Diastolic Blood Pressure In Group Research Articles

Comparison of the Efficacy of Labetalol and Nifedipine in Preeclampsia: A Prospective Interventional Study

Introduction: Hypertensive disorders of pregnancy constitute the most widely analysed conditions in pregnancy. Previously, methyldopa was the most commonly used drug, which nowadays has been largely replaced by T. labetalol and T. nifedipine due to the slower onset of action of methyldopa. Chronic hypertension is associated with more maternal and perinatal adverse events, so it is important to determine the optimal antihypertensive therapy. Aim: To compare drug side effects, obstetric complications, and mode of delivery between Group A (T. labetalol administered) and Group B (T. nifedipine administered). Materials and Methods: A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology, Dhiraj Hospital and SBKS Medical Institute and Research Centre, Vadodara, Gujrat, India from December 2022 to May 2023 at Dhiraj Hospital, involving 200 pregnant women with hypertension or Blood Pressure (BP) readings ≥140 mmHg Systolic Blood Pressure (SBP) or ≥90 mmHg Diastolic Blood Pressure (DBP) after 20 weeks gestation. They were randomly divided into two groups: Group A (n=100) with T. labetalol administered and Group B (n=100) with T. nifedipine. The two groups were compared with variables like age, side effects of respective drugs, pregnancy complications, and outcomes, including vaginal or caesarean delivery. The Chi-square and t-test were used to compare variables between the two groups. Results: The mean age in Group A was 25.52±4.10 years, and in Group B, it was 25.95±4.47 years. In Group A (T. labetalol), the majority of cases, i.e., 34 (34%), required a 200 mg dose, followed by 300 mg in 26 (26%) of cases. In Group B (T. nifedipine), the majority of cases, i.e., 48 (48%), required a 30 mg dose, followed by 20 mg in 28 (28%) and 40 mg in 24 (24%) of cases. In Group A (T. labetalol), 2 (1%) cases had Intrauterine Growth Restriction (IUGR), 4 (2%) had oligohydramnios, and 2 (1%) had Intrauterine Demise (IUD). In Group B (T. nifedipine), 6 (3%) cases had IUGR, 6 (3%) had oligohydramnios, and 0 (0%) mmHg had IUD. No significant difference was found between Group A and B (p=0.213). In Group A (T. labetalol), 76 (38%) cases had vaginal delivery, 14 (7%) had emergency caesarean sections, and 10 (5%) had elective caesarean sections. In Group B (T. nifedipine), 70 (35%) cases had vaginal delivery, 18 (9%) had emergency caesarean sections, and 12 (6%) had elective caesarean sections. No significant difference was found between groups A and B (p=0.628). Post-intervention SBP in Group A was 126.06±6.6 mmHg, and in Group B, it was 126.96±8.17 mmHg with no statistically significant difference (p=0.3925). Post-intervention DBP in Group A was 80.6±2.38 mmHg, and in Group B, it was 80.2±1.40 mmHg with no statistically significant difference (p=0.14). Conclusion: Both T. labetalol and T. nifedipine were found to be equally effective. However, with respect to drug side effects and tolerability, T. labetalol was found to be significantly better compared to T. nifedipine.

Effect of Gamelan and progressive muscle relaxation on blood pressure in hypertensive patients

Chronically elevated blood pressure was a prominent risk factor for cardiovascular diseases. The management of hypertension, especially in community settings, should combine pharmacological and non-pharmacological interventions. This study aimed to evaluate whether music-assisted progressive muscle relaxation (PMR) using Gamelan, Javanese classical music, could reduce blood pressure more effectively in hypertensive elderly individuals in Malang, Indonesia, than PMR alone. This study employed a pre-test and post-test study design with a control group. Fifty-eight respondents were randomly assigned to the intervention group (n = 31) and the control group (n = 27). Three respondents in the control group did not complete the study; thus, they were excluded from the analysis. The intervention group was trained and guided to perform PMR while listening to Gamelan. Meanwhile, the control group only received PMR. The intervention was conducted twice a week for 20 minutes for eight weeks. Dependent variables in this study were systolic and diastolic blood pressure, which were measured using an aneroid sphygmomanometer. Data were analyzed using descriptive statistics, paired t-tests, independent t-tests, and Mann-Whitney test. We found a significant decrease in systolic and diastolic blood pressure in both groups. A Mann-Whitney test showed that there was a significant difference in the reduction of systolic blood pressure in the intervention group compared to the control group (p = 0.000). Meanwhile, the independent t-test showed that the diastolic blood pressure in the intervention group reduced more significantly than that in the control group. The efficacy of Gamelan-assisted PMR in significantly reducing both systolic and diastolic blood pressure showcases the potential of such combined interventions in managing hypertension. We recommend Gamelan-assisted PMR as a complementary therapy for the elderly with primary hypertension.

The Effect of Adding 1% Glucose to Crystalloid on Maternal Hemodynamics After Spinal Anesthesia for Cesarean Delivery: A Double-Blind, Randomized Clinical Trial

Background: We aimed to evaluate the effect of glucose-containing crystalloid infusion before anesthesia induction on hemodynamics and postanesthesia complications. Methods: This double-blind, randomized clinical trial was conducted on 60 parturient cases scheduled for elective Cesarean delivery under spinal anesthesia who were referred to the teaching hospitals of Mashhad University of Medical Sciences (Iran). The parturients were randomized into two groups. Both groups received 5 - 7 mL/kg of intravenous bolus serum before spinal anesthesia. The parturients in the glucose-containing normal saline (GcNS) group received 1% glucose solution in normal saline. The normal saline (NS) group received only normal saline. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), blood glucose concentrations, neonatal Apgar scores, postanesthesia complications, and ephedrine and atropine consumption were evaluated. Results: Sixty patients were recruited (30 in each group), with a mean age of 29.14 ± 6.01 and 29.76 ± 6.15 years in the GcNS and NS groups, respectively. There was no significant difference between the two groups in SBP, DBP, or HR after baseline adjustment. The incidence of hypotension was higher in the NS (70.0%) compared to the GcNS group (46.6%), but the difference was not significant. There was no significant difference in Apgar scores. The incidence of nausea, vomiting, pallor, and shivering was higher in the NS group. However, only nausea and vomiting 10 minutes after anesthesia induction were significant. Ephedrine and atropine consumption was higher in the NS group, but not significantly. Conclusions: The present study did not show any clear benefit for adding 1% glucose to normal saline solution preload for hypotension in parturients undergoing Cesarean delivery with spinal anesthesia.

Abstract P424: Postpartum Blood Pressure Trajectories After Hypertensive Disorders Of Pregnancy

Background: Following a hypertensive disorder during pregnancy, blood pressure (BP) generally decreases rapidly in the first three weeks postpartum followed by a period of stabilization. Little is known about patterns of deviation from this trend. Methods: Patients with hypertension during pregnancy (chronic, gestational, or during delivery hospitalization) were enrolled in a remote BP monitoring program and provided with a cell-enabled cuff to take daily BP measurements during their first six weeks postpartum. Measurements were transmitted to a portal and integrated with their electronic medical record. Patients delivering between January 2021 and December 2022 with ≥2 BP measures at an urban safety net hospital were included (n=1,571). Quadratic group-based trajectory models were used to identify latent patterns of postpartum systolic BP (SBP) and diastolic BP (DBP) over time, a method that can be used to capture clinically distinct sub-groups of patients. Patients were grouped into one of four trajectories based on posterior probabilities. Demographic and reproductive characteristics of each trajectory group were examined. Results: Based on 1,571 patients with an average of 15 postpartum BP measurements per patient, the group trajectory model identified 4 trajectories of SBP and DBP (labeled as starting BP value-rate of BP decline): (1) low-steep (SBP 123, DBP 78), (2) moderate-steep (SBP 134, DBP 87), (3) high-gradual (SBP 143, DBP 93), and (4) high-flat (SBP 146, DBP 95). The percent of patients falling into each SBP trajectory group were (1)22.6 (n=346), (2)38.0 (n=611), (3)28.6 (n=451), (4)10.8 (n=163), and for DBP were (1)18.2 (n=288), (2)35.4 (n=557), (3)31.9 (n=508), and (4)14.4 (n=218). Key demographic and pregnancy characteristics varied across SBP and DBP trajectory groups. The high-flat groups were most likely to be older (≥36 years) and non-Hispanic Black. The high-flat SBP and DBP groups had the highest percentage of preterm births (26.4%, 43 out of 163; 20.6%, 45 out of 218, respectively). Conclusion: In this on-going observational study, we characterized 4 distinct group trajectories of SBP and DBP in the 6-weeks postpartum. These data may aid in the identification of patients at risk of persistent postpartum hypertension.

Abstract P150: Dynamic Alu Cpg Methylation Change In Elevated Diastolic Blood Pressure

Hypertension is recognized as age-related disease. However, its interaction with aging at the epigenetic level is still not fully understood. Hypomethylation of Alu elements, the most abundant class of interspersed repetitive sequence in the genome, is associated with global hypomethylation, an important epigenetic event of aging. Dermal fibroblasts have been observed to be affected by hypertension. In vitro study has shown that hypertension accelerated expression of age-related phenotypes. Therefore, in our study, we aimed to examine the relationship between blood pressure, age and Alu methylation status using dermal fibroblasts as a model. Biopsies of dermal fibroblasts were performed on 39 patients with various ages and blood pressure statuses. The patients were grouped into three categories based on their systolic blood pressure (SBP) and diastolic blood pressure (DBP): Normal (SBP = 130 mmHg; DBP = 85 mmHg), High Normal (SBP = 130-139 mmHg; DBP = 85-89 mmHg) and Hypertensive (SBP ≥ 140 mmHg; DBP ≥ 90 mmHg). Combined Bisulfite Restriction Analysis was performed to determine the Alu methylation level and pattern. The data was analyzed using Two Way ANOVA factoring in age groups. The Alu methylation level in the normal, high normal and hypertensive groups according to SBP is 30.3 ± 2.15%, 30.2 ± 2.15%, and 30.1 ± 2.06% and 29.6 ± 1.85%, 31.1 ± 1.78%, and 30.2 ± 2.48% according to DBP (data displaying in mean ± SD). The percentages of u C u C methylation pattern were 42.8 ± 5.57%, 42.7 ± 3.84%, 41.9 ± 4.84%, 44.2 ± 5.19%, 40.4 ± 2.95%, and 42.3 ± 4.79% for normal, high normal and hypertensive group, by SBP and DBP respectively. There were statistically significant differences between groups of DBP status with methylation level lowest in the high normal group. u C u C methylation pattern was the highest in high normal DBP group (p-value < 0.05). There was also a statistically significant interaction between age and DBP level to Alu methylation. However, there was no statistically significant difference between SBP groups. We conclude that there is a dynamic Alu methylation change in the elevation of DBP with overarching trend of Alu hypomethylation. This phenomenon suggests that Alu methylation may have a role in how hypertension accelerate cellular aging in different tissues.

CORRELATION BETWEEN LOW DIASTOLIC BLOOD PRESSURE AND SEVERITY OF CORONARY ARTERY DISEASE USING SYNTAX SCORE

Objective: Hypertension remains a leading cause of morbidity and mortality, and the optimum blood pressure target remains debated, especially in coronary artery disease, given concerns for reduced myocardial perfusion if diastolic blood pressure is too low. The aim of this work was to study the relationship between diastolic blood pressure (DBP) and severity, and burden of coronary artery disease (CAD) as quantified by SYNTAX Score. Design and method: Six hundred consecutive stable patients with signs or symptoms of CAD who underwent elective coronary angiography were included in the study. Patients were divided into three groups according to SYNTAX Score as low, intermediate, and high. Results: Patients were predominantly males (72%), their age ranged from 35 - 82 years, with mean age of 59.55 ± 9.44 years. 426 patients (71%) were hypertensive, 82.1%,69.4%,70% of high, intermediate, and low SYNTAX groups respectively had hypertension. SYNTAX score ranged from 2.0 – 53.0 with a mean of 17.32 ± 9.87. In DBP group <60 mmHg, SYNTAX score ranged from 8.0 – 53.0 with a mean of 26.47 ± 10.59. In DBP group 60 – 69 mmHg, SYNTAX score ranged from 5.0 – 45.50 with a mean of 22.13 ± 7.77. In DBP group 70 – 79 mmHg, SYNTAX score ranged from 3.0 - 34.0 with a mean of 13.91 ± 7.09. In DBP group > = 80 mmHg, SYNTAX score ranged from 2.0 – 46.50 with a mean of 12.90 ± 8.21, SYNTAX score was significant higher in DBP groups <60 and 60 – 69 mmHg than other groups (p < 0.001). High atherosclerotic burden was identified by the presence of intermediate or high SYNTAX score. The frequency of high atherosclerotic burden was significantly increased with decreasing DBP, for mean SYNTAX Scores of 41.1, 35.6, 10 and 13.3 in DBP <60, 60 – 69, 70 – 79, and > = 80 mmHg; p < 0.0001 for all. There was negative significant correlation between diastolic blood pressure and SYNTAX score (rs = -0.471, p < 0.001). Conclusions: A low DBP level had an independent association with high SYNTAX Score. Lower DBP, particularly <60 mmHg, may be important to recognize a potential pathophysiological contribution of too low DBP in the development of complexity and increased atherosclerotic burden, which is identified by the presence of intermediate or high SYNTAX Score in stable patients with obstructive CAD.

EFEKTIVITAS PUDING JAMBU BIJI MERAH TERHADAP PENURUNAN TEKANAN DARAH PADA PREHIPERTENSI DI PUSKESMAS PADASUKA KOTA BANDUNG

Prehypertension is an early condition that can cause arterial hypertension in its later development into cardiovascular disease. Low intake of vitamin C and high intake of sodium at productive age have the risk of triggering the development of degenerative diseases such as hypertension. This study aims to determine the effectiveness of giving guava pudding on blood pressure in the prehypertension group in the work area of ​​the Padasuka Public Health Center, Bandung City. This type of research is a quasi two group with a control experimental design using pre-test and post-test. The sampling technique used is simple random sampling. Intake data were collected using a Semiquantitative Food Frequency Questionnaire (SFFQ) method while blood pressure data was measured using a Digital Sphygmomanometer. The research data were analyzed using Paired T-Test and Wilcoxon test. The results showed that the average intake of vitamin C in the treatment group increased by 186% and sodium intake decreased by 19.1%, better than the control group, the decrease in systolic blood pressure in the treatment group was 3.2% or higher than the control group and an average The treatment group's diastolic blood pressure decreased 5.2% or lower than the control group. There was an effect of the intervention on the intake of vitamin c and sodium in the treatment group (p<0.05). There was an effect on vitamin c intake (p<0.05) and no effect on sodium intake in the control group (p>0.05). The results of the study on systolic blood pressure in the treatment group showed an effect of giving the intervention product (p<0.05) while the diastolic blood pressure in the treatment group, systolic blood pressure, and diastolic blood pressure in the control group showed no effect on giving the intervention product (p>0.05). The study concluded that there was an effect of giving red guava pudding on systolic blood pressure, but there was no difference in the decrease in systolic and diastolic blood pressure between the two sample groups.

COMPARISON OF DEXMEDETOMIDINE AND LIGNOCAINE ON ATTENUATION OF PRESSOR RESPONSES DURING TRACHEAL EXTUBATION

Objectives: The aim of the study was to evaluate and observe the effects of single bolus intravenous dose of Dexmedetomidine with Lignocaine on the hemodynamic changes and pressor responses during tracheal extubation in patients undergoing elective surgery under general anesthesia. Methods: This prospective and observational study was conducted in anesthesia department of tertiary care teaching hospital of Gujarat. Group A received single bolus dose of Dexmedetomidine 0.5μg/kg IV (diluted in 10 ml normal saline) over 10 min after completion of surgery and Group B received single bolus dose of Lignocaine 1.5 mg/kg IV (diluted in 10ml normal saline) over 60 s before extubation. Hemodynamic parameters were recorded before administration of drug (baseline), at extubation and post-extubation in both groups. Extubation quality was evaluated using a five-point scale. Complications were also compared in both the groups. Results: Heart rate was 89.67±7.19 beats/minute in Group A at the time of extubation and in Group B, it was 115±6.88 beats/min which was found highly significant (p<0.0001). Mean systolic blood pressure (SBP) in Group A was 130.55±9.4 mmHg at the time of extubation and in Group B, it was 142±9.58 mmHg which was highly significant (p<0.0001). Mean diastolic blood pressure (DBP) in Group A was 85.76±3.26 mmHg at the time of extubation and in Group B, it was 99.1±2.86 mmHg which was highly significant (p<0.0001). Statistical significant difference was also observed between both the groups for heart rate, SBP, and DBP from extubation to 60 min post-extubation (p<0.05). Conclusions: This study concluded that single bolus dose of intravenous Dexmedetomidine was more effective in maintaining hemodynamic stability and attenuating airway reflex responses as compared to lignocaine.

Abstract 9705: Diastolic Blood Pressure and Intensive Blood Pressure Control on Cognitive Outcomes: Insights From the SPRINT Trial

Introduction: The potential benefits or harms of intensive systolic blood pressure (SBP) lowering on cognitive function in individuals with low diastolic blood pressure (DBP) remain unclear. Hypothesis: The effects of intensive SBP lowering on cognitive outcomes were consistent across baseline DBP levels. Methods: In this post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), 8563 participants with at least one follow-up cognitive assessment were included. Cognitive outcomes were the occurrence of probable dementia, mild cognitive impairment (MCI), and a composite of probable dementia or MCI. Cox regression models and likelihood ratio tests were used to assess the interaction between DBP quartiles and intensive SBP control on cognitive outcomes. Results: The incidence rates of cognitive outcomes among participants in the lowest DBP quartile were higher than those in the other three DBP quartiles (Figure 1). However, participants in the intensive group had a lower incidence rate of probable dementia or MCI than those in the standard group, regardless of DBP quartiles. There were no significant interactions between SBP intervention and DBP quartiles for probable dementia ( P for interaction =0.06), MCI ( P for interaction =0.80), or a composite of probable dementia or MCI ( P for interaction =0.24) (Figure 2). Conclusions: In this post hoc analysis of the SPRINT study, patients with lower DBP had a higher incidence of cognitive impairment. However, the effects of intensive SBP lowering on cognitive outcomes were consistent across different DBP groups.

Examining the Linear Association Between Blood Pressure Levels and Cardiovascular Diseases in the Absence of Major Risk Factors in China.

Many studies demonstrate a J-shaped association between blood pressure and cardiovascular diseases (CVDs), but the findings are plagued by confounding from other traditional cardiovascular risk factors (CVRFs). Our aims were to examine the associations of systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels with CVD in individuals without major CVRFs and whether there were thresholds for the association. In the 4C study (China Cardiometabolic Disease and Cancer Cohort), 36 042 CVRF-free participants without CVD, diabetes, dyslipidemia, hypertension, or smoking were identified during 2011 to 2012. Among CVRF-free participants, 17 476 CVRF-preferable individuals with better glycemic (fasting glucose, <110 mg/dL; 2-hour post-load glucose, <140 mg/dL) and lipid profile (total cholesterol, <200 mg/dL; LDL [low-density lipoprotein] cholesterol, <130 mg/dL) were selected. The total person-years of follow-up for CVRF-free subjects and CVRF-preferable subjects were 130 147 and 63 573 person-years, respectively. Information on the development of major CVDs was collected during 2014 to 2016. Cox proportional hazard models were performed to estimate the risks for incident CVD by SBP and DBP groups, respectively. We found that both baseline SBP and DBP presented significantly linear associations with CVD risks in CVRF-free and CVRF-preferable participants. There is significant increase in the CVD risk among CVRF-free participants with baseline SBP level of 110 to 119 mm Hg (hazard ratio, 1.79 [95% CI, 1.19-2.71]), 120 to 129 mm Hg (hazard ratio, 2.03 [95% CI, 1.36-3.03]), and 130 to 139 mm Hg (hazard ratio, 2.15 [95% CI, 1.40-3.28]) compared with SBP <110 mm Hg. Significant increases were also observed for DBP level of 80 to 89 mm Hg (hazard ratio, 1.43 [95% CI, 1.03-1.97]) compared with DBP <70 mm Hg. Similar results were observed in CVRF-preferable participants. SBP and DBP with levels currently considered normal were significantly and linearly associated with incident CVD without thresholds above 110/70 mm Hg among Chinese adults without major CVRFs.

Adherence to the main prognosis-modifying drugs and the control of risk factors for coronary artery disease in patients after coronary stenting

BACKGROUND: Adherence to drug therapy in patients with coronary artery disease is quite low nowadays, both in patients with myocardial infarction and in patients with chronic forms of coronary artery disease.&#x0D; AIMS: of our work was to assess adherence to drug therapy (aspirin and statins) and control of risk factors for coronary artery disease in patients undergoing coronary stenting 12 months after endovascular treatment.&#x0D; MATERIALS AND METHODS: The study included 279 patients, of whom 3 groups were formed. Patients of group 1 (n=96) personally visited the National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, adherence to the prescribed therapy and its effectiveness were assessed during the examination by a cardiologist, and if necessary, it was corrected. Patients of group 2 (n=95) contacted the study coordinator remotely. Patients of group 3 (n=88) were monitored by a general practitioner and visited a cardiologist at the National Medical Research Center of Cardiology according to the decision of the general practitioner.&#x0D; RESULTS: At baseline, adherence to therapy in all groups was low and did not differ significantly between groups. 12 months after stenting, groups 1 and 2 showed a significant increase in the number of highly adherent individuals (from 17 to 33 and from 13 to 42, respectively, p 0.05), as well as a significant decrease in the number of individuals with low adherence to treatment (from 63 to 42 and from 67 to 36, respectively, p 0.05). The adherence to antiplatelet drugs was higher than to statins: 57.9% of people reduced the dose or stopped taking statins. After the follow-up time, there was a significant decrease in systolic blood pressure in groups 1 and 2 and a significant decrease in diastolic blood pressure in group 2. In group 2, a significant decrease in the number of smokers was noted: from 46.3 to 31.6% of the total number of patients in the group (p 0.05).&#x0D; CONCLUSION: Active monitoring of patients by a cardiologist both during the visit and remotely contributes to an increase in adherence to drug therapy and improves control of risk factors for coronary artery disease.

LARYNGEAL MASK AIRWAY INSERTION: COMPARISON OF SEVOFLURANE WITH PROPOFOL IN ADULTS

Methods: A cross-sectional observational study was conducted on patients scheduled for vascular, reconstructive, gynaecological, and day care surgeries for whom propofol (P) and sevoflurane (S) were used as induction agent for LMA insertion. All patients who fulfilled the inclusion and exclusion criteria and had given propofol or sevoflurane at various departments during the specified duration were included in the study and data were collected using pre-defined protocol. A total of 100 consecutive patients (50 patients in each group) were included in the study. Objectives: The objectives of the study were to evaluate and compare sevoflurane in one vital capacity breath with propofol in dose of 2 mg/kg for ease of laryngeal mask airway (LMA) insertion in adults. Results: The mean age for sevoflurane (S) group and propofol (P) group was 35.30, standard deviation (SD) 8.74 and 34.88, SD 9.37, respectively. Heart rate (HR) at 2 min, 3 min, and 4 min after induction showed a fall with propofol which was statistically significant. There was statistically significant difference in systolic blood pressure at on 1 min, 2 min, 3 min, and 4 min when compared between the two groups. A statistically significant fall in the systolic blood pressure in Group P was noted when compared to Group S. There was statistically significant difference in diastolic blood pressure at 4 min when compared between the two groups. A fall in the diastolic blood pressure in Group P was noted when compared to Group S at 4 min. There was fall in blood pressure in Group P when compared with Group S and this was significant. Fall in oxygen saturation in 3 and 4 min was significant. However, this fall was not clinically significant, as the values remained above 94%. There was increase in end-tidal carbon dioxide in 1, 2, 3, and 4 min and was statistically significant between the two groups. Sevoflurane took longer time for induction and LMA insertion. Loss of eye lash reflex, jaw relaxation, and LMA insertion were lost earlier with propofol and were statistically significant. The overall LMA insertion was excellent with propofol in 50 patients and with sevoflurane 48 patients had excellent condition and two were satisfactory. Conclusion: In our study, sevoflurane was associated with good hemodynamic stability, but quality of anesthesia provided with propofol was superior. Delayed jaw relaxation with sevoflurane when compared to propofol delayed LMA insertion. The overall insertion was excellent with propofol with all 50 patients as compared to sevoflurane.

The Effect of Dexmedetomidine on Attenuation of Per-operative Hemodynamic Changes During Laparoscopic Cholecystectomy

Background: Dexmedetomidine is a newer adjuvant anesthetic agent which is gaining its popularity day by day in our perspective. As an anaesthetic adjuvant dexmedetomidine has been shown to provide good perioperative haemodynamic stability during laparoscopic surgeries. But still it is to be judged its efficacy as adjuvant agent in our aspect. Objective: To observe the haemodynamic effects of intravenous dexmedetomidine during laparoscopic cholecystectomy. Methods: Eighty(80) patients (ASA grade l and ll) who underwent laparoscopic cholecystectomy surgery were randomly selected and were scrutinized according to eligibility criteria.The selected patients were divided into two groups on even and odd number basis. Even number Group A (n=40): received a bolus dose of I.V dexmedetomidine 1μg/kg over 10 minutes before induction of Anesthesia and then I.V infusion of 0.5 μg/kg/hr as a maintenance infusion and odd number Group B(n=40): received a bolus dose of same volume of normal saline before induction of Anesthesia and infusion was continued during surgery. General anesthesia was administered in all patients using fentanyl, thiopentone, succinylcholine, nitrous oxide in oxygen, halothane and muscle relaxation maintained with vecuronium bromide. A pre-tested, observation based, peer-reviewed data collection sheet was prepared before study. Results: Intra-operative mean Heart rate of Group B patients were more higher than those of Group A patients and showed statistically significant differences (P=0.003). Mean arterial pressure of Group B patients were far more higher than Group A patients in different events of peroperative period which is statistically significant (P=0.001). Mean diastolic blood pressure in Group B was significantly higher than that of Group A (P=0.0001). Conclusion: Dexmedetomidine is an effective drug that can be used as adjunctive infusion in general anesthesia in an intention to stable the hemodynamic profile in the peroperative period of different surgeries. Specially in laparoscopic cholecystectomy some patients with cardiac risk become vulnerable after CO2 gas in sufflation which can be properly managed using Dexmedetomidine. J Shaheed Suhrawardy Med Coll 2021; 13(1): 26-32

The effect of text messaging intervention on lowering modifiable risk factors for cardiovascular diseases, Riyadh, Saudi Arabia

Objective: To determine whether SMS reduces modifiable cardiovascular risk factors.Methods: From February to July 2018, the authors performed an RCT on primary care patients at King Khaled University Hospital (KKUH). The patients completed a questionnaire with personal data, and E-SEHI was used to evaluate their low-density lipoprotein (LDL), glycated hemoglobin (HBA1C), systolic blood pressure (SBP), diastolic blood pressure (DBP), Body Mass Index (BMI), and smoking status at baseline and 6-month later. Then After six months, the intervention group received four weekly SMS motivating messages that urged them to exercise frequently, quit smoking, eat well, and stick to medications, whereas the control group did not get SMS intervention.Results: Five hundred forty-five participants participated in this study. The intervention group included 202 (37.1%) persons, while the control group had 343 (62.9%). Comparable age and gender distributions were seen in the intervention and control groups.Total cholesterol and LDL dropped in the intervention group. Control group HBA1c and FBS levels improved.SBP and DBP decreased in both intervention and control groups. However, the intervention group's DBP decreased more than the control groups, whereas the control group's SBP decreased less. Those aged 36-60, men, and those with less than a high school degree had lower HBA1c values (p 0.05). Furthermore, the control group decreased more than the intervention group.The intervention group's 36-60-year-olds with less than a high school education lowered their total cholesterol and LDL levels more (p 0.05).DBP in the intervention group decreased across both sexes and low-educated adults (p 0.05).Conclusion: Text messaging has been demonstrated to be a helpful and cost-effective way to modify cardiovascular risk factors. To enhance effectiveness considerably, we advocate delivering patients' interventional massages, which are well designed, interactive audiovisual, automated, focused, and personalized, more frequently and for a longer period.

COMPARSION OF LIPID PROFILE IN DIABETIC HYPERTENSIVES VS DIABETIC NORMOTENSIVES

Background: Lipid abnormalities are linked to a higher risk of cardiovascular disease and other morbidity in people with diabetes. Dyslipidemia may signal the onset of Type 2 diabetes in the future. A trio of diminished high density lipoprotein (HDL), increased triglycerides (TG), and increased low density lipoprotein (LDL) is known as diabetic dyslipidemia. As a result, diabetic dyslipidemia serves as a separate risk factor and predictor for coronary artery disease (CAD). Aim: To compare Serum lipid profile levels in type-2 diabetics with hypertension (Group 1) and type-2 diabetics without hypertension (Group 2). Methods: Prospective observational study was undertaken on 200 subjects aged 40-60 years from November 2019 to October 2020 with patients of Type-2 diabetes mellitus (both old and new cases) with hypertension (Group 1) and Type-2 diabetes mellitus without hypertension (Group 2) having any of the complications associated with diabetes and on age and sex matched diabetics without hypertension. Results: Mean value of total cholesterol ± standard deviation of Group 1 was 188.92 ± 34.66 mg/dl and that of Group 2 was 190 ± 46.54, the difference between the two groups being statistically not significant (p=0.853). Mean value of triglycerides ± standard deviation of Group 1 was 214.81 ± 78.35 mg/dl and that of Group 2 was 184.04 ± 62.69 mg/dl, the difference between the two groups being statistically highly significant (p=0.003). Mean value of LDL ± standard deviation of Group 1 was 104.42 ± 31.26 mg/dl and that of Group 2 was 109.57 ± 39.78 mg/dl, the difference between the two groups being statistically not significant (p=0.309). Mean value of HDL ± standard deviation of Group 1 was 42.98 ± 6.20 mg/dl and that of Group 2 was 43.80 ± 6.47 mg/dl, the difference between the two groups being statistically not significant (p=0.361). Mean systolic and diastolic blood pressure in Group 1 was 127.64 ± 13.41 and 86.20 ± 7.06 mmHg and that of Group 2 was 118 ± 10.80 and 77.52 ± 7.87 mmHg, the difference between the two groups being statistically highly significant (p&lt;0.0001). Mean Fasting Blood sugar of Group 1 was 197.80 ± 74.75 mg/dl and that of Group 2 was 177.91 ± 62.52mg/dl the difference being highly statistically significant (p= 0.043). Conclusion: The findings of this study concluded that there is a positive relationship between type-2 diabetes mellitus and lipid profile. Mean values of total cholesterol, LDL, triglycerides were significantly raised in type-2 diabetics, supporting the hypothesis that dyslipidemia is a significant complication of type-2 diabetes mellitus, which further contributes to the increased risk of multiple organ morbidities in diabetes. A significant difference in mean triglyceride level was found in both groups. There were no significant differences in mean HDL, LDL and cholesterol levels among the two groups as the levels of these parameters were raised to an almost equal extent in both the groups.

BMI COMPARISON IN DIABETIC HYPERTENSIVES VS DIABETIC NORMOTENSIVES

Background: Increased body fat levels are associated with an increased risk of metabolic disorders such as type 2 diabetes, high blood pressure, and dyslipidemia. Recommendations for treating obesity are currently based on BMI conditions, with variable cut-off points based on the presence or absence of obesity-related disease. In addition, many people with type 2 diabetes are either overweight or obese. Although these basic clinical ideas may be well-received by many physicians and researchers, and are thought to be easily found in medical literature, the authors are unaware of any previous reports summarizing data on the important relationship between BMI and type 2 diabetes in a broad way. Aim: To compare BMI in diabetic hypertensives and diabetic normotensives. Methods: A prospective screening study was conducted in 200 studies aged 40-60 from November 2019 to October 2020 on patients with type 2 diabetes (both old and new cases) with high blood pressure without having any complications related to diabetes and age and gender-matched sex without high blood pressure. Results: The BMI average in group 1 was 27.98 ± 4.60 kg / m² and that in group 2 was 25.73 ± 3.02 kg / m², the difference between the two groups was statistically significant (p &lt;0.0001). The average systolic and diastolic blood pressure in Group 1 was 127.64 ± 13.41 and 86.20 ± 7.06 mmHg and for Group 2 blood it was 118 ± 10.80 and 77.52 ± 7.87 mmHg, the difference between the two groups was significant (010.0 in high numbers). Means Fasting Blood Group 1 blood sugar was 177.91 ± 62.52 mg / dl and Group 2 blood was 197.80 ± 74.75 mg / dl, the difference being statistically significant (p = 0.043). Conclusion: The BMI ratio in patients with diabetes and high blood pressure was significantly higher than in diabetes alone, indicating that high BMI is a risk factor for the development of macrovascular disorders and thus a sign of illness and death.

Blood pressure and mortality after percutaneous coronary intervention: a population-based cohort study

Revascularization procedures, including percutaneous coronary intervention (PCI), for coronary artery disease (CAD) are increasingly performed in Korea. However, studies on blood pressure control targets in these patients remain insufficient. To assess the relationship between baseline blood pressure and all-cause mortality in CAD patients who underwent PCI. A population-based retrospective cohort study based on the national claims database of the Korean National Health Insurance System, which represents the entire Korean population. A total 38,330 patients with a history of PCI for CAD between 2005 and 2008 were recruited and followed up for all-cause mortality until December 31, 2017. Baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and they were classified into eight SBP and DBP groups each. The hazard ratios (HRs) for all-cause mortality were measured for each group. The pattern of SBP and DBP in this population followed a J-curve relationship for all-cause mortality, with the nadir point at 119 and 74 mmHg, respectively. In subjects aged > 60 years, high SBP (≥ 160 mmHg) and high DBP (≥ 90 mmHg) were significantly related to death. Moreover, in subjects aged > 60 years, low DBP (< 70 mmHg) was significantly related to mortality. There is a J-curve relationship between baseline blood pressure and all-cause mortality in patients who underwent PCI, and intensive lowering of blood pressure may be beneficial for these patients. However, the elderly population needs more attention as excessive BP lowering, particularly DBP, could instead increase the risk of death.

The role of non-drug methods of increasing adherence to the treatment of patients with arterial hypertension in a polyclinic

Introduction. Arterial hypertension (AH) is one of the important high-risk factors for the development of heart diseases, but its diagnosis and treatment does not require high technologies and substantial costs. However, the asymptomatic course of AH combined with a low level of medical literacy contributes to low adherence to treatment.Aim. To study the indirect impact of remote blood pressure monitoring (RBPM), the introduction of educational materials (EMs) in comparison with self-monitoring of blood pressure (SMBP) on adherence of patients with AH to outpatient treatment.Materials and methods. 60 subjects with an established fact of partial or complete refusal to use antihypertensive therapy were enrolled in the study and randomized into four equal and comparable groups: 1 – SMBP, 2 – RBPM, 3 – SMBP + EMs, 4 – RBPM + EMs. The impact of using RBPM was assessed by comparing blood pressure values in groups 1 and 2; the impact of EM – by comparing the results of questionnaire surveys in groups 1 and 2 and groups 3 and 4.Results and discussion. Additional training of patients with AH contributed to a twofold increase in adherence in using SCAD and RBPM. The average systolic blood pressure in groups 1 and 2 was 134 mm Hg, in groups 3 and 4 – 129 mm Hg; diastolic blood pressure in groups 1 and 2 – 78.5 mm Hg, in groups 3 and 4 – 77.5 mm Hg.Conclusion. The maximum impact on adherence to AH treatment can be achieved with the introduction of a set of measures. However, the introduction of RBPM has a number of limitations associated with the additional economic burden and the lack of an approved methodology. However, the provision of treatment and prevention facilities with EMs does not require additional development of methodology and is significantly cheaper than the cost of modern blood pressure monitors.

Early and Late Haemodynaemic Effects after Adding Fentanyl to Bupivacaine-Lignocaine Mixtures in Supraclavicular Brachial Plexus Block: A Randomized Control Trial

Background Objectives: Haemodynamic changes are very crucial issues during regional anaesthesia. The purpose of the present study was to observe the immediate and late haemodynaemic effects after adding fentanyl to bupivacainelignocaine mixtures in supraclavicular brachial plexus block. Methodology: This randomized clinical study was conducted in the Department of Anesthesiology in Chittagong Medical College Hospital (CMCH) from March 2011 to May 2012 for a period of one year. All patients with the age group of 18 to 65 years who were selected for upper limb surgery distal to the mid arm were the study population. The random allocation of the patient was done into Group A patients (control group) who were received injection Bupivacaine (0.25%) with injection lignocaine A (1%) with injection Normal saline (0.9%). Group B patients (treatment group) were received injection bupivacaine (0.25%) with injection Ligonocaine A (1%) with injection fentanyl. With all aseptic precaution, supraclavicular brachial plexus block was done using paresthesia technique. Pulse and blood pressure were measured at baseline, intra-operatively and post-operatively. Result: A total of 60 patients were enrolled in this study with 30 patients in each group named group A and group B. The mean age of group A and group B were 32.43±12.25 and 34.90±13.05 respectively (p=0.453). The mean pulse rate of group A (79.53±5.03) and group B (78.10±4.26) at baseline level increased at the time of injection (88.30±5.77 and 85.63±4.87 respectively). At 8 hours interval mean pulse rate of group A was 86.47±5.51 compared to that of group B (86.07±3.08). The mean systolic blood pressure of group A (126.50±18.21) and group B (120.07±11.61) at baseline level increased at 0 minute at the time of injection (129.70±15.34 and 123.17±10.57 respectively). The mean diastolic blood pressure of group A (71.73±11.20) and group B (72.73±11.45) at baseline level increased at 0 minute (75.97±12.74 and 75.80±12.85 respectively). At 8 hrs interval mean diastolic pressure of group A was71.73 ±11.20 compared to that of group B (71.73±11.20). Conclusion: In conclusion there is no significant immediate or late haemodynaemic effects after adding fentanyl to bupivacaine-lignocaine mixtures in supraclavicular brachial plexus block. J Bangladesh Coll Phys Surg 2022; 40: 17-22

Considering Psychosocial Factors When Investigating Blood Pressure in Patients with Short Sleep Duration: A Propensity Score Matched Analysis.

Few studies have considered psychosocial characteristics when investigating the associations between sleep duration and blood pressure (BP). In this study, we took propensity score matching (PSM) to adjust for psychosocial characteristics when comparing BP between individuals with short sleep duration and those with normal sleep duration. A total of 429 participants were included. 72 participants with sleep duration ≤6 h and 65 participants with sleep duration >6 h were matched after PSM. We compared office BP, 24-hour BP, and prevalence of hypertension in the populations before and after PSM, respectively. In the unmatched population, participants with sleep duration ≤6 h were observed with higher office diastolic BP (DBP) and 24-h systolic BP (SBP)/DBP (all P < 0.05). In the matched populations, the differences between the two groups (sleep duration ≤6 h vs. sleep duration >6 h) in office DBP (88.4 ± 10.9 vs. 82.5 ± 11.1 mm Hg; P=0.002), 24-h SBP (134.7 ± 12.0 vs. 129.3 ± 11.6 mm Hg; P=0.009), and 24-h DBP (83.4 ± 9.9 vs. 78.1 ± 10.1 mm Hg; P=0.002) become more significant. Participants with sleep duration ≤6 h only show higher prevalence of hypertension based on 24-h BP data, while analysis after PSM further revealed that these with sleep duration ≤6 h presented about 20% higher prevalence of elevated BP up to office diagnosed hypertension threshold. Therefore, psychosocial characteristics accompanied with short sleep duration should be fully valued in individuals at risks for elevated BP. This trial is registered with NCT03866226.