Mean Difference In Blood Pressure Research Articles

Abstract P547: Soluble Fiber Diet Alters Cardiovascular Responses To Stress In Normotensive Wky Rats

Gut microbiota is crucial for function of the gastrointestinal (GI) tract, and modulates the communication between the GI tract and the central nervous system. Microbial metabolites such as propionate have been shown to regulate blood pressure (BP), while butyrate, one of the major bacterial fermented byproducts, reportedly produces beneficial effects in multiple dysbiosis-related diseases. We previously showed that chronic supplementation with soluble fiber-rich, butyrolytic diet modified microbiota and increased BP in the spontaneously hypertensive rat (SHR). Here, we tested the impact of same diet on BP regulation in the Wistar Kyoto rats (WKY). Methods: Male 4 weeks old WKY were placed on either the fructooligosaccharides/inulin-rich diet (fiber, N=6), or its calorie-matched control diet (control, N=6) (Research Diets, Inc.) for 14 weeks. Baseline BP was measured by tail cuff every week for the duration of the study, and by telemetry at the end of the study and during 20 minutes of restraint stress. Spectral analysis of BP waveform was performed during restraint stress to measure autonomic variables. Results: We observed no significant difference in mean BP measured by tailcuff or by telemetry between the two groups. However, there was an increase in mean BP after 2 minutes of restraint (104.5 ± 7.45 mmHg vs. 116.3 ± 3.19 mmHg; p=0.0411, n=6), which was associated with a trend in increase in LF/HF variable linked with vasovagal balance (1.99 ± 1.43 vs. 3.04 ± 1.46, p=0.17) in the fiber group when submitted to restraint stress. Conclusion: Unlike in the SHR, fiber-rich diet did not alter baseline BP in the normotensive WKY. However, chronic fiber diet produced autonomic imbalance and increased BP in response to restraint stress in the WKY.

Abstract 126: Blood Pressure in Childhood Predicts HTN in Adulthood: The International CV Cohorts Consortium

The natural history of blood pressure (BP) tracking from childhood to adulthood is not well defined. Using data from the International Childhood CV Cohorts Consortium, consisting of 7 international longitudinal cohorts, participants (N=5042) were evaluated by self-reported adult hypertension (HTN). Correlation between mean of all measures of BP on a subject during childhood (8-11 years) or adolescence (15-18 years) and adult BP (28-31 years) was evaluated with Spearman correlation coefficients. Differences in mean BP, body mass index (BMI) and laboratory values were evaluated by t-tests. Participants at time of self-report of HTN were mean age 48.5 years (81.7% white, 17.4% black; 39% male). Prevalence of HTN (N=1562) was 31%; 3480 were normotensive (NT). Correlations between child and adolescent SBP and DBP were r=0.43, 0.42, respectively, child and young adult r=0.24, 0.23 and adolescent and young adult r=0.41, 0.27 (all p<0.0001). Participants self-reporting HTN were more likely to be non-white (46.8% black, 30.2% white, 29.7% other, p<0.0001). Males were more likely to report HTN (33% vs 28% females, p<0.0001). They had significantly higher SBP and BMI as children and adolescents and also significantly higher DBP and fasting glucose by adolescence and lower HDL and higher TG by young adulthood (all p<0.01). We conclude that adult HTN begins in childhood with higher BP and BMI which appear to be important clinical markers for progressive increases in metabolic risk factors as these individuals age through adolescence and young adulthood.

Differences in perioperative femoral and radial arterial blood pressure in neonates and infants undergoing cardiac surgery requiring cardiopulmonary bypass

ObjectiveSeveral reports claim that blood pressure (BP) in the radial artery may underestimate the accurate BP in critically ill patients. Here, the authors evaluated differences in mean blood pressure (MBP) between the radial and femoral artery during pediatric cardiac surgery to determine the effectiveness of femoral arterial BP monitoring. MethodThe medical records of children under 1 year of age who underwent open-heart surgery between 2007 and 2013 were retrospectively reviewed. Radial and femoral BP were measured simultaneously, and the differences between these values were analyzed at various times: after catheter insertion, after the initiation of cardiopulmonary bypass (CPB-on), after aortic cross clamping (ACC), after the release of ACC, after weaning from CPB, at arrival in the intensive care unit (ICU), and every 6h during the first day in the ICU. ResultsA total of 121 patients who underwent open-heart surgery met the inclusion criteria. During the intraoperative period, from the beginning to the end of CPB, radial MBPs were significantly lower than femoral MBPs at each time-point measured (p<0.05). Multivariate analysis showed that longer CPB time (>60min, odds ratio: 7.47) was a risk factor for lower radial pressure. However, discrepancies between these two values disappeared after arrival in the ICU. There was no incidence of ischemic complications associated with the catheterization of both arteries. ConclusionThe authors suggest that femoral arterial pressure monitoring can be safely performed, even in neonates, and provides more accurate BP values during CPB-on periods, and immediately after weaning from CPB, especially when CPB time was greater than 60min.

Comparing volume-clamp method and intra-arterial blood pressure measurements in patients with atrial fibrillation admitted to the intensive or medium care unit

International guidelines highlight the importance of blood pressure (BP) in patients with atrial fibrillation (AF). However, BP measurement in AF is complicated by beat-to-beat fluctuation. Automated BP measurement devices are not validated for patients with AF and no consensus exists on how to measure BP in AF manually. Beat-to-beat BP measurement using the volume-clamp method (VCM) could represent a non-invasive method to accurately assess BP, but has not been validated in AF. 31 admitted patients with sustained AF and 10 control patients with sinus rhythm underwent simultaneous intra-arterial and non-invasive BP measurement using a VCM monitor (Nexfin®, BMEYE, Amsterdam, The Netherlands). Patients with compromised peripheral perfusion, high doses of vasopressor drugs or peripheral edema were excluded. Differences in systolic, diastolic and mean BP of 5 (standard deviation; SD 8) mmHg (accuracy and precision) between both methods were considered acceptable. Additionally, the magnitude of beat-to-beat fluctuations in systolic BP of both methods was compared. In AF, the differences between noninvasive and invasive BP were −4 (SD 12), +1 (SD 7) and 0 (SD 8) mmHg for systolic, diastolic and mean BP respectively. Absolute differences in beat-to-beat BP fluctuations were 1.5 (IQR 0.8–3.8) mmHg. Accuracy of VCM in AF was similar to sinus rhythm. In conclusion, in patients with AF, accurate and precise measurement of non-invasive beat-to-beat BP measurement using the VCM is possible, the one exception being the precision of systolic BP. Beat-to-beat variability can be accurately reproduced.

Association of Changes in Neighborhood-Level Racial Residential Segregation With Changes in Blood Pressure Among Black Adults

Despite cross-sectional evidence linking racial residential segregation to hypertension prevalence among non-Hispanic blacks, it remains unclear how changes in exposure to neighborhood segregation may be associated with changes in blood pressure. To examine the association of changes in neighborhood-level racial residential segregation with changes in systolic and diastolic blood pressure over a 25-year period. This observational study examined longitudinal data of 2280 black participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective investigation of adults aged 18 to 30 years who underwent baseline examinations in field centers in 4 US locations from March 25, 1985, to June 7, 1986, and then were re-examined for the next 25 years. Racial residential segregation was assessed using the Getis-Ord Gi* statistic, a measure of SD between the neighborhood's racial composition (ie, percentage of black residents) and the surrounding area's racial composition. Segregation was categorized as high (Gi* >1.96), medium (Gi* 0-1.96), and low (Gi* <0). Fixed-effects linear regression modeling was used to estimate the associations of within-person change in exposure to segregation and within-person change in blood pressure while tightly controlling for time-invariant confounders. Data analyses were performed between August 4, 2016, and February 9, 2017. Within-person changes in systolic and diastolic blood pressure across 6 examinations over 25 years. Of the 2280 participants at baseline, 974 (42.7%) were men and 1306 (57.3%) were women. Of these, 1861 (81.6%) were living in a high-segregation neighborhood; 278 (12.2%), a medium-segregation neighborhood; and 141 (6.2%), a low-segregation neighborhood. Systolic blood pressure increased by a mean of 0.16 (95% CI, 0.06-0.26) mm Hg with each 1-SD increase in segregation score after adjusting for interactions of time with age, sex, and field center. Of the 1861 participants (81.6%) who lived in high-segregation neighborhoods at baseline, reductions in exposure to segregation were associated with reductions in systolic blood pressure. Mean differences in systolic blood pressure were -1.33 (95% CI, -2.26 to -0.40) mm Hg when comparing high-segregation with medium-segregation neighborhoods and -1.19 (95% CI, -2.08 to -0.31) mm Hg when comparing high-segregation with low-segregation neighborhoods after adjustment for time and interactions of time with baseline age, sex, and field center. Changes in segregation were not associated with changes in diastolic blood pressure. Decreases in exposure to racial residential segregation are associated with reductions in systolic blood pressure. This study adds to the small but growing body of evidence that policies that reduce segregation may have meaningful health benefits.

ACE gene titration modulates acute myocardial infarction‐induced autonomic and functional changes in mice

Acute myocardial infarction is one of the leading causes of mortality worldwide. The Angiotensin Converting Enzyme (ACE) act in the production of ANG II and in the degradation of bradykinin. It is believed that higher levels of ACE could modulate susceptibility to coronary occlusion. To investigate this possibility we used adult males mice genetically modified to express different concentrations of ACE similar to that found in humans. Animals (1, 2 or three copies; n = 6 each group) were subjected to acute myocardial infarction (AMI) and evaluated after 7 days. Systolic, diastolic and mean blood pressure as well as heart rate, heart rate (HRV) and blood pressure (BPV) variability and cardiac function by echocardiography were evaluated. Regarding hemodynamic data, AMI induced no difference in systolic, diastolic and mean blood pressure (ECA1: 74.02 ± 3.0; ACE2: 108.65 ± 2.8; ECA3: 102.07 ± 4.1mmHg). Regarding heart rate it was observed a reduction in 3 copies group (ECA1: 654.51 ± 26.34; ACE2: 668.22 ± 10; ECA3: 534.11 ± 33.4 BPM). HRV evaluated in the time domain by SDNN (ACE1: 5.16 ± 0.93; ACE2: 5.84 ± 1:32; ACE 3: 7.69 ± 1.4 ms) and RMSSD indexes (ECA1: 5.91 ± 0.69; ACE2: 5.7 ± 1:14; ECA3: 6.78 ± 1.2ms) was higher in the infarcted ACE3 group, as well as the total variance (ACE1: 30 ± 12.4; ACE2: 37 ± 13.8; ACE3: 69.9 ± 25.6 ms). Regarding the spectral analysis a higher sympathetic modulation (ACE1: 5.14 ± 3; ACE2: 7.2 ± 2.8; ACE3: 12.9 ± 4.1ms2) and lower parasympathetic modulation (ACE1: 7 ± 2; ACE2: 8.6 ± 3.2; ACE3: 9.5 ± 2.8 ms2) was observed in ACE 3 infarcted group. BPV (ACE1: 18.7 ± 6.2; ACE2: 14.85 ± 1.6; ACE3: 13.76 ± 4.2 mmHg2) and the Low Frequency (sympathetic) peripheral component of BPV were reduced in the ACE 3 AMI group (ACE1: 60.5 ± 6.2; ACE2: 54.6 ± 1.7; ACE3: 53 ± 3.3 mmHg2). Echocardiographic data showed a reduction in IRT isovolumetric relaxation time (ITR)(ACE1: 26.1 ± 3.1; ACE2: 32.3 ± 3.4; ACE3: 26.5 ± 3.1 ms), increased E/A ratio (ACE1: 3.40 ± 0.67; ACE2: 3:02 ± 1:36; ACE3: 2.0 ± 0.75) and an increase in FAC – Fractional Area Change (ACE1: 27.9 ± 4.5; ACE2: 26.4 ± 5.7; ACE3: 33.5 ± 1.3) in the ACE 3 group after AMI. Our data suggest that increasing the number of ACE gene copies may promote autonomic imbalance evidenced by increased sympathetic modulation of the cardiovascular system, reduction of parasympathetic modulation of HRV and impaired diastolic function.

Fixed-dose combination therapy for the prevention of atherosclerotic cardiovascular diseases.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death and disability worldwide, yet ASCVD risk factor control and secondary prevention rates remain low. A fixed-dose combination of blood pressure- and cholesterol-lowering and antiplatelet treatments into a single pill, or polypill, has been proposed as one strategy to reduce the global burden of ASCVD. To determine the effect of fixed-dose combination therapy on all-cause mortality, fatal and non-fatal ASCVD events, and adverse events. We also sought to determine the effect of fixed-dose combination therapy on blood pressure, lipids, adherence, discontinuation rates, health-related quality of life, and costs. We updated our previous searches in September 2016 of CENTRAL, MEDLINE, Embase, ISI Web of Science, and DARE, HTA, and HEED. We also searched two clinical trials registers in September 2016. We used no language restrictions. We included randomised controlled trials of a fixed-dose combination therapy including at least one blood pressure-lowering and one lipid-lowering component versus usual care, placebo, or an active drug comparator for any treatment duration in adults 18 years old or older, with no restrictions on presence or absence of pre-existing ASCVD. Three review authors independently selected studies for inclusion and extracted the data for this update. We evaluated risk of bias using the Cochrane 'Risk of bias' assessment tool. We calculated risk ratios (RR) for dichotomous data and mean differences (MD) for continuous data with 95% confidence intervals (CI) using fixed-effect models when heterogeneity was low (I2 < 50%) and random-effects models when heterogeneity was high (I2 ≥ 50%). We used the GRADE approach to evaluate the quality of evidence. In the initial review, we identified nine randomised controlled trials with a total of 7047 participants and four additional trials (n = 2012 participants; mean age range 62 to 63 years; 30% to 37% women) were included in this update. Eight of the 13 trials evaluated the effects of fixed-dose combination (FDC) therapy in populations without prevalent ASCVD, and the median follow-up ranged from six weeks to 23 months. More recent trials were generally larger with longer follow-up and lower risk of bias. The main risk of bias was related to lack of blinding of participants and personnel, which was inherent to the intervention. Compared with the comparator groups (placebo, usual care, or active drug comparator), the effects of the fixed-dose combination treatment on mortality (FDC = 1.0% versus control = 1.0%, RR 1.10, 95% CI 0.64 to 1.89, I2 = 0%, 5 studies, N = 5300) and fatal and non-fatal ASCVD events (FDC = 4.7% versus control = 3.7%, RR 1.26, 95% CI 0.95 to 1.66, I2 = 0%, 6 studies, N = 4517) were uncertain (low-quality evidence). The low event rates for these outcomes and indirectness of evidence for comparing fixed-dose combination to usual care versus individual drugs suggest that these results should be viewed with caution. Adverse events were common in both the intervention (32%) and comparator (27%) groups, with participants randomised to fixed-dose combination therapy being 16% (RR 1.16, 95% CI 1.09 to 1.25, 11 studies, 6906 participants, moderate-quality evidence) more likely to report an adverse event . The mean differences in systolic blood pressure between the intervention and control arms was -6.34 mmHg (95% CI -9.03 to -3.64, 13 trials, 7638 participants, moderate-quality evidence). The mean differences (95% CI) in total and LDL cholesterol between the intervention and control arms were -0.61 mmol/L (95% CI -0.88 to -0.35, 11 trials, 6565 participants, low-quality evidence) and -0.70 mmol/L (95% CI -0.98 to -0.41, 12 trials, 7153 participants, moderate-quality evidence), respectively. There was a high degree of statistical heterogeneity in comparisons of blood pressure and lipids (I2 ≥ 80% for all) that could not be explained, so these results should be viewed with caution. Fixed-dose combination therapy improved adherence to a multidrug strategy by 44% (26% to 65%) compared with usual care (4 trials, 3835 participants, moderate-quality evidence). The effects of fixed-dose combination therapy on all-cause mortality or ASCVD events are uncertain. A limited number of trials reported these outcomes, and the included trials were primarily designed to observe changes in ASCVD risk factor levels rather than clinical events, which may partially explain the observed differences in risk factors that were not translated into differences in clinical outcomes among the included trials. Fixed-dose combination therapy is associated with modest increases in adverse events compared with placebo, active comparator, or usual care but may be associated with improved adherence to a multidrug regimen. Ongoing, longer-term trials of fixed-dose combination therapy will help demonstrate whether short-term changes in risk factors might be maintained and lead to expected differences in clinical events based on these changes.

Effect of an epinephrine mixture for interscalene block on hemodynamic changes after the beach chair position under general anesthesia: a retrospective study.

BackgroundThe beach chair position (BCP) can cause significant hypotension. Epinephrine is used to prolong the duration of local anesthetics; it is also absorbed into blood and can exert systemic effects. This study determined the effects of epinephrine mixed with ropivacaine for an interscalene block (ISB) on hemodynamic changes related to BCP.MethodsPatient data collected from March 2013 to August 2014 were used retrospectively. We divided the patients into three groups: 1) ISB only, 2) I+G (general anesthesia after ISB without epinephrine), and 3) I+E+G (general anesthesia after ISB with epinephrine). Mean blood pressure (MBP) and heart rate (HR) were measured for 30 minutes at 5-minute intervals.ResultsThe study analyzed data from 431 patients. MBP tended to decrease gradually in the groups I+G and I+E+G. There were significant differences in MBP between the groups I+G and I, and between the groups I+G and I+E+G. Group I+E+G showed a significant increase in HR compared with the other two groups.ConclusionsISB with an epinephrine mixture did not prevent hypotension caused by the BCP after general anesthesia. HR increased only in response to the epinephrine mixture. A well-planned prospective study is required to compare hemodynamic changes in that context.

Comparative Study of Intubation Performance between Macintosh, the Channeled King Vision and the C-MAC D-Blade Videolaryngoscope in Controlled Hypertensive Patients

Background: The common cause of anesthesia related injury is inability to intubate the trachea. Video laryngoscopes present an enlarged video image of glottis while intubating the trachea. The aim of this study is to compare efficacy of intubation by Macintosh with C-MAC D-Blade and King Vision video laryngoscope (VL) in controlled hypertensive patients. Patients and methods: 105 ASA II T2: just before intubation; T3: 2 min after intubation; T4: 5 min after intubation. Primary outcome: time and number of attempts required to successful intubation. Secondary outcomes: ease of laryngoscope insertion, Quality of view, Assist maneuvers, Intubation difficulty, Complications. Results: Differences in heart rate and mean blood pressure between all groups were statistically significant at T3&T4. Differences in duration of successful intubation were statistically significant between group (M) and group(C), also between group (M) and group (K). Statistically significant differences were obtained between all groups regarding quality of view of glottis, ease of insertion of laryngoscope, and use of assist maneuvers for intubation. Conclusion: Video laryngoscopes provide hemodynamic stability and better view of glottis than Macintosh during intubation. King Vision VL has advantages of ease of insertion, less need of assist maneuvers for intubation, with less complication. Thus, it is beneficial to use King Vision for intubation in hypertensive patients.

The Effects of a Community-Based Sodium Reduction Program in Rural China - A Cluster-Randomized Trial.

BackgroundAverage sodium intake and stroke mortality in northern China are both among the highest in the world. An effective, low-cost strategy to reduce sodium intake in this population is urgently needed.ObjectiveWe sought to determine the effects of a community-based sodium reduction program on salt consumption in rural northern China.DesignThis study was a cluster-randomized trial done over 18 months in 120 townships (one village from each township) from five provinces. Sixty control villages were compared to 60 intervention villages that were given access to a reduced-sodium, added-potassium salt substitute in conjunction with a community-based health education program focusing on sodium reduction. The primary outcome was the difference in 24-hour urinary sodium excretion between randomized groups.ResultsAmong 1,903 people with valid 24-hour urine collections, mean urinary sodium excretion in intervention compared with control villages was reduced by 5.5% (-14mmol/day, 95% confidence interval -26 to -1; p = 0.03), potassium excretion was increased by 16% (+7mmol/day, +4 to +10; p<0.001), and sodium to potassium ratio declined by 15% (-0.9, -1.2 to -0.5; p<0.001). Mean blood pressure differences were -1.1 mm Hg systolic (-3.3 to +1.1; p = 0.33) and -0.7 mm Hg diastolic (-2.2 to +0.8, p = 0.35) and the difference in the proportion with hypertension was -1.3% (-5.1 to 2.5, p = 0.56).ConclusionThere were clear differences in population sodium and potassium intake between villages that were most likely a consequence of increased use of salt substitute. The absence of effects on blood pressure reflects the moderate changes in sodium and potassium intake achieved.Trial RegistrationClinicaltrials.gov identifier: NCT01259700.

Home and Online Management and Evaluation of Blood Pressure (HOME BP) digital intervention for self-management of uncontrolled, essential hypertension: a protocol for the randomised controlled HOME BP trial

IntroductionSelf-management of hypertension, including self-monitoring and antihypertensive medication titration, lowers blood pressure (BP) at 1 year compared to usual care. The aim of the current trial is to assess the...

Cadmium body burden and increased blood pressure in middle-aged American Indians: the Strong Heart Study.

Cadmium is an environmental pollutant that has been associated with cardiovascular disease in populations, but the relationship of cadmium with hypertension has been inconsistent. We studied the association between urinary cadmium concentrations, a measure of total body burden, and blood pressure in American Indians, a U.S. population with above national average cadmium burden. Urinary cadmium (Cd) was measured using inductively coupled plasma mass spectrometry, and adjusted for urinary creatinine concentration. Among 3,714 middle-aged American Indian participants of the Strong Heart Study (mean age 56 years, 41% male, 67% ever-smokers, 23% taking anti-hypertensive medications), urinary Cd ranged from 0.01 to 78.48 μg/g creatinine (geometric mean=0.94 μg/g) and it was correlated with smoking pack-year among ever-smokers (r2=0.16, P<0.0001). Participants who were smokers were on average light smokers (mean 10.8 pack-years), and urinary Cd was similarly elevated in light- and never-smokers (geometric means of 0.88 μg/g creatinine for both categories). Log-transformed urinary Cd was significantly associated with higher systolic blood pressure in models adjusted for age, sex, geographic area, body mass index, smoking (ever vs. never, and cumulative pack-years) and kidney function (mean blood pressure difference by lnCd concentration [β]=1.64, P=0.002). These associations were present among light- and never-smokers (β=2.03, P=0.002, n=2,627), although not significant among never-smokers (β=1.22, P=0.18, n=1,260). Cd was also associated with diastolic blood pressure among light- and never-smokers (β=0.94, P=0.004). These findings suggest there is a relationship between cadmium body burden and increased blood pressure in American Indians, a population with increased cardiovascular disease risk.

Abstract P196: Effects of the Physiological Increase in Angiotensin-converting Enzyme in Acute Myocardial Infarction

The angiotensin converting enzyme (ACE) act in the production of ANG II and degradation of bradykinin. It is believed that higher levels of ACE could modulate susceptibility to coronary occlusion. To investigate this possibility we used adult males mice genetically modified to express different concentrations of ACE similar to that found in humans. Animals (1, 2 or three copies of ACE gene; n = 6 each group) were subjected to acute myocardial infarction (AMI) and evaluated 7 days after. Systolic, diastolic, and mean blood pressure (BP), heart rate, heart rate variability (HRV) were evaluated as well as cardiac function by echocardiography. Regarding hemodynamic data, AMI induced no difference in systolic, diastolic and mean BP of diferente gene copies mice (ACE1: 74.02 ± 3.0; ACE2: 108.65 ± 2.8; ACE3: 102.07 ± 4.1mmHg). Regarding heart rate it was observed a reduction in 3 copies group (ACE1: 654.51 ± 26.34; ACE2: 668.22 ± 10; ACE3: 534.11 ± 33.4 BPM). The heart rate variability evaluated by SDNN (ACE1: 5.16 ± 0.93; ACE2: 5.84 ± 1:32; ACE3: 7.69 ± 1.4 ms), RMSSD (ACE1: 5.91 ± 0.69; ACE2: 5.7 ± 1:14; ACE3: 6.78 ± 1.2ms), and the total variance (ACE1: 30 ± 12.4; ACE2: 37 ± 13.8; ACE3: 69.9 ± 25.6 ms) was higher in the ACE 3 infarcted group. Regarding the spectral analysis of HRV a higher sympathetic modulation (ACE1: 5.14 ± 3; ACE2: 7.2 ± 2.8; ACE3: 12.9 ± 4.1ms 2 ) and a lower parasympathetic modulation (ACE1: 7 ± 2; ACE2: 8.6 ± 3.2; ACE3: 5.5 ± 2.8 ms 2 ) were observed in ACE 3 infarcted mice. The variability of the BP (ACE1: 18.7 ± 6.2; ACE2: 14.85 ± 1.6; ACE3: 13.76 ± 4.2 mmHg 2 ) and the sympathetic modulation component of the vessels were reduced in the ACE 3 AMI group (ACE1: 60.5 ± 6.2; ACE2: 54.6 ± 1.7; ACE3: 53 ± 3.3 mmHg 2 ). Echocardiographic data showed diastolic dysfunction expressed by E / A ratio (ACE1: 3.40 ± 0.67; ACE2: 3:02 ± 1:36; ACE3: 2.0 ± 0.75) and increase in FAC - Fractional Area Change (ACE1: 27.9 ± 4.5; ACE2: 26.4 ± 5.7; ACE3: 33.5 ± 1.3) in the ACE 3 group after AMI. Our data suggest that increasing the number of ACE gene copies may promote autonomic imbalance evidenced by increased sympathetic modulation and the reduction of parasympathetic modulation of the cardiovascular system as well as the impairment of the diastolic function.

Randomised comparison of haemodynamics in spinal block with hyperbaric bupivacaine in sitting versus lateral decubitus position for transurethral prostatectomy

Spinal anaesthesia is a commonly used anaesthetic technique for transurethral resection of the prostate for its efficiency, speed, minimal effects on mental state, protection against thromboembolic complications, early mobilisation after surgery, minor respiratory complications, continuous analgesia and shorter hospital stay. ObjectiveTo determine whether administration of hyperbaric bupivacaine in spinal anaesthesia in sitting position causes minor changes in blood pressure and heart rate compared to the lateral decubitus position. MethodologyProspective, longitudinal, comparative, randomised study. A total of 50 patients were included in two groups. Group A (n=23) patients were administered 12.5mg of hyperbaric bupivacaine in the sitting position and the position was maintained for 5min. Group B (n=27) patients were administered 12.5mg of hyperbaric bupivacaine in lateral decubitus position. Blood pressure, heart rate, and levels and latency of sensory and motor block were compared. Descriptive statistics were used and analysed by Student's “t” test to compare the means of the values found. ResultsThere were no significant differences in heart rate and systolic blood pressure. Diastolic blood pressure was higher in group A, showing a significant difference from 5min after administration of the block, with a significant difference in mean arterial pressure from minute 10. The onset of sensory and motor blockade was faster, and the level of sensitive block achieved higher, in group B. The regression of the motor block was faster in group A. ConclusionsThere were significant differences in mean and diastolic blood pressure as well as onset of sensory and motor block with the sitting position. This proves that applying spinal anaesthesia in a sitting position involves less haemodynamic variation (heart rate and blood pressure) for elderly patients undergoing transurethral resection of prostate.

The accuracy of blood pressure measured by arterial line and non-invasive cuff in critically ill children.

BackgroundThe accuracy of arterial lines (AL) using the flush test or stopcock test has not been described in children, nor has the difference between invasive arterial blood pressure (IABP) versus non-invasive cuff (NIBP) blood pressure.MethodsAfter ethics approval and consent, we performed the flush test and stopcock test on AL (to determine over damping, under damping, and optimal damping), and determined the difference (NIBP–IABP) in systolic, diastolic, and mean blood pressure (ΔSBP, ΔDBP, and ΔMAP). The primary outcome was incidence (95 % CI) of optimally damped AL. Predictors of ΔBP (effect size (95 % CI)) were determined using multiple linear regression.ResultsThere were 147 AL tests in 100 enrolled patients with mean age 44.7 (SD 56) months, weight 16.8 (SD 18.3) kg, male 59 %, postoperative-cardiovascular 52 %, peripheral-AL 78 %, inotropes 29 %, vasodilators 15 %, and ventilated 73 %. The flush test performed in 66 patients (45 %) showed optimal damping in 30 (46 %; 95 % CI 34, 57 %), over damping in 25 (38 %) and under damping in 11 patients (17 %). The stopcock test was over-damped in 128/146 patients (88 %), with the same damping as the flush test in 24/64 (38 %). In optimally damped (flush test) AL, ΔSBP, ΔDBP, and ΔMAP were 0.8 (SD 12.2), −5.2 (SD 8.7), and −4.9 (7.6) respectively. A second set of AL tests was done 2 h later on the same day in 62 patients; AL damping often changed (10/28 flush tests) and ΔBPs correlated poorly (r = 0.31–0.55). Predictors (effect size) of ΔDBP were vasodilator infusion (15.6 (2.9 to 28.3); p = 0.016) and optimal damping (−7.2 (−12.2 to 2.2); p = 0.005); and of ΔMAP were vasodilator infusion (10.0 (−0.3 to 20.4); p = 0.057) and optimal damping (−4.0 (−8 to 0.1); p = 0.058). There were no independent predictors of damping category (n = 66 flush tests).ConclusionsOptimally damped AL occur in half of critically ill children, and this is not predictable. There is much variability in ∆BP between NIBP and the gold standard IABP, and this varies even in the same patient on the same day, and is not easily predictable. In critically ill children, NIBP may not be accurate enough to guide management, and more attention to ensuring the AL is optimally damped is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1354-x) contains supplementary material, which is available to authorized users.

Effect of Simultaneous Nephrectomy on Perioperative Blood Pressure and Graft Outcome in Renal Transplant Recipients with Autosomal Dominant Polycystic Kidney Disease

Background: For various reasons, kidney transplant recipients with autosomal dominant polycystic kidney disease (ADPKD) often undergo native nephrectomy in preparation for the transplantation. Simultaneous nephrectomy can result in hypotensive events perioperatively and affect transplant outcome adversely. Our aim was to evaluate the effect of simultaneous native nephrectomy (SNx) on perioperative blood pressure and graft outcome compared to non-nephrectomy (NNx) in renal transplant recipients with ADPKD.Methods: Data regarding renal function and blood pressure were collected from 42 renal transplant recipients with ADPKD. The primary outcome was graft function over 1 year post-transplant. The secondary outcomes were patient and graft survival, postoperative hypotensive events, and blood pressure control. We compared units of anti-hypertensive medication used by transplanted ADPKD patients in the SNx and NNx groups. Results: Patients with SNx during kidney transplantation showed similar rates of patient and graft survival and renal function. Although they had significantly more hypotensive events during the perioperative period (69.2% vs. 37.5% in NNx, P=0.045), no harmful influence on renal function was observed. No difference in mean blood pressure during the 1-year post-transplant period was observed between the two groups; however, the SNx group required fewer units of anti-hypertensive medication. Conclusions: SNx is a relatively safe procedure. Graft outcome in the SNx group was not inferior to that of the NNx group, and patients with SNx can have well-controlled blood pressure.

Effects of mineralocorticoid receptor antagonists in patients with hypertension and diabetes mellitus: a systematic review and meta-analysis.

Blood pressure (BP) control is important to ameliorate cardiovascular events in patients with diabetes mellitus (DM). However, achieving the target BP with a single drug is often difficult. The objective of this study was to evaluate the antihypertensive effects of mineralocorticoid receptor antagonists (MRAs) as add-on therapy to renin–angiotensin system (RAS) inhibitor(s) in patients with hypertension and DM. Studies were searched through October 2014 in MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. Randomized, controlled trials or prospective, observational studies regarding concomitant administration of MRA and RAS inhibitor(s) in patients with DM were included. Articles were excluded if the mean systolic BP (SBP) was <130 mm Hg before randomization for interventional studies or at baseline for prospective cohort studies. We identified nine eligible studies (486 patients): five randomized placebo-controlled trials; three randomized active drug-controlled trials; and one single-arm observational study. The mean differences in office SBP and diastolic BP (DBP) between the MRA and placebo groups were −9.4 (95% confidence interval (CI) −12.9 to −5.9) and −3.8 (95% CI, −5.5 to −2.2) mm Hg, respectively. Subgroup analysis results for study type, age, baseline office SBP and follow-up duration were similar to those of the main analysis. MRA mildly increased serum potassium (0.4 mEq l−1; 95% CI, 0.3–0.5 mEq l−1). A consistent reduction of albuminuria across these studies was also demonstrated. MRA further reduced SBP and DBP in patients with hypertension and DM already taking RAS inhibitors. Serum potassium levels should be monitored to prevent hyperkalemia.

Automated Outreach for Cardiovascular-Related Medication Refill Reminders.

The objective of this study was to evaluate the effectiveness of an automated telephone system reminding patients with hypertension and/or cardiovascular disease to obtain overdue medication refills. The authors compared the intervention with usual care among patients with an overdue prescription for a statin or lisinopril-hydrochlorothiazide (lisinopril-HCTZ). The primary outcome was refill rate at 2weeks. Secondary outcomes included time to refill and change in low-density lipoprotein cholesterol and blood pressure. Significantly more patients who received a reminder call refilled their prescription compared with the usual-care group (statin cohort: 30.3% vs 24.9% [P<.0001]; lisinopril-HCTZ cohort: 30.7% vs 24.2% [P<.0001]). The median time to refill was shorter in patients receiving the reminder call (statin cohort: 29 vs 36days [P<.0001]; lisinopril-HCTZ cohort: 24 vs 31days [P<.0001]). There were no statistically significant differences in mean low-density lipoprotein cholesterol and blood pressure. These findings suggest the need for interventions that have a longer-term impact.

Flaxseed Consumption May Reduce Blood Pressure: A Systematic Review and Meta-Analysis of Controlled Trials1–3

Background: High blood pressure is a major health burden positively associated with the risk of cardiovascular disease and other chronic diseases. Flaxseed is a rich dietary source of α-linolenic acid, lignans, and fiber, with a number of positive health benefits on blood pressure.Objective: The purpose of this study was to clarify the effect of flaxseed consumption on blood pressure. Further, the influence of baseline blood pressure, type of flaxseed supplementation, and duration of flaxseed supplementation on blood pressure was explored.Method: PubMed (MEDLINE), Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library (Central) were searched through July 2014 for studies in which humans supplemented their habitual diet with flaxseed or its extracts (i.e., oil, lignans, fiber) for ≥2 wk.Results: A total of 11 studies (14 trials) were included in the analysis. Random-effects meta-analyses were conducted for the mean difference in blood pressure. Results indicated that flaxseed supplementation reduced systolic blood pressure (−1.77 mm Hg; 95% CI: −3.45, −0.09 mm Hg; P = 0.04) and diastolic blood pressure (−1.58 mm Hg; 95% CI: −2.64, −0.52 mm Hg; P = 0.003). These results were not influenced by categorization of participants into higher baseline blood pressure (≥130 mm Hg). An improvement in diastolic blood pressure was observed in subgroup analysis for consuming whole flaxseed (−1.93 mm Hg; 95% CI: −3.65, −0.21 mm Hg; P < 0.05) and duration of consumption ≥12 wk (−2.17 mm Hg; 95% CI: −3.44, −0.89 mm Hg; P < 0.05).Conclusion: The present meta-analysis suggests that consumption of flaxseed may lower blood pressure slightly. The beneficial potential of flaxseed to reduce blood pressure (especially diastolic blood pressure) may be greater when it is consumed as a whole seed and for a duration of >12 wk.

A nationwide report on blood pressure of children and adolescents according to socioeconomic status: The CASPIAN-IV study.

Background:Hypertension is a major leading factor for global burden of diseases. Blood pressure (BP) tracks from childhood to adulthood. So, it is important to investigate its aff ecting factors. In this study we aimed to compare the BP status in the Iranian pediatric population according to the socioeconomic status (SES) of their living area.Materials and Methods:In this nationwide study, a representative sample of 14,880 students, aged 6-18 years was chosen by multistage random cluster sampling from 30 provinces in Iran. Anthropometric indices and BP were measured. A validated questionnaire, including the questions of the World Health Organization Global School-based Student Health Survey was completed. Findings were compared across the four regions of the country, categorized based on their elevating SES: Southeast, north-northeast, west, and central.Results:Participants consisted of 13,486 children and adolescents, that is, a participation rate of 90.6%, composed of 49.2% girls and 75.6% urban residents. The mean (standard deviation) age of participants was 12.47 (3.36) years. The region with highest SES (central) had the lowest rate of high BP (HBP), that is, 3.0% (95% of confidence interval [CI]: 2.4-3.9), and the region with lowest SES (southeast) had the highest rate, that is, 7.4% (4.4-12.2). The mean (95% CI) values of systolic BP for the four regions from lowest to highest SES were 100.5 (99.6-101.3), 100.9 (100.3-101.4), 101.7 (101.3-102), and 101.7 (101.2-102.1) mmHg. The corresponding mean Diastolic BP values were as follows: 65.4 (64.6-66.1), 63.4 (62.9-63.8), 65.6 (65.3-65.8), and 64.4 (64.0-64.7) mmHg.Conclusion:We found significant differences in mean BP and the frequency of HBP according to the SES of the living area. Further studies are necessary to find the underlying factors resulting in such differences.