respectively. Results There were no differences in supine, seated, or delta SBP and HR between different sport classes in rugby or basketball (all p > 0.23). Athletes with autonomically complete injuries (SSR score 0‐1) exhibited a lower supine SBP, seated SBP and delta SBP compared to those with autonomically incomplete injuries (SSR score >1; all p < 0.010), independent of sport played. There was no association between self-report OH and measured OH (χ2 = 1.63, p = 0.20). Conclusion We provide definitive evidence that sports specific classification is not related to the degree of remaining autonomic cardiovascular control in Paralympic athletes with SCI. We suggest that testing for remaining autonomic function, which is closely related to the degree of cardiovascular control, should be incorporated into sporting classification.Implications for RehabilitationSpinal cord injury is a debilitating condition that affects the function of almost every physiological system.It is becoming increasingly apparent that spinal cord injury induced changes in autonomic and cardiovascular function are important determinants of sports performance in athletes with spinal cord injury.This study shows that the current sports classification systems used in wheelchair rugby and basketball do not accurately reflect autonomic and cardiovascular function and thus are placing some athletes at a distinct disadvantage/advantage within their respective sport.

Dialysate Sodium Prescription and Blood Pressure in Hemodialysis Patients

Diffusive sodium removal has been recommended to control hypertension in hemodialysis patients. Recent evidence on hospitalizations and mortality, however, challenged the benefit of lower dialysate sodium prescriptions and ignited a debate in the dialysis community. We therefore studied the relationship between dialysate sodium and blood pressure over the longer term. We used multiply adjusted linear mixed models to estimate the association between dialysate sodium and predialysis systolic blood pressure (SBP) as well as change in SBP (delta SBP; postdialysis minus predialysis) in 23,962 patients from the international Dialysis Outcomes and Practice Patterns Study. We found that 43% of hemodialysis facilities had variable (individualized) dialysate sodium prescriptions (125-155 mEq/L), whereas 57% had uniform dialysate sodium prescriptions (135-145 mEq/L) for ≥90% patients. Between-group comparisons of these 2 facility types suggested that dialysate sodium, when variably prescribed, might have been used to modify predialysis SBP (P interaction = 0.01) and perhaps delta SBP levels (P interaction = 0.08). Within facilities not prone to indication bias, because dialysate sodium was not variable, higher uniform dialysate sodium (per 2 mEq/L) was associated with slightly higher SBP (+0.9 mm Hg, 95% confidence interval (CI) = 0.1-1.6 among all patients; +1.7 mm Hg, 95% CI = 0.1-3.2 among patients not treated with blood pressure medication) and no increase in delta SBP. Patients assigned to hemodialysis facilities with uniformly higher dialysate sodium do not have markedly higher predialysis SBP, providing rather limited support for lowering dialysate sodium to control hypertension, particularly in view of hospitalization and mortality risks associated with lower dialysate sodium.

Visit-to-visit blood pressure variability in the elderly: Associations with cognitive impairment and carotid artery remodeling

ObjectiveRecently, visit-to-visit blood pressure (BP) variability has been shown to be associated with vascular remodeling and cognitive dysfunction. However, there have been no studies that focused on the relationship between visit-to-visit BP variability and cognitive dysfunction in relation to vascular remodeling. In this study, we investigated the relationships among visit-to-visit BP measures, carotid artery remodeling and cognitive function in the elderly at high risk of cardiovascular disease. MethodsThe cognitive function was evaluated using a Mini-Mental State Examination (MMSE) and global deterioration scale (GDS) in 201 elderly subjects at high risk of cardiovascular disease (79.9 ± 6.4 years old; female 75%). Based on 12 visits (once a month), visit-to-visit BP variability (expressed as the coefficient of variation [CV] and as delta [maximum − minimum] BP) were measured. Carotid ultrasound was performed to measure intima-media thickness (IMT) and the stiffness parameter β. ResultsThe patients having both high delta systolic BP (SBP) and high IMT had significantly higher prevalence of low MMSE score than those with both low delta SBP and low IMT (p < 0.05), and the patients having both high delta SBP and high stiffness parameter β also had significantly higher prevalence of low MMSE score than those with both low delta SBP and low stiffness parameter β (p < 0.01). In the logistic regression analysis adjusted for age, calcium channel blocker use, low density lipoprotein, average heart rate, and average SBP level, a significant interaction was found between delta SBP and stiffness parameter β for the low MMSE score (p < 0.05). ConclusionsIn the high risk elderly, exaggerated visit-to-visit BP variability and advanced carotid artery remodeling have a synergetic association with cognitive dysfunction.