Drop In Blood Pressure Research Articles

Early drop in systolic blood pressure is associated with poor diuretic response and prognosis in patients with acute heart failure.

Although an excessive drop in systolic blood pressure (SBP) during acute heart failure (AHF) negatively impacts prognosis, the association between changes in SBP and the diuretic response (DR) is unclear. We aimed to clarify the association between an early drop in SBP and DR/prognosis in patients with AHF. This was a sub-analysis of the REALITY-AHF study, which registered patients with AHF admitted through emergency departments (EDs). An early SBP drop was defined as the difference between baseline SBP and the lowest value during the first 48 h of hospitalization. DR was defined as the urine output achieved per 40 mg of intravenous furosemide administered. SBP was measured on admission, at 90 min, and 6, 24, and 48 h after admission. Patients were divided into four groups according to their median SBP drop and DR: greater SBP drop/poor DR (n = 322), smaller SBP drop/poor DR (n = 409), greater SBP drop/good DR (n = 419), and smaller SBP drop/good DR (n = 314). The study included 1,464 patients. A greater SBP drop/poor DR was associated with higher baseline SBP and vasodilator use. Multivariable linear regression analysis showed that a greater drop in SBP was associated with poorer DR following adjustment for potential covariates. Cox proportional hazards analysis demonstrated that a greater SBP drop/poor DR was independently associated with 1-year mortality. Both SBP and DR changes were independently associated with prognosis. An early drop in SBP during the first 48 h of hospitalization was associated with poor DR and 1-year mortality in patients with AHF. URL: http://www.umin.ac.jp/ctr/Unique identifier: UMIN000014105.

LOCAL ANESTHESICS

Introduction: The use of local anesthetics is essential in the dental routine to perform painless procedures. Among them are lidocaine, mepivacaine, articaine, bupivacaine and prilocaine. For greater effectiveness, we found vasoconstrictors associated with these substances, which will provide greater hemostasis and anesthetic duration due to the contraction of blood vessels and less contact with the nerve fiber. Aim: The main objective of this study was to evaluate the possible adverse effects resulting from the use of local anesthetic salts during a dental procedure, mainly the presence of migraine, nausea and increased blood pressure. Methodology: This observational cross-sectional study selected patients treated at the Dental Clinic of the Centro Universitário da Serra Gaúcha-FSG between March and June 2022. Patients were submitted to questionnaires in order to find candidates compatible with the inclusion criteria of the search. Thirty patients were included, who received anesthetic salts with vasoconstrictor for the performance of procedures, and thus, blood pressure was evaluated before and after anesthesia and the signs and symptoms reported. Results: Few patients had an increase in systolic and diastolic pressure, prevailing the state of falling and stability. Only one patient received two types of anesthetic salts and he only presented an increase in blood pressure. Lidocaine was the most used substance and the one that most resulted in a drop in systolic and diastolic blood pressure. After the post-consultation questionnaire, 53% of the patients reported some type of symptom after anesthesia, predominantly tongue numbness (24%), mucosal excitement and swelling (21%) and nervousness (17%). Conclusion: From the results obtained, it can be concluded that more than half of the patients reported some type of post anesthesia symptom, but it cannot be said that these reported symptoms are directly linked to some type of adverse reaction to the anesthetic salts used, and these symptoms may be associated with fear of the procedure that would be performed or even to the poorly conducted anesthetic technique.

Blood Flow Restriction Prevents The Drop In Blood Pressure Upon Head-up Tilt

Many astronauts develop orthostatic intolerance following spaceflight and this change may be more prevalent in females. Although the blood pressure response to standing should normalize in the weeks following their return to Earth, there may be emergencies where an immediate short-term solution is necessary. PURPOSE: To examine the effects of different levels of blood flow restriction on blood pressure and heart rate when a person is transitioned from supine to an upright position and determine whether this change differs based on sex. METHODS: 45 men and 44 women partook in this four-visit study. The first visit included the determination of the applied pressure for the different conditions, and familiarization with the tilt table protocol. Visits 2-4 were the experimental visits completed in a randomized order on the tilt table: 1) Sham, 2) Moderate, or 3) High pressure. Brachial blood pressure was measured at baseline, upon inflation of the cuffs in a supine position, immediately after tilt (70°), and 8 more times separated by 45 seconds. RESULTS: Data are presented as mean (SD) and as a change from the baseline measurement. Changes in systolic blood pressure were pressure dependent (High > Moderate > Sham). Notably, the application of blood flow restriction was able to prevent the drop in systolic blood pressure when moving from a supine to the head-up tilt position [High vs Sham: 5.5 (7.4) mmHg, High vs Moderate: 3 (7.4), and Moderate vs Sham: 2.4 (8.4) mmHg]. Diastolic blood pressure increased following head-up tilt and changes were greatest with the High pressure with no differences between Moderate and Sham [High vs Sham: 2.4 (5.3) mmHg, High vs Moderate: 1.9 (6.3), and Moderate vs Sham: 0.6 (5.1) mmHg]. Heart rate increased following head-up tilt and the change was initially greatest in the Sham condition [High vs Sham: -3.5 (9.1) mmHg, High vs Moderate: 0.5 (9.1), and Moderate vs Sham: -3.6 (9.3) mmHg]. However, heart rate changed the most in the High pressure condition by the end of the head-up tilt period. CONCLUSIONS: The application of blood flow restriction prevented the initial drop in blood pressure when transitioning from the supine to the upright position. This could be useful when astronauts need to exit the spacecraft quickly upon landing, where a failure to maintain blood pressure could be fatal.

Abstract 124: Angiotensin-(1-12) Immunoneutralization: A New Approach To Hypertension Treatment

There is a critical need to identify new therapeutic targets and treatments, given emerging data documenting the limited effectiveness of current antihypertensive drugs to have a marked impact in preventing target organ damage and cardiovascular death. While monoclonal antibodies (mAb) are revolutionizing the treatment of human diseases, including severe hypercholesterolemia, their applicability to long-term hypertension control remains unexplored. Identification of angiotensin-(1-12) [Ang-(1–12)] as a non-renin-dependent substrate for Ang II generation in rodents and humans led us to engineer a mAb directed against the C-terminus of human Ang-(1–12) [h-Ang-(1-12)] sequence. We utilized a model of hypertension expressing the human angiotensinogen (AGT) gene in the rat genome [TGR(hAGT)L1623 rats] to address the effectiveness of endogenous h-Ang-(1–12) immunoneutralization in controlling the elevated blood pressure and reversing hypertension-induced target organ damage. Acute delivery of the h-Ang-(1–12) mAb (30 mg/Kg, i.v.) in anesthetized hypertensive transgenic rats induced a prompt arterial pressure fall (M ± SE: -18 ± 6/-16 ± 3 mm Hg, n=7; p< 0.001) in the absence of corresponding heart rate changes. The antihypertensive effect of the h-Ang-(1-12) mAb triggered a rise in plasma renin concentrations (from 107 ± 24 to 381 ± 260 ng/mL/h) that was inversely correlated with the fall in mean arterial pressure (r= -0.92, p< 0.001). Prior intravenous delivery of aliskiren fumarate (3-5 mg/Kg, i.v.) while inducing a fall in arterial pressure did not mask the antihypertensive action of the h-Ang-(1-12) mAb. Extension of these acute effects of the h-Ang-(1-12) mAb to awake instrumented transgenic hypertensive rats given consecutive daily doses of the mAb (30 mg/Kg, i.m. x 4 -5 days, n=7) documented a trend for significant statistical drops in daytime blood pressure and no changes in heart rate. We conclude that Ang-(1–12) is an endogenous Ang II forming substrate participating in the control of arterial pressure in a humanized model of high blood pressure and that selective immunoneutralization of this alternate substrate is a promising and novel therapeutic approach to treat hypertension and prevent its adverse cardiovascular sequelae.

Abstract P015: Characteristics And Care Of Inpatients With Orthostatic Hypotension

Background: Orthostatic hypotension (OH) contributes to over 80,000 hospitalizations annually, yet most studies of OH are conducted in outpatient settings. We sought to better characterize the causes, care, and course of OH in hospitalized patients in a large academic center. Methods: In this observational study, we reviewed 101 electronic medical records of adults with OH during admission to Beth Israel Deaconess Medical Center in Boston between January 1, 2017 and June 30, 2021, extracting details related to symptoms, etiology, interventions, blood pressure (BP), and post-hospital follow-up. OH was defined as a drop in systolic or diastolic BP of at least 20 or 10 mm Hg, respectively. Results: Of these patients (39.6% female, 9.9% Black, mean length of stay of 6.8 days), 30.7% had evidence of OH on initial presentation (Table) . While dizziness (32.7%) and lightheadedness (29.7%) were common, 19.8% of patients were asymptomatic. Volume resuscitation (64.4%), medication changes (53.5%), and physical therapy (24.8%) were the most frequent interventions. Among medication changes, reductions in beta blockers (37.0%) and loop diuretics (27.8%) were most common. On average, orthostatic systolic and diastolic BP improved by 7.9 and 3.0 mm Hg, respectively, and OH improved or resolved in 64.3% of patients. Within six months of discharge, 24.8% of patients had a subsequent encounter for OH. Conclusion: This study identifies important foci for further study of inpatient OH, including detection among asymptomatic patients, clinical practices focused on BP augmentation strategies (volume resuscitation, down-titration of beta blockers and loop diuretics), and high recurrence rates.

Abstract 038: The Association Of Supine Hypertension Versus Standing Hypotension With Adverse Cardiovascular Events Among Middle-aged Adults

Background: Clinical management of orthostatic hypotension (OH) prioritizes the prevention of standing hypotension (HYP), sometimes at the expense of supine hypertension (HTN). It is unclear whether supine HTN is associated with adverse outcomes relative to standing HYP. Objectives: To compare supine HTN and standing HYP among middle-aged adults with and without OH. Methods: The Atherosclerosis Risk in Communities Study measured supine and standing blood pressure (BP) in adults aged 45-64 between 1987-1989. We defined OH as a positional drop in systolic BP ≥20 mmHg or diastolic BP ≥10 mmHg, supine HTN as a BP≥140/≥90 mmHg, and standing HYP as a BP≤105/≤65 mmHg. ARIC participants were followed >30 years. Coronary heart disease (CHD) and mortality were adjudicated; falls and syncope were based on hospital claims. We used adjusted Cox models that included both supine HTN and standing HYP. Results: Of 12,580 participants (55% female, 26% Black, mean age 54±6) 5% had OH. Among those without OH (N=11936), 19% had supine HTN and 21% had standing HYP, while among those with OH (N=644), 11% had supine HTN and 34% had standing HYP. Supine HTN was associated with CHD (HR 1.49; 1.36, 1.63), syncope (HR 1.26; 1.15, 1.39), and all-cause mortality (HR 1.47; 1.38, 1.57), while standing HYP was only associated with all-cause mortality (HR 1.08; 1.00, 1.16) and to a lesser extent than supine HTN (P comparing coefficients <0.001) (Table). Associations did not differ for those with OH (P-interactions>0.25). Conclusion: Supine HTN was associated with more adverse events than standing HYP, regardless of OH status, questioning conventional practices of prioritizing standing HYP among adults with OH.

Objectives & background: Drug-induced hepatotoxicity (DIH) is a common side effect of anti-TB drugs. Acute viral hepatitis (AVH) may be confounded with chronic alcoholic hepatitis clinically, biochemically, and histologically (CAH). Place of Study: Rashid Latif Medical College Lahore Duration of Study: March 2019 to January 2021 Methods: This prospective research examined the effect of acute viral hepatitis as a contributing

Background: Diabetes, low nighttime blood pressure, and nonarteritic ischemic optic neuropathy may be associated. Not too many studies present whether this relationship applies to patients. Objective: Diabetes mellitus, low blood pressure at night, and nonarteritic ischemic optic neuropathy were studied in a group of individuals. Methods: The ophthalmology clinic will conduct a cross-sectional research on patients with nonarteritic ischemic optic neuropathy from March 2019 to December 2021. Nonarteritic ischemic optic neuropathy patients were tested for diabetes. Some participants wore ambulatory blood pressure monitors during the trial. Nighttime blood pressure drops are typical, muted, severe, and reverse. Results: Nonarteritic ischemic optic neuropathy was identified in 67 individuals. 587 of 67 patients were selected. 34 patients (50.7%) had diabetes, while 39 (58.2%) had hypertension. 32 people's blood pressure dropped during sleep. Only four (5.9%) saw substantial drops. Conclusions: Diabetes may be linked to nonarteritic ischemic optic neuropathy, but not nocturnal blood pressure declines. Keywords: Optic Neuropathy, Diabetes Mellitus, Hypertension

Intradialytic hypotension frequency is reduced by levocarnitine supplementation

Introduction: Intradialytic hypotension (IDH) is a frequent complication of hemodialysis. IDH causes intradialytic discomfort and subclinical ischemia, resulting in a higher rate of morbidity and mortality. Levocarnitine (LC) administration has been suggested for the treatment of IDH, but conflicting reports about its efficacy have been published. We describe the effect of LC supplementation in patients experiencing recurrent IDH episodes, in spite of common strategies used to prevent it. Methods: Sixteen hemodialysis patients were studied. IDH was defined as a drop in systolic blood pressure ≥20 mmHg, with or without symptoms, prompting an intervention by the dialysis staff, such as reducing/stopping ultrafiltration rate and/or fluid administration. Blood pressure was recorded for 192 hemodialysis sessions, before LC supplementation. Thereafter LC (30 mg/kg dry weight) was administered at the beginning of each hemodialysis, registering blood pressure for 384 hemodialysis treatments. The difference between the predialysis systolic blood pressure and the minimum systolic blood pressure of each hemodialysis was evaluated (∆SBP), before and after LC supplementation. Cardiac ejection fraction was also measured. Results: Predialysis and postdialysis systolic, diastolic, and mean arterial pressures did not differ before and after LC supplementation. Before LC supplementation, 36 episodes of IDH occurred (19%), while after LC supplementation, the IDH episodes were 29 during 384 hemodialysis sessions (8%; χ2 = 16.03; p = 0.0001). ∆SBP was lower after LC supplementation, even though the difference was not significant (p = 0.22). Conclusion: IDH frequency was significantly reduced by predialysis LC supplementation, which can be helpful for patients’ well-being and reduction in IDH-associated risks.

Comparison of optical measurements of critical closing pressure acquired before and during induced ventricular arrhythmia in adults.

.Significance: The critical closing pressure (CrCP) of cerebral circulation, as measured by diffuse correlation spectroscopy (DCS), is a promising biomarker of intracranial hypertension. However, CrCP techniques using DCS have not been assessed in gold standard experiments.Aim: CrCP is typically calculated by examining the variation of cerebral blood flow (CBF) during the cardiac cycle (with normal sinus rhythm). We compare this typical CrCP measurement with a gold standard obtained during the drops in arterial blood pressure (ABP) caused by rapid ventricular pacing (RVP) in patients undergoing invasive electrophysiologic procedures.Approach: Adults receiving electrophysiology procedures with planned ablation were enrolled for DCS CBF monitoring. CrCP was calculated from CBF and ABP data by three methods: (1) linear extrapolation of data during RVP (; the gold standard); (2) linear extrapolation of data during regular heartbeats (); and (3) fundamental harmonic Fourier filtering of data during regular heartbeats ().Results: CBF monitoring was performed prior to and during 55 episodes of RVP in five adults. and demonstrated agreement (, (95%CI, 0.72 to 1.38). Agreement between and was worse; was higher than (mean ± SD; ).Conclusions: Our results suggest that DCS-measured CrCP can be accurately acquired during normal sinus rhythm.

Efficacy and Safety of Yangyin Shuxin Decoction-a Chinese Herbal Medicine Formula For Heart Failure with Preserved Ejection Fraction: A Randomized Controlled Trial.

Heart failure with preserved ejection fraction (HFpEF) is a large subtype of heart failure (HF) characterized by exercise intolerance and reduced quality of life. Studies have shown that traditional Chinese medicine (TCM) combined with conventional Western medicine has a good effect on improving exercise tolerance and quality of life in patients with HFpEF, but the overall quality of evidence is low. This study aimed to determine the safety and efficacy of Yangyin Shuxin (YYSX) decoction in the treatment of HFpEF. A prospective, single-blind, single-center, randomized controlled clinical study was conducted. 64 patients with HFpEF were randomly assigned to receive oral YYSX decoction (150 ml, twice a day) combined with conventional Western treatment or conventional Western treatment alone at a ratio of 1 : 1. The course of treatment was 2 weeks, and the follow-up was 3 months. The primary outcome was peak oxygen uptake (peak VO2) measured by the cardiopulmonary exercise test (CPET). Furthermore, the safety of YYSX decoction was assessed. 63 patients (31 in the YYSX group and 32 in the control group) were included in the full analysis set. The peak VO2 of the YYSX group was significantly higher than that of the control group (12.04 ± 3.41 vs. 11.02 ± 3.33, P = 0.013) after 2 weeks. The maximum voluntary ventilation (MVV) was significantly higher in the YYSX group compared with the control group (P < 0.05). The YYSX group had a higher EQ-visual analogue scale (EQ-VAS) score (71.13 ± 13.95 vs. 70.94 ± 13.70, P < 0.05) and a lower TCM Four-Dimensional Diagnostic Information Scale (TCMFDIS) score (49.74 ± 24.73 vs. 64.16 ± 27.15, P < 0.05) than the control group. There was no statistical difference between two groups (P = 0.160), although 51.61% of patients in the YYSX group showed a decrease in brain natriuretic peptide (BNP) levels of at least 30%, compared with 37.50% of patients in the control group. No serious adverse events were reported in either group, but systolic and diastolic blood pressure decreased and serum sodium levels increased slightly in the control group. The YYSX decoction combined with conventional Western treatment was superior to the conventional Western treatment alone in improving exercise tolerance, quality of life, and cardiopulmonary function of patients with HFpEF. YYSX decoction is safe and may prevent a drop in blood pressure and sodium retention. Trial Registration. Chinese Clinical Trial Registry (www.chictr.org/cn/, No. ChiCTR-IOR-17014206).

Livedo reticularis

A 32-year-old woman with a long history of Raynaud's phenomenon presented to the rheumatology clinic for assessment of severe fatigue and a mottled, purplish discolouration of the skin of her lower extremities. In 2014, she was diagnosed with chronic idiopathic dysautonomia, which leads to orthostatic hypotension and postural orthostatic tachycardia syndrome (POTS). Tilt-table testing resulted in a progressive drop in systolic blood pressure by 30–35 mm Hg and diastolic blood pressure by 15–20 mm Hg when tested at a tilt angle of 70 degrees for 18 min. During this test, she also developed progressive sinus tachycardia, with her heart rate increasing from 117 beats per min to 170 beats per min.

Complications and pitfalls of endovenous laser therapy for varicose veins of lower extremities.

Varicose veins of lower extremities are a common disorder affecting a significant proportion of adult population. Endovenous techniques have been used in clinical practice for more than 20 years for their radical treatment; of these, laser therapy is one of the most widely utilized options. However, this treatment modality, too, has its specific side effects and complications which can be divided into perioperative (difficult venous access, fiber or sheath damage, vasovagal reaction with a drop in blood pressure and bradycardia, cutaneous thermal injury), and postoperative (bruising and hematomas, exceptionally pain, superficial venous thrombosis (phlebitis) and fibrous cord formation or pigmentations). Paresthesias, infections, arteriovenous fistulas, deep venous thrombosis and pulmonary embolism are very rare. The introduction of new generators with higher wavelengths and fibers with radial emission of laser energy has substantially reduced the side effects and complications. Performing the surgery in the outpatient setting using tumescent local anesthesia and under perioperative ultrasound control is an essential condition of the procedure.

Personalised physiological medicine: Orthostatic hypotension

Orthostatic hypotension (OH) is a very common and debilitating condition, characterised by a significant drop in blood pressure (BP) on standing upright. Multiple neuro-cardiovascular mechanisms should stabilise BP when moving to an upright position but in OH, BP decline results from dysfunction of neuro-cardiovascular mechanisms. With the advent of non-invasive, beat-to-beat BP measurement, the detailed postural BP profile presents an opportunity to explore the underlying pathological deficits seen in OH. To date, several distinct clusters of postural BP drop have been identified, typically defined by the rate and duration of BP decline and the degree of recovery. The morphology of the BP drop may reflect the underlying cardiac output and peripheral vascular resistance. There are three principal treatment strategies for OH; conservative management, fludrocortisone or midodrine. As each of these therapies have different therapeutic mechanisms, in this review we hypothesise how they could be used in a more targeted manner to treat the underlying physiological deficit - conservative management for ‘initial drop, quick recovery’, fludrocortisone for ‘medium drop, slow recovery/venular-deficit’ and midodrine for ‘large drop, non-recovery/arteriolar-deficit’.

Discovery of small-molecule modulators of the secretin receptor: Purmorphamine as novel anti-hypertensive agent

The Secretin/Secretin receptor (SCTR) axis is well-known for its important role in water/salt homeostasis and blood pressure control. Recent studies revealed that absence of Secretin could lead to hypertension in animals and the administration of external Secretin leads to a sharp drop in blood pressure. Therefore, Secretin receptor has emerged as a crucial drug target of interest. In this report, using structure based drug design strategy, we have identified a small compound-based Secretin receptor modulator (i.e. purmorphamine or KSD179019). The virtual docking of KSD179019 with SCTR crystal structure and homology models revealed similar binding interactions. Based on active pharmacophores of KSD179019, several derivatives were designed and sythesized. SAR studies revealed that KSD179019 is the most effective SCTR modulator and chosen for further biological evaluation, including drug like properties and anti-hypertensive effect. KSD179019 not only has a similar blood pressure lowering effect as SCT peptide, but more importantly, it has a much longer half-life (∼8 h) and can be taken orally. Preliminary preclinical studies revealed extended bioavailability and low toxicity of this compound.

The circadian rhythm of blood pressure in patients with panic disorder and generalized anxiety disorder

BackgroundAnxiety disorders affect blood pressure both during the day and at night. Little is known about the effect of individual anxiety disorders on the circadian rhythm of blood pressure.Objectives: The purpose of this study is to compare the nocturnal drop in blood pressure in patients with panic disorder (PD), generalized anxiety disorder (GAD), and healthy individuals. MethodsThe study was conducted on fifty consecutive outpatients with anxiety disorders and personality disorders who participated in intensive group psychotherapy. Diagnoses were made according to DSM-IV-TR criteria using the PSE-10 questionnaire. Out of 50 patients under study, 17 were diagnosed with PD and 21 with GAD. The control group consisted of 40 healthy people recruited in the course of other studies. The resulting three groups were compared in terms of circadian blood pressure using the ABPM method. ResultsMean nocturnal falls in systolic and diastolic blood pressure were the following: 2% and 3% (PD), 11% and 12% (GAD), 27% and 23% (control). Four people out of PD group had higher systolic and diastolic blood pressure at night than during the day. The ratios between non-dippers/dippers were: 0/15 (PD), 8/21 (38% - GAD) and 40/40 (100% - control). ConclusionsThe patients with PD were characterized by an almost flat course of circadian blood pressure. The patients with GAD had a lower mean nocturnal fall in blood pressure than the control group, but significantly higher than the patients with PD. The differences in the circadian course of blood pressure between PD and GAD are so large that the impact of these disorders should be investigated separately.

Renal Transplantation in Pure Autonomic Failure.

Renal Transplantation in Pure Autonomic Failure.

Factors influencing the safety of outpatient coronary CT angiography: a clinical registry study

ObjectivesSince the safety of coronary CT angiography (CTA) is of great importance, especially with regard to widening indications and increasing morbidity, the aim of this study was to assess influencing...

Elevated Cardiac Troponin I following Asymptomatic Intradialytic Hypotension: A Pilot Study with a 2-Year Follow-Up.

Background Intradialytic hypotension (IDH) has been recognized as a serious and frequent complication during hemodialysis (HD) of end-stage renal disease (ESRD) patients, but the effect of asymptomatic IDH on cardiac troponin I (cTnI) levels is not definitively elucidated. Methods 70 asymptomatic HD patients with negative predialysis cTnI were included. They were on maintenance HD thrice weekly. All patients were monitored during the HD session for hemodynamic changes and symptoms related to IDH. Patients were followed for two years, and their outcomes are noted as an acute coronary syndrome (ACS), cardiac death, no ACS, noncardiac death, and kidney transplant. Results Compared with the baseline blood pressure values, there was a drop in systolic blood pressure for all subjects, but according to the 2007 European Best Practice Guidelines on hemodynamic instability, asymptomatic IDH was defined in 27 (38.6%) patients. The results demonstrated a significant correlation (r = 0.492) (p < 0.05) between asymptomatic IDH and elevated postdialysis levels of cTnI. In 2-year follow-up of patients, ACS and cardiac death happened more in patients with elevated cTnI. Conclusion The results of our study suggest that asymptomatic IDH affects cTnI levels. Given that cTnI is a marker of myocardial damage and a predictor of cardiovascular mortality in ESRD patients, these findings recommend that considering the asymptomatic decrease in blood pressure levels during HD is very important and critical.

Clinical Effect of Renal Arterial Sympathetic Radiofrequency Ablation on Secondary Hypertension.

Sympathetic hyperactivity is one of the main mechanisms of secondary hypertension. Reducing renal sympathetic activity through surgery can effectively reduce blood pressure. Many cases have shown that renal denervation (RDN) can selectively block renal artery sympathetic nerve activity to control refractory hypertension. This surgery is a minimally invasive surgery, and the risk of surgery-related adverse events is significantly reduced compared with surgery. Therefore, the purpose of this study is to explore the efficacy of radiofrequency ablation of renal artery sympathetic nerve in the treatment of secondary hypertension. Eight patients with secondary hypertension diagnosed by the cardiovascular department of our hospital and treated with RDN were followed up for 3-18 months, of which 5 cases were followed up for more than 12 months and 8 cases were followed up for more than 3 months. Eight patients were treated with radiofrequency ablation of renal artery catheter. The parameters such as preoperative blood pressure, antihypertensive drugs, organ function, intraoperative ablation resistance, power, time, and temperature were determined. The related changes of blood pressure, antihypertensive drugs, and visceral function and the occurrence of side effects at 1 week and 1, 3, 6, and 12 months after operation were related to the operation. In conclusion, RDN has a significant clinical effect in the treatment of refractory hypertension, with stable postoperative blood pressure drop, reduced drug dosage, and less side effects.

Development of toxic shock syndrome as one of the causes of mortality in streptococcal infection

Toxic shock syndrome is a condition in which a state of shock with a drop in blood pressure to critical numbers and multiple organ failure develops against the background of exposure to endoand exotoxins produced by bacteria and viruses. Every third patient who enters the intensive care unit suffers from certain manifestations of toxic shock syndrome. This term was first introduced in 1978 by the English pediatrician Jim Todd, who observed hyperthermia, hypotension, occurrence of rashes against the background of confusion and severe asthenia in patients. Type B enterotoxin produced by Staphylococcus aureus was isolated from blood samples of one of the patients, which made it possible to suspect the infectious nature of this process. This pathological condition can be observed with the development of postpartum sepsis, presence of wounds and burn surfaces, including closed wounds, occur against the background of postoperative interventions, or complicate the course of allergic contact dermatitis. Mortality in toxic shock syndrome reaches 5-15%, and if Streptococcus pyogenes acts as the causative agent, the mortality rate can increase several times and reach 50-60%. The main reservoir of streptococcus in the human body is the pharynx, but at the same time it can be found on the surface of the skin, rectal mucosa and vagina. A considerable number of cases of the development of toxic shock syndrome occurs in women who have been using vaginal tampons during menstruation for a long time.