Drop In Systolic Blood Pressure Research Articles

Construction of an Early Alert System for Intradialytic Hypotension before Initiating Hemodialysis Based on Machine Learning

Introduction: Intradialytic hypotension (IDH) is prevalent and associated with high hospitalization and mortality rates. The purpose of this study was to explore the risk factors for IDH and use artificial intelligence to establish an early alert system before hemodialysis sessions to identify patients at high risk of IDH. Materials and Methods: We obtained data on 314,534 hemodialysis sessions conducted at Sichuan Provincial People’s Hospital from the renal disease treatment information system. IDH was defined as a systolic blood pressure drop ≥20 mm Hg, a mean arterial pressure drop ≥10 mm Hg during dialysis, or the occurrence of clinical hypotensive events requiring nursing intervention. After pre-processing, the data were randomly divided into training (80%) and testing (20%) sets. Four interpolation methods, three feature selection methods, and 18 machine learning algorithms were used to construct predictive models. The area under the receiver operating characteristic curve (AUC) was the main indicator for evaluating the performance of the models, while Shapley Additive ExPlanation was used to explain the contribution of each variable to the best predictive model. Results: A total of 3,906 patients and 314,534 dialysis sessions were included, of which 142,237 cases showed IDH (incidence rate, 45.2%). Nineteen parameters were identified through artificial intelligence feature screening. They included age, pre-dialysis weight, dry weight, pre-dialysis blood pressure, heart rate, prescribed ultrafiltration, blood cell counts (neutrophil, lymphocyte, monocyte, eosinophil, lymphocyte, and platelet counts), hematocrit, serum calcium, creatinine, urea, glucose, and uric acid. Random forest, gradient boosting, and logistic regression were the three best models, and the AUCs were 0.812 (95% confidence interval [CI], 0.811–0.813), 0.748 (95% CI, 0.747–0.749), and 0.743 (95% CI, 0.742–0.744), respectively. Conclusion: Our dialysis software-based artificial intelligence alert system can be used to predict IDH occurrence, enabling the initiation of relevant interventions.

Two syringes technique for spinal anesthesia to prevent hypotension in patients undergoing elective cesarean section

Aims: To compare the incidence of hypotension after intrathecal administration of hyperbaric bupivacaine and fentanyl in two different syringes against standard injection of mixed fentanyl with hyperbaric bupivacaine.
 Methods: This was a prospective comparative study conducted in 174 parturients undergoing elective caesarean section at Paropakar Maternity & Women’s Hospital. Hemodynamic effects and characteristics of block were monitored and recorded and compared between the two groups, group S (single syringe) and group D (double syringe).
 Results: The incidence of hypotension was almost similar in the two groups but the drop in systolic blood pressure and mean arterial pressure at 5 minutes and 7.5 minutes after subarachnoid block was significant in group S as compared to group D (p<0.005 and p<0.005 respectively).
 Conclusion: Hyperbaric bupivacaine with fentanyl, which when injected separately without mixing, is associated with lesser incidence of hypotension following subarachnoid block.

Asymptomatic orthostatic hypotension and risk of falls in community-dwelling older people.

Many older people with orthostatic hypotension (OH) may not report typical symptoms of dizziness, light-headedness or unsteadiness. However, the relationships between OH and falls in the absence of typical symptoms are not yet established. Continuous orthostatic blood pressure (BP) was measured during active stand using a Finometer at Wave 1 of The Irish Longitudinal Study on Ageing in participants aged ≥ 70years.OH, with and without dizziness, was defined as a sustained drop in systolic BP ≥ 20 and/or diastolic BP ≥ 10mm Hg at 30, 60 and 90seconds post-standing.The association between symptoms of dizziness and orthostatic BP was assessed with multi-level mixed-effects linear regression; logistic regression models assessed the longitudinal relationship between OH and falls at 6-year follow-up (Waves 2-5). Almost 11% (n = 934, mean age 75years, 51% female) had OH, two-thirds of whom were asymptomatic.Dizziness was not associated with systolic BP drop at 30 (β = 1.54 (-1.27, 4.36); p = 0.256), 60 (β = 2.64 (-0.19, 5.47); p = 0.476) or 90seconds (β = 2.02 (-0.91, 4.95); p = 0.176) after standing in adjusted models.Asymptomatic OH was independently associated with unexplained falls (odds ratio 2.01 [1.11, 3.65]; p = 0.022) but not explained falls (OR 0.93 [0.53, 1.62]; p = 0.797) during follow-up. Two-thirds of older people with OH did not report typical symptoms of light-headedness. Dizziness or unsteadiness after standing did not correlate with the degree of orthostatic BP drop or recovery. Participants with asymptomatic OH had a significantly higher risk of unexplained falls during follow-up, and this has important clinical implications for the assessment of older people with falls.

The effect of blood pressure variability on the prognosis of patients with acute cerebral hemorrhage: Possible mechanism

Antihypertensive therapy in the acute phase of intracerebral hemorrhage (ICH) can reduce hematoma expansion. Numerous studies have demonstrated that blood pressure variability secondary to antihypertensive therapy has adverse effects on neurological outcomes, but the conclusions are diverse, and the mechanism of this occurrence is unknown. The aim of this research was to analyze the impact of blood pressure variability after antihypertensive treatment on the prognosis of patients with acute ICH, along with the possible mechanism. A total of 120 patients within 20 h of onset of ICH were divided into a good prognosis group (mRS ≤ 2 points) and a poor prognosis group (mRS ≥ 3 points) according to their 90-day mRS scores. The basic patient information, NIHSS score, GCS score, mRS score at 90 days after admission, head CT examination at admission and 24 h and CTP examination at 24 h were collected from some patients. The blood pressure values of patients were collected within 24 h, and multiple blood pressure variation (BPV) parameters within 1 and 24 h were calculated. (1) After excluding confounding factors such as age, whether the hematoma ruptured into the ventricle, confounding signs, amount of bleeding, edema around the hematoma, NIHSS on admission, operation or non-operation, and 24-h hematoma increment, the fourth quartile systolic blood pressure (SBP) maximum and minimum difference within 1 h [OR: 5.069, CI (1.036-24.813) P = 0.045] and coefficient of continuous variation (SV) within 24 h [OR: 2.912 CI (1.818-71.728) P = 0.009] were still independent factors affecting the 90-day mRS in ICH patients. (2) There was a negative correlation between SBP SV and CBF in terms of the difference between the contralateral side and the perihematomal region at 24 h (Rs = -0.692, P = 0.013). Blood pressure variability after antihypertensive therapy in acute ICH is one of the influencing factors for 90-day mRS in patients. A 1-h dramatic drop in SBP and 24-h SBP SV may affect the long-term prognosis of patients by reducing whole cerebral perfusion.

Preferential impairment of parasympathetic autonomic function in type 2 diabetes.

Cardiovascular autonomic neuropathy is a known complication in type 2 diabetes (T2D). However, the extent of sympathetic dysfunction and its relation to blood pressure (BP) dysregulation is insufficiently studied. We therefore assessed the cardiovascular sympathetic function using a standardized autonomic test-battery. Forty T2D patients (mean age and duration of diabetes ±SD, 65.5±7.3 and 9.5±4.2years) and 40 age- and gender-matched controls were examined through autonomic testing, assessing cardiovascular responses to deep breathing, Valsalva maneuver and tilt-table testing. Additionally, 24-hour oscillometric BP and self-reported autonomic symptoms on COMPASS-31 questionnaire was recorded. Patients with T2D had reduced parasympathetic activity with reduced deep breathing inspiratory:expiratory-ratio (median [IQR] T2D 1.11 [1.08-1.18] vs. controls 1.18 [1.11-1.25] (p=0.01)), and reduced heart rate variability (p<0.05). We found no differences in cardiovascular sympathetic function measured through BP responses during the Valsalva maneuver (p>0.05). 24-hour-BP detected reduced night-time systolic BP drop in T2D (9.8%±8.8 vs. controls 15.8%±7.7 (p<0.01)) with more patients having reverse dipping. Patients with T2D reported more symptoms of orthostatic intolerance on the COMPASS-31 (p=0.04). Patients with T2D showed reduced parasympathetic activity but preserved short-term cardiovascular sympathetic function, compared to controls, indicating autonomic dysfunction with predominantly parasympathetic impairment. Despite this, T2D patients reported more symptoms of orthostatic intolerance in COMPASS-31 and had reduced nocturnal BP dipping, indicating that these are not a consequence of cardiovascular sympathetic dysfunction.

Neonatal Hemodynamic Characteristics of the Recipient Twin of Twin-To-Twin Transfusion Syndrome Not Treated with Fetoscopic Laser Surgery.

This paper's intent is to describe the neonatal hemodynamic characteristics of recipient twins of monochorionic pregnancies complicated with twin-to-twin transfusion syndrome (TTTS), born without prenatal fetoscopic selective laser coagulation (FSLC). Retrospective analysis of hemodynamic characteristics was performed during the first five days of life of recipient twins from untreated TTTS. Forty-two recipient twins were included and divided into three groups: no hemodynamic impairment (NoHI) (n = 15, 36%), isolated high blood pressure (HighBP) (n = 12, 28%), and cardiac failure group (CF) (n = 15, 36%). Patients of both CF and HighBP groups had high systolic blood pressure during the first 12 h of life and ventricular hypertrophy at early echocardiography. Cardiac failure occurred at a median age of 14 h (IQR = 6-24) and was followed by a drop in systolic and diastolic blood pressure. Acute kidney injury was more frequent (93% vs. 25%, p &lt; 0.001) and severe (p &lt;0.001) in the CF group than in the HighBP group. The mortality rate in the CF group was 40%. Factors associated with CF were twin anemia-polycythemia sequence (p = 0.012), very preterm birth (p = 0.040), and polycythemia (p = 0.002). One-third of recipient twins born without prenatal FSLC developed life-threatening cardiac failure during the first 24 h of life.

Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trial

Haemodialysis centres have conventionally provided maintenance haemodialysis using a standard dialysate temperature (eg, 36·5°C) for all patients. Many centres now use cooler dialysate (eg, 36·0°C or lower) for potential cardiovascular benefits. We aimed to assess whether personalised cooler dialysate, implemented as centre-wide policy, reduced the risk of cardiovascular-related death or hospital admission compared with standard temperature dialysate. MyTEMP was a pragmatic, two-arm, parallel-group, registry-based, open-label, cluster-randomised, superiority trial done at haemodialysis centres in Ontario, Canada. Eligible centres provided maintenance haemodialysis to at least 15 patients a week, and the medical director of each centre had to confirm that their centre would deliver the assigned intervention. Using covariate-constrained randomisation, we allocated 84 centres (1:1) to use either personalised cooler dialysate (nurses set the dialysate temperature 0·5-0·9°C below each patient's measured pre-dialysis body temperature, with a lowest recommended dialysate temperature of 35·5°C), or standard temperature dialysate (36·5°C for all patients and treatments). Patients and health-care providers were not masked to the group assignment; however, the primary outcome was recorded in provincial databases by medical coders who were unaware of the trial or the centres' group assignment. The primary composite outcome was cardiovascular-related death or hospital admission with myocardial infarction, ischaemic stroke, or congestive heart failure during the 4-year trial period. Analysis was by intention to treat. The study is registered at ClinicalTrials.gov, NCT02628366. We assessed all of Ontario's 97 centres for inclusion into the study. Nine centres had less than 15 patients and one director requested that four of their seven centres not participate. 84 centres were recruited and on Feb 1, 2017, these centres were randomly assigned to administer personalised cooler dialysate (42 centres) or standard temperature dialysate (42 centres). The intervention period was from April 3, 2017, to March 31, 2021, and during this time the trial centres provided outpatient maintenance haemodialysis to 15 413 patients (about 4·3 million haemodialysis treatments). The mean dialysate temperature was 35·8°C in the cooler dialysate group and 36·4°C in the standard temperature group. The primary outcome occurred in 1711 (21·4%) of 8000 patients in the cooler dialysate group versus 1658 (22·4%) of 7413 patients in the standard temperature group (adjusted hazard ratio 1·00, 96% CI 0·89 to 1·11; p=0·93). The mean drop in intradialytic systolic blood pressure was 26·6 mm Hg in the cooler dialysate group and 27·1 mm Hg in the standard temperature group (mean difference -0·5 mm Hg, 99% CI -1·4 to 0·4; p=0·14). Centre-wide delivery of personalised cooler dialysate did not significantly reduce the risk of major cardiovascular events compared with standard temperature dialysate. The rising popularity of cooler dialysate is called into question by this study, and the risks and benefits of cooler dialysate in some patient populations should be clarified in future trials. Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Renal Network, Ontario Strategy for Patient-Oriented Research Support Unit, Dialysis Clinic, Inc., ICES (formerly known as the Institute for Clinical Evaluative Sciences), Lawson Health Research Institute, and Western University.

Impact of saline infusion and citrate infusion rate during donor plasmapheresis.

The purpose of our research was to evaluate the effects of saline infusion to counteract incidents of severe hypotension during donor plasmapheresis (DP; synonym with plasma donation), and on immunoglobulin G (IgG) content in collected plasma, and on donor hematological values. It examines the clearance (Cl) of IgG during DP without saline to calculate the distribution of citrate and citrate infusion rate (CIR) during DP. It is based on three studies: an observation of saline infusion in donors with severe drops in blood pressure at DP, and two crossover trials of 32 repeat plasma donors each on saline infusion during DP. We observed 50 cases with a significant drop of mean systolic blood pressure ≤90 mm Hg in 1 year, predominantly in young, female first-time donors. In trial 1, there was a reduction of IgG concentration in collected plasma related to the average IgG serum concentration without saline to 85.5% vs to 80.5% with saline (P< .001). In trial 2, there was an important 11%-12% increase of the donor hematological values without saline during DP. An average of 84.6% of citrate was removed in retained plasma; our calculated minimal CIR of 0.16 ± 0.17 mg/kg/min was confirmed by other empirical studies. Our research has led to significant improvements in the practice of DP: (a) Saline should be infused at DP as clinically indicated in agreement with the donor. (b) Young, female first-time donors require special care. (c) The long-time effects of minimal amounts of citrate on bone metabolism are improbable.

336 ASYMPTOMATIC ORTHOSTATIC HYPOTENSION AND RISK OF FALLS IN COMMUNITY-DWELLING OLDER PEOPLE

Abstract Background Many older people with Orthostatic Hypotension (OH) may not report typical symptoms of dizziness, light-headedness, or unsteadiness. However, the relationships between OH and falls in the absence of typical symptoms are not yet established. Methods Continuous orthostatic BP was measured during active stand using a Finometer at Wave 1 of TILDA in participants aged≥70 years. OH, with and without dizziness, was defined as a sustained drop in systolic BP≥20 and/or diastolic BP≥10 mm Hg at 30, 60 and 90 seconds post-standing. The association between symptoms of dizziness and orthostatic BP was assessed with multi-level mixed-effects linear regression; logistic regression models assessed the longitudinal relationship between OH and falls at 6-year follow-up (Waves 2-5). Results Almost 11% (n=934; mean age: 75 years; 51% female) had OH, two-thirds of whom were asymptomatic. Dizziness was not associated with systolic BP drop at 30 (β=1.54; –1.27, 4.36; p=0.256), 60 (β=2.6; –0.19, 5.47; p =0.476) or 90 (β=2.02; –0.91, 4.95; p=0.176) seconds after standing in adjusted models. Asymptomatic OH was independently associated with unexplained falls (Odds Ratio: 2.01; 1.11, 3.65; p=0.022) but not explained falls (OR 0.93; 0.53, 1.62; p=0.797) during follow-up. Conclusion Two-thirds of older people with OH did not report typical symptoms of light-headedness. Dizziness or unsteadiness after standing did not correlate with the degree of orthostatic BP drop or recovery. Participants with asymptomatic OH had a significantly higher risk of unexplained falls during follow-up, and this has important clinical implications for the assessment of older people with falls.

331 THE USE OF BODY MASS INDEX IN PREDICTING ORTHOSTATIC HYPOTENSION IN OLDER ADULTS

Abstract Background The presence of Orthostatic Hypotension (OH) is known to be associated with an increased mortality risk. Previous Irish research has shown that elevated Body Mass Index (BMI) may be protective against OH, with overweight and obese patients having significantly smaller Systolic Blood Pressure (SBP) drops during Head-Up-Tilt (HUT) Testing. Methods Demographics, including age, height and weight, were obtained retrospectively from all head up tilt testing performed in a tertiary Irish hospital between 2000 and 2021. All incomplete records were excluded. A total of 4,717 patients were analysed. Linear regression models were used to examine the relationship between BMI and change in tilt SBP. Results 2,089 males and 2,628 females over the age of 60 years old were examined. The mean age is 77 years ± 7.8 (S.D.), with majority (51.5%) of the cohort overweight or obese. 69.7% of individuals demonstrated OH. The mean change in tilt SBP was –7mmHg in the underweight and healthy weight group, and –10mmHg in the overweight or obese group. The linear regression model established that BMI significantly predicted a change in tilt SBP (beta=0.394, 95% CI: 0.235 to 0.554, p&amp;lt;0.001), but remains a poor predictive variable (R2=0.004) for this cohort. This correlation was similar for both genders (male: r=0.08, female: r=0.07). Conclusion Our findings confirmed a correlation between BMI and its predictive impact on OH in older adults. Future studies should explore targeted populations with multivariate analysis, taking into consideration age and gender, to reduce the heterogeneity of data.

Novel function of Roxadustat (FG-4592) as an anti-shock drug in sepsis by regulating mitochondrial oxidative stress and energy metabolism

BackgroundSeptic shock is a serious clinical syndrome leading to high mortality. A new anti-anemia drug Roxadustat (FG-4592) protected against cardiac injury and hypertension. However, its effect and mechanism on shock and cardiac dysfunction induced by sepsis require to be investigated. MethodsC57BL/6j mice received FG-4592 (10 mg/kg/day) by i.p injection, followed by lipopolysaccharide (LPS) or cecal ligation and puncture (CLP) treatment. Mortality and shock status were monitored during the experiment. Cardiac function was assessed using echocardiography and serum lactate dehydrogenase (LDH) and creatine kinase-MB (CK-MB) assay. TEM, COX-SDH staining and ATP production were used to evaluate mitochondrial function. A non-targeted metabolomic analysis was performed to evaluate the metabolic disorders. ResultsBoth pre- and post-treatment of FG-4592 could improve the survival rate in LPS- and CLP-induced sepsis mice with a better effect in pre-treated animals. Meanwhile, FG-4592 improved systolic blood pressure and body temperature drop in septic mice along with alleviated cardiac dysfunction (as shown by the restoration of decreased LVEF and LVFS and increased LDH and CK-MB) and inflammation. Interestingly, we observed that FG-4592 improved mitochondrial oxidative stress possibly by upregulating the anti-oxidative enzymes of SOD2 and HO-1. Furthermore, FG-4592 improved the energy supply and glycerophospholipid metabolism in cardiomyocytes, possibly through upregulating the HIF-1α-targeted genes of LDHA and PDK1 in glycolysis and CHK-α, respectively. ConclusionsFG-4592 protected against mortality and shock in septic animals possibly by antagonizing mitochondrial oxidative stress and metabolic disorders. General significanceThis study provides a potential of FG-4592 as a novel drug for treating septic shock.

New definition of hypotension in patients with reflex syncope using 24-hour ambulatory blood pressure monitoring (SynABPM Study)

Abstract Background Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking. Purpose We hypothesized that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM than control subjects and we aimed to define the SBP cut-off values that allow identification of patients with hypotensive susceptibility. Methods We compared ABPM data from reflex syncope patients and controls, matched by average 24-hour SBP, age, sex and hypertension. Patients with constitutional hypotension, orthostatic hypotension, predominant cardioinhibition or competing causes of syncope were excluded. Daytime and night-time SBP drops (&amp;lt;110, 100, 90, 80 mmHg) were assessed. Findings were validated in an independent sample. Results In the Derivation cohort, daytime SBP drops were significantly more common in 158 syncope patients than 329 controls. One or more daytime drop &amp;lt;90 mmHg provided the best diagnostic yield (91% specificity, 32% sensitivity, Odds Ratio [OR]=4.6, p=0.001). Two or more-daytime drops &amp;lt;100 mmHg achieved 84% specificity and 40% sensitivity (OR=3.5, p=0.001). Results were confirmed in the Validation cohort: one or more daytime SBP drop &amp;lt;90 mmHg provided 94% specificity and 29% sensitivity (OR=6.2, p&amp;lt;0.001), while two or more daytime SBP drops &amp;lt;100 mmHg achieved 83% specificity and 35% sensitivity (OR=2.6, p&amp;lt;0.001) (Figure 1). Conclusion SBP drops during ABPM are more common in reflex syncope patients than in controls. Cut-off values that may be applied in clinical practice are defined. This study expands the current indications for ABPM to patients with reflex syncope. Funding Acknowledgement Type of funding sources: None.

Correlation between hypotension during dobutamine myocardial perfusion imaging and severity of stress-induced ischemia

Objectives: An accurate non-invasive evaluation of coronary artery disease (CAD) is essential in choosing the right management plan. Dobutamine stress myocardial perfusion imaging (MPI) is a substitute test for patients who cannot exercise. This study aimed to assess the relationship between dobutamine-induced hypotension and risk stratification of annual hard cardiac events evaluated by MPI.&#x0D; Methods: This study is a retrospective study conducted on 1004 patients from October 2015 to august 2019.These patients referred to Rasoul Akram Hospital, because they could not exercise electrocardiography or had contraindications to vasodilator therapy, they were subjected to dobutamine Tc99m-Sestamibi single photon emission tomography (SPECT) protocol. During the protocol, blood pressure was measured with a one-minute interval. From among the participants, 247 patients had decreased blood pressure by more than 20 mmHg during infusion. Then for patients, a gated MPI scan was performed, and MPI with a quantitative and visual interpretation determined the risk stratification of the patients. Multivariable logistic regression model assessed the associations between decrease in blood pressure (above 20 mmHg) and risk stratification.&#x0D; Results: A total of 1004 patients with a mean age of 59.07 years were studied. Of these patients, 247 had &gt; 20mmHg drop in systolic BP from baseline. This study revealed a significant correlation between hypotension during the dobutamine stress test and high-risk scan patterns in myocardial perfusion scan. Moreover, there was a significant correlation between age increase, smoking, diabetes mellitus, transient ischemic dilation (TID), high baseline blood pressure, and history of CABG or angioplasty with a high-risk scan pattern in MPI.&#x0D; Conclusions: This study demonstrated that hypotension during the dobutamine stress test is correlated with high-risk scan patterns in MPI.

Circadian Blood Pressure Profile in Pediatric Patients with Primary Hypertension

Our study aimed to evaluate factors affecting circadian BP profile and its association with hypertension-mediated organ damage (HMOD) in pediatric patients with primary hypertension (PH). The study included 112 children (14.7 ± 2.1 age, 79 boys, 33 girls) with untreated PH. Non-dipping was defined as a nocturnal drop in systolic or diastolic BP (SBP, DBP) < 10%, and a nocturnal drop >20% was defined as extreme dipping. The nocturnal SBP drop was 10.9 ± 5.9 (%), and the DBP drop was 16.2 ± 8.5 (%). Non-dipping was found in 50 (44.6%) children and extreme dipping in 29 (25.9%) patients. The nocturnal SBP decrease correlated with BMI Z-score (r = −0.242, p = 0.010) and left ventricular mass index (LVMI) (r = −0.395, p = 0.006); diastolic DBP decrease correlated with augmentation index (AIx75HR) (r = 0.367, p = 0.003). Patients with a disturbed blood pressure profile had the highest LVMI (p = 0.049), while extreme dippers had the highest augmentation index (AIx75HR) (p = 0.027). Elevated systolic and diastolic BP dipping were risk factors for positive AIx75HR (OR 1.122 95CI (1.009–1.249) and OR 1.095 95CI (1.017–1.177). We concluded that disturbed circadian BP profile was common in children with PH and should not be considered a marker of secondary hypertension. A disturbed circadian BP profile may be associated with higher body weight. In pediatric patients with PH, non-dipping is associated with increased left ventricular mass, and extreme dipping may be a risk factor for increased arterial stiffness.

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.

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 &gt;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 &lt;0.001) (Table). Associations did not differ for those with OH (P-interactions&gt;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.

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 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.

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.