Drop In Systolic Blood Pressure Research Articles

Intra-cardiac motion detection catheter for the early identification of acute pericardial tamponade during invasive cardiac procedures.

To develop and test an intra-cardiac catheter fitted with accelerometers to detect acute pericardial effusion prior to the onset of hemodynamic compromise. Early detection of an evolving pericardial effusion is critical in ensuring timely treatment. We hypothesized that the reduction in movement of the lateral heart border present in developing pericardial effusions could be quantified by positioning an accelerometer in a lateral cardiac structure. A "motion detection" catheter was created by implanting a 3-axis accelerometer at the distal tip of a cardiac catheter. The pericardial space of 5 adult sheep was percutaneously accessed, and pericardial tamponade was created by infusion of normal saline. The motion detection catheter was positioned in the coronary sinus. Intracardiac echocardiography was used to confirm successful creation of pericardial effusion and hemodynamic parameters were collected. Statistically significant reduction in acceleration from baseline was detected after infusion of only 40 ml of normal saline (p < 0.05, ANOVA). In comparison, clinically significant change in systolic blood pressure (defined as >10% drop in baseline systolic blood pressure) occurred after infusion of 80 ml of normal saline (107 ± 22 mmHg vs. 90 ± 12 mmHg p = 0.97, ANOVA), and statistically significant change was recorded only after infusion of 200 ml (107 ± 22 mmHg vs. 64 ± 5 mmHg, p < 0.05, ANOVA). An intra-cardiac motion detection catheter is highly sensitive in identifying acute cardiac tamponade prior to clinically and statistically significant changes in systolic blood pressure, allowing for early detection and treatment of this potentially life-threatening complication of all modern percutaneous cardiac interventions.

Night-time hot spring bathing is associated with improved blood pressure control: A mobile application and paper questionnaire study.

Hot spring bathing practice helps to manage hypertension. However, the details of the relationship between hot spring bathing and hypertension remain unknown. Older people are thought to be less adept than younger people at using digital devices such as mobile applications. Whether mobile application questionnaires, which have been increasing in recent years, can be used by older people is unclear. To address the knowledge gap regarding the management of older patients with hypertension, we prospectively evaluated mobile application and paper questionnaires regarding night-time hot spring bathing in respondents who had a choice of which to use. Changes in blood pressure because of hot spring bathing were evaluated. To investigate the effects of night-time hot spring bathing on blood pressure in adults, 1116 volunteers at 14 institutions in Beppu completed the study, including 562 in the mobile application questionnaire group and 556 in the paper questionnaire group. A total of 474 of 477 (99.3%) respondents aged ≥65 years used paper questionnaires. There was a significantly lower drop in both systolic and diastolic blood pressure after using hot springs in respondents aged ≥65 years than in respondents aged <65 years (p<0.001). An age ≥65 years, hypertension with medication, arrhythmia, depression, and using a chloride hot spring were independently and significantly associated with a lower drop in both systolic and diastolic blood pressure after night-time hot spring bathing (p<0.001). Night-time hot spring bathing was significantly associated with reduced blood pressure in older adults (p<0.001). Extending this research by examining how psychosocial factors in respondents aged ≥65 years influence preferences for mobile and paper questionnaires may be beneficial, and further investigation is warranted.

Ambient temperature and the occurrence of intradialytic hypotension in patients receiving hemodialysis.

Intradialytic hypotension (IDH) is a common hemodialysis complication causing adverse outcomes. Despite the well-documented associations of ambient temperatures with fluid removal and pre-dialysis blood pressure (BP), the relationship between ambient temperature and IDH has not been adequately studied. We conducted a cohort study at a tertiary hospital in southern Taiwan between 1 January 2016 and 31 October 2021. The 24-h pre-hemodialysis mean ambient temperature was determined using hourly readings from the weather station closest to each patient's residence. IDH was defined using Fall40 [systolic BP (SBP) drop of ≥40mmHg] or Nadir90/100 (SBP <100 if pre-dialysis SBP was ≥160, or SBP <90mmHg). Multivariate logistic regression with generalizing estimating equations and mediation analysis were utilized. The study examined 110400 hemodialysis sessions from 182 patients, finding an IDH prevalence of 11.8% and 10.4% as per the Fall40 and Nadir90/100 criteria, respectively. It revealed a reverse J-shaped relationship between ambient temperature and IDH, with a turning point around 27°C. For temperatures under 27°C, a 4°C drop significantly increased the odds ratio of IDH to 1.292 [95% confidence interval (CI) 1.228 to 1.358] and 1.207 (95% CI 1.149 to 1.268) under the Fall40 and Nadir90/100 definitions, respectively. Lower ambient temperatures correlated with higher ultrafiltration, accounting for about 23% of the increased IDH risk. Stratified seasonal analysis indicated that this relationship was consistent in spring, autumn and winter. Lower ambient temperature is significantly associated with an increased risk of IDH below the threshold of 27°C, irrespective of the IDH definition. This study provides further insight into environmental risk factors for IDH in patients undergoing hemodialysis.

Home Based Walking Exercises and Alternative Nasal Breathing Decrease Blood Pressure in Pre-Elderly People with Hypertension

The condition known as hypertension is brought on by the body's elevated blood pressure as a result of the heart pounding too hard. Hypertension is caused by a variety of causes, including both modifiable and unmodifiable ones. The purpose of this study is to evaluate the impact of alternate nostril breathing and walking exercise at home on the blood pressure of senior hypertension patients. A quasi-experiment with a pre-post test control group design methodology is used in the research design. Using the Total Sampling approach, 50 respondents with hypertension made up the research sample. In two weeks, the intervention was performed four times. The paired t-test results indicate that the combination of alternate nostril breathing and home-based walking exercise has an effect on blood pressure in the treatment group (both diastolic and systolic have p values = 0.000), while the control group experiences no change in blood pressure (diastolic has p values = 0.200 and systolic has p values = 0.195). The findings of the Independent T-Test demonstrated variations in blood pressure changes in both the systolic and diastolic domains between the treatment and control groups (diastolic p-value = 0.000), and systolic (p-value = 0.000). The findings of the Independent T-Test demonstrated variations in blood pressure changes in both the systolic and diastolic domains between the treatment and control groups ,diastolic (p-value = 0.000), and systolic (p-value = 0.000). Systolic and diastolic blood pressure drop as a result of an increase in endorphin chemicals and a decrease in cortisol. This calms and relaxes the body and balances the actions of the sympathetic and parasympathetic nervous systems. It is advised that individuals with pre-elderly hypertension who are able to independently implement combination therapies in an attempt to control their blood pressure. Kata kunci: Home Based Walking Exercise, Alternate Nostril Breathing, Pre-Elderly, Hypertension

Neurogenic orthostatic hypotension in Parkinson’s disease: is there a role for locus coeruleus magnetic resonance imaging?

Locus coeruleus (LC) is the main noradrenergic nucleus of the brain, and degenerates early in Parkinson’s disease (PD). The objective of this study is to test whether degeneration of the LC is associated with orthostatic hypotension (OH) in PD. A total of 22 cognitively intact PD patients and 52 age-matched healthy volunteers underwent 3 T magnetic resonance (MRI) with neuromelanin-sensitive T1-weighted sequences (LC-MRI). For each subject, a template space-based LC-MRI was used to calculate LC signal intensity (LC contrast ratio—LCCR) and the estimated number of voxels (LCVOX) belonging to LC. Then, we compared the LC-MRI parameters in PD patients with OH (PDOH+) versus without OH (PDOH−) (matched for sex, age, and disease duration) using one-way analysis of variance followed by multiple comparison tests. We also tested for correlations between subject’s LC-MRI features and orthostatic drop in systolic blood pressure (SBP). PDOH− and PDOH+ did not differ significantly (p > 0.05) based on demographics and clinical characteristics, except for blood pressure measurements and SCOPA-AUT cardiovascular domain (p < 0.05). LCCR and LCVOX measures were significantly lower in PD compared to HC, while no differences were observed between PDOH− and PDOH+. Additionally, no correlation was found between the LC-MRI parameters and the orthostatic drop in SBP or the clinical severity of autonomic symptoms (p > 0.05). Conversely, RBD symptom severity negatively correlated with several LC-MRI parameters. Our results failed to indicate a link between the LC-MRI features and the presence of OH in PD but confirmed a marked alteration of LC signal in PD patients.

The effect of lower limb strengthening exercise on orthostatic blood pressure and the skeletal muscle pump in older people with orthostatic hypotension.

Activation of muscles during standing is recommended to activate the skeletal muscle pump, increasing venous return and increasing blood pressure (BP) in people with orthostatic hypotension (OH). The aim of this study is to determine if increasing the strength of the lower limb muscles can improve the effectiveness of the venous pump and postural BP in older people with OH. Ten older people with OH underwent an 8-week lower limb strengthening intervention. Repeated measurements of orthostatic BP, calf venous ejection fraction (EF) and muscle strength took place before, during and after intervention. The intervention increased calf muscle strength by 21% (interquartile range: 18-28), p = 0.018, from a median baseline of 38 (34-45) kg. Participants had normal levels of venous EF 64% (51-75) at baseline, with little to no venous reflux. The median ejection volume at baseline was 44 (36-58) mL per calf. Despite increasing muscle strength, venous EF did not increase (percentage change -10% (-16 to 24), p = 0.8) and systolic BP drop did not improve (percentage change 0% (-17 to 16), p = 1.0). Similarly, visual analysis of individual case-series trends revealed increasing muscle strength with no clinically meaningful change in EF or orthostatic BP. Muscle strengthening exercise does not increase the effectiveness of the skeletal muscle pump and is not an efficacious intervention for OH. As there is little to no venous pooling in the calf during standing in older people with OH, below knee compression is unlikely to be clinically effective.

Quantitative autonomic testing after recovery from acute COVID-19 infection: comparison with findings in controls and individuals with neurogenic autonomic dysfunction

Abstract Background/Introduction Cardiovascular autonomic dysfunction (CvAD) is believed to contribute to the persistence of troublesome symptoms following apparent recovery from an acute COVID-19 infection. Common complaints in this setting include cognitive impairment (‘brain fog’), fatigue, and both postural and exertional intolerance with a sensation of excessive rapid heart beating. However, while the occurrence of CvAD post-acute COVID-19 has been widely recognized, its quantitative assessment remains largely unexplored. Purpose The purpose of this study was to determine whether quantitative cardiovascular autonomic testing in post-acute COVID-19 patients differ from findings in Controls and are more similar to individuals with Neurogenic CvAD, such as those with Pure Autonomic Failure. Methods Quantitative autonomic testing was prospectively undertaken in two patient groups: post-acute COVID-19 and Neurogenic CvAD patients, and in control subjects. Acute COVID-19 was documented by the nasopharyngeal PCR method and all affected patients had recovered at least 1 week prior to their autonomic study. Neurogenic CvAD patients were studied as part of their diagnostic evaluation, and none had a COVID-19 infection prior to their study. Measurements included i) heart rate (HR) and blood pressure (BP) responses during active standing (AS), ii) time to BP nadir and time to BP recovery during AS, iii) Valsalva ratio (VR), and iv) respiratory sinus arrhythmia (RSA). The unpaired student t-test and Mann Whitney U test were used to analyze normally and non-normally distributed data, respectively, between post-acute COVID patients and the Control and Neurogenic CvAD patients. All variables were continuous and presented as means with corresponding standard deviations (SD) when normally distributed or interquartile ranges (IQR) when non-normally distributed. A p-value of &amp;lt;0.05 was considered statistically significant. Results Post-acute COVID-19 patients (N=55, 83.6% female) and Controls (N=82, 86.6% female) were of similar age (39 [IQR 27.3, 49.2] vs. 33 [IQR 21.4, 40.0] years, respectively, p=0.034). Neurogenic CvAD patients (N=27, 51.9% female) were older (68 [IQR 62.9, 74.3], p&amp;lt;0.00001). The main findings (Table 1, mean [SD]) indicate that post-acute COVID-19 patients exhibited HR and BP responses during AS similar to the Control group; on the other hand, average VR, maximum systolic BP drop during AS, and maximum HR increase during AS in COVID-19 patients trended towards findings in Neurogenic CvAD patients. Conclusion Recovered post-acute COVID-19 patients referred for autonomic dysfunction evaluation due to persisting symptoms exhibit autonomic testing findings similar to control subjects but trending towards observations in neurogenic CvAD.

Abstract 14807: Direct Carotid Sinus Nerve Stimulation in Anesthetized Human Subjects

Introduction: Drug resistant hypertension is a growing clinical phenomenon across the world and there is a critical need for alternative therapeutic modalities. Hypothesis: A novel multi-contact electrode designed to interface with the carotid sinus nerve in conjunction with a unique implantation technique can selectively activate the baroreflex causing reversible drops in blood pressure (BP) &amp; heart rate (HR) in anesthetized humans. Methods: Patients undergoing therapeutic operations that necessitated carotid bulb exposure were prospectively enrolled in this IRB approved trial. Using a novel surgical approach, an application specific electrode was placed around the CSN followed by contact interface mapping to identify presumed baroafferent fibers which were selectively stimulated. Outcome measures included change in systolic BP (SBP), diastolic BP (DBP), and HR during and after stimulation. Results: 14 subjects met eligibility criteria. In 13, following correct contact identification, stimulation caused a 23±20mmHg (mean±SD) maximum drop in SBP with associated drops in DPB (11±9mmHg), and HR (10±9bpm). All subjects recovered immediately following stimulation withdrawal. All drops were significant (p&lt;0.001, t-test). In subjects with baseline SBP &gt;120mmHg (n=8), maximum SBP drop was 30±23mmHg, while subjects with baseline SBP &lt;120mmHg (n=5) exhibited a maximum SBP drop of 11±3mmHg. There was evidence of a positive dose (current) response relationship. Conclusions: Using a novel surgical approach and electrode, CSN stimulation in anesthetized human subjects caused a marked drop in BP/HR followed by rapid recovery with stimulation withdrawal. There was evidence of dose dependency.

Proteome-Wide Changes in Blood Biomarkers During Hemodialysis

IntroductionDuring hemodialysis, proteins in the blood can decrease in concentration due to diffusion, convective clearance, dialyzer adsorption, or cellular uptake, while others may increase in concentration due to production, cellular release, secretion, or ultrafiltration of water. We examined the impact of hemodialysis on blood protein concentrations on a proteome-wide scale. MethodsA nested cohort of 44 patients (25 male, 19 female) including 29 with intradialytic hypotension were selected from the prospective Hemodialysis Outcomes and SympToms assessment (HOST) cohort. 1,163 proteins were measured before and after a hemodialysis treatment using Olink. Pre- and post-dialysis concentrations were compared, and the impact of protein characteristics and intradialytic hypotension on protein concentration was evaluated. Results189 proteins (16%) significantly decreased and 54 (5%) significantly increased in concentration. Change in concentration was associated with protein molecular weight (r = 0.37, P = 2.8 x 10-16), isoelectric point (r = -0.26, P = 6.4 x 10-14), and pre-dialysis concentration (r = -0.21, P = 3.0 x 10-9). There was enrichment for cardiovascular biomarkers in those nominally associated with a drop in systolic blood pressure during treatment (P = 2.8 x 10-8). ConclusionsChanges in the blood proteome are detectable during hemodialysis on a high throughput scale. Protein properties and intradialytic hypotension events appear associated with changes in biomarker concentration. Larger proteome-wide biomarker studies may identify measures of dialysis adequacy and reveal pathological processes contributing to adverse effects of dialysis.

The Effect of Stretching Excercise as Complimentary Therapy on Blood Pressure in Patients with Hypertension in the Cibodasari Health Center Tangerang

This study aims to determine the effect of complementary therapy stretching exercises on blood pressure in hypertension patients. This research uses a quantitative approach with a quasi-experiment design and a one-group pre-test and post-test design. The intervention provided was stretching exercises for 30 minutes twice a week in the morning and evening for 2 weeks, by measuring the blood pressure before and after the intervention. The number of samples taken was 15 respondents from a total population of 374 hypertension sufferers in the Cibodasari Community Health Center Tangerang, using a purposive sampling technique. Using the paired sample t-test for bivariate analysis, the average drop in respondents' systolic blood pressure was 6,133, from 151.20 (pre-test) to 145.07 (post-test), and the average drop in respondents' diastolic blood pressure was 7,333, from 89.20 (pre-test) to 81.87 (post-test). Based on the t-dependent statistical test, significant results were obtained with a p-value of 0.002 for systolic pressure and a p-value of 0.003 for diastolic pressure. The results of the study show that stretching exercises have an effect on reducing blood pressure in hypertension sufferers, which can be applied simultaneously with other pharmacological therapies.

Effects of 12 weeks colostrum milk supplement among older adults: A randomised, double-blind and placebo-controlled trial

The effects of milk intake, particularly bovine colostrum-enriched skim milk among older adults, were investigated. Sixty-six adults aged 50–69 years old were recruited for a 12-weeks double-blind, randomised, placebo-controlled trial. Participants were instructed to consume colostrum-enriched or placebo skim bovine milk in two sachets daily. Participants in the intervention and placebo groups showed significant (p <0.05) drop in BMI, hip circumference, systolic and diastolic blood pressure, improvement in physical fitness test and increment in differential white cell count. Further, consumption of bovine colostrum-enriched skim milk could significantly (p <0.05) improve verbal memory (as indicated by Rey Auditory Verbal Learning Test score), and reduce total cholesterol and LDL cholesterol levels among older adults. However, none of the outcome measurements showed a significant interaction effect of group and time. In conclusion, consuming milk, especially the bovine colostrum-enriched skim milk could provide beneficiary health effects and promote healthy ageing among older adults.

Acute effect of levodopa on orthostatic hypotension and its association with motor responsiveness in Parkinson's disease: Results of acute levodopa challenge test

ObjectiveLevodopa administration can induce or worsen orthostatic hypotension (OH) in patients with Parkinson's disease (PD). Understanding of acute OH post levodopa (AOHPL) is important for rational drug use in PD patients. Primary objective of this study was to investigate the incidence of AOHPL in PD patients. The secondary objectives were a) hemodynamic character of AOHPL; b) risk factors of AOHPL; c) relationship between motor responsiveness and blood pressure (BP) change. Methods490 PD inpatients underwent acute levodopa challenge test (LCT). Supine-to-standing test (STS) was done 4 times during LCT, including before levodopa and every hour post levodopa intake within 3 h. Patients were classified into two groups, AOHPL and non-AOHPL. A comprehensive set of clinical features scales was assessed, including both motor (e.g., motor response, wearing-off) and nonmotor symptoms (e.g., autonomic dysfunction, neuropsychology). Results33.1% PD patients had OH before drug, 50.8% the same subjects had AOHPL during levodopa effectiveness. PD patients who had better response to levodopa likely to have lower standing mean artery pressure (MAP) and severer systolic BP drop after levodopa intake. BP increased when the motor performance worsened and vice versa. Beneficial response was a risk factors of AOHPL (OR = 1.624, P = 0.017). ConclusionsAOHPL was very common in PD patients. We suggested that PD patients with risk factors should monitor hemodynamic change during LCT to avoid AOHPL following the introduction or increase of oral levodopa. The fluctuations of BP were complicated and multifactorial, likely caused by the process of PD and levodopa both.

207 What is the association between psychotropic medication use and orthostatic hypotension in community-dwelling older people: data from TILDA

Abstract Background Psychotropic medications increase the risk of falls among older people. The aim of this study is to examine the link between psychotropic medication use and Orthostatic Hypotension (OH), a frequent cause of falls in later life. Methods: Participants ≥65 years at TILDA Wave 1 had an active stand to assess orthostatic blood pressure. OH was defined as a blood pressure (BP) drop ≥20 mmHg systolic and/or ≥ 10 mm Hg diastolic beyond 30 seconds post-standing. Medication lists were examined for the following anatomic therapeutic chemical classification codes: N06A (Antidepressants); N05BA, N05CD, N03AE (Benzodiazepines); ‘N05CF (‘Z’ Drugs); N05A (Antipsychotics) and medications with ‘definite’ anticholinergic effects on the Anticholinergic Cognitive Burden Scale. Logistic regression models, reporting odds ratios (OR), assessed the association between psychotropic medication use and OH. Analyses were adjusted for age, sex, educational attainment, alcohol excess, depression, cognitive impairment, chronic disease burden, heart disease and sleep quality. Results Of the 1,875 participants (mean age 71 years, 52% female), 12% were prescribed ≥1 psychotropic medication (234/1,875), while 4% (78/1,875) were prescribed ≥2. Psychotropic medication use was associated with a larger drop in systolic BP at 30 seconds (7.81 (95% CI 5.61–10.02) vs 3.46 (95% CI 2.61–4.32) mm Hg; p &amp;lt; 0.001) and 60 seconds (4.02 (95% CI 1.82–6.21) vs 1.28 (0.44–2.13); p = 0.025) post standing. In fully adjusted models, psychotropic medication use was associated with a higher likelihood of OH (OR 1.50 (95% CI 1.10–2.08; p = 0 0.013), with a stronger association noted for those taking ≥2 psychotropics (OR 2.19 (95% CI 1.34–3.57); p = 0.002). Conclusion Psychotropic medication use is independently associated with delayed BP recovery after standing. Older people prescribed psychotropics have a 50% higher likelihood Of OH related to their use, highlighting the importance of reviewing these medications as part of a comprehensive geriatric assessment, particularly in older people with falls.

What is the prevalence of orthostatic hypotension in an Australasian emergency department population?

Orthostatic hypotension (OH) is associated with increased morbidity and there is limited research on the prevalence in the Australian ED population. The aim was to determine the prevalence of OH in an Australian ED population. Secondary outcomes included any associations of OH with symptoms, presenting complaints, patient demographics, or hospital admission, and the timing of OH findings. Patients presenting to a regional Australasian ED underwent orthostatic measurements at 1, 3 and 5 min of standing following 5 min of supine bed rest. OH was defined as a drop in systolic and/or diastolic blood pressure by ≥20 and ≥10 mmHg, respectively. Of the 312 patients who were enrolled in the study, 69 (22.1%, 95% confidence interval 17.7-27.2%) had OH and 76.8% of cases were detected after 3 min of standing. There was evidence of difference in the prevalence of OH with age (P < 0.001). Similarly, there was evidence of a difference in supine systolic and diastolic blood pressure measurements (P = 0.012 and P < 0.001, respectively) between orthostatic and normotensive subjects. No association was found with OH and hospital admission, presenting complaints or comorbid medical illnesses. In this single Australian ED population, there was a high prevalence of OH (22.1%) with most cases detected within 3 min of standing. A higher-powered study across multiple sites would better substantiate these findings.

Abstract P158: Associations Of Orthostatic Hypotension And Resting Hypertension With Biomarkers Of Subclinical Cardiovascular Disease

Background: Orthostatic hypotension (OH) is associated with cardiovascular disease (CVD), but mechanisms for this relationship are unclear. Objective: To determine associations between orthostatic, seated, or standing hypotension with two biomarkers of subclinical injury—high sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)—relative to orthostatic, seated, or standing hypertension (HTN). Methods: We performed a secondary analysis of the Study to Understand Fall Reduction and Vitamin D in You (STURDY) using standardized seated and standing blood pressure (BP) assessments. We defined OH as a drop in systolic BP (SBP) ≥20 or diastolic BP (DBP) ≥10 mm Hg upon standing; seated or standing hypotension as BP ≤105/≤65 mm Hg; orthostatic HTN as an increase in BP ≥20/≥10 mm Hg upon standing; and seated or standing HTN as BP ≥140/≥90 mm Hg. Associations between BP phenotypes and serum Hs-cTnI and NT-proBNP were determined using mixed-effects Tobit models. Results: Of 673 participants (mean age 76.5 ± 5.4 years; 43% female; 17% Black), 63% had prior CVD. Those with seated HTN had a 10.2% greater hs-cTnI ( P = 0.001) and 11.0% greater NT-proBNP ( P = 0.002) than those without seated HTN ( Table) . Participants with standing HTN had an 8.6% ( P = 0.004) greater hs-cTnI and 11.8% greater NT-proBNP ( P = 0.0005) than those without standing HTN. No hypotensive phenotypes were associated with biomarkers. Conclusions: Both seated and standing HTN are associated with greater hs-cTnI and NT-proBNP, but hypotensive phenotypes were not. Hypoperfusion may not be a major contributor to subclinical cardiac injury among older adults with OH.

Association of Supine Hypertension Versus Standing Hypotension With Adverse Events Among Middle-Aged Adults.

Management of orthostatic hypotension (OH) prioritizes prevention of standing hypotension, sometimes at the expense of supine hypertension. It is unclear whether supine hypertension is associated with adverse outcomes relative to standing hypotension. To compare the long-term clinical consequences of supine hypertension and standing hypotension among middle-aged adults with and without OH. The ARIC study (Atherosclerosis Risk in Communities) measured supine and standing blood pressure (BP) in adults aged 45 to 64 years, without neurogenic OH, between 1987 and 1989. We defined OH as a positional drop in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg, supine hypertension as supine BP≥140/≥90 mm Hg, and standing hypotension as standing BP≤105/≤65 mm Hg. Participants were followed for >30 years. We used Cox regression models to examine associations with cardiovascular disease events, all-cause mortality, falls, and syncope. Of 12 489 participants (55% female, 26% Black, mean age 54 years, SD 6), 4.4% had OH. Among those without OH (N=11 943), 19% had supine hypertension and 21% had standing hypotension, while among those with OH (N=546), 58% had supine hypertension and 38% had standing hypotension. Associations with outcomes did not differ by OH status (P-interactions >0.25). Supine hypertension was associated with heart failure (hazard ratio, 1.83 [95% CI, 1.68-1.99]), falls (hazard ratio, 1.12 [95% CI, 1.02-1.22]), and all-cause mortality (hazard ratio, 1.45 [95% CI, 1.37-1.54]), while standing hypotension was only significantly associated with mortality (hazard ratio, 1.06 [95% CI, 1.00-1.14]). Supine hypertension was associated with higher risk of adverse events than standing hypotension, regardless of OH status. This challenges conventional OH management, which prioritizes standing hypotension over supine hypertension.

At-Home Blood Pressure Measurements Provide Better Assessments of Orthostatic Hypotension in Parkinson's Disease.

Orthostatic hypotension (OH) is common in Parkinson's Disease (PD). It is intermittent, exacerbated by stressors including meals, medications, and dehydration, and frequently is unrecognized. Although intermittent, assessment is usually by a single "in clinic" BP measurement. This study examines whether 10 home measurements are more sensitive in detecting OH than a single "in clinic" measurement. Participants (44 people with PD and 16 controls) were instructed to measure lying and standing BP at home. BP was measured on five consecutive days upon waking and before bedtime. Symptoms were also assessed using the Movement Disorder Society United Parkinson's Disease Rating Scale and the Non-Motor Questionnaire. While a postural drop in systolic BP (≥20 mmHg) was recorded "in clinic" in thirteen of the forty-four PD participants, a postural drop was found in at least one of the ten home measurements in twenty-eight of the forty-four participants. Morning hypertension and variability in lying systolic BP was more common in these subjects than in those without a postural drop or the controls. A greater number of measurements of lying and standing BP are more likely to reveal orthostatic hypotension, variation in systolic BP, and hypertension than a single office measurement in people with PD.

The Effect of a Biofeedback-Based Integrated Program on Improving Orthostatic Hypotension in Community-Dwelling Older Adults: A Pilot Study.

Orthostatic hypotension (OH) is prevalent among community-dwelling older adults and is associated with multiple negative health outcomes. Older adults are susceptible to developing OH because aging alters autonomic nervous system function. Biofeedback is a noninvasive, nonpharmacological intervention that can modulate autonomic nervous system dysfunction in older adults. Our aim in this study was to examine the effect of a biofeedback-based integrated program on community-dwelling older adults with OH. We conducted a controlled pilot study. Community-dwelling older adults 65 years or older who had nonneurogenic OH were eligible. Data from 51 participants, comprising 27 in the intervention group and 24 in the control group, were analyzed. Weekly biofeedback-based integrated program consisting of biofeedback training along with group education about behavioral modification, physical activities, and telephone counseling was provided for 12 weeks. Orthostatic hypotension was evaluated by measuring the drop in systolic and diastolic blood pressure after postural changes. Autonomic nervous system function was measured using heart rate variability. Among the indicators of heart rate variability, total power (P = .037) and low frequency (P = .017) increased significantly, suggesting that autonomic function improved. Severity of orthostatic symptoms (P < .001) and drops in systolic (P = .003) and diastolic (P = .012) blood pressure after postural changes decreased significantly in the intervention group. Biofeedback-based integrated program was effective in improving autonomic nervous system function and alleviated OH. Therefore, biofeedback-based integrated program should be tested in a larger randomized controlled study with long-term follow-up.

Challenges in Assessing Blood Pressure in Adults Following Intravenous Paracetamol Infusion in the Emergency Room.

Background and objective The negligible side effects of paracetamol along with its ease of availability have catapulted paracetamol to be a widely used medication in emergency room management to reduce pain and subsequent elevations in blood pressure (BP). Our study aimed to address thechallenges in informed clinical decision-making in the emergency room following paracetamol intravenous infusion. Methods This was a retrospective cross-sectional studyinvolving the extraction of data from electronic medical records of patients who received intravenous paracetamol infusion between January 2022 and May 2022. Demographic information and BP-related data were collected for analysis. Results We initially considered a total of 162 patient records, with 132 of them eventually meeting the inclusion criteria. Among patients receiving paracetamol infusion for 15 minutes or less, 34% showed a drop of 1-5 mmHg in systolic BP (SBP), while 26% experienced a drop of 6-10 mmHg. However, infusion time longer than 16 minutes did not significantly reduce SBP. Diastolic BP (DBP) was not significantly affected by theduration of the paracetamol infusion.Analysis of the drop in SBP revealed no significant associations with age, gender, or ethnicity. Mean arterial pressure (MAP) was not significantly affected by theduration of paracetamol infusion. Conclusion Our findings suggest that intravenous paracetamol infusion does not significantly lower BP in adults in the emergency room, except for infusions ofshorter durations. However, various factors, including infusion rate, patient characteristics, and concomitant medications, may influence BP measurements. The study emphasizes the need for establishing standardized criteria and conducting further research to assess intravenous paracetamol's hemodynamic effects accurately.

Post-cesarean Delivery Analgesia Using Spinal Anesthesia: Ropivacaine-Fentanyl vs. Ropivacaine-Sufentanil.

To improve the quality of intraoperative and postoperative analgesia during spinal anesthesia, intrathecal opioids are used as adjuvant drugs in combination with local anesthetics. This study aimed to compare the intrathecal injection of ropivacaine-fentanyl with ropivacaine-sufentanil in terms of the duration of analgesia after cesarean section (CS). This randomized, double-blind clinical trial study was conducted on women referred to Imam Khomeini Hospital of Ahvaz City for elective CS in 2021. A total of 51 patients were randomly divided into 2 groups. The first group (n = 25) received ropivacaine (17.5 mg) + fentanyl (25 μg), while the second group (n = 26) received ropivacaine (17.5 mg) + sufentanil (2.5 μg) for spinal anesthesia. Eventually, several parameters were investigated, including the duration of sensory and motor block, duration of analgesia (based on the Visual Analog Scale (VAS)), hemodynamic parameters, and possible complications. The duration of surgery (P = 0.059) and the duration of motor block (P = 0.962) were not significantly different between the 2 groups. The mean duration of analgesia (from the time of entering recovery to reaching VAS = 3) was 203.12 ± 72.93 and 207.46 ± 69.59 minutes in the fentanyl and sufentanil groups, respectively (P = 0.658). Systolic and diastolic blood pressure (SBP/DBP) drops in minute 5 were observed more frequently in the sufentanil group than in the fentanyl group (P = 0.027 and P = 0.002, respectively). At the other time points, however, no significant difference was observed between the 2 groups in terms of hemodynamic variables (P > 0.05). Finally, the frequency of pruritus was higher in the sufentanil group than in the fentanyl group (26.9% vs. 4.0%; P = 0.024). Adding fentanyl or sufentanil to intrathecal ropivacaine provides a similar duration of analgesia. However, fentanyl was associated with better hemodynamic stability and a lower incidence of pruritus.