Drop In Blood Pressure Research Articles

Artificial intelligence driven clustering of blood pressure profiles reveals frailty in orthostatic hypertension.

Gravity, an invisible but constant force , challenges the regulation of blood pressure when transitioning between postures. As physiological reserve diminishes with age, individuals grow more susceptible to such stressors over time, risking inadequate haemodynamic control observed in orthostatic hypotension. This prevalent condition is characterized by drops in blood pressure upon standing; however, the contrary phenomenon of blood pressure rises has recently piqued interest. Expanding on the currently undefined orthostatic hypertension, our study uses continuous non-invasive cardiovascular data to explore the full spectrum of blood pressure profiles and their associated frailty outcomes in community-dwelling older adults. Given the richness of non-invasive beat-to-beat data, artificial intelligence (AI) offers a solution to detect the subtle patterns within it. Applying machine learning to an existing dataset of community-based adults undergoing postural assessment, we identified three distinct clusters (iOHYPO, OHYPO and OHYPER) akin to initial and classic orthostatic hypotension and orthostatic hypertension, respectively. Notably, individuals in our OHYPER cluster exhibited indicators of frailty and sarcopenia, including slower gait speed and impaired balance. In contrast, the iOHYPO cluster, despite transient drops in blood pressure, reported fewer fallers and superior cognitive performance. Surprisingly, those with sustained blood pressure deficits outperformed those with sustained rises, showing greater independence and higher Fried frailty scores. Working towards more refined definitions, our research indicates that AI approaches can yield meaningful blood pressure morphologies from beat-to-beat data. Furthermore, our findings support orthostatic hypertension as a distinct clinical entity, with frailty implications suggesting that it is worthy of further investigation.

Prevalence of orthostatic hypotension and associated factors among older people with hypertension in Northern Ethiopia.

The prevalence of hypertension increases with age, and older people with this condition are at increased risk of developing orthostatic hypotension (OH) due to age-related changes in blood pressure regulation mechanisms as well as prescribed medications. OH increases the risk of falls, often with subsequent fractures as well as other morbidity and even mortality. The prevalence and characteristics of OH in older people with hypertension in Low-Income Countries have not been well characterized. This study aims to determine the prevalence of OH and associated factors among older people with hypertension in northern Ethiopia. A hospital-based cross-sectional study was conducted using a convenience sample of patients aged 60 years and older with hypertension receiving pharmacotherapy and followed up at the University of Gondar Hospital, Ethiopia. Blood pressure (BP) was measured in the supine position, and after 3min of standing; the level of BP drop (> 20/10) was used to define measured OH. Data regarding symptoms of OH were also collected using the Orthostatic Hypotension Questionnaire (OHQ). The data were entered into Microsoft Excel version 2016 and exported to SPSS version 20 for statistical analysis. Logistic regression analysis was conducted to assess the factors associated with OH. A total of 240 participants were included, with a mean age of 68.8 ± 7.1 years. The prevalence of OH was 23.8% (CI: 21.5%, 26.1%). Of the medications used, calcium channel blocker (CCBs) treatment was strongly associated with OH (AOR = 2.03[95%CI = 1.08-3.8]). Two-thirds (61.4%) of participants with measured OH experienced relevant symptoms of OH. There was a high prevalence of OH among older patients with hypertension attending a tertiary care hospital in Gondar, with one in four affected. The use of CCBs was identified as an independent risk factor for OH. Most patients with OH experienced relevant symptoms, so monitoring this condition in this group may help prevent adverse consequences.

Effect of Lidocaine on Ciprofol Dosage and Efficacy in Patients Who Underwent Gastroscopy Sedation.

BACKGROUND Intravenous ciprofol is a short-acting sedative with minimal respiratory and circulatory suppression and limited analgesia. Intravenous lidocaine provides analgesia during surgical procedures. This study included 70 patients who underwent gastroscopy with analgesia and aimed to evaluate the effects of intravenous lidocaine on the dose of ciprofol required to produce 50% of the maximal effect (ED50). MATERIAL AND METHODS Seventy patients scheduled for elective painless gastroscopy were randomly assigned into 2 groups: group L (n=35, received ciprofol and 1.5 mg/kg lidocaine) and group S (n=35, received ciprofol and normal saline). The primary outcomes measured were the ED50 and the 95% effective dose (ED95) of ciprofol, determined using the modified up-down sequential method and Probit analysis. Secondary outcomes included induction, operation, and recovery times; monitoring of vital signs such as mean arterial pressure, heart rate, and oxygen saturation; and evaluation of postoperative adverse reactions, including sore throat, nausea, vomiting, abdominal pain, and satisfaction scores from endoscopists and anesthesiologists. RESULTS The ED50 of ciprofol in group L was 0.315 mg/kg (95% CI, 0.291-0.342 mg/kg), which was significantly lower than that in group S, 0.42 mg/kg (95% CI, 0.371-0.491 mg/kg). Additionally, group L exhibited shorter induction and recovery times, a lower incidence of postoperative sore throat, and a temporary drop in blood pressure following induction. CONCLUSIONS Intravenous lidocaine during painless gastroscopy reduces the required ciprofol dose, shortens induction and recovery times, and lowers the incidence of postoperative complications, such as sore throat. These findings support its effective role in improving sedation quality and patient outcomes during gastroscopy.

Association between autonomic dysfunction, 12-year mortality and 10-year incident cardiovascular disease

Abstract Background Standing from a supine position requires a co-ordinated response in peripheral and central haemodynamic signals to protect the brain and body from sudden drops in blood pressure (BP) and has previously been shown to be an important measure of neuro-cardiovascular health (1-3). Previous studies have found an association between BP and heart rate recovery (HRR) to standing with all-cause mortality, cardiovascular disease and other health outcomes (4-8). However, almost all of these studies have exclusively investigated the association of consensus-defined HR/BP phenotypes measured at specific timepoints during standing. Purpose We hypothesised that assessing information from the entire haemodynamic response to orthostasis - instead of discrete timepoints or consensus definitions - may uncover novel associations between BP/HR responses to active stand and neuro-cardiovascular health in older adults. This may afford better physiological understanding of the longitudinal relationships between the response to standing and both Cardiovascular Disease (CVD) and mortality. Methods We used functional Principal Components Analysis (FPCA) to examine the determinants of variability in the complete haemodynamic response to active stand and examine which components were related to mortality and incident CVD in >4500 community-dwelling adults aged 50+. Results Figure 1 shows the mean response curve according to mortality status and Figure 2 the mean curve for participants free of CVD at baseline who later have CVD vs those who remain CVD-free during 10 year follow-up. All-cause mortality was associated with functional principal components which discriminate higher baseline HR, blunted HR peak and impaired HRR up to ~25 seconds after standing. Components that discriminated high baseline and impaired recovery of SBP from the post-stand nadir to 60 seconds post stand were also associated with all-cause mortality. This association remained even after covariate adjustment. Interestingly, neither baseline SBP nor orthostatic hypotension (OH) were associated with mortality. Components which discriminate high baseline and blunted HR peak; elevated stroke volume index and impaired recovery of DBP from ~25 seconds post stand were associated with 10-year incident CVD. Conclusions To our knowledge this is the first study to incorporate data driven information over the entire trace of the haemodynamic response to standing to investigate associations with incident CVD and mortality. The fact that components which discriminated high BP and impaired recovery of BP were associated with 12-year mortality and 10-year incident CVD when traditional summary measures of OH and baseline BP were not; suggests that incorporating information across the entire response to standing allows for richer and more flexible associations with health outcomes to be uncovered and allows for a better understanding of the underlying physiology leading to such associations.Figure 1:Mean trace of Mortality StatusFigure 2:Mean Trace of CVD Status

THE RELATIONSHIP BETWEEN BODY MASS INDEX AND ORTHOSTATIC HYPOTENSION AMONG ADULTS

Background: Orthostatic hypotension (OH) is a condition characterized by a significant drop in blood pressure upon standing, potentially leading to dizziness and falls. Body Mass Index (BMI) has been identified as a potential risk factor for OH, yet the relationship remains underexplored, particularly in specific populations. Objective: This study investigates the association between BMI and the prevalence of OH among adults in Ndola City, Copperbelt Province, Zambia, while also examining the influence of gender on this relationship. Methods: A descriptive cross-sectional study was conducted involving adults aged 16 to 60 years, selected through simple random sampling from local health centers. Data on BMI, blood pressure measurements, and demographic information were collected. Chi-square tests were employed to assess associations between BMI and OH, as well as between gender and OH. Results: The analysis revealed a statistically significant association between BMI and the occurrence of OH (Pearson Chi-Square: 63.8815, p < 0.001). In contrast, no significant association was found between gender and OH (Pearson Chi-Square: 1.8646, p = 0.172). These findings suggest that variations in BMI are related to the prevalence of OH among adults in Ndola City, while gender differences appear to have minimal impact. Conclusion: The study highlights the importance of monitoring BMI as a potential risk factor for orthostatic hypotension in adults. While gender does not significantly influence the occurrence of OH, further research is warranted to explore additional contributing factors and develop targeted interventions for the local population. These insights can inform public health strategies aimed at managing OH related to BMI.<p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/soc/0798/a.php" alt="Hit counter" /></p>

AGEING, ORTHOSTATIC HYPOTENSION, AND MENTAL HEALTH: A CROSS-SECTIONAL STUDY IN NDOLA CITY OF ZAMBIA

<p><strong>Background:</strong> This study examines the relationship between ageing, standing blood pressure, and mental health in 770 adults from Ndola City, Zambia, focusing on orthostatic hypotension (OH). OH, characterized by a significant drop in blood pressure upon standing, is particularly prevalent among older adults and is associated with mental health disorders such as depression and stress. <strong>Methods:</strong> Using a cross-sectional design, participants were categorized by age, and standard blood pressure measurements were taken to assess OH. Mental health was evaluated using the Depression, Anxiety, and Stress Scale (DASS21) and the General Health Questionnaire (GHQ12). Statistical analyses, including Pearson chi-square tests, were employed to explore associations between age groups, the prevalence of OH, and mental health conditions. <strong>Results:</strong> Results indicated no significant association between age and the occurrence of OH (Pearson chi2(4) = 7.5702, Pr = 0.109). However, a significant relationship was found between age and depression (Pearson chi2(8) = 23.4265, Pr = 0.003), suggesting that older age correlates with higher depression levels. In contrast, anxiety did not show a significant association with age (Pearson chi2(4) = 4.5814, Pr = 0.333). Stress levels were significantly associated with age (Pearson chi2(8) = 37.1247, Pr = 0.000), as were distress levels (Pearson chi2(4) = 9.9089, Pr = 0.042). Conclusion: While age does not significantly impact the occurrence of OH, it is correlated with increased levels of depression and stress among older adults, highlighting the need for mental health interventions in this population.</p><p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/soc/0794/a.php" alt="Hit counter" /></p>

Microscopic Varicocelectomy under Local Anesthesia as the Treatment of Varicocele.

Varicocele, characterized by the dilation of veins within the spermatic cord, is a prevalent disease in males, accounting for 35%-40% of infertility cases among men of reproductive age. This condition may disrupt normal neuroregulation, blood supply, and temperature regulation in the testicles, thereby impacting sperm count, quality (morphology, fragmentation rate), and functionality (motility). It may even induce symptoms such as pain and testicular atrophy. The international standard treatment method is microscopic varicocelectomy, typically performed under general anesthesia. This requires patients to fast before surgery and necessitates recovery and fasting care postoperatively. The arterial blood pressure drop caused by anesthesia may obscure the fluctuation of the spermatic artery, making the precise intraoperative isolation and protection of the spermatic artery more challenging. Therefore, this study proposes and implements microscopic varicocelectomy under local anesthesia. This method facilitates rapid and precise identification of the fluctuating spermatic artery, reducing the risk of spermatic artery damage. It also provides more humane care for patients, reduces economic burden, and offers a new perspective on the treatment of varicocele.

Hypotension after Induction of Anesthesia as a Predictor of Hypotension after Opening the Dura Mater during Emergency Craniotomy.

Background: The subject of this study is intraoperative hypotension during the evacuation of acute subdural haematoma (ASH). We examined the association between the decrease in intraoperative blood pressure (BP) after the induction of anaesthesia and the decrease in BP after opening the dura mater. The second aim of this study was to assess the relationship between preoperative hypertension and the emergence of an intraoperative drop in BP. Methods: This was a retrospective cohort study on adult patients undergoing emergency craniotomy due to ASH. In total, 165 medical records from a 2-year period were analysed. The patients were divided into two groups: high blood pressure (HBP) (n = 89) and normal blood pressure (NBP) (n = 76). The HBP group included patients with hypertension in the preoperative period (systolic blood pressure (SBP) > 150 mmHg). The NBP group included patients with an SBP between 90 and 150 mmHg. Results: We observed a significant drop in blood pressure in two operational periods: after the induction of anaesthesia and after opening the dura mater. A highly relevant positive correlation was noted between the decrease in SBP after anaesthesia induction and the opening of the dura mater (p < 0.001). In the HBP group, after opening the dura mater, there was a 44% SBP decrease from the baseline value. Conclusions: The reduction in BP after the induction of anaesthesia is a predictor of a subsequent drop in BP after opening the dura mater during urgent surgery due to ASH. Patients with hypertension in the preoperative period of ASH tend to have a greater intraoperative drop in BP and worse outcomes.

7883 Atypical Presentation of Macroprolactinoma: Discordantly Low Serum Prolactin and Therapeutic Challenges

Abstract Disclosure: S. Hossain: None. M.S. Hossain: None. B. Gautam: None. S.C. Kumar: None. H. Liao: None. D.S. Rosenthal: None. Introduction: Pituitary tumors are categorized as microadenomas (&amp;lt;1 cm) and macroadenomas (&amp;gt;1 cm) with prolactinomas being one of the most common causes. The mean prevalence of prolactinomas is 10 per 100,000 in men and 30 per 100,000 in women. Serum prolactin levels corresponds to the size of the prolactinoma and any discrepancy should be treated with caution as that may indicate co-existence of pluripotent cells. We present a patient who presented with visual field defect and headaches, found to have a pituitary macroadenoma with discordantly low serum prolactin level compared to the size of adenoma, prompting a change in the treatment course. Case Presentation: A 42 year old male with no past medical history was seen as an endocrinology consult requested by neurosurgery for frequent headaches and visual problems for 1 year. Vital signs were normal, with negative orthostatic drop of blood pressure. He had prominent bitemporal hemianopsia confirmed by formal visual field testing by Ophthalmology. No galactorrhea or features suggestive of acromegaly or hyperthyroidism. He complained of erectile dysfunction but appeared to have normal male secondary sexual characteristics. MRI of brain showed a suprasellar mass measuring 3.8 x 2.6 x 2.2 cm with mass effect on the optic chiasm, hypothalamus with extension and infiltration into the right cavernous sinus. Lab results showed elevated prolactin of 1343.5 ng/ml confirmed by serial dilution, low serum testosterone level of 134 ng/dl and inappropriately normal FSH and LH. Complete blood counts, comprehensive metabolic panel, TFT, ACTH, cortisol and IGF-1 were normal. Patient was started on bromocriptine and he noticed improvement in his field of vision and acuity within one week of starting therapy. He continued to show sustained improvement in vision and resolution of his headaches at the one-month mark. MRI 2 months from starting bromocriptine showed modest reduction in size of the tumor to 2.1 x 2.3 x 2.4 cm with continued mass effect on the optic chiasm. Prolactin level decreased to 69.3 ng/ml. Therefore, although there was some improvement in visual fields, surgical resection was recommended to alleviate the mass effect on the optic chiasm. Conclusion: Our case highlights the significance of identifying discrepancies between the size of a prolactinoma and serum prolactin levels. Expected prolactin level from a prolactinoma similar in size to our case would be &amp;gt;3000 ng/ml when ours was 1343.5ng/ml. Despite undergoing treatment and lowering of prolactin levels our patient's pituitary adenoma did not significantly reduce in size after two months of treatment with bromocriptine and the mass continued to exert pressure on the optic chiasm. This suggests possible presence of pluripotent cells in addition to prolactin-producing cells within the tumor. The recommended course of action was surgical resection of the mass. Presentation: 6/1/2024

Unraveling the stride: exploring the influence of neurogenic orthostatic hypotension on gait and balance in Parkinson’s disease

PurposeNeurogenic orthostatic hypotension (nOH) and gait impairment are frequent sources of disability in Parkinson’s disease (PD). However, the impact of nOH on balance and gait features remains unclear. This cross-sectional study aimed to assess the influence of nOH on postural and gait parameters in a cohort of patients with PD by means of wearable inertial sensors.MethodsGait and balance were assessed using Opal inertial sensors. nOH was defined as sustained systolic blood pressure (BP) drop ≥ 20 mmHg or diastolic BP drop ≥ 10 mmHg within 3 min of standing, with a ΔHR/ΔSBP ratio ≤ 0.5 bpm/mmHg. Analysis of covariance was performed to evaluate differences in gait/balance features between patients with and without nOH, adjusting for age, cognitive status, and motor disability. Moreover, we performed the same analysis considering the presence of hemodynamically relevant nOH (orthostatic mean BP ≤ 75 mmHg).ResultsA total of 82 patients were enrolled, 26 with nOH (31.7%), of which 13 presented with hemodynamically relevant nOH. After correcting for confounders, nOH was independently associated with lower gait speed (p = 0.027), shorter stride length (p = 0.033), longer time for postural transitions (p = 0.004), and increased postural sway (p = 0.019). These differences were even more pronounced in patients with hemodynamically relevant nOH. Higher postural sway was associated with a 7.9-fold higher odds of falls (p = 0.040).ConclusionsOur study presents an objective demonstration of the independent negative impact of nOH on gait and balance in PD, emphasizing the need for careful detection and management of nOH to mitigate gait and balance disturbances in PD.

Orthostatic blood pressure phenotypes prevalence in type 2 diabetes mellitus

Background and aims Orthostatic hypotension (Ohypo) and hypertension (Ohyper) have emerged early markers for high risk of cardiovascular events. Data on the prevalence and risk factors of Ohypo and Ohyper in patients with type 2 diabetes (T2D) are scarce. Methods Within the framework of the Brazilian Diabetes Study, this is an observational, cross-sectional study. The diagnosis of Ohypo was based on drops in systolic blood pressure (SBP) ≥20mmHg or diastolic blood pressure (DBP) ≥10mmHg when transitioning from sitting to standing. Ohyper was defined by either a SBP increase ≥20mmHg during this transition or a sustained elevation to 140 mmHg in otherwise normotensive individuals. Results The study population (n = 900) had a mean age of 57 ± 8 years, 57% male and the median T2D duration was 8 years. Sitting SBP and DBP were 140 ± 20 mmHg and 82 ± 11 mmHg, respectively. Of the total sample, 108 (12%) had Ohypo and 83 (9%) had Ohyper. Each 1-year increase in age was associated with 3.7% higher odds of orthostatic hypotension (OHypo). Additionally, each 1 mmHg increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) corresponded to a 3.0, 5.5, and 5.4% increase in the odds of OHypo, respectively. Ohyper risk did not associate with age but showed an inverse relationship with sitting BP values. Conclusions Ohypo and Ohyper are common occurrences in patients with T2D. Advanced age significantly elevates the risk of developing Ohypo, whereas sitting BP emerges as an independent risk factor for both Ohypo and Ohyper.

Improving diabetes self-management and control through individualized patient counseling: A quasi-experimental study

BACKGROUND: Diabetes is one of the most common chronic diseases, affecting a large proportion of the global population. This study aims to evaluate the effects of individualized patient counseling on diabetes self-management. MATERIALS AND METHODS: This quasi-experimental study utilized a non-randomized two-arm pre-post design. It was conducted at the out-patient clinics of a tertiary care hospital, Gujarat, from February 2023 to August 2023. There were 300 type 2 diabetes patients who belonged to an intervention group receiving 3 monthly 30-minute individualized counseling sessions (n = 150) or a control group continuing usual care (n = 150). Assessments at baseline and 3 months post-intervention compared treatment effects. The outcomes measured were diabetes knowledge, attitudes/beliefs, medication/lifestyle adherence, self-reported quality of life, blood pressure (BP), and HbA1c. The intervention covered medication and lifestyle guidance, self-monitoring skills, barrier identification, and problem-solving with a focus on patient empowerment. The analysis compared within- and between-group changes. RESULTS: At 3 months, counseled patients showed significantly greater improvements in knowledge (difference 13.6 points), self-care abilities (lifestyle adherence difference 6.6 points), 5.9 mmHg extra drop in systolic BP, and 0.6% higher HbA1c reduction versus controls (all P &lt; 0.05). Greater knowledge gain is strongly correlated with improved HbA1c (r = 0.42). Patients reported medication counseling as the most useful and cost and cultural dietary habits as key ongoing barriers. CONCLUSION: Individualized counseling promoted better self-management behaviors, improved clinical measures, and subjective well-being in diabetes patients versus usual care alone. Routine Counseling should be considered to complement medical management in high-risk chronic diseases.

Cerebral Hypoperfusion And Future Falls Risk Among Community Dwelling Older Adults with Orthostatic Hypotension

Abstract Background Falls occur in approximately 33% of those over 65 annually, with 10-20% resulting in injury or hospitalisation. Orthostatic Hypotension (OH) characterised by significant blood pressure (BP) drops upon standing is frequently identified in those with unexplained falls (UF). Cerebral hypoperfusion is regarded as the mechanism by which OH contributes to falls risk. However, work looking at the direct interaction between OH, cerebral perfusion and falls is lacking. Methods Near Infrared Spectroscopy (NIRS) derived frontal lobe cerebral oxygenation (reported as tissue saturation index (TSI)) and continuous beat-to-beat BP by finometer were measured in parallel during active standing among participants aged ≥55 at wave3 of TILDA (n=2478). OH, was defined as persisting systolic BP drop ≥20mmHg and/or diastolic BP drop ≥10mmHg at 30, 60 and 90seconds post standing. TSI drop from baseline ≥75th centile at 30seconds informed the “greater TSI drop” variable for longitudinal analysis. Multilevel linear regression models assessed the association between change in TSI from baseline and OH. Multilevel logistic regression models assessed the longitudinal relationship between OH, cerebral perfusion and future UF at 4years follow up (waves 4-5). Results Twenty percent had OH and were more likely to be older and have cardiovascular disease. TSI drops from baseline after standing were significantly greater in those with OH at 30 (beta=0.32 [CI 0.15-0.49]; p&amp;lt;0.001), 60 (beta=0.41 [CI 0.23-0.6]; p&amp;lt;0.001), and 90 (beta=0.46 [CI 0.27-0.65]; p&amp;lt;0.001) seconds in fully adjusted models. After robust adjustment, combination of OH with greater TSI drops was strongly associated with future UF (Odds Ratio (OR) 2.23 [CI 1.35-3.69]; p=0.002), while OH and lower TSI drops were not (OR 1.27 [CI 0.87-1.85]; p=0.216). Conclusion These novel findings confirm that degree of cerebral hypoperfusion on standing informs risk of future UF in those with OH and has important clinical implications for the risk assessment of older people presenting with falls.

Application of UHPLC-QqQ-MS/MS Method for Quantification of Beta-Adrenergic Blocking Agents (β-Blockers) in Human Postmortem Specimens.

Betablockers are one of the most frequently used medications in cardiology. They can lead to fatal drops in blood pressure and heart rhythm disturbances. Death is functional, and poisoning with this group of drugs can be difficult to detect. The liquid-liquid extraction (LLE) method developed using ethyl acetate at pH 9 successfully identified 18 β-blockers in human blood. The method's limit of quantification (LOQ) was in the range of 0.1 to 0.5 ng/mL. No carryover of substances between samples was detected, and no interfering ion current signals were observed in the biological samples at the retention times of the compounds or internal standards. All compounds had a coefficient of determination (R2) above 0.995. Intraday and interday precision (RSD%) and accuracy (RE%) for low and high QC levels were within 1.7-12.3% and -14.4 to 14.1%, respectively. Very good recovery (80.0-119.6%) and matrix effect (±20.0%) values were achieved for all compounds. In addition, fragmentation spectra were collected for all the examined substances, and high-resolution spectra were presented for landiolol and metipranolol, because they are not available in commercial HRMS spectra databases. The developed method was applied in authentic postmortem samples.

Abstract P156: Timing of Orthostatic Blood Pressure Changes is Associated with Orthostatic Symptoms in Very Old Adults: Findings from the ARIC Study.

Background: The timing of orthostatic changes in blood pressure (BP) and their associations with orthostatic symptoms among very old adults is undercharacterized. Objective: To determine the prevalence of distinct orthostatic BP patterns and their relationships with orthostatic symptoms. Methods: We measured three supine and six standing BP readings (timed at 0, 1, 2, 3, 4, and 5 minutes after standing) among ARIC participants (2021-2023). OH patterns (primary, initial, early, delayed, and sustained) were based on when a drop in BP (systolic ≥20 or diastolic ≥10 mmHg) occurred (see Figure for definitions). We quantified OH prevalence overall and by anti-hypertensive medication use and determined the associations of OH patterns with orthostatic symptoms, both concurrent with positional change and in the prior 30-days via logistic regression adjusted for age, sex, and Black race. Results: Of 1,044 participants (58.8% female, 16.5% Black, mean age 83.9±3.7 years), 24.5% had primary OH. Initial and early OH were more common than sustained and delayed OH. Participants using any hypertension medications had a higher prevalence of most types of OH ( Panel 1 ). Primary, early, and sustained OH were associated with orthostatic symptoms during the rise from supine to standing or when standing, while initial OH was associated with orthostatic symptoms only during the rise from supine to standing ( Panel 2 ). Sustained OH was associated with higher odds of prior light-headedness or dizziness and early OH with higher odds of prior imbalance. Conclusion: Clinicians should consider timing of BP changes when screening for OH and evaluating its contribution to orthostatic symptoms among very old adults.

Abstract P414: Association between postpartum sleep and blood pressure reduction in women with hypertensive disorders of pregnancy

Importance: It is anticipated that many women do not get enough sleep after delivery. However, it is unclear how poor sleep affects postpartum blood pressure. Objective: To investigate the relationship between postpartum blood pressure and sleep habits, we examined women who developed hypertensive disorders of pregnancy by using automated blood pressure monitors and accelerometers. Setting: The blood pressure, pulse rate, and sleep were monitored at home. Total sleep time, sleep efficiency, sleep fragmentation coefficient, and wake after sleep onset were measured. Participants completed a behavior chart including breastfeeding frequency. The 24-hour, awake time and sleep time mean blood pressures were calculated for each participant as well as the change in blood pressure between postpartum days 7 and 14. Participants: We recruited 11 women who delivered singletons and developed hypertensive disorders of pregnancy at the National Center for Child Health and Development from April to September 2021. Intervention or Exposure: None Main Outcomes: The relationship between the change in blood pressure and sleep measurements and frequency of breastfeeding were analyzed. Results: Seven participants were included in the final analysis. The mean total sleep time was 5.3 hours, and the mean breastfeeding frequency was 6.1 times per day. Mean systolic and diastolic blood pressure and pulse rate during sleep periods tended to be lower than those during awake periods (-8.5±4.5 mmHg, -8.8±2.7 mmHg, -8.7±2.7 bpm, respectively). Lower sleep time was significantly correlated with smaller 24h-systolic and diastolic blood pressure drop (correlation coefficient r=-0.823, p=0.023 and r=-0.812, p=0.026, respectively. No association was found between other sleep measurements and the change in 24h-blood pressure. The blood pressure and pulse rate values in six of the seven participants during the early sleep phase (≤30 min) were similar to those in later sleep phases (&gt;30 min), showing that beneficial effects of sleep on blood pressure were apparent throughout the sleep phases. Conclusions and Relevance: Our results suggest that longer total sleep time, even if sleep is fragmented, is associated with a greater decrease in postpartum blood pressure among women who developed hypertensive disorders of pregnancy.

A case report on cefoperazone induced cardiogenic shock - kounis syndrome

Background: Kounis Syndrome is a hypersensitive coronary artery disease caused by the body being exposed to allergens that can be triggered by various medications and environmental factors. The body's defense mechanism launches a surge of chemicals during an anaphylactic reaction that could cause a state of shock, drop in blood pressure and constriction of the breathing passage, which makes breathing difficult. Case presentation: A 55-year-old woman presented in our department with edema and a growth over her right buccal mucosa. A punch biopsy performed was indicative of squamous cell carcinoma. Considering Chronic Kidney Disease (CKD), consultation with a nephrologist was scheduled and proceeded with the advised recommendations. Following the first injection dose of Cefoperazone and Sulbactum, within 5 minutes, the patient reported chest discomfort and difficulty in breathing. CPR was given according to ACLS protocol. Adrenaline injection was administered and was connected to defibrillator shock. Conclusion: It is imperative for healthcare providers and pharmacists to recognize that, cephalosporins may result in fatal disorders such as Kounis Syndrome (KS) in order to appropriately prescribe the treatment and take preventative measures.

Flow restoration during mechanical thrombectomy for large vessel occlusion is associated with an immediate reduction of systemic blood pressure.

Managing blood pressure in patients with large vessel occlusion affects infarct size and clinical outcomes. We examined how restoring blood flow impacts systemic blood pressure during mechanical thrombectomy. Patients with large vessel occlusion in the anterior circulation undergoing mechanical thrombectomy between June 2016 and January 2018 were screened. We included those treated under local anesthesia or conscious sedation and analyzed standardized anesthesia protocols to assess systolic and diastolic blood pressure levels throughout the procedure. The primary outcome was the change of blood pressure, compared 5 min before versus 5 min after the last recanalization attempt. Successful reperfusion was defined as Thrombolysis in Cerebral Infarction score ⩾ 2b. Of 134 patients, 117 (87%) achieved successful angiographic reperfusion, showing a notable systolic blood pressure drop 5 min after flow restoration (10.2 ± 14.6 vs 3.24 ± 8.65 mm Hg, p = 0.009). Successful angiographic reperfusion was a significant predictor for this decrease in multivariable logistic regression: OR = 1.34 (95% CI: 1.03-1.73, p = 0.0299). Among 66 patients not given circulation-affecting meds, a significant systolic pressure reduction was also observed (155 ± 17 mm Hg to 148 ± 17 mm Hg ; p < 0.001). No diastolic pressure changes were significant. Flow restoration was associated with an immediate reduction of systolic blood pressure values in patients undergoing mechanical recanalization under local anesthesia or conscious sedation. This suggests a complex interplay between endovascular stroke therapy and cardiovascular hemodynamics.

A Safety-Centric Study on the Use of Inflatable Abdominal Binders for Managing Orthostatic Hypotension.

The study focuses on the design and evaluation of inflatable abdominal binders for managing Orthostatic Hypotension. Orthostatic hypotension is a condition characterized by a significant drop in blood pressure when a person stands up, leading to symptoms such as dizziness, lightheadedness, and even fainting. The management of orthostatic hypotension typically involves a combination of pharmacological and non-pharmacological strategies. In the context of this research, an inflatable abdominal binder was designed, leveraging components that are not only economically viable but also easily obtainable. The evaluation of this device was conducted using a medical education manikin, specifically the CAE iStan manikin. The results demonstrated a correlation between the inflation values of the belt and the resulting pressure values exerted on the body. The general recommendation for an abdominal binder is to exert a pressure of 20-40 mmHg. Contrary to this, the study found that to maintain safe external pressure on the abdomen, the binder should not be inflated over 25 mmHg. This safety threshold was used as a reference point in the study, suggesting a potential need to revisit the standard recommendations for abdominal binder pressure. Further research is needed to assess the device's effectiveness in human subjects and to potentially redefine the safe and effective pressure range for abdominal binders.

Evaluation of the Predictive Character of the Expiratory Inferior Vena Cava/Abdominal Aorta (eIVC/Ao) Index for Minimum Blood Pressure Following Spinal Anesthesia With 0.5% Hyperbaric Bupivacaine.

Spinal anesthesia has many side effects, one of them being a drop in blood pressure (BP). Identifying predictive factors for this drop is a clear matter of concern. In this regard, the expiratory inferior vena cava/abdominal aorta (eIVC/Ao) index has already been spotted as such for doses of 0.5% hyperbaric bupivacaine greater than 12mg. Departing from the demonstrated correlation between this index and hypotension post-spinal anesthesia, our study aimed to (1) evaluate whether an eIVC/Ao index greater than 0.7, thus defining non-hypovolemic patients, can also predict minimal BP for doses inferior to 12mgand (2) identify other predictive factors for minimal BP post-spinal anesthesia. Lastly, we verified whether preoperative fasting induces hypovolemia. This single-center prospective observational pilot study included 20 patients. The baseline measurements of BP, eIVC/Ao index, and fasting time were recorded at time T0'. Then spinal anesthesia was administered with 0.5% hyperbaric bupivacaine in doses inferior to 12 mg. The patients' systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and metameric levels were each recorded at times T5', T10', T15', and T20'. The results indicated that baseline DBP was predictive of low DBP and minimum MAP, which reflect myocardial perfusion and systemic pressures, respectively. Therefore, it should trigger prophylaxis (spinal-lateralized, continuous, or lower dose) in patients with a low DBP baseline. Additionally, baseline SBP was predictive of minimumSBP, an independent risk factor for post-anesthetic hypotension if its baseline is lessthan 120 mmHg. Although female gender was linked to minimum SBP, other confounding factors (size, dose administered, and type of surgery related to gender) must also be considered. Moreover, a correlation was established between height and MAP in parturients. Hypotension was not recorded at local anesthetic (LA) doses between 8 and 12 mg and the doses administered were sufficient to achieve the metameric levels required for surgery (ether tests). Since 8 mg of 0.5% hyperbaric bupivacaine achieved the same level as 12 mg, lower doses of LA might prevent a significant drop in BP and its deleterious effects. Therefore, in the current cohort, the eIVC/Ao index was not predictive of minimum BP during spinal anesthesia with doses less than 12 mg of 0.5% hyperbaric bupivacaine. However, predictive factors for minimum BP included gender and baseline SBP (for minimum SBP), height and baseline DBP (for minimum MAP), and baseline DBP (for minimum DBP). Lastly, preoperative fasting did not cause hypovolemia.