Mean Difference In Blood Pressure Research Articles

Flush hypertension during infusion of saline

Salt-sensitivity is present in approximately half of the population with essential hypertension.1 Among several methods used to diagnose salt-sensitivity, Weinberger’s saline infusion test is widely accepted; this test compares the blood pressure (BP) measured after infusing 2 l of isotonic saline over 4 h with the BP measured during a salt-restricted diet and administration of three 40-mg doses of oral furosemide. A 10 mmHg or greater difference in mean BP between the salt-loaded and salt-depleted phases of the test is defined salt-sensitivity.2 In three patients to be described, infusion of isotonic saline induced a surge of BP far in excess to the mild hypertensive effect required to diagnose salt-sensitive hypertension. Such episodes are not well described in the literature. ### Patient 1 A 96-year-old woman was referred with the diagnosis of left lower lobe pneumonia. Amoxicillin/clavulanate intravenous (i.v.) 1 g × 3/day was started. Notable in the patient’s medical history were multi-infarct dementia, dysphagia, grade I arterial hypertension, vitamin B12 and iron deficiency. Her regular medications were simvastatin 20 mg, furosemide 40 mg, vitamin B12 and ferum sulfate 160 mg/day. The patient’s BP readings on the day of admission were 185/90, 139/77, 145/65 mmHg, the heart rate 72 bpm, temperature 38.6°C. The serum creatinine was 0.7 mg/dl, WBC 12 300/mm3, polymorphonuclear leukocytes 79%. Two days later, the temperature returned to normal but the abdomen became distended with no passage of stool or gas and high-pitched bowel sounds suggesting intestinal obstruction or pseudoobstruction. On plain abdominal X-ray, the colon was distended, air visible in all colonic segments including the rectosigmoid and the maximum cecal diameter 7 cm. The BP was 138/70 mmHg. Serum levels of sodium, potassium, calcium and thyrotropin were within the normal range. On surgical consultation, a diagnosis of colonic pseudoobstruction was posited and conservative management recommended. The patient was kept fasted and i.v. saline was started. Four hours later, she became …

Abstract P055: Diet, Lifestyle And Blood Pressure of Non-alcohol Drinkers and Alcohol Drinkers in The Intermap Study

Background: Non-drinkers and alcohol drinkers differ in social and cultural traits, lifestyle habits (e.g., smoking, exercise, diet) and blood pressure (BP). Objective: Assess whether differences in lifestyle traits, particularly food intake, among non-alcohol drinkers, moderate and heavy alcohol drinkers account for higher BP of heavy drinkers. Methods: The INTERMAP Study is a cross-sectional epidemiologic investigation of 4,680 men and women ages 40–59 years from 17 population samples in China, Japan, United Kingdom and United States. With standardized quality-controlled methods, four 24-hour dietary recalls, 2 timed 24-hour urine collections, 8 BP measurements and questionnaire data were accrued. Data on lifetime alcohol use and daily alcohol consumption over the previous 7 days were obtained at two visits (14 days total). Results: Heavy alcohol drinkers (>26 g alcohol/day for men; >13 g alcohol/day for women) were more likely to be cigarette smokers, and had lower age-sex-sample adjusted mean body mass index (BMI) and higher adjusted total energy intake than moderate and non-alcohol drinkers (P<0.001). Heavy alcohol drinkers had mean systolic and diastolic BP higher by 3.2/2.1 mm Hg (P<0.001) compared to non/moderate drinkers adjusted for sex, population sample, age, years of education, cigarette smoking, physical activity, employment, marital status, family history of hypertension, cardiovascular disease and diabetes mellitus diagnosis, supplement intake, and special diet. With additional adjustment for BMI, the BP differences between non/moderate drinkers and heavy drinkers increased 8% to 3.5 mm Hg for systolic and 2.3 mm Hg for diastolic (P<0.001). Heavy drinkers had significantly lower intakes of pasta and rice, bread, cereals, milk, ice-cream, table spread, vegetable oil, fresh fruits, fruit juices, raw vegetables, cooked vegetables, sweet snacks and non-alcoholic beverages, and higher intakes of meat, fish, shellfish and nuts compared to non-drinkers and moderate drinkers. Of 17 foods with significantly different intakes between heavy drinkers and non/moderate drinkers had little or no influence on the higher BP of heavy drinkers (range from 0.00 to 0.16 mm Hg, 0 to 5% changes). With adjustment for possible confounders and multiple foods, the adjusted mean BP differences between non/moderate drinkers and heavy drinkers were 3.2 mm Hg for systolic (P<0.001) and 2.1 mm Hg for diastolic (P<0.001). Results were similar for men and women analysed separately. Conclusions: Differences in food intake did not account for the significantly higher BP among heavy drinkers suggesting that other lifestyle traits may operate, and/or that heavy drinking per se is the responsible trait.

Moderate to Vigorous Physical Activity and Sedentary Time and Cardiometabolic Risk Factors in Children and Adolescents

Sparse data exist on the combined associations between physical activity and sedentary time with cardiometabolic risk factors in healthy children. To examine the independent and combined associations between objectively measured time in moderate- to vigorous-intensity physical activity (MVPA) and sedentary time with cardiometabolic risk factors. Pooled data from 14 studies between 1998 and 2009 comprising 20 871 children (aged 4-18 years) from the International Children's Accelerometry Database. Time spent in MVPA and sedentary time were measured using accelerometry after reanalyzing raw data. The independent associations between time in MVPA and sedentary time, with outcomes, were examined using meta-analysis. Participants were stratified by tertiles of MVPA and sedentary time. Waist circumference, systolic blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, and insulin. Times (mean [SD] min/d) accumulated by children in MVPA and being sedentary were 30 (21) and 354 (96), respectively. Time in MVPA was significantly associated with all cardiometabolic outcomes independent of sex, age, monitor wear time, time spent sedentary, and waist circumference (when not the outcome). Sedentary time was not associated with any outcome independent of time in MVPA. In the combined analyses, higher levels of MVPA were associated with better cardiometabolic risk factors across tertiles of sedentary time. The differences in outcomes between higher and lower MVPA were greater with lower sedentary time. Mean differences in waist circumference between the bottom and top tertiles of MVPA were 5.6 cm (95% CI, 4.8-6.4 cm) for high sedentary time and 3.6 cm (95% CI, 2.8-4.3 cm) for low sedentary time. Mean differences in systolic blood pressure for high and low sedentary time were 0.7 mm Hg (95% CI, -0.07 to 1.6) and 2.5 mm Hg (95% CI, 1.7-3.3), and for high-density lipoprotein cholesterol, differences were -2.6 mg/dL (95% CI, -1.4 to -3.9) and -4.5 mg/dL (95% CI, -3.3 to -5.6), respectively. Geometric mean differences for insulin and triglycerides showed similar variation. Those in the top tertile of MVPA accumulated more than 35 minutes per day in this intensity level compared with fewer than 18 minutes per day for those in the bottom tertile. In prospective analyses (N = 6413 at 2.1 years' follow-up), MVPA and sedentary time were not associated with waist circumference at follow-up, but a higher waist circumference at baseline was associated with higher amounts of sedentary time at follow-up. Higher MVPA time by children and adolescents was associated with better cardiometabolic risk factors regardless of the amount of sedentary time.

Sources of Dietary Protein in Relation to Blood Pressure in a General Dutch Population

BackgroundLittle is known about the relation of different dietary protein types with blood pressure (BP). We examined whether intake of total, plant, animal, dairy, meat, and grain protein was related to BP in a cross sectional cohort of 20,820 Dutch adults, aged 20–65 y and not using antihypertensive medication.DesignMean BP levels were calculated in quintiles of energy-adjusted protein with adjustment for age, sex, BMI, education, smoking, and intake of energy, alcohol, and other nutrients including protein from other sources. In addition, mean BP difference after substitution of 3 en% carbohydrates or MUFA with protein was calculated.ResultsTotal protein and animal protein were not associated with BP (ptrend = 0.62 and 0.71 respectively), both at the expense of carbohydrates and MUFA. Systolic BP was 1.8 mmHg lower (ptrend<0.01) in the highest (>36 g/d) than in the lowest (<27 g/d) quintile of plant protein. This inverse association was present both at the expense of carbohydrates and MUFA and more pronounced in individuals with untreated hypertension (−3.6 mmHg) than in those with normal (+0.1 mmHg) or prehypertensive BP (−0.3 mmHg; pinteraction<0.01). Meat and grain protein were not related to BP. Dairy protein was directly associated with systolic BP (+1.6 mmHg, ptrend<0.01), but not with diastolic BP (ptrend = 0.24).ConclusionsTotal protein and animal protein were not associated with BP in this general untreated Dutch population. Plant protein may be beneficial to BP, especially in people with elevated BP. However, because high intake of plant protein may be a marker of a healthy diet and lifestyle in general, confirmation from randomized controlled trials is warranted.

The Impact of Intra‐Aortic Balloon Pump Weaning Protocols on In‐Hospital Clinical Outcomes

Current literature recommends weaning intra-aortic balloon pump (IABP) support prior to discontinuation. To date, no studies have compared various weaning strategies for safety or efficacy. This study was designed to evaluate the impact of weaning on in-hospital clinical outcomes. From 5/1/07 through 5/1/09 429 patients receiving IABP therapy were retrospectively identified using CPT1 billing codes. The study population and clinical outcomes analysis were stratified by use of weaning protocols versus immediate discontinuation of the IABP. In a subset analysis the patients receiving weaning protocols prior to IABP discontinuation were stratified for further analysis of clinical outcomes by whether they had received 1:3 ratio counterpulsation during their wean or whether they only received 1:2 counterpulsation prior to IABP discontinuation. These groups were analyzed for differences in primary and secondary end-points. Of the 429 patients identified, 344 (80.2%) were weaned prior to IABP discontinuation and 85 (19.8%) of the patients had their IABP abruptly discontinued. Patients not weaned had a lower heart rate after IABP discontinuation than those weaned, but no difference in systolic and mean blood pressure or urine output. There was no significant difference in mortality. Weaning was associated with a nonsignificant trend toward increased length of stay. This study suggests that weaning protocols offer no hemodynamic benefits or improvement in in-hospital mortality rates. Weaning is associated with trend toward increased length of stay. We conclude that weaning offers no advantage over direct device removal and would advocate that balloon pumps be directly withdrawn when counterpulsation is terminated.

Do differences in blood pressure between arms matter?

In The Lancet, Christopher Clark and colleagues 1 Clark CE Taylor RS Shore AC Ukoumunne OC Campbell JL Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet. 2012; (published online Jan 30.)https://doi.org/10.1016/S0140-6736(11)61710-8 Summary Full Text Full Text PDF Scopus (274) Google Scholar present data from a systematic review and meta-analysis assessing the available evidence linking differences in blood pressure between arms with both central and peripheral vascular disease. They establish that systolic differences of at least 15 mm Hg are associated with an increased risk of peripheral vascular disease (relative risk 2·5, 95% CI 1·6–3·8) and report weaker but significant associations with cerebrovascular disease and mortality. When subclavian stenoses are angiographically proven, Clark and co-workers estimate that the mean difference in blood pressure between arms is 36·9 mm Hg (95% CI 35·4–38·4), and rates of subclavian stenosis are high when differences are present. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysisA difference in SBP of 10 mm Hg or more, or of 15 mm Hg or more, between arms might help to identify patients who need further vascular assessment. A difference of 15 mm Hg or more could be a useful indicator of risk of vascular disease and death. Full-Text PDF

Cardiorespiratory responses during and after water exercise in pregnant and non-pregnant women Respostas cardiorrespiratórias durante e após exercício aquático em gestantes e não gestantes

to compare the blood pressure and oxygen consumption (VO(2)) responses between pregnant and non-pregnant women, during cycle ergometer exercise on land and in water. ten pregnant (27 to 29 weeks of gestation) and ten non-pregnant women were enrolled. Two cardiopulmonary tests were performed on a cycle ergometer (water and land) at the heart rate corresponding to VO(2), over a period of 30 minutes each. Exercise measurements consisted of recording blood pressure every five minutes, and heart rate and VO(2) every 20 seconds. Two-way ANOVA was used and α=0.05 (SPSS 17.0). there was no difference in cardiovascular responses between pregnant and non-pregnant women during the exercise. The Pregnant Group demonstrated significant differences in systolic (131.6±8.2; 142.6±11.3 mmHg), diastolic (64.8±5.9; 74.5±5.3 mmHg), and mean blood pressure (87.0±4.1; 97.2±5.7 mmHg), during water and land exercise, respectively. The Non-pregnant women Group also had a significantly lower systolic (130.5±8.4; 135.9±8.7 mmHg), diastolic (67.4±5.7; 69.0±10.1 mmHg), and mean blood pressure (88.4±4.8; 91.3±7.8 mmHg) during water exercise compared to the land one. There were no significant differences in VO(2) values between water and land exercises or between pregnant and non-pregnant women. After the first five-minute recovery period, both blood pressure and VO(2) were similar to pre-exercise values. for pregnant women with 27 to 29 weeks of gestation, water exercise at the heart rate corresponding to VO(2) is physiologically appropriate. These women also present a lower blood pressure response to exercise in water than on land.

Accuracy of Microlife WatchBP Office ABI monitor assessed according to the 2002 European Society of Hypertension protocol and the British Hypertension Society protocol

To determine the accuracy of the WatchBP Office ABI monitor for blood pressure measurement developed by the Microlife Company. The device accuracy was tested in 85 subjects with a mean age of 54 ± 19 years. Their systolic and diastolic blood pressure (SBP/DBP) at entry was 141 ± 30/86 ± 19 mmHg, and upper arm circumference was 28 ± 5 cm. Initially, the data from 33 participants were examined according to the 2002 version of the European Society of Hypertension (ESH) protocol. An additional 52 subjects were then enrolled to fulfill the requirements of the British Hypertension Society (BHS) protocol. In all participants, sequential same arm measurements were performed by two trained observers. The device passed all three phases of the ESH protocol for SBP and DBP. For the BHS protocol the device was graded A for both SBP and DBP. The A/A grade was achieved in the low blood pressure category (< 130/80 mmHg), the B/A grade in the medium category (130-160/80-100 mmHg) and the A/A grade in the high category (> 160/100 mmHg). Mean blood pressure difference between device and observers in the first 33 subjects was -0.9 ± 5.5 mmHg for SBP and -2.2 ± 4.5 mmHg for DBP and in the 85 participants it was -1.2 ± 6.5 mmHg and -2.3 ± 5.1, respectively. These data show that the Microlife WatchBP Office ABI monitor satisfied the recommended ESH accuracy levels and achieved A/A grade of the BHS protocol across a wide range of BP.

Validation of the UEBE Visomat Double Comfort upper arm blood pressure monitor, in oscillometric mode, for clinic use and self-measurement in a general population according to the European Society of Hypertension International Protocol, revision 2010

To validate the UEBE Visomat Double Comfort, an upper arm blood pressure monitor designed for self-measurement of blood pressure and for clinical use in a general population according to the European Society of Hypertension International Protocol revision 2010. The device is provided with two operational modalities, a microphonic mode and an oscillometric mode. In this study, the oscillometric modality was tested. Device evaluation was performed in 33 participants with a mean ± standard deviation age of 56.3 ± 20.0 years (range, 25-85 years). Their systolic blood pressure was 140.4 ± 27.7 mmHg, diastolic blood pressure was 86.8 ± 17.2 mmHg, and arm circumference was 29.3 ± 3.9 cm. The protocol requirements were followed precisely. The device passed all of the requirements fulfilling the standards of the protocol. Mean blood pressure differences between device and observer were -0.9 ± 4.1 mmHg for systolic blood pressure and -0.1 ± 3.3 mmHg for diastolic blood pressure. As the Visomat Double Comfort in the oscillometric modality has achieved the required standards, it is recommended for clinical use in an adult population.

Renal function and endocrine responses to arm exercise in euhydrated individuals with spinal cord injury

This study investigated the renal and endocrine responses to arm exercise in persons with spinal cord injury (SCI) under euhydration conditions (ad libitum drinking of water) and determined the physiological effects of exercise on renal function in these subjects. Eleven SCI (spinal lesions between T6 and L1, American Spinal Injury Association impairment scale A) and 14 able-bodied (AB) persons first rested for 1h in a sitting position, before undergoing 2-h arm-crank ergometer exercise at 60% of maximum oxygen consumption followed by a 2-h recovery period. On another day, all subjects participated in a time control study (5h of rest condition in sitting position). Urine and blood samples were collected hourly. There were no differences in mean blood pressure between the two groups. SCI patients showed attenuated increase in plasma adrenaline and increase in plasma aldosterone compared with AB controls, but similar changes in human atrial natriuretic polypeptide, plasma renin activity and plasma antidiuretic hormone following the exercise. Creatinine clearance, osmolal clearance, free water clearance and fractional excretion of Na(+) did not change during exercise in any of the subjects. These findings suggested that activated aldosterone and attenuated adrenaline responses during exercise in SCI could be due to adaptation to disordered sympathetic nervous system triggered to maintain renal function. The results showed no exercise-related adverse effects on renal function in hydrated subjects with SCI.

Validation of the UEBE Visomat Double Comfort upper arm blood pressure monitor, in auscultation mode, for clinic use and self-measurement in a general population, according to the European Society of Hypertension International Protocol revision 2010

To validate the UEBE Visomat Double Comfort, an upper arm blood pressure monitor, in a general population according to the European Society of Hypertension International Protocol revision 2010. The Visomat Double Comfort is a device designed for self-measurement of blood pressure and for clinical use. The monitor is provided with two operational modalities, a microphonic mode and an oscillometric mode. In this study, the auscultatory modality was tested. Device evaluation was performed in 33 participants with a mean±standard deviation age of 55±20 years (age range 25–88 years). Their systolic blood pressure was 140±28 mmHg, diastolic blood pressure was 87±17 mmHg, and arm circumference was 29±4 cm. The protocol requirements were followed precisely. The device passed all of the requirements fulfilling the standards of the protocol. Mean blood pressure differences between device and observer were −1.1±4.0 mmHg for systolic blood pressure and −0.4±4.1 mmHg for diastolic blood pressure. As the Visomat Double Comfort has achieved the required standards, it is recommended for clinical use in an adult population.

Survival with Treated and Well-Controlled Blood Pressure: Findings from a Prospective Cohort Study

AimTo compare survival and incident cardiovascular disease between normotensive, untreated hypertensive, treated and poorly-controlled hypertensive and treated and well-controlled hypertensive adults.Methods and ResultsData from the British Regional Heart Study (men) and British Women's Heart and Health Study (women) were used (N = 6476). Blood pressure and treatment were assessed at baseline (1998–2001) when participants were aged 60–79 years and participants were followed up for a median of 8 years. Date and cause of death were obtained from death certificates and non-fatal cardiovascular disease events were obtained from repeat detailed medical record reviews. Of the whole cohort 52% of women and 49% of men had untreated hypertension and a further 22% and 18%, respectively, had poorly treated hypertension. Just 3% of women and 4% of men had treated and well controlled hypertension and 23% and 29%, respectively, were normotensive. Compared to normotensive individuals, incident cardiovascular disease (fatal and non-fatal) was increased in those with poorly-controlled hypertension (Hazard Ratio (HR): 1.88; 95%CI: 1.53, 2.30), those with untreated hypertension (HR 1.46; 95%CI 1.22, 1.75) and those who were well-controlled hypertension (HR 1.38; 95%CI 0.94, 2.03). Adjustment for baseline differences in mean blood pressure between the groups resulted in attenuation of the increased risk in the poorly-controlled (1.52 (1.18, 1.97) and untreated groups (1.21 (0.97, 1.52), but did not change the association in the well-controlled group. All-cause mortality was also increased in all three hypertension groups but estimates were imprecise with wide confidence intervals.ConclusionsHalf of women and men aged 60–79 in Britain had untreated hypertension and only a very small proportion of those with diagnosed and treated hypertension were well controlled. Those with hypertension, irrespective of whether this was treated and controlled or not, were at greater risk of future cardiovascular disease than those who are normotensive.

Accuracy of the Microlife large–extra large-sized cuff (32–52 cm) coupled to an automatic oscillometric device

To determine the accuracy of the large-extra large-sized (L-XL) cuff (32-52 cm) coupled to a Microlife WatchBP Office ABI blood pressure measuring device tested according to the requirements of the International Protocol of the European Society of Hypertension. The L-XL cuff tested in this study is designed to provide accurate blood pressure measurements in patients with large arms (arm circumference≥32 cm) over a wide range of arm circumferences using a single 145±1×320±1 mm bladder. The evaluation was made in 33 patients with a mean±standard deviation age of 53±17 years (range: 30-96 years). Their systolic blood pressure (SBP) was 142±21 mmHg (range: 110-180 mmHg), diastolic blood pressure (DBP) was 87±14 mmHg (range: 62-106 mmHg) and arm circumference was 36±5 cm (range: 32-50 cm). Blood pressure measurements were made in the sitting position. The L-XL cuff coupled to the WatchBP Office ABI passed all three phases of the European Society of Hypertension protocol for SBP and DBP. Mean blood pressure differences between device and observer were -1.3±5.1 mmHg for SBP and -1.8±5.8 mmHg for DBP. Similar device-observer differences were observed in patients divided into two subgroups according to whether their arm circumference was above or below the median in the group. These results indicate that the L-XL cuff coupled to the WatchBP Office ABI monitor provides accurate blood pressure readings in patients with large arms over a wide range of arm circumferences.

Ethnic Differences in Diabetes Management in Patients With and Without Comorbid Medical Conditions

OBJECTIVETo examine ethnic disparities in diabetes management among patients with and without comorbid medical conditions after a period of sustained investment in quality improvement in the U.K.RESEARCH DESIGN AND METHODSThis cross-sectional study examined associations between ethnicity, comorbidity, and intermediate outcomes for mean A1C, total cholesterol, and blood pressure levels in 6,690 diabetes patients in South West London.RESULTSThe presence of ≥2 cardiovascular comorbidities was associated with similar blood pressure control among white and South Asian patients when compared with whites without comorbidity but with worse blood pressure control among black patients, with a mean difference in systolic blood pressure of +1.5, +1.4, and +6.2 mmHg, respectively.CONCLUSIONSDespite major reforms to improve quality, disparities in blood pressure management have persisted in the U.K., particularly among patients with cardiovascular comorbidities. Policy makers should consider the potential impacts of quality initiatives on high-risk groups.

Age effects on the differences between Omron HEM 907 blood pressure monitor and manual mercury sphygmomanometer blood pressure readings

Background: To validate Omron HEM 907 XL blood pressure monitor (test device) against auscultatory mercury sphygmomanometer in children aged 7–18 years old in accordance with International Protocol of European Society of Hypertension revised in 2010 (ESH-IP2) and British Hypertension Society (BHS) protocol. Methods: Seventy-five children and adolescents were recruited for the study. A validation procedure was performed following the protocol which was prepared on the basis of ESH-IP2 and BHS protocol for children and adolescents. Each underwent 7 sequential blood pressure (BP) measurements alternatively with a mercury sphygmomanometer and the test device. The results were analyzed according to the validation criteria of ESH-IP2. Results: The mean BP (± standard deviation [SD]) difference of absolute value between the test device and mercury sphygmomanometer readings in all the 75 subjects was 3.26 ± 3.08 mm Hg for systolic BP and 4.11 ± 3.50 mm Hg for diastolic BP. These results fulfilled AAMI criterion of mean ± SD below 5 ± 8 mm Hg for both systolic and diastolic BP. The proportion of test device-observer mercury sphygmomanometer BP differences within 5, 10 and 15 mm Hg were 81%, 96%, 99% for SBP and 72%, 93%, 99% for diastolic blood pressure (DBP), respectively, in the part 1 analysis, so both systolic blood pressure (SBP) and DBP passed the part 1 criteria. As for the part 2 analysis, SBP passed the criteria, bur DBP failed. Conclusions: Omron HEM 907 XL BP monitor failed an adapted ESH-IP2, though SBP passed. When comparing the BP readings by oscillometers with mercury sphygmomanometer, the differences between them, particularly in diastolic BP, should be taken into account, because DBP can be underestimated. (J Korean Soc Hypertens 2011;17(3):114-124)

Optimal target concentration of remifentanil during cataract surgery with monitored anesthesia care

Study objective To determine the effect-site target concentration (C et) of remifentanil that provides optimal conditions for patients and operators during cataract surgery during monitored anesthesia care using a target controlled infusion (TCI) of propofol and remifentanil. Design Prospective, randomized, double-blinded study. Setting Operating room and postoperative recovery area of a university-affiliated hospital. Patients 66 adult, ASA physical status I, II, and III patients undergoing cataract surgery Interventions Group I received C et of remifentanil 0.5 ng/mL; Group 2 received C et of remifentanil one ng/mL; and Group 3 received C et of remifentanil 1.5 ng/mL. After giving TCI propofol (C et; one μg/mL) - remifentanil, an ophthalmologist administered topical anesthesia. Measurements and main results Intraoperative hemodynamics, pain scores, sedation scores, patient satisfaction scores, and operators’ satisfaction scores regarding surgical conditions were recorded. No statistical differences in heart rate or mean blood pressure were detected among the three groups during surgery. Pain scores (Group 1: 31.9 ± 17.9 vs. Group 2: 11.8 ± 7.7 and Group 3: 11.8 ± 7.7; P < 0.05) were higher and patient satisfaction scores (Group 1: 4.7 ± 0.8 vs. Group 2: 5.4 ± 0.4 and Group 3: 5.5 ± 0.4; P < 0.05) were lower in Group 1 than Groups 2 and 3. On the other hand, surgeon satisfaction was lowest in Group 3 (Group 3: 2.9 ± 1.3 vs. Group 1: 4.7 ± 0.4 and Group 2: 4.6 ± 0.7; P < 0.05) due to ocular movement. Conclusion C et values of remifentanil and propofol of one ng/mL and one μg/mL, respectively, appear to provide optimal conditions for patients and operators during cataract surgery using monitored anesthesia care with TCI.

Early predictors of hypertension in prematurely born adolescents

To assess the blood pressure of former preterm and term matched adolescent controls and to identify risk factors associated with blood pressure at 16 years. Observational cohort study. Secondary analysis of a randomized clinical trial. Three academic centres participating in the Multicenter Indomethacin IVH Prevention Trial. A total of 296 children born in 1989-1992 with birth weights 600 to <1250 g who participated in the Multicenter Indomethacin IVH Prevention Trial and 95 term controls were evaluated at 16 years. Blood pressure and predictors of blood pressure. The adjusted mean difference in blood pressure for preterm adolescents was 5.1 mm Hg; p=0.002 for systolic and 2.1 mm Hg; p=0.027 for diastolic blood pressure. Among preterms, the primary predictors of increased systolic blood pressure were weight gain velocity between birth and 36 months (b=8.54, p<0.001), pre-eclampsia (b=5.67, p=0.020), non-white race (b=3.77, p=0.04) and male gender (b=5.09). Predictors of diastolic blood pressure were weight gain velocity between birth and 36 months (b=4.69, p=0.001), brain injury (b=6.51, p=0.002) and male gender (b=-2.4, p=0.02). Early programming secondary to increased early weight gain velocity, intrauterine stress and neonatal brain injury may all contribute to risk of increased blood pressure among former preterm adolescents.

Association between circulating specific leukocyte types and blood pressure: the Atherosclerosis Risk in Communities (ARIC) study

Although total white blood cell (WBC) count has been associated with hypertension, the association between specific WBC types and blood pressure (BP) levels has not been studied. In a cohort of 5746 middle-age African-American and white adults free of clinical cardiovascular disease and cancer and not taking hypertension or anti-inflammatory medications, BP was measured at baseline and 3, 6, and 9 years later. Levels of circulating neutrophils, lymphocytes, and monocytes were measured at baseline. In African-Americans, but much less so in whites, increased neutrophil levels and decreased lymphocyte levels were significantly associated with elevation of BP but did not influence the rate of change of BP over time. The mean BP difference between the highest and lowest quartiles of neutrophils was approximately 8 mm Hg for systolic BP (SBP), 4 mm Hg for mean arterial pressure (MAP), and 5 mm Hg for pulse pressure (PP). The mean BP difference between the lowest and highest quartiles of lymphocytes was approximately 6 mm Hg for SBP, 2 mm Hg for diastolic BP (DBP), 3 mm Hg for MAP, and 4 mm Hg for PP. Increased neutrophils and decreased lymphocytes are significantly correlated with the regulation of BP and the development of hypertension, especially in African-Americans.

Psoriasis Relapse Evaluation with Week-End Cyclosporine a Treatment: Results of a Randomized, Double-Blind, Multicenter Study

Cyclosporine A (CsA) effectively controls psoriasis, however, its long-term continuous use is not recommended. This study aims to evaluate the efficacy and tolerability of week-end CsA microemulsion for the reduction of relapse rate in patients with chronic plaque psoriasis who had achieved clinical remission following continuous CsA therapy. The PREWENT (Psoriasis Relapse Evaluation with Week-End Neoral Treatment) study was a 24 week, randomized, double-blind, multicenter study, carried out in 22 Italian hospital or University Dermatology units. CsA was discontinued for 8 days previous to the patients being randomized to oral CsA 5 mg/kg/day or placebo for two consecutive days/week, for a total period of 24 weeks. The primary endpoint was clinical success rate at week 24, defined as the proportion of patients with no clinical worsening (no relapse or a Psoriasis Area and Severity Index (PASI) < 75 percent of pre-treatment PASI). A total of 162 patients were randomized to CsA and 81 to placebo. Clinical success rates at 24 weeks were 66.9 and 53.2 percent with CsA and placebo, respectively (p = 0.072). Time to first relapse was significantly prolonged with CsA versus placebo (p = 0.023), and PASI was significantly lower from weeks 4 to 16 in CsA recipients. In patients with moderate-severe psoriasis, the clinical success rate was significantly increased with CsA compared to placebo (69.9% vs 46.3%; p = 0.011), and significantly lower increases in PASI were observed from week 4 to week 24 (p < 0.05 vs placebo). CsA was well tolerated, with no differences in mean blood creatinine or blood pressure between CsA and placebo recipients. However, the high withdrawal rate (22.2% of randomized patients), which was not related to side effects, may have led to an overestimation of efficacy, but the study had a good statistical power (88% greater than that observed in similar studies, i.e. 80%). Week-end CsA administration was shown to prolong safely and effectively the time to first relapse in psoriasis patients.

Associations of Early Pregnancy Sleep Duration with Trimester-Specific Blood Pressures and Hypertensive Disorders in Pregnancy

We evaluated the influence of maternal self-reported habitual sleep duration during early pregnancy on blood pressure (BP) levels and risk of hypertensive disorders of pregnancy. Prospective cohort study. Clinic-based study. A cohort of 1,272 healthy, pregnant women. We abstracted maternal antenatal BP values from medical records and estimated mean BP differences across hours of sleep categories in regression models, using generalized estimating equations. Odds ratios (OR) and 95% confidence intervals (95% CIs) for pregnancy induced hypertension (PIH) and preeclampsia (PE) in relation to long and short sleep duration were estimated. Mean 1st and 2nd trimester systolic (S) and diastolic (D) BP values were similar among women reporting to be short sleepers (< or = 6 h) vs. women reporting to sleep 9 hours. However, both short and long sleep duration in early pregnancy were associated with increased mean 3rd trimester SBP and DBP. For example, mean 3rd trimester SBP was 3.72, and 2.43 mm Hg higher for women reporting < or = 6 h and 7-8 h sleep, respectively, compared with women reporting 9 h of sleep. Mean 3rd trimester SBP was 4.21 mm Hg higher for women reporting long sleep (> or = 10 h) vs. the reference group. Short and long sleep durations were associated with increased risks of PIH and PE. The ORs for very short (< 5 h) and long (> or = 10 h) sleepers were 9.52 (95% CI 1.83 to 49.40) and 2.45 (95% CI 0.74 to 8.15) for PE. Our findings are consistent with a larger literature that documents elevated blood pressure and increased risks of hypertension with short and long sleep duration.