Differences In Blood Pressure Values Research Articles

#2649 Blood pressure tend to decrease following COVID-19 infection in patients with chronic kidney disease—lessons learned from a community based cohort

Abstract Background and Aims Pre-existing hypertension (HTN) has been implicated as one of the most common co-morbidities in COVID-19 patients, likely contributing to disease severity. Additionally, the port of viral entry to the host cell—ACE2 receptor, which is a part of the renin-angiotensin-aldosterone system, was initially thought to cause blood pressure (BP) dysregulation. Recently, several large cohorts have been published, connecting COVID-19 infection to new-onset HTN. Nevertheless, the association of HTN with COVID-19 in patients with chronic kidney disease (CKD) in a community setting has not been fully elucidated. We aimed to study the effect of COVID-19 infection on BP in patients with CKD. Method In this cohort study we utilized the Maccabi Healthcare Services (MHS) database during the COVID-19 pandemic. MHS is a nationwide health care payer-provider, providing health services to approximately 2.6 million Israelis. Data is automatically collected and includes comprehensive laboratory results from a single central lab, full pharmacy prescription and purchase data, physician visits, vital signs documentation, imaging and extensive demographic information on each patient. The database includes several automatically formulated registries including a well validated CKD registry. On July 31st 2023 we looked at point prevalence of patients registered as having CKD stages I-V, defined as eGFR <60 ml/min and/or albuminuria over 30 mg on 24 hour urine collection or 30 mg/g creatinine on urine albumin to creatinine ratio, or proteinuria above 150 mg either at spot urine protein to creatinine ratio or over 24 hour collection. We included CKD patients over the age of 18 years, who had mostly mild COVID-19 disease, detected by SARS-CoV-2 PCR or antigen test between January 1st 2020 and December 31st 2022. Examinees were included only if they had at least one blood pressure measurement documented, in their primary care clinic, in the year prior to infection, and at least one measurement during the 12 months period following COVID-19. Only the 1st documented COVID-19 infection of each patient was included. We compared the differences in BP values between pre and post COVID-19. Results Out of 1,821,685 adults at Maccabi HMS in 2023, 193,566 patients were registered as having CKD. Of those, 86,618 had a documented first COVID-19 infection between the years 2020-2022, and 44,410 of them had documented BP measurements both prior and after COVID-19 were analyzed. Mean age for all CKD patients who had COVID-19 was 69.2 (SD-12.9) years and 22,151 (49.9%) were males. Most patients had CKD stage III—26,939 (60%), and 535 (1.2%) were on dialysis. Not surprisingly, 76% of CKD patients had a preexisting diagnosis of HTN and 44% had diabetes mellitus. Average BP values during the year prior to COVID-19 were 133/76.5 mmHg (SD 14.8 and 8.55, respectively). Mean BP values post COVID-19 were 132/75/9 mmHg (SD 15.5 and 8.9, respectively). This translates into a reduction of 1 mmHg in systolic BP and 0.6 mmHg in diastolic BP in the year prior to COVID-19 infection as compared with pre-covid-19 infection (P-value 0.03 and 0.004, respectively). Conclusion Contrary to previous studies, that linked COVID-19 infection to a higher set-point of BP, our data demonstrates in a large community-based cohort of CKD patients, that BP does not increase and even trends down following COVID-19. As patients were one year older during their post-covid year, and some had withdrew ACE inhibitors or ARB, due to erroneous fear of adverse effect on Covid-19 infectivity, we believe that our results may even underestimate the extent of decrease in BP. Further investigation might reveal the possible mechanisms related to this favorable BP decrease after COVID-19 infection, in CKD patients.

Perbedaan Nilai Tekanan Darah Antara Operator Produksi Dengan Petugas Laboratorium Pabrik Spunbond Di Balongbendo

Employees who work in their jobs must achieve work goals within a certain period of time. The purpose of the study was to determine the difference in blood pressure values and hemoglobin levels between Production Operators and Laboratory Officers of the Spunbond Factory in Balongbendo. Blood pressure measurement used ABN aneroid tensimeter, while hemoglobin level measurement used easy touch GCHB. The type of research used was quantitative observational analytic with a cross sectional approach. Data analysis using Statistical Package for Social Science (SPSS) includes chi square test, paired sample t-test, and independent sample t-test. Independent sample t-test statistical test obtained p-value> 0.05. Indicates that there is no significant difference between systolic and diastolic blood pressure values before and after working Production Operators with Laboratory Officers. The results of measuring the hemoglobin level of Production Operators, obtained an average hemoglobin level of 15.0 mmHg. While the results of measuring the hemoglobin level of Laboratory Officers obtained an average value of 15.4 mmHg. The results of the independent sample t-test statistical test obtained a p-value of 0.280 or p-value> 0.05. That there is no significant difference in hemoglobin levels between Production Operators and Laboratory Officers.

Comparison of clinical blood pressure measurements to measurements according to guidelines in women admitted to the maternity ward for hypertension.

Objective: To assess the adherence to recommended guidelines on measurement of blood pressure in obstetric clinical practice and to determine the difference in blood pressure values between observed clinical measurements and measurements strictly following recommended guidelines. Methods: We assessed blood pressure of 60 women admitted to the maternity ward for a hypertensive disorder of pregnancy in pregnancy or postpartum. Blood pressure was measured by hospital staff according to usual clinical practice, and study personnel performed the measurement in accordance with international guidelines. Groups were compared using paired sample t-test and the Mantel-Haenszel test. Results: None of the clinical measurements fulfilled all recommended guidelines. Study systolic and diastolic readings were lower than those obtained in the usual clinical setting (systolic BP -7.0 mmHg (95% confidence interval: -9.2 to -4.8), p<0.001; diastolic BP -2.0 mmHg (95% confidence interval: -3.7 to -0.4), p=0.02). The risk of being categorized as hypertensive (≥140/90mmHg) decreased by 22% (95% confidence interval: 0.05-0.40, p=0.01) and 22/58 (38%) women shifted to a 10 mmHg category lower in systolic blood pressure along with 15/58 (26%) in diastolic blood pressure when measurements were performed by study personnel following recommended guidelines. Conclusion: Following recommended blood pressure measurement guidelines significantly lowers blood pressure readings and the risk of being categorized as hypertensive. TWEETABLE ABSTRACT: Following recommended guidelines significantly decreases blood pressure readings and reduces the risk of being categorized as hypertensive in an obstetrical population.

Pengendalian Tekanan Darah dengan Black Garlic Varian Bawang Lanang pada Pasien Hipertensi

Cardiovascular disease is a major health problem in the world. Hypertension is one of the most common cardiovascular diseases. Efforts to control and treat hypertension are very important so as not to cause complications. Hypertension control can be done with pharmacological and non-pharmacological therapy. One of the non-pharmacological therapies is black garlic therapy with solo garlic variant. The type of research used is pre experimental with a one-group pretest and post-test design. Researchers analyzed the respondents' blood pressure before and after being given black garlic variant solo garlic therapy for 14 days. The research was carried out in the working area of the Gedangan Village Health Center, Malang Regency from March to June 2022. The population in this study were patients with hypertension in the working area of the Gedangan Health Center. The sampling technique used consecutive sampling with a total sampling of 20 samples. Analysis of the data used by using the paired t test. The results showed that there were differences in blood pressure values after consuming black garlic variants of garlic (systole -value 0.000, diastole -value 0.014). The hope is that the public can use non-pharmacological black garlic therapy, especially the solo garlick variant, as a complementary therapy in controlling blood pressure.

Optimization of premedication of patients with arterial hypertension and severe ventricular rhythm disturbances with Amiodarone-associated thyrotoxicosis

Introduction: The effectiveness of premedication of patients with arterial hypertension and severe ventricular rhythm disturbances against the background of Amiodarone-associated thyrotoxicosis, high anxiety and cyclothymiae disorders should be based on the pharmacological positions of the need to reduce the risk of dangerous adverse cardiovascular reactions.
 Materials and methods: During the research, a clinical group of 114 patients with arterial hypertension, severe ventricular arrhythmias and Amiodarone-associated type I thyrotoxicosis was formed: four subgroups were identified. In Subgroup 1 (n=22), no premedication was given. In Subgroup 2 (n=32), premedication was given with Diazepam and magnesium sulfate in a prolonged mode. In Subgroup 3 (n=30), the patients received Diazepam the day before surgery. In Subgroup 4 (n=30), premedication was given with Midazolam. A dynamic assessment of the severity of anxiety, depression, sedation and daily monitoring of blood pressure and ECG were carried out.
 Results and discussion: After surgery, in Subgroup 1, the level of anxiety and depression increased. In all other Subgroups, regardless of the type of premedication, the use of benzodiazepines was accompanied by a decrease in the level of anxiety after surgery. A decrease in pressure load and an increase in the stability of the parameters of systemic hemodynamics were registered in Subgroup 2 of patients, whereas in Subgroup 4 of patients, the pressure load increased while limiting the differences in blood pressure values during the day. After surgery, in Subgroup 2, cardiac rhythm disturbances were less common; in Subgroup 3, the structure of rhythmogenesis disturbances in the heart almost did not change, and in Subgroup 4, there was an unfavorable trend of an increase in the frequency of supraventricular, single and group ventricular extrasystoles.
 Conclusion: The prolonged premedication with long-acting benzodiazepines and magnesium preparations in patients with arterial hypertension, ventricular rhythm disturbances against the background of Amiodarone-associated thyrotoxicosis reduces the level of anxiety, as well as the risk of developing cardiovascular complications and instability of systemic hemodynamics.

English

BACKGROUND Anaesthesia for neurosurgery requires special considerations. The brain is enclosed in a rigid cranium, so the rise in intracranial pressure (ICP) which impairs cerebral perfusion pressure (CPP), results in irrepairable damage to various vital areas in the brain. Stable head position is required in long neurosurgical procedures. This is obtained with the use of clamps which fix the head rigidly. This is done usually under general anaesthesia because it produces intense painful stimuli leading to stimulation of sympathetic nervous system which in turn causes release of vasoconstrictive agents. This can impair perfusion in all organ systems. The increase in blood pressure due to sympathetic nervous system causes increase in blood flow. This causes increases in intracranial pressure which result in reduction in cerebral perfusion pressure once the auto regulatory limits are exceeded. We compared the effects of dexmedetomidine 1 µgm/kg and propofol 100 µgm/kg given as infusion over a period of 10 minutes before the induction of anaesthesia and continued till 5 minutes after pinning to attenuate the stress response while cranial pinning. In this study, we wanted to compare the effects of dexmedetomidine and propofol as infusion to attenuate the stress response while cranial pinning in patients undergoing neurosurgical procedures. METHODS This is a randomized interventional trial. Patients were divided into 2 groups of 20 each. Group 1 receiving dexmedetomidine and group 2 receiving propofol, both drugs given as infusion. Haemodynamic variables were monitored before and after cranial pinning. Data was analysed using IBM statistical package for social sciences (SPSS) statistics. The parameters recorded were analysed with the help of a statistician. RESULTS The two groups were comparable in demographic data. Incidence of tachycardia between group 1 and 2 showed that tachycardia to pinning was better controlled with propofol than dexmedetomidine (P < 0.05) which is statistically significant. There is no statistically significant difference in blood pressure values between group 1 and 2 after pinning. CONCLUSIONS From our study, we came to a conclusion that propofol was superior to dexmedetomidine in attenuating the heart rate response to cranial pinning. The effect of propofol and dexmedetomidine was comparable in attenuating the blood pressure response to cranial pinning. KEYWORDS Cranial Pinning, Dexmedetomidine, Propofol

Implementation of Outpatient Pharmacist-led Hypertension Management for Under-Resourced Patients: A Pilot Study.

The purpose of this study was to implement and evaluate a pharmacist-led hypertension (HTN) program for under-resourced patients discharged from the emergency department (ED) or screened at community health events who are lacking a regular primary care provider (PCP) relationship. This was a single arm, prospective, pilot study to recruit patients from the Detroit Medical Center (DMC) Sinai Grace Hospital (SGH) ED and community health events. The outpatient pharmacist-led transitional care clinic (TCC) was implemented through a collaborative practice agreement (CPA) with ED physicians. Eligible patients 18 to 60 years with elevated blood pressure (BP) (> 140/90 mmHg) and lacking a PCP relationship were referred to the TCC for HTN management. The primary outcome measure was change in systolic and diastolic BP (SBP and DBP). Difference in BP values was evaluated using Wilcoxon Signed Ranks test and descriptive statistics were used to explain demographic data. There were 116 patients enrolled May 2017 to August 2018; 44 (37.9%) completed visit one [cohort 1], 30 (25.9%) completed at least three visits [cohort 2], and 16 (13.8%) completed five visits [cohort 3]. Most patients were African American (AA) 97.7%, 47.8% were male, and an average of 42.11 (SD 9.70) years. For cohorts 2 and 3, there was significant reduction in BP between TCC visits one and two and the reduction was maintained through five visits for patients that remained in the study. Patients who completed five visits (n=16) showed a significant change from visit one to visit five in SBP of -23 mmHg (p=0.002) and achieved BP goal with an average SBP 139 mmHg (SD 19.33) and DBP 90 mmHg (SD 10.17). The pharmacist-led TCC was successfully implemented. Outpatient pharmacists collaborating with ED physicians increased access to HTN management with a positive impact on BP outcomes in an under-resourced population.

Hypertension in people in middle and late adulthood during sports and physical training

Aim. Comparative analysis of changes in blood pressure (BP) measured before and after the physical exertion in veteran athletes and persons practicing physical training (late and middle adulthood). Material and methods . The 200 competitive athletes and 45 persons practicing physical training, aged 40 to 72 years were questioned in order to identify the main factors of cardiovascular risk. All measurements and results obtained under this research were treated with regard to the diagnosis of hypertension (HTN), prior determined by a physician, and also to the administered therapy. Results . A total of 54,7% of subjects was diagnosed with the HTN, with 32,6% out of them not taking antihypertensives. 53% of athletes and 62.2% persons practicing physical training were diagnosed with the arterial hypertension. Among athletes, the HTN incidence was 53%, among persons practicing physical training — 62,2%. Among athletes, 49% had pre-exercise elevated systolic BP (SBP) and 42,5% had elevated pre-exercise diastolic BP (DBP). While only 17% of persons practicing physical training demonstrated the elevated SBP and only 13,3% of them were recorded with the elevated DBP. One third of athletes without HTN in their everyday activities were diagnosed with the elevated both SBP and DBP during physical exertion. Immediately after the exercise stress, 39% of all the examined athletes were diagnosed with the elevated post-exercise SBP, and 36,2% of them with the elevated post-exercise DBP. Among persons practicing physical training, 33% of subjects were diagnosed with the elevated postexercise SBP, and 24,4% of them with the elevated post-exercise DBP. Conclusion. A major part of the athletes are diagnosed with the elevation in pre- and post-exercise BP. Whereas, persons practicing physical training demonstrate normal average pre- and post-exercise SBP and DBP values in most of the cases. Post-exercise differences in BP values in athletes and persons practicing physical training are almost leveled out. Post-exercise HTN >140/90 mm Hg is detected both in people with HTN receiving antihypertensive therapy, and in people without HTN. Elderly people involved in sports or fitness have significant differences in the response of BP to the exertion. However, in a significant part of this HTN people, BP changes during exercise are in the hypertensive range and can be an additional cardiovascular risk factor.

Effect of Early-Onset Preeclampsia on Offspring's Blood Pressure during the First Month of Life

To explore the effect of early-onset preeclampsia on the blood pressure of offspring during the first month of life. This prospective case-control study included 106 neonates of mothers with early-onset preeclampsia (developing at <34weeks of gestation) and 106 infants of normotensive mothers, matched 1-to-1 for sex and gestational age. Serial blood pressure measurements were obtained on admission, daily for the first postnatal week, and then weekly up to the fourth week of life. There were no differences in blood pressure values on admission and the first day of life between cases and controls. Conversely, infants exposed to preeclampsia had significantly higher systolic (SBP), diastolic (DBP), and mean blood pressure (MBP) on the subsequent days up to the fourth postnatal week (P<.001-.033). Multiple regression analyses with adjustment for sex, gestational age, antenatal corticosteroid use, and maternal antihypertensive medication use confirmed the foregoing findings (P<.001-.048). Repeated-measures ANOVA also identified preeclampsia as a significant determinant of trends in SBP, DBP, and MBP during the first month of life (F=16.2, P<.001; F=16.4, P<.001; and F=17.7, P<.001, respectively). Infants of mothers with early-onset preeclampsia have elevated blood pressure values throughout the neonatal period compared with infants born to normotensive mothers.

POSSIBLE ROLE OF THE SPLEEN IN THE DEVELOPMENT OF HYPERTENSION IN HUMANS

Objective: Immune system (in particular T lymphocytes) is involved in the pathogenesis of arterial hypertension and microvascular remodelling. It has also been recently suggested a crucial role for spleen in the development and onset of hypertension, through a neuroimmune mechanism mediated by a splenic factor, the Placental growth factor (PIGF), in different models of experimental hypertension (Carnevale D, et al Immunity 2014, Carnevale D, et al. Nat Commun. 2016, Perrotta M, et al. Cardiovasc Res. 2018). However, to date no data are present in humans.Design and method: We investigated 29 patients: 19 were previously splenectomized for idiopathic thrombocytopenic purpura or marginal lymphoma (clinical conditions associated with good survival) and 10 patients underwent an elective surgical intervention (cholecystectomy) in the same period, well matched for ages, sex and cardiovascular risk factors. In all patients clinical and 24-hours blood pressure (BP) were recorded. Wall to lumen ratio of retinal arterioles (WLR) was obtained by Adaptive Optics as index of microvascular damage. Functional (basal) and structural (total) capillary density were studied by capillaroscopy before and after venous congestion. Results: The groups did not present statistically significant differences for clinical or 24-hours BP values (Clinical BP: 126.94 ± 8.20/72.38 ± 13.7 mmHg in splenectomized patients vs 125.56 ± 12.9/76.67 ± 5.59 mmHg in the cholecystectomized patients, p = NS; 24-hours BP: 119.7 ± 13.8/66.4 ± 6.60 vs 119.20 ± 8.76/69.10 ± 7.53 mmHg respectively, p = NS). No differences in central BP and Augmentation index were observed between the groups. Retinal arteriole morphology and capillary density did not differ between the groups. However, WLR was slightly higher, albeit not significant, in cholecystectomized than in splenectomized patients (Table). Conclusions: Our preliminary data did not confirm in humans the hypothesis of a difference in blood pressure values and indices of microvascular damage in splenectomized patients compared to cholecystectomized patients. However, a statistically not significant trend towards a greater WLR was observed in cholecystectomized patients. For a definitive conclusion about the involvement of the spleen in the genesis of hypertension also in humans it is necessary to extend the evaluation to a larger population.

EFFECT OF VERAPAMIL SUSTAINED RELEASE ON CEREBROVASCULAR REACTIVITY IN HYPERTENSIVE PATIENTS WITH RHEUMATOID ARTHRITIS

Objective: To investigate the effect of verapamil sustained release (SR) on cerebrovascular reactivity (CVR) in patients with hypertension (HT) and rheumatoid arthritis (RA). Design and method: The study comprised 30 patients with HT of grade 1-2 and RA, aged 59.7 ± 9.1 years. All patients were treated with 120 mg or 240 mg verapamil SR for 24 weeks. Ambulatory 24-hour blood pressure (BP) monitoring and evaluation of CVR were performed twice: initially and at the end of the study. CVR was evaluated using transcranial Doppler ultrasound of the middle cerebral arteries (MCA) in the hyperoxia and hypercapnia tests. We measured MCA time average maximal blood flow velocity (TAMX), peak systolic velocity (Vps) at baseline, during 2 min inhalation of oxygen (O2) and during 3 min recovery phase. The hypercapnia test was carried out according to the same protocol with inhalation of the 4% mixture of carbonic gas with air (CO2). We used three parameters for CVR evaluation: index changes of flow velocity mean (IFVm), speed modification of velocity (SMFVm) and index of recovery for velocity (IRVmrec). IFVm = (Vps2–Vps0)/Vps0*100%. SMFVm = (Vps2-Vps0)/120. IRVmrec = Vps0/Vps4. Vps0 is starting parameter. Vps2 is the parameter during 2 minute of inhalation. 120 is time of inhalation in seconds. Vps4 is the parameter during 4 minutes of test. The differences in BP values and parameters for CVR evaluation were tested with Student's t-test for paired samples. Results: Verapamil SR treatment reduced both systolic/diastolic office and 24-h BP by 14.1/8.2 mmHg for office BP and 13.5/9.9 mmHg for 24-h BP, all P < 0.0000. After Verapamil SR treatment, the parameters of MCA blood flow and CVR did not change either in the hyperoxia or in the hypercapnia tests compared with those before treatment. Conclusions: Treatment with verapamil SR did not improve the parameters of CVR in hypertensive patients with RA.

Attended and Unattended Automated Office Blood Pressure Measurements Have Better Agreement With Ambulatory Monitoring Than Conventional Office Readings.

BackgroundAutomated office blood pressure (AOBP) measurement is superior to conventional office blood pressure (OBP) because it eliminates the “white coat effect” and shows a strong association with ambulatory blood pressure.Methods and ResultsWe conducted a cross‐sectional study in 146 participants with office hypertension, and we compared AOBP readings, taken with or without the presence of study personnel, before and after the conventional office readings to determine whether their variation in blood pressure showed a difference in blood pressure values. We also compared AOBP measurements with daytime ambulatory blood pressure monitoring and conventional office readings. The mean age of the studied population was 56±12 years, and 53.4% of participants were male. Bland–Altman analysis revealed a bias (ie, mean of the differences) of 0.6±6 mm Hg systolic for attended AOBP compared with unattended and 1.4±6 and 0.1±6 mm Hg bias for attended compared with unattended systolic AOBP when measurements were performed before and after conventional readings, respectively. A small bias was observed when unattended and attended systolic AOBP measurements were compared with daytime ambulatory blood pressure monitoring (1.3±13 and 0.6±13 mm Hg, respectively). Biases were higher for conventional OBP readings compared with unattended AOBP (−5.6±15 mm Hg for unattended AOBP and oscillometric OBP measured by a physician, −6.8±14 mm Hg for unattended AOBP and oscillometric OBP measured by a nurse, and −2.1±12 mm Hg for unattended AOBP and auscultatory OBP measured by a second physician).ConclusionsOur findings showed that independent of the presence or absence of medical staff, AOBP readings revealed similar values that were closer to daytime ambulatory blood pressure monitoring than conventional office readings, further supporting the use of AOBP in the clinical setting.

PP.02.15] EFFICIENCY OF BISOPROLOL IN THE TREATMENT OF STAGE I HYPERTENSION “BIPREZ” STUDY

Objective: The aim was to assess the efficiency and safety of bisoprolol therapy in patients with Stage I hypertension in three doses; 2.5 mg, 5 mg, and 10 mg. Design and method: A cross-sectional study comprised 9060 patients (65% women and 35% men) with stage I arterial hypertension, aged 61.6 ± 11.5 years. Blood pressure (BP) was measured by an oscillometric device at the beginning of the study, and after three months of therapy. The treatment initiated with 2.5 mg bisoprolol; the dose was increased to 5 mg after two weeks in persons who failed to decrease blood pressure adequately; the dose was increased to 10 mg after further 4 weeks in persons whose blood pressure remained increased. Patients were followed up for 8 weeks in total. Blood glucose, total cholesterol, and triglycerides were measured with standard biochemical procedures. The differences in blood pressure values after eight-week therapy in comparison to the baseline were tested with Student's t-test for paired samples. Results: Mean systolic blood pressure (SPB) at the beginning of the study was 141.1 mmHg; mean diastolic blood pressure (DBP) was 90.5 mmHg. After eight weeks of therapy, mean SBP was significantly reduced to 128.9 mmHg (p < 0.01), and DBP was significantly reduced to 79.0 mmHg (p < 0.01). At the end of the eight-week treatment, 27.8% of the patients had normal blood pressure, 51.5% had prehypertension, and 20.7% still had stage I hypertension. The therapy lead to significant decrease of heart rate from 82.2 beats/min to 71 beats/min (p < 0.01), as well as to decrease of the following biochemical parameters: glucose (from 6.05 mmol/l to 5.83 mmol/l), total cholesterol (from 5.97 mmol/l to 5.73 mmol/l), LDL-cholesterol (from 3.65 mmol/l to 3.46 mmol/l) and triglycerides (from 1.96 mmol/l to 1.82 mmol/l) (all p < 0.01). Conclusions: Eight-week therapy with bisoprolol not only reduces blood pressure and heart rate in hypertensive men, but decreases glucose, cholesterol and triglyceride levels, and is metabolically neutral as well.

PP.24.06] CARDIAC PHENOTYPE BASED ON ANGIOGRAPHIC SUBTYPES AND VASCULAR INVOLVEMENT IN PATIENTS WITH FIBROMUSCULAR DYSPLASIA –ARCADIA-POL STUDY

Objective: To evaluate echocardiographic morphology and function in patients with fibromuscular dysplasia (FMD) in relation to angiographic subtypes and vascular involvement of FMD. Design and method: 137 patients with FMD underwent whole body angio-CT. 117 patents (F-94, M-23) with renal FMD were divided according to type of FMD in renal arteries as: unifocal and multifocal groups. Left ventricular mass index (LVMI) was obtained by echocardiography. Systolic function was assessed by ejection fraction and global longitudinal strain (GLS). Diastolic function was measured by mitral flow parameters (A, E) and early diastolic myocardial velocity (E’). E/A, E/E’ and E’/A’ ratio were calculated. Results: Patients with multifocal FMD (n = 79) were older then patients with unifocal FMD (n = 38). There were no differences in blood pressure values as well as in LVMI and systolic function between analyzed groups (Table 1). There were significant differences in diastolic function between multifocal and unifocal groups (Table 1). After correcting for age or removing patients with significant renal arteries stenosis, the results remained still significant. There were no differences in echocardiographic parameters when patients were divided according to the number of vascular beds involved FMD.Conclusions: Our study showed that patients with multifocal renal FMD differed in diastolic function parameters as compared to unifocal angiographic type. There were no differences in systolic function assessed by speckle tracking echocardiography method between analysed groups.

Associations between PPARG polymorphisms and the risk of essential hypertension.

BackgroundPeroxisome proliferator-activated receptor gamma (PPARG) plays an important role in the pathogenesis and maintenance of essential hypertension (EH). It has been suggested that polymorphisms of PPARG are associated with the risk of EH. However, findings to date remain controversial. To elucidate the associations between the PPARG Pro12Ala and C161T polymorphisms and EH risk, a meta-analysis was carried out.MethodsA comprehensive literature search of PubMed, Embase, CNKI (Chinese National Knowledge Infrastructure), VIP and Wanfang databases was conducted. The pooled odds ratios (ORs) and 95% confidence interval (CI) were calculated to estimate the size of the effect using the random-effects model. At the same time, the pooled standardized mean difference (SMD) with 95% CI was used for the meta-analysis of the PPARG Pro12Ala polymorphism and blood pressure.ResultsFinally, Fifteen papers (seventeen studies) including 4,151 cases and 4,997 controls to evaluate the association of the PPARGPro12Ala polymorphism and EH risk, were included in this study. Overall, the results suggested that Ala allele was associated with the decreased EH risk (for allelic model, OR = 0.757, 95%CI: 0.624–0.918, P = 0.005; for dominant model, OR = 0.771, 95%CI: 0.627–0.946, P = 0.013). The subgroup analysis stratified by ethnicity showed that the significant association between the PPARG Pro12Ala polymorphism and EH was only detected in the Asian subgroup. There was no difference in blood pressure values between Ala carriers and non-carriers. For the C161T polymorphism, only 5 studies comprising 1,118 cases and 1,357 controls met the inclusion criteria. The overall results showed that the PPARG C161T polymorphism was not associated with the risk of EH. But in the subgroup analysis, we found that the PPARG C161T polymorphism significantly associated with the risk of EH in the Asian subgroup (for allelic model, OR = 0.719, 95% CI: 0.537–0.963, P = 0.027; for dominant model, OR = 0.653, 95% CI: 0.439–0.972, P = 0.036).ConclusionOur meta-analysis suggested that the PPARG polymorphisms might be associated with the risk of EH.

Blood pressure cuff comparability study.

Manufacturer-supplied blood pressure (BP) cuffs are part of the automatic oscillometric BP devices algorithm. This study assessed the differences in BP values using the Omron HEM 907-XL (Omron) device with two types of cuffs: the Baum cuff (BC) and the supplied Omron cuff (OC). A sample of 102 adults participated in the study, 34 per cuff size (adult, large, and extra-large). After a 5-min resting period, three pairs of BP determinations (systolic and diastolic) were taken simultaneously on both arms. One arm was cuffed with a BC and the other arm was cuffed with an OC. The cuffs were switched to opposite arms after 5 min of rest. The order was decided randomly as to which cuff was applied to which arm first. The BP readings were highly correlated between the cuffs (systolic BP, r=0.98; diastolic BP, r=0.98). The overall mean differences (BC-OC) were 2.66 mmHg (SD=3.9 mmHg) for systolic BP (P<0.05) and 0.33 mmHg (SD=2.03 mmHg) for diastolic BP (P>0.05). Increased cuff size corresponded to increased differences in systolic BP values (adult: 1.51 mmHg; large: 2.56 mmHg; and extra-large: 3.9 mmHg; P<0.05). For diastolic BP values, a statistically significant difference was observed only for adult cuff size (difference=1.31 mmHg, SD=1.34 mmHg, P<0.05). Using a BC with the Omron could result in higher systolic BP readings and higher diastolic BP readings with the adult cuff size.

Birth weight and blood pressure in first-grade elementary school students: A preliminary study

Background Fetal programming theory reveals that low birthweight is associated with higher risks of hypertension and cardio-vascular diseases in the adulthood.Objective To study the difference in blood pressure among first-grade students of different birth weight groups.Methods A cross-sectional study was performed. Blood pressureof 214 healthy first-grade elementary school students (102 malesand 112 females) in Bunaken Subdistrict, Manado, Indonesia, wasmeasured using a standard sphygmomanometer with appropriatecuff for arm size. Two readings were taken. Parents were asked tocomplete a questionnaire concerning the information on birth weightand length and confirmed by retrieving the record on a growthchart and/or a maternal-child health book. The subjects were di-vided into 6 groups according to their birth weight. The differencesin blood pressure values between birth weight groups were exam-ined by ANOVA.Results Systolic blood pressures were significantly higher in the&lt;2500 g birth weight group (100.73+9.99 mmHg vs. 93.70+8.29mmHg) and in the 2500-&lt;3000 g birth weight group compared tothose of the 3500-&lt;4000 g one (99.56+9.14 mmHg vs. 93.70+8.29mmHg) with a P of 0.048 and 0.014, respectively. There was nodifference between diastolic blood pressure and birth weight.Conclusion Our study showed that the lower birth weight grouptends to have a higher systolic blood pressure than that of childrenwith normal birth weight

PP.28.05] CHARACTERISTICS OF BLOOD PRESSURE IN PATIENTS UNDERGOING CHRONIC HEMODIALYISIS

Objective: Cardiovascular (CV) disease is the most important cause of morbidity and mortality among patients with chronic kidney disease particularly in those undergoing chronic hemodialysis (HD). Hypertension (HT), the most important CV risk factor is frequently present and has several particular characteristics. Our aim was to analyze characteristics of HT in our group 194 patients undergoing HD. Design and method: In this study we have analyzed characteristics of HT and arterial stiffness (i.e. PWV) in 194 patients (118 m, 83 w; mean age 63+/-15 y). All patients were dialyzed three times a week with standard bicarbonate hemodialysis solutions and synthetic dialyzers according to the recent international guidelines. All measurements were done mid week day. Blood pressure (BP) was measured with Omron M6 (after dialysis session), ABPM using Spacelab 90207 (24 h) and PWV (before dialysis session) was determined with Arteriograph. Results: Significant difference in BP values measured after dialysis and ABPM were found (day, night, for both systolic and diastolic BP). Only 6.6% patients were normotensive, 63.3% hypertensive, while white coat (WCH) and masked hypertension (MH) were diagnosed in 26.4% and 3.7%, respectively (no gender differences). There were no differences in BP values between men and women, but PWV > 10m/s were found more frequently in men than in women in (m vs. w 56.5% vs.39.7%;p = 0.049; 48.3% in total; 10.4 +/-1.9 vs.9.7+/-1.7;p < 0.01). In logistic regression age was the most important predictor for pathologic values of PWV. WCH had slightly higher values of PWV than normotensives (9.7 +/-2.0 vs.8.5+/-1.3; p = 0.09). PWV in MH was not different compared to the sustained HT (10.2+/-1.7). Non-dipping status was established in 45.3%, extreme dipping in 18.8%, and only 21.6% were dippers. Conclusions: Our results confirmed significant clinical value of ABPM in patients undergoing dialysis. Determination of WCH subjects and non-dippers is of utmost importance for everyday tailoring of therapy. Increased arterial stiffness should be considered as well.

PP.13.15] BISOPROLOL THERAPY REDUCES THE NUMBER OF ANGINA ATTACKS

Objective: The aim was to assess the effects of three-month therapy with bisoprolol on blood pressure and the number of angina attacks in hypertensive persons. Design and method: The study comprised 6799 patients with stage I arterial hypertension, aged 61.60 ± 11.54 years. All patients were treated with 2.5 mg or 5 mg bisoprolol for three months. Blood pressure (BP) was measured by an oscillometric device at the beginning of the study, and after three months of therapy. The number of angina attacks at the beginning of the study, and after three months of therapy was self-reported. The differences in blood pressure values and number of angina attacks from baseline were tested with Student's t test for paired samples. Results: Mean systolic blood pressure (SPB) at the beginning of the study was 147.1 mmHg; mean diastolic blood pressure (DBP) was 90.5 mmHg. After three months of therapy, mean SBP was significantly reduced to 128.9 mmHg, and DBP was significantly reduced to 79.0 mmHg. At the end of the three-month treatment, 27.8% of the patients had normal blood pressure, 51.5% had prehypertension, and 20.7% had stage I hypertension. As for the number of angina attacks, the average number was 2.03 per week at the beginning of the study, but was significantly reduced to 0.91 attacks per week after the therapy. All differences from the baseline values were highly statistically significant (p < 0.001). Conclusions: Three-month therapy with bisoprolol not only reduces blood pressure in hypertensive persons, but decreases the number of angina attacks after three-month treatment.

Male prairie voles display cardiovascular dipping associated with an ultradian activity cycle

Mammals typically display alternating active and resting phases and, in most species, these rhythms follow a circadian pattern. The active and resting phases often are accompanied by corresponding physiological changes. In humans, blood pressure decreases during the resting phase of the activity cycle, and the magnitude of that “nocturnal dipping” has been used to stratify patients according to the risk for cardiovascular disease. However, in contrast to most mammals, prairie voles (Microtus ochrogaster) have periods of activity and rest that follow an ultradian rhythm with period lengths significantly <24h. While rhythmic changes in blood pressure across a circadian activity cycle have been well-documented, blood pressure patterns in species that display ultradian rhythms in activity are less well-studied. In the current study, we implanted pressure-sensitive radiotelemetry devices in male prairie voles and recorded activity, mean arterial pressure (MAP), and heart rate (HR) continuously for 3days. Visualization of the ultradian rhythms was enhanced using a 1h running average to filter the dataset. Positive correlations were found between activity and MAP and between activity and HR. During the inactive period of the ultradian cycle, blood pressure decreased by about 15%, which parallels the nocturnal dipping pattern seen in healthy humans. Further, the duration of inactivity did not affect any of the cardiovascular measures, so the differences in blood pressure values between the active and inactive periods are likely driven by ultradian oscillations in hormones and autonomic function. Finally, specific behavioral patterns also were examined. Both the instrumented animal and his non-instrumented cagemate appeared to show synchronized activity patterns, with both animals displaying sleep-like behavior for more than 90% of the inactive period. We propose that the prairie vole ultradian rhythm in blood pressure is an analogue for circadian blood pressure variability and can be used to study the long-term effects of commonly prescribed drugs on blood pressure dipping.