Diastolic Blood Pressure Readings Research Articles

COMPARISON OF ANTI-PROTEINURIC EFFECTS OF AMLODIPINE AND CILNIDIPINE AS AN ADD-ON DRUG TO BASELINE MEDICATION IN HYPERTENSIVE CHRONIC KIDNEY DISEASE PATIENTS

Objectives: The objectives of the study were to compare the anti-proteinuric effects of amlodipine and cilnidipine in individuals with Chronic Kidney Disease (CKD) on baseline medication. Methods: This was a prospective observational study carried out in the Department of Nephrology at Government T.D. Medical College, Alappuzha spanning a duration of 1 year from January 2016 to December 2016. The study encompassed a total of 90 hypertensive CKD patients-45 were administered amlodipine and the remaining 45 were given cilnidipine in conjunction with their existing baseline medications. The inclusion criteria consisted of hypertensive CKD patients aged between 18 and 80 years possessing a Glomerular Filtration Rate (GFR) between 30 and 60 mL/min and exhibiting blood pressure readings surpassing 140/90 mmHg despite receiving a loop diuretic (Tab. Frusemide 80 mg BD), an α-blocker (Tab. Prazosin 10 mg BD) and a β-blocker (Tab. Metoprolol 50 mg BD) for a minimum duration of one month. The key parameters that were monitored were sitting systolic and diastolic blood pressure readings and proteinuria which was evaluated by determining the Urine Protein Creatinine (UPC) ratio using untimed random urine samples. The GFR was calculated utilizing the Cockcroft-Gault formula. Results: The number of patients who improved to stage 3A CKD from stage 3B CKD were more with cilnidipine which indicates its reno-protective action. Amlodipine was seen to have no effect on UPC ratio whereas cilnidipine decreased UPC ratio significantly. Conclusion: Unlike amlodipine, cilnidipine exhibits marked reduction in proteinuria and improved GFR thereby preventing progression of hypertensive CKD patients to end stage renal failure.

Auto-Immune Cardiac Degeneration as a Complication of Essential Hypertension

Essential hypertension is persistent high blood pressure in the systemic arteries with no identifiable secondary cause. The study was designed to assess auto-immune cardiac degeneration in essential hypertensive patients in Ekiti State. The study included 40 subjects with no history of hypertension (control), 40 hypertensive subjects undergoing treatment and 40 hypertensive subjects without treatment. Body Mass Index (BMI) was calculated, systolic and diastolic blood pressure (SBP and DBP) readings were taken using digital sphygmomanometer, Aspartate Aminotransferase (AST) was measured using spectrophotometer, Cardiac Troponin (CTnI) and Anti-mitochondrial antibody M7 (AMA-M7) were estimated using ELISA. Results obtained were expressed as mean ± SD and statistical analysis was done using SPSS. Values were statistically significant at p<0.05. The results obtained showed that BMI and DBP of treated hypertensive patient was insignificant when compared with control subjects (p>0.05), whereas SBP, AST, AMA-M7 and CTnI were significantly higher (p<0.05) in treated hypertensive patients compared with the control subjects. Similarly, BMI, SBP, DBP, AMA-M7, AST and CTnI of untreated hypertensive patient were significantly higher (p<0.05) compared with non-hypertensive subjects (control). Furthermore, BMI, SBP, DBP, AMA-M7, AST and CTnI were significantly lower (p<0.05) in treated hypertensive patient compared with untreated hypertensive subjects. In conclusion, AMA-M7 is more sensitive marker in detecting auto-immune cardiac degeneration faster than the routine serum AST and Cardiac Troponin I in indicating the functional state of the heart. Therefore, early detection of auto-immune cardiac degeneration in hypertension subjects is important as there is a link between autoimmunity and hypertension.

Home blood pressure measurement self-reporting in real-life practices using the Hy-Result app: self-monitoring and digital pathway.

Little real-life information is available on the clinical characteristics of information and communication technologies (ICTs) users, particularly in the context of hypertension and home blood pressure measurement (HBPM). This retrospective observational study describes HBPM practices obtained through the Hy-Result® system, a validated app designed to help patients perform HBPM and understand their results through an automatic interpretation of the readings using web interface. We analyzed 19,176 HBPM reports (sequence of 1 to 7 days of measurements; 3 in the morning, 3 in the evening) collected in real life circumstances from two groups of users: primary care (Prim) and hypertension center (Hosp). Population: among the 19,176 reports, 63.2% declared receiving antihypertensive medication, having diabetes (15.2%), chronic kidney disease (9.7%) or history of stroke (7.6%). Treated users were older than normotensives [mean ± standard deviation (SD) age 64±12 vs. 58±14 years] with higher prevalence of comorbidities. Compliance with the HBPM schedule: the majority of reports (90.2%) totaled 15 systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings or more, of which 96.1% were Hosp users and 89.3% Prim users, with a significant difference between both groups (P<0.001). The compliance rate for 7 days of measurement was higher in the Hosp group (57.6% vs. 30.5%; P<0.001). Blood pressure (BP) levels: in the 17,289 reports with a minimum of 15 readings, 42.7% had an average SBP and/or DBP above the recommended thresholds (below 135 and/or 85 mmHg), among whom, 36.8% were untreated subjects. Hosp users had better BP control than Prim (P<0.001). Users that are followed in the European Society of Hypertension (ESH) excellence center (Hosp) had better BP control than those in a Prim setting (P<0.001). HBPM oscillometric devices: in both groups, treated patients and untreated users, used the arm cuff devices more frequently than the wrist device. Our real-life study shows that 90% of the HBPM reports include the required minimum number of BP readings to allow the calculation of a reliable average among whom 40% have uncontrolled BP levels. The self-management Hy-Result web app demonstrates significant potential for inclusion in the patient care process and reinforces the patient's engagement to independently monitor and self-reported their BP. When the mean BP is not within the recommended range, the users were automatically prompted by text messages to seek medical advice by the software. Further research should determine the extent to which users adhere to text messages advice.

Emergency hypertension and hypertensive crisis prevalence and associated factors

Objective: The purpose of this study was to determine the prevalence of emergency hypertension in patients who had been diagnosed with hypertensive crisis. Methods: An analysis of adult patients with complete medical records who were hospitalized to King Saud Medical City in Riyadh, Saudi Arabia between September 2022 and September 2023 and diagnosed with hypertensive crisis was carried out. Results: The study subsequently gathered 151 patient records. Patients were diagnosed with a hypertensive crisis when their systolic blood pressure and diastolic blood pressure (SBP/DBP) readings were more than 180 / 120 mmHg. The average age of the patients was 61.2 years, with females making up 54.3% patients. Around 66.6% had a history of using antihypertensive medications. History of hypertension was shown to be the most prevalent medical risk factor (72.8%). Stroke was the most common complication (n=32, 21.2%). Additionally, headache was the most common complaint at admission (41.1%). Further, 92.7% patients were discharged after showing improvement, and 6.6% patients reported deaths. Conclusion: Multivariate logistic regression analysis revealed that the gender of the patient and the presence of a history of hypertension were independently associated factors with hypertensive emergency. Monitoring and counselling hypertensive persons is crucial, and screening for hypertension might help prevent or minimize damage to target organs.

PROFILE OF NITRIC OXIDE METABOLISM INDICATORS IN PRETERM INFANTS WITH PERINATAL CENTRAL NERVOUS SYSTEM INJURIES

Introduction. Premature infants often experience a heightened risk of brain damage, potentially leading to various disorders affecting motor, cognitive, behavioral, social, and sensory functions. The underlying pathological processes of hypoxic-ischemic central nervous system (CNS) injury predominantly stem from compromised cerebral blood flow and oxygen transport. Timely diagnosis and treatment options for prematurely born children with perinatal CNS damage remain limited. Nitric oxide, a universal regulator of physiological functions, plays a crucial role. Endothelial dysfunction, marked by the loss of the neurovascular protective functions of nitric oxide, could significantly contribute to the development of cognitive impairment in hypoxic-ischemic CNS damage. Objectives. The study aims to evaluate the specificities of nitrate metabolism indicators in premature infants with hypoxic-ischemic CNS lesions in the early neonatal period. This involves examining and comparing clinical indicators characterizing hemodynamics, as well as the levels of nitrites, nitrates, and nitrosothiols in urine among patients in the studied groups. Subjects and Methods. The study comprised 14 premature infants with hypoxic-ischemic CNS injury (main group), with a separate selection of 4 infants who did not survive during the neonatal period. The comparison group included 20 relatively healthy prematurely born children. Stratification was based on the results of a genetic study, specifically the determination of the rs61722009 polymorphism of the eNOS gene. The patients underwent routine clinical examinations, including blood pressure measurements, and assessments of nitrates, nitrites, and nitrosothiols in urine. Subgroups were identified as follows: 1st subgroup - 4bb (n=10), and 2nd subgroup - 4aa/4ab (n=10). Results. It was observed that newborns who did not survive had significantly lower systolic and diastolic blood pressure readings on the first day of life, in comparison to relatively healthy children in the two control subgroups (day 1 - p=0.018; p=0.027; p=0.036; p=0.053). Additionally, they exhibited lower heart rate indicators on the first day (p=0.001; p=0.002). However, overall, hemodynamic indicators in newborns with hypoxic-ischemic central nervous system damage did not show statistically significant differences from the corresponding indicators in relatively healthy children. The results indicate a significantly lower level of diuresis in children who died as a result of severe with hypoxic-ischemic central nervous system damage, probably due to the development of multiple organ failure immediately after birth. As a result, it was found that the levels of nitrites (p&lt;0.001; p&lt;0.0001) and nitrates (p&lt;0.01; p&lt;0.0001) were reduced in children with with hypoxic-ischemic central nervous system damage, compared to children in the control groups, regardless of genotype variant. While the level of nitrosothiols did not differ significantly, it was even much higher in children who did not survive, 3.55±0.39 vs 2.23±0.22; p=0.008. The differences found may indicate a disruption of the regulatory effect of nitric oxyde on vascular tone and the condition of neuroglia, particularly in children with hypoxic-ischemic central nervous system damage, as a result of its insufficient production, as well as insufficient mobilization from the depot due to nitrite and nitrate reductases. Conclusions. Hemodynamic patterns in children from the examined groups, except for those who did not survive, did not exhibit significant differences. The notably lower urine output in deceased children indicates the development of multiple organ failure due to severe hypoxia. In children with hypoxic-ischemic central nervous system damage, there is a reduction in the levels of nitrites and nitrates in urine compared to relatively healthy premature infants, while the level of nitrosothiols did not show significant differences and was even notably higher in children who did not survive. The outcome of studying the levels of nitrates, nitrites, and nitrosothiols in urine in a larger patient sample may lead to the development of an algorithm for early diagnosis and management, contingent on the severity of metabolic disorders resulting from hypoxia, considering the potential influence of nitric oxide on energy deficit and mitochondrial dysfunction.

Prevalence of Contributing Factors Leading to the Development of Insulin Resistance Among Male Medical Students at a Private College in Saudi Arabia.

Background Insulin resistance can result from various genetic and lifestyle factors. Initially, symptoms of insulin resistance may not be readily noticeable, but as the condition progresses, individuals may start experiencing symptoms. This study aimed to investigate the factors contributing to the development of insulin resistance among medical students at a private college in Saudi Arabia. Methodology We conducted a cross-sectional study using a convenient non-probability sampling technique, with a sample size of 241 participants. We employed validated questionnaires to gather information on physical activity, sleep, dietary habits, and stress. Specifically, we used the International Physical Activity Questionnaire (IPAQ)-Short Form for assessing physical activity, the Single-Item Sleep Quality Scale (SQS) for evaluating sleep quality, the Healthy Eating Quiz (HEQ) to gauge dietary patterns, and the stress questionnaire designed by the International Stress Management Association (ISMA) to measure stress levels. Additionally, we collected anthropometric measurements, as well as systolic and diastolic blood pressure readings. We calculated prevalence using percentages and employed the chi-square test to analyze variables, with a significance level set at p-values <0.05. Results This study investigated risk factors associated with lifestyle, focusing on waist circumference as an indicator of insulin resistance. Our findings revealed that a majority of individuals with high waist circumference were physically inactive and more susceptible to stress, and this difference was statistically significant when compared to those with normal waist circumference. Additionally, we observed that sleep deprivation and poor nutrition were more prevalent among individuals with high waist circumference, although these differences were not statistically significant. Conclusions This study highlights a high prevalence of elevated waist circumference, indicating insulin resistance, among medical students. Furthermore, it underscores the significant presence of well-known risk factors associated with insulin resistance within this population of medical students.

The association of allostasis with alcohol use: a case-control study in males with and without alcohol use disorder.

Allostatic load (AL) is associated with a heightened predisposition to disease due to prolonged activation of biological stress-response systems. Alcohol use disorder (AUD) is known to activate these systems. The primary aim of the current study was to examine the relationship between AL and AUD. Participants were males (100%) with DSM-IV Alcohol Dependence (n = 48) and healthy participants with no history of substance use disorder (n = 17). Participants with AUD were 4-6 weeks abstinent. The AL index used cortisol, interluken-6 (IL-6), fibrinogen, tumor necrosis factor-alpha (TNFa), C-reactive protein (CRP), glucose, insulin, leptin, pulse, systolic blood pressure readings, diastolic blood pressure readings, and body mass index (BMI). Physiological dysregulation for each biological measure was determined based on values within the 25th or 75th percentiles; AL was calculated as the total number of physiologically dysregulated biological measures. No differences in mean AL scores between the cases and controls (t(63) = .48, p = .63) were observed. Among cases, AL was not associated with lifetime drinks per drinking day (F(2, 42) = .42, p = .66), lifetime total drinks (F(2, 42) = .48, p = .62), total drinks 6-months prior to participating in the study (F(2, 43) = .58, p = .56), or drinks per drinking day at 3-month follow-up (F(2, 35) = 1.93, p = .16). AL was negatively associated with drinks per drinking day 6-months prior to study participation (F(2, 42) = 3.71, p = .033). The hypotheses were not supported. Given that alcohol is likely to lead to physiological dysregulation, the apparent absence of a relationship between biomarkers of cumulative stress as indicated by AL and drinking status was both unanticipated and remarkable. Based on the results, AL in the context of drinking status or drinking among males with AUD may not be applicable.

Assessment of oxidative stress and protein modification in essential hypertensive subjects

&#x0D; &#x0D; Hypertension has been identified to be the leading cause of cardiovascular disease and premature death worldwide due to its numerous comorbidities and associated risk of damage to vital body organs like the brain, heart and kidneys. The aim of this study was to determine the level of protein modifications and oxidative stress of hypertensive patients. One hundred and fourteen (114) participants were recruited for this study comprising 81 subjects with essential hypertension and 33 control (non- hypertensive) subjects. Body Mass Index (BMI) was calculated, systolic and diastolic blood pressure(SBP and DBP) readings were taken using digital sphygmomanometer, glutathione peroxidase (GPx) and carbonyl (CO) group was estimated using ELISA, while protein sulfhydryl (SH) group was estimated using colorimetric assay. The results obtained showed that BMI of treated hypertensive patients was significantly decreased (p&lt;0.0001) compared with control. Systolic and diastolic blood pressure was significantly increased when treated patients were compared with control (p&lt;0.0001). GPx and SH groups of treated hypertensive patients was significantly increased (p&lt;0.0001) in treated hypertensive patients as compared to control. The study concludes that protein modification occurs as a result of oxidative stress resulting in reduced levels of glutathione peroxidase which could be a risk factor associated with the development of essential hypertension These findings could help in designing quality diagnostic strategies and effective treatment and management approach for better clinical outcomes.

Hemodynamic changes following injection of local anesthesia with vasoconstrictor agent in controlled hypertensive patients

Local anesthesia is considered the most commonly used in dentistry. Vasoconstrictors are added to its composition to maximize its advantages. However, it is considered a tourniquet and acts on beta 1 and 2 receptors. This causes augmentation of heart rate and blood pressure. This study aimed to evaluate the safety of vasoconstrictors during simple tooth extraction in controlled hypertensive patients by monitoring the changes in blood pressure, heart rate and oxygen saturation. A prospective clinical study was carried out in a control group (normotensive patients n=60) and study group (hypertensive patients) (n=60). The following hemodynamic parameters (blood pressure [diastolic and systolic], heart rate and oxygen saturation) were monitored at four different time points (before infiltration of local anesthesia (R1), after 3 minutes of local anesthesia (R2), immediately after extraction (R3) and 25 minutes after local anesthesia infiltration (R4). One carpule of local anesthesia for each patient was provided in the form of lidocaine 2% with adrenaline as vasoconstrictor 1/100,000; (3) Results: Mean heart rate increased from one to four beats per minute in all groups, but the increment was lesser in hypertensive group. The increase of systolic blood pressure in hypertensive patients during (R2, R3 and R4) was significantly lower than in the normotensive group (p&lt;0.001). The diastolic blood pressure reading fell in the hypertensive group more than in the normotensive group during (R2, R3 and R4). No changes in oxygen saturation were recorded between both groups; (4) Conclusions: no adverse effects in well-controlled hypertensive patients were seen during simple tooth extraction. One carpule of local anesthesia with 1\100,000 adrenaline does not induce blood pressure augmentation in hypertension patients included in this study. The changes in heart rate were within the safe limits. Keywords: local anesthesia, adrenaline, vasoconstrictors, hypertensive patients, hemodynamic changes.

Prevalence and risk factors associated with dysglycemia among overweight and obese Palestinian adolescents in the Hebron governorate

Background: The prevalence of dysglycemia among adolescents and younger children has been rising, yet health professionals are still unaware of the significance of this problem. According to the Palestinian Ministry of Health (MOH) records, most diabetic children under the age of 20 in Palestine are classified as type 1; nonetheless, very limited data are available for policymakers to frame cost-effective screening programs. This study aims to determine the prevalence of dysglycemia in a sample of obese and overweight Palestinian adolescents, identify risk factors associated with dysglycemia, and examine risk factors variance by gender. Methods: A cross-sectional sample of observed obese and overweight adolescents was selected from public schools in the Hebron governorate. Informed consent, physical examination, anthropometric, and laboratory tests (Random Blood Glucose Level (BGL) and fasting BGL ) were performed on a sample of 511 students (44.6% boys and 55.4% girls) aged 13–18-years (13-15 years =46.2% and 16-18 years =53.8%). Results: The prevalence of confirmed overweight and obese cases was 73.2%, and dysglycemia prevalence among the confirmed cases was 3.7% (5.3% boys and 2.5% girls). The BMI classifications of the dysglycemic children indicated that 42.1% were overweight and 31.1% were obese. Furthermore, 64.6% reported high systolic and/or diastolic blood pressure readings. Conclusions: The results of this study provide valuable information about the rising problem of dysglycemia among Palestinian adolescents and underlines the need for rapid screening programs and protocols for early detection and classification of the disease, leading to initiation of early prevention and treatment plans.

Impact of Successive Office Blood Pressure Measurements During a Single Visit on Cardiovascular Risk Prediction: Analysis of CARTaGENE.

Multiple office blood pressure (BP) readings correlate more closely with ambulatory BP than single readings. Whether they are associated with long-term outcomes and improve cardiovascular risk prediction is unknown. Our objective was to assess the long-term impact of multiple office BP readings. We used data from CARTaGENE, a population-based survey comprising individuals aged 40 to 70 years. Three BP readings (BP1, BP2, and BP3) at 2-minute intervals were obtained using a semiautomated device. They were averaged to generate BP1-2, BP2-3, and BP1-2-3 for systolic BP (SBP) and diastolic BP. Cardiovascular events (major adverse cardiovascular event [MACE]: cardiovascular death, stroke, and myocardial infarction) during a 10-year follow-up were recorded. Associations with MACE were obtained using adjusted Cox models. Predictive performance was assessed with 10-year atherosclerotic cardiovascular disease scores and their associated C statistics. In the 17 966 eligible individuals, 2378 experienced a MACE during follow-up. Crude SBP values ranged from 122.5 to 126.5 mm Hg. SBP3 had the strongest association with MACE incidence (hazard ratio, 1.10 [1.05-1.15] per SD) and SBP1 the weakest (hazard ratio, 1.06 [1.01-1.10]). All models including SBP1 (SBP1, SBP1-2, and SBP1-2-3) were underperformed. At a given SBP value, the excess MACE risk conferred by SBP3 was 2× greater than SBP1. In atherosclerotic cardiovascular disease scores, SBP3 yielded the highest C statistic, significantly higher than most other SBP measures. In contrast to SBP, all diastolic BP readings yielded similar results. Cardiovascular risk prediction is improved by successive office SBP values, especially when the first reading is discarded. These findings reinforce the necessity of using multiple office BP readings.

Concurrent Spinal Trauma in Patients with Traumatic Head Injury: A Seven-Year Retrospective Analysis.

BACKGROUND Assessing spinal injuries in patients with traumatic head injuries is crucial due to their potential to alter functionality and increase mortality rates. This single-center retrospective study was conducted to understand the prevalence and characteristics of concurrent spinal injuries in adults with traumatic head injury from April 2015 to April 2022. MATERIAL AND METHODS The study incorporated demographic, clinical, traumatological, and hemodynamic data from 1,501 adult patients presenting with traumatic head injuries. Spinal injuries were identified through symptoms, physical signs, and radiological findings. RESULTS During the study period, 179 patients (12%) were reported with associated spinal injuries. These patients were predominantly male (p=0.0012), aged 65 years or above (p=0.0452), had thoracic injuries (p=0.0004), and arrived at the emergency department more than three hours post-trauma (p=0.0004). Most injuries were caused by motor vehicle accidents (p=0.0412) or falls from heights greater than 3 meters (p=0.0481). In addition, these patients had higher Abbreviated Injury Scale scores (≥2, p=0.0391), Eppendorf-Cologne Scale scores (≥2, p=0.0412), and lower systolic and diastolic blood pressure readings (p=0.0481, p=0.0412) along with lower heart rates (p=0.0482). However, no correlation was found between systolic and diastolic pressures and age among patients with spinal injuries. CONCLUSIONS This study reveals that the prevalence and severity of spinal injuries in patients with traumatic head injuries are influenced not only by demographic and clinical parameters, but also by the degree and extent of head trauma.

Accuracy of wearable electronic device compared to manual and automatic methods of blood pressure determination.

Blood pressure (BP) is the main biomarker for monitoring patients, as its lack of control above values considered normal is a modifiable risk factor for target organ damage. The aim of this study is to evaluate the accuracy of the wearable electronic device photoplethysmography technology (PPG) Samsung Galaxy Watch 4 in determining BP in young patients compared to manual and automatic methods of BP determination. This is a quantitative and cross-sectional study, following validation protocols for wearable devices and BP measurement. It was carried out with twenty healthy young adults, in which BP was measured using four instruments, namely, standard sphygmomanometer device (manual), automatic arm oscillometric device (reference), wrist oscillometric device, and Smartwatch PPG. Eighty systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings were observed. SBP means manual 118 ± 2.20,arm 113 ± 2.54, wrist 118 ± 2.51, and PPG (smartwatch) 113 ± 2.58. Among means, arm and PPG difference is 0.15, arm and wrist 4.95, arm and manual 4.45 wrist with PPG. The mean DBP manual 76.7 ± 1.84, arm 73.6 ± 1.92, wrist 79.3 ± 1.87, and PPG 72.2 ± 1.38. Among means, the difference between the arm and PPG is 1.4 and arm and hand 3.5mmHg. The correlation shows PPG with manual, arm, and wrist. There was a strong SBP correlation and a moderate DBP correlation between the methods tested, evidencing the accuracy of the PPG smartwatch in relation to the reference method.

White Coat Effect: Is It Because of the Hospital Setting, or Is It Physician-Induced?

White coat hypertension (WCH) patients are those individuals who have high blood pressure (BP) in the medical environment but are normal during their daily activities. White coat hypertensive patients with normal daytime ambulatory blood pressure monitoring (ABPM) rapidly progress to sustained hypertension. WCH is mainly treated with non-pharmacological methods. Alpha-1 agonists and beta blockers are logical treatment choices for patients with fixed hypertension with the White Coat Effect (WCE). Masked hypertension patients are those individuals who have normal values at the doctor's office but elevated BP at home or during 24-hour ABPM (24-hour or daytime). ABPM is a more practical and reliable method for detecting patients with WCH. This observational study was conducted at Dayanand Medical College & Hospital, Ludhiana, over the course of one year (December 2015 to November 2016). The primary objective of the study was to determine whether there was a difference in blood pressure readings between the home setting and the hospital setting. The secondary objective was to determine whether the difference, if present, between the hospital and home readings was due to the hospital setting, physician presence, or a combination of both. Patients with stage 1 hypertension were included in the study, irrespective of antihypertensive treatment. Patients with ischemic heart disease, chronic liver failure, and chronic kidney disease who could not follow protocol instructions were excluded. In our study, the mean age of patients was 53.91±12.86 years. The patient's mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings at the hospital were higher than their home readings (p-0.012; p-0.001, respectively). Mean hospital SBP and DBP readings recorded by the physician were higher than readings recorded by patients alone at home (p-0.002; p-0.014, respectively) and alone at the hospital (p-0.004; p-0.001, respectively). BP readings taken by the physician with a manual sphygmomanometer were significantly lower than those taken with a digital sphygmomanometer by patients and physicians in all settings (p<0.05). The mean rise in BP was significant in both the physician's presence and the hospital environment (p<0.05 for both), and this rise was more significantly associated with the hospital effect than the physician effect (p<0.05). Misdiagnosis of hypertension results in inappropriate prescription and overuse of antihypertensive medications for individuals who are not persistently hypertensive. So it is very important to rule out WCH in both the hospital setting and the physician's presence, more precisely by ABPM. WCH can be diagnosed with regular BP monitoring by a digital sphygmomanometer at home.

Efficacy and safety of dexmedetomidine to prevent shivering in cesarean delivery under spinal anesthesia: a double-blind, randomized controlled trial

Background &amp; objective: Postoperative shivering is a source of much discomfort to the patients following spinal anesthesia (SA), especially in patients undergoing cesarean delivery. The anesthetists have employed various medications and a variety of measures to prevent shivering in their patients. The objective of this study was to investigate the efficacy and safety of intravenous (IV) dexmedetomidine in preventing shivering in patients undergoing cesarean delivery under SA.&#x0D; Methodology: This prospective, double-blind, randomized trial involved 62 parturients undergoing cesarean delivery under SA. They were randomly divided into two groups; patients in dexmedetomidine group (Group D, n = 31) received dexmedetomidine 0.5 µg/kg IV over 10 min followed by infusion of 0.4 µg/kg/h until the end of surgery; whilst patients in the control group (Group C, n = 31) received equivalent loading and infusion volume of 0.9% saline. Both groups were operated upon by a standardized spinal anesthesia technique. The occurrence of shivering, sedation score and hemodynamic parameters were recorded intraoperatively. The recording anesthetist was blinded regarding the study or the control groups.&#x0D; Results: The occurrence of shivering was significantly reduced in Group D as compared to Group C (3.2% vs 64.5%, P &lt; 0.001). Patients in Group D were more sedated as compared to Group C (51.6% vs 0%, P &lt; 0.001). There was no statistically significant difference in systolic and diastolic blood pressure readings between both of the groups. Heart rates in Group D were significantly lower than the Group C but still were within normal physiological range.&#x0D; Conclusion: IV dexmedetomidine was effective in reducing the occurrence of shivering but with significant sedative effect and lowering of heart rate than the placebo. Although the heart rates remained within normal range in both groups.&#x0D; Key words: Anesthesia, Spinal; Cesarean; Dexmedetomidine; Shivering&#x0D; Citation: Wan Md Adnan WAA, Wan Hassan WMN, Seevaunnamtum P, Omar SC, Nik Mohamad NA. Efficacy and safety of dexmedetomidine to prevent shivering in cesarean delivery under spinal anesthesia: a double-blind, randomized controlled trial. Anaesth. pain intensive care 2023;27(6):632−638; DOI: 10.35975/apic.v27i6.2346&#x0D; Received: January 09, 2023; Reviewed: January 29, 2023; Accepted: February 08, 2023

Relationship between measures of adiposity and hypertension amongst secondary school adolescents in an urban setting in Cameroon.

measures of obesity such as body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) have been shown to be associated with high blood pressure (BP) in children and adolescents. The purpose of this study was to determine the proportion of secondary school adolescents with elevated BP and high BP in relation to some measures of adiposity (BMI, WC, WHtR) and to examine the association between BP and adiposity indices amongst the children. the study was an institutional-based cross-sectional study involving 534 adolescents (mean age 15.1 ± 2.3 years) attending 4 secondary schools (2 public and 2 private) in the Bamenda municipality of the North West Region of Cameroon. Anthropometric and BP measurements were carried out following standard procedures. Diagnosis of hypertension in the children was done by obtaining three elevated systolic or diastolic BP readings (BP ≥ 95th percentile for the child's age, sex and height). Linear regression was used to determine the relationship between BP and some measures of adiposity (BMI, WC, WHtR) amongst the children. the prevalence of elevated BP and hypertension amongst the study participants was 33.3% and 33.3% in the BMI-obese children, 25.9% and 25.2% in the WC overweight/obese children and 29.4% and 41.2% in the "high risk" (WHtR ≥ 0.5) children respectively. Body mass index-obese, WC overweight/obese and "high risk" (WHtR ≥ 0.5) children had a significantly (p <0.05) higher mean SBP and DBP compared to their healthy weight counterparts. Linear regression indicated a significant association (p <0.001) between WC (β=0.75; 95% CI = 0.57, 0.92), BMI (β=0.88; 95% CI = 0.49, 1.25) and WHtR (β= 67.08; 95% CI = 45.64, 88.51) with systolic BP for the unadjusted analysis. After adjusting for age, gender and school type, only WC (β= 0.66; 95% CI = (0.43, 0.89) showed a positive significant (p <0.001) relationship with systolic BP. this study has demonstrated that WC is positively associated with high BP in children and adolescents. Thus, WC can be used in predicting children and adolescents with a high risk of developing high BP in our setting.

Efficacy and safety of single pill combination of amlodipine and valsartan in hypertensive Saudi patients.

A significant global health issue that affects 25.5% of Saudi people is hypertension (HTN). According to international recommendations, most HTN patients require more than one therapy to reach their blood pressure targets (BP). Therefore, it would be preferable to utilize two medications from distinct classes separately or in a predetermined combination. According to recent studies, a single-pill combination (SPC) may be more efficient. This study evaluated the safety and tolerability of Amlodipine/Valsartan (Aml/Val) SPC in Saudi hypertensive patients, as well as the effectiveness of the medication. Observational research was done prospectively at the King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia. The effectiveness of the treatment and the percentage of 159 hypertensive patients who achieved the target blood pressure values (140/90; 130/80 mmHg) among those with diabetes mellitus (DM), chronic kidney disease (CKD), other cardiovascular disorders, and responders were assessed from the beginning to the endpoint (week 23). According to the results, taking Aml/Val SPC significantly lowered all patients' baseline systolic and diastolic blood pressure readings by -17.97 and 8.58 mmHg, respectively. 43.4% of patients successfully met their BP therapeutic objectives by bringing their blood pressure levels back to normal, including 51.4% of patients under 65, 39.3% of patients with chronic kidney disease, and 26.2% of diabetic patients. Aml/Val 10/160 mg significantly lowers SBP, more than Aml/Val 5/160 mg (-13.32% vs. -9.00%, p<0.050). Vertigo (6.30%), respiratory tract infections (4.0%), and ankle edema (2.50%) were the most frequent adverse events. Aml/Val SPC therapy effectively lowered BP and had few side effects while being well-tolerated in people with hypertension.

The study of offspring and mothers with gestational diabetes treated with metformin or glibenclamide in a randomized controlled trial after 9 years

Introduction: Follow-up of the mothers and their offspring recruited to a randomized controlled trial comparing neonatal outcomes in women with gestational diabetes treated with metformin or glibenclamide was conducted 9 years ago. A significant decrease in neonatal hypoglycemia in the group treated with metformin was seen in the original study. Methodology: Results of clinical examination, blood sample collection, and dual-energy X-ray absorptiometry (DEXA) scan not published in a brief communication are described in this study. The nutritional status was assessed using a 3-day recall method using the Indian Food Composition Table 2017. The physical activity of offspring was assessed using the Global Physical Activity Questionnaire. Results: The overall follow-up rate of the cohort was 49% and similar in both the groups. The anthropometric details, blood tests, and DEXA in the women and their offspring were similar except that the offspring of the group on metformin had higher triglyceride values than the offspring of the women treated with glibenclamide. The average body mass index of the offspring was similar and was 18. Currently, women who were treated with glibenclamide 9 years ago had higher fasting plasma glucose levels (9.2 [7.3, 12.6]) than the metformin group (7.2 [6.1, 8.4] median [interquartile range]), P = 0.02. They also had significantly higher diastolic blood pressure readings 77.1mmHg (8.9) and 72.1mmHg (11.7) mean (SD), P = 0.035. (Information from the previously published brief communication). Conclusion: No significant adverse outcome was seen in women treated with metformin and the offspring 9 years later.

Effect of a Multicomponent Intervention Delivered on a Web-Based Platform on Hypertension Control

The prevalence of hypertension is high and still increasing across the world, while the control rate remains low in many countries. Emerging technology, such as telemedicine, may offer additional support to change the unsatisfactory situation. To establish a multicomponent intervention delivered on a web-based telemedicine platform and oriented with the Chinese hypertension management guidelines and to evaluate the effect of the intervention on blood pressure (BP) control for patients with hypertension. This cluster randomized clinical trial of a hypertension management program was conducted at 66 community health centers in China from October 1, 2018, to May 31, 2020, with a 12-month follow-up. Patients with hypertension were blinded to randomization and were randomized to either the intervention group or control group. Hypertension was diagnosed at mean systolic BP (SBP) and diastolic BP (DBP) readings higher than 140 and 90 mm Hg or with use of antihypertensive medication. Evaluation of the intervention effect was based on the principle of modified intention to treat. Multicomponent intervention was delivered on a web-based platform and consisted of a primary prevention program for cardiovascular disease and standardized management for hypertension. The primary outcome was the change in BP control rate (SBP and DBP levels <140 and 90 mm Hg, or <130 and 80 mm Hg for patients with diabetes) from baseline to the 12-month follow-up among patients with hypertension in the intervention and control groups. A total of 4118 patients (mean [SD] age, 61.6 [9.4] years; 2265 women [55.0%]) were included in the analysis, with 2985 in the intervention group and 1133 in the control group. The BP control rate at baseline was 22.8% in the intervention group and 22.5% in the control group. After 12 months of the intervention, the BP control rate for the intervention group compared with the control group was significantly higher (47.4% vs 30.2%; odds ratio, 1.18; 95% CI, 1.13-1.24; P < .001). The intervention effect on SBP level was -10.1 mm Hg (95% CI, -11.7 to -8.5 mm Hg; P < .001) and on DBP level was -1.8 mm Hg (95% CI, -2.8 to -0.8 mm Hg; P < .001). Results of this trial showed that a multicomponent intervention delivered on a web-based platform improved BP control rate and lowered BP level more than usual care alone. Such a telemedicine program may provide a new, effective way to treat patients with hypertension in the community and may generate public health benefits across diverse populations. Chinese Clinical Trial Registry Identifier: ChiCTR1800017791.

The Echo Graphic Assessment of Inappropriate Left Ventricular Mass and Left Ventricular Hypertrophy in Patients with Diastolic Function

Objective: To evaluate the echo graphic assessment of inappropriate left ventricular mass and left ventricular hypertrophy in patients with diastolic function. Method: This cross sectional study was carried out at tertiary medical hospital where Two-dimensional echocardiography was performed on 200 patients with simple hypertension at a tertiary medical center. If a woman had an LVM index of more than 88 g/m2 of body-surface area, or if a man had an LVM index of more than 102 g/m2 of body-surface area, they were considered to have an unhealthy amount of LVM. Women with a septal wall thickness of more than 0/9 cm and males with a thickness of more than 1 cm are considered to have LVH. Early diastolic peak velocity (E) was compared to late diastolic peak velocity (A), deceleration time (DT), and early diastolic peak velocity (E′) were also assessed as echocardiographic parameters. Results: Patients' averaged systolic and diastolic blood pressure readings on the day of admission were 142.87 18.12 and 88.45 9.18 mmHg, respectively. Twenty-one percent of the individuals had an abnormal LV mass, with 5.6% having a mild abnormality and 5.6% having a severe abnormality. Patients with mild left ventricular hypertrophy had a higher mean age and body mass index (P 0.05). Patients with more severe ventricular hypertrophy had longer E/A ratios and longer deceleration times after controlling for age, gender, body mass index, and systolic and diastolic blood pressures. The mean body mass index (BMI) of subjects with severe was 33. 7 3.7 (P 0.001). Slightly different levels of diastolic dysfunction were associated with varying degrees of improper LV mass (P = 0.065). However, there was no correlation between E/A, E/E′, or deceleration time and excessive LV mass (P &gt; 0.05). The relationship between diastolic dysfunction and LV mass was analyzed using Spearman's Rank test (P = 0.025). Conclusion: While LVH is a strong predictor of diastolic dysfunction severity as measured .......