Effect Of Pressure Reduction Research Articles

L-Arginine and Taurisolo® Effects on Brain Hypoperfusion-Reperfusion Damage in Hypertensive Rats.

Acute and chronic hypertension causes cerebral vasculopathy, increasing the risk of ischemia and stroke. Our study aimed to compare the effects of arterial pressure reduction on the pial microvascular responses induced by hypoperfusion and reperfusion in spontaneously hypertensive Wistar rats, desamethasone-induced hypertensive Wistar rats and age-matched normotensive Wistar rats fed for 3 months with a normal diet or normal diet supplemented with L-arginine or Taurisolo® or L-arginine plus Taurisolo®. At the end of treatments, the rats were submitted to bilateral occlusion of common carotid arteries for 30 min and reperfusion. The microvascular parameters investigated in vivo through a cranial window were: arteriolar diameter changes, permeability increase, leukocyte adhesion to venular walls and percentage of capillaries perfused. Hypoperfusion-reperfusion caused in all rats marked microvascular changes. L-arginine treatment was effective in reducing arterial blood pressure causing vasodilation but did not significantly reduce the damage induced by hypoperfusion-reperfusion. Taurisolo® treatment was less effective in reducing blood pressure but prevented microvascular damage from hypoperfusion-reperfusion. L-arginine plus Taurisolo® maintained blood pressure levels within the physiological range and protected the pial microcirculation from hypoperfusion-reperfusion-induced microvascular injuries. Therefore, the blood pressure reduction is not the only fundamental aspect to protect the cerebral circulation from hypoperfusion-reperfusion damage.

Effect of Intraocular Pressure Lowering Treatment on Peripapillary and Macular Vessel Density on Normotensive Eyes with Optic Disc Drusen: A Randomized Controlled Trial

ABSTRACT To evaluate the effect of intraocular pressure (IOP) reduction on peripapillary and macular vessel density parameters from optical coherence tomography angiography (OCT-A) in normotensive eyes with optic disc drusen (ODD). Randomized controlled trial, with 6 months of follow-up, including normotensive eyes with ODD divided into two groups: control group (lubricating eye drop) and case group (latanoprost 50mcg/ml). We used OCT-A to evaluate peripapillary and macular vessel density parameters. Data were collected at baseline and at 1, 3, and 6 months following the use of eye drops. This study included a total of 32 eyes (16 cases and 16 controls) from 19 patients. After 6 months, the group using latanoprost IOP reduced IOP to 10.8 ± 0.64 versus 13.5 ± 0.54 mmHg in the control group (p < 0.001). We observed significant changes in OCT-A vessel density peripapillary parameters. The total radial peripapillary capillary (RPC) density (%) at month 6, in the eyes using latanoprost was 55.1 ± 1.05% and control was 57.9 ± 0.88%, p = 0.033. However, no changes were observed in macular vessel density parameters as well as retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness between groups after 6 months of using latanoprost. No sight-threatening events were observed during follow-up in either group. Until now there is no evidence that just lowering IOP can benefit normotensive patients with ODD. In fact, we observed a significant decrease in RPC vessel density after 6 months of IOP reduction using latanoprost, compared to the control group.

Effect of intraocular pressure reduction on progressive high myopia (PHM study): study protocol of a randomised controlled trial

BackgroundIn adult patients with high myopia (HM), progressive axial elongation poses a significant risk for the development of subsequent ocular complications that may lead to visual impairment. Effective strategies to...

An Efficient Seepage Element Containing Drainage Pipe

Drainage pipes are often positioned downstream of embankments to mitigate pore pressure, thereby reducing the risk of dam failure. Considering that the size of drainage pipes is much smaller than that of embankment dams, directly discretizing the drainage pipes will generate a huge number of elements. Therefore, this paper proposes a seepage element containing drainage pipes. In this element, the permeability of the drainage pipe is taken as the third type of permeable conductivity condition, and it is considered in the energy functional. The governing equations for the steady-state and the transient seepage element containing drainage pipe are derived using the variational principle, and the infiltration matrix, equivalent nodal seepage array, and water storage matrix of the seepage element containing drainage pipe are obtained. In conjunction with the user-defined element module UEL of ABAQUS 2016 software, the established seepage element containing drainage pipe is programmed. The accuracy and efficiency of the proposed seepage element containing drainage pipe are verified through seepage field simulations of three examples. Finally, the influence of the permeable conductivity of drainage pipes on the pressure reduction effect is investigated, providing a reference for the layout of drainage pipes in embankment defense systems.

Optic Nerve Head Pulsatile Displacement in Open-Angle Glaucoma after Intraocular Pressure Reduction Measured by Optical Coherence Tomography: A Pilot Study.

This study investigated the effect of intraocular pressure (IOP) reduction on pulsatile displacement within the optic nerve head (ONH) in primary open-angle glaucoma (POAG) patients with and without axial myopia. Forty-one POAG patients (19 without myopia, 9 with axial myopia and 13 glaucoma with no intervention) participated. Swept-source optical coherence tomography (OCT) videos of the ONH were obtained before and after IOP-lowering treatment (medical or surgical) achieving a minimum IOP drop of 3 mmHg. A demons registration-based algorithm measured local pulsatile displacement maps within the ONH. Results demonstrated a significant 14% decrease in pulsatile tissue displacement in the non-myopic glaucoma cohort after intervention (p = 0.03). However, glaucoma patients with axial myopia exhibited no statistically significant change. There were no significant changes in the pulsatile ONH deformation in the control group. These findings suggest a potential link between IOP reduction and reduced pulsatile displacement within the ONH in POAG patients without myopia, offering new insights into the disease's pathophysiology and warranting further investigation into underlying mechanisms and clinical implications.

The short-term effect of Blood Pressure Reduction after Biofeedback in Malignant Hypertension: A case report

Objectives: The purpose of this study was to report the short-term blood pressure-lowering effects observed in a patient with malignant hypertension through slow breathing maneuver with heart rate variability(HRV) biofeedback.Methods: Biofeedback sessions, totaling 13, each lasting 10 minutes, were administered. Blood pressure was measured pre and post-treatment, as well as thrice daily at 10 am, 4 pm, and 8 pm. Systolic blood pressure(SBP), diastolic blood pressure(DBP), and pulse rate were recorded for comparative analysis.Results: Before biofeedback, the average SBP, DBP, and pulse rate were 227.2±18.3, 135.2±11.0, and 104.4±5.3, respectively. Immediately post-biofeedback, these values changed to 213.7±15.2, 126.9±8.5, and 99.2±3.6. However, sustained long-term blood pressure reduction was not observed.Conclusions: The findings suggest that biofeedback therapy induces a short-term reduction in blood pressure in cases of malignant hypertension, potentially associated with autonomic nervous system regulation. Integrating biofeedback with other Korean medicine treatments, such as acupuncture or moxibustion, may offer a comprehensive approach for managing malignant hypertension.

Chronic Intermittent Hypobaric Hypoxia Reduces Hypothalamic N-Methyl-d-Aspartate Receptor Activity and Sympathetic Outflow in Spontaneously Hypertensive Rats.

Guo, Xinqi, Hongyu Ma, Ziye Cui, Qiyue Zhao, Ying Zhang, Lu Jia, Liping Zhang, Hui Guo, Xiangjian Zhang, Yi Zhang, Yue Guan, and Huijie Ma. Chronic intermittent hypobaric hypoxia reduces hypothalamic N-Methyl-d-Aspartate Receptor activity and sympathetic outflow in spontaneously hypertensive rats. High Alt Med Biol. 25:77-88, 2024. Objective: This study aims to determine the role of hypothalamic renin-angiotensin system (RAS) in the antihypertensive effect of chronic intermittent hypobaric hypoxia (CIHH). Methods: Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHRs) received 35 days of hypobaric hypoxia simulating an altitude of 4,000 m, 5 h/day. The levels of RAS, blood pressure, and N-methyl-d-aspartate receptor (NMDAR) activities of hypothalamic paraventricular nucleus (PVN) presympathetic neurons from each group of rats were determined. Results: The systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure (MAP) of SHRs significantly decreased from the third week of CIHH treatment. This blood pressure reduction effect could be maintained for at least 2 weeks after stopping the CIHH treatment. CIHH treatment also attenuated the decrease in MAP and renal sympathetic nerve activity induced by hexamethonium administration in SHRs, but not in WKY rats. Furthermore, CIHH reversed the increase in serum angiotensin (Ang)II concentration and the expression of PVN angiotensin-converting enzyme (ACE) and AngII type 1 (AT1) receptors, as well as the decrease in serum Ang1-7 concentration and the expression of PVN ACE2 and Mas receptors in SHRs. In addition, the administration of CIHH resulted in a reduction in the frequency of miniature excitatory postsynaptic currents and amplitude of NMDAR current in PVN presympathetic neurons of SHRs, which means that CIHH decreased the pre- and postsynaptic NMDAR activity of PVN presympathetic neurons in SHRs. However, pretreatment with A779 (a Mas receptor blocker) or AngII abrogated the above effects. Meanwhile, Ang1-7 pretreatment mimicked the CIHH effect on pre- and postsynaptic NMDAR activity of presympathetic neurons in SHRs. Conclusions: Our data indicate that CIHH reduces pre- and postsynaptic NMDAR activity of PVN presympathetic neurons, sympathetic outflow, and blood pressure by decreasing the activity of the ACE/AngII/AT1 axis and increasing the activity of ACE2/Ang1-7/Mas axis in the hypothalamus in hypertension.

Lowering blood pressure by exercise: investigating the effect of sweating.

High blood pressure (hypertension), is a common medical condition, affecting millions of people and is associated with significant health risks. Exercise has been suggested to manage hypertension by inducing sweating and the corresponding loss of sodium and water from the body.Thus, a variety of epidemiological and clinical studies have been conducted to investigate the relationship between sweating and exercise-induced blood pressure reduction and its impacts on hypertension. The mechanisms underlying exercise-induced blood pressure reduction are complex and still not fully understood. However, several pathways have been suggested, including the loss of sodium and water through sweat, a decrease in peripheral resistance, and an improvement in endothelial function in the blood vessels. The decrease in sodium and water content in the body associated with sweating may result in a reduction in blood volume and thus a decrease in blood pressure. Moreover, the reduction in peripheral resistance is thought to be mediated by the activation of the nitric oxide synthase pathway and the release of vasodilators such as prostacyclin and bradykinin, which lead to vasodilation and, thus, a reduction in blood pressure. In conclusion, exercise-induced sweating and consequent sodium and water loss appear to be a reliable biological link to the blood pressure-reducing effects of exercise in hypertensive individuals. Additionally, the mechanisms underlying exercise-induced blood pressure reduction are complex and involve several biological pathways in the cardiovascular system. Therefore, understanding the role of sweat production in blood pressure management is important for developing effective exercise interventions to prevent and manage hypertension.

Investigation of a new reverse drainage construction and the pressure-reducing effect of a tunnel in a water-rich karst location

It is quite simple to create cracking, leaking, and other disasters in the tunnel during operation because water-rich karst tunnels are subject to the action of the high head. If the drainage is not timely, this results in high-pressure water collection around the tunnel lining. The study was conducted depending on Tongzi Tunnel to resolve the issue of water pressure encountered by water-rich karst tunnel lining under high head action and to lessen the issue of operational tunnel illness under long-term water pressure. The mechanical reaction of the number of reverse drainage holes and the size of pipe diameter at the raised arch under various water heads on the tunnel construction was studied using model testing in combination with numerical simulation analysis. It was discovered that using the traditional drainage system would subject the supine arch to extremely high-water pressure, which is often hard to efficiently remove. The major issue causing the elevated arch bulging tragedy is that water pressure in the elevated arch increases as head height increases. High water pressure in the raised arch may be efficiently dealt with using the suggested reverse drainage approach. The pressure reduction rate compared to the traditional drainage method achieved 13.6 % for the investigation of the fractured Tongzi tunnel reverse drainage holes, which had a total of five holes with a diameter of roughly 100 mm. Reverse drainage structures have the potential to save project costs while also realizing “point to point” pressure reduction at the elevation arch of the tunnel and have positive effects on total tunnel pressure reduction. The study's findings can serve as a guide for designing and building comparable water-rich karst tunnel constructions as well as for maintaining drainage systems while they are in use.

Comparison of different medical treatments for primary hyperaldosteronism: a systematic review and network meta-analysis.

The effectiveness and side effects between different medical treatments in patients with primary hyperaldosteronism have not been systematically studied. To analyze the efficacy between different mineralocorticoid receptor antagonists (MRAs) and epithelial sodium channel (ENaC) inhibitors in a network meta-analysis (NMA) framework, while also evaluating adverse events. Systematic review and NMA. The systematic review and NMA was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, MEDLINE, the Cochrane library, and Excerpta Medica database (EMBASE) were searched for randomized controlled trials (RCTs) involving adult patients with primary hyperaldosteronism until 23 June 2023. Studies that compared the efficacy and side effects of different medical treatments of primary hyperaldosteronism were included. The primary outcomes included the effect on blood pressure, serum potassium, and major adverse cardiovascular events. The secondary outcomes were adverse events related to MRAs (hyperkalemia and gynecomastia). Frequentist NMA and pairwise meta-analysis were conducted. A total of 5 RCTs comprising 392 participants were included. Eplerenone, esaxerenone, and amiloride were compared to spironolactone and demonstrated comparable effect on the reduction of systolic blood pressure. In comparison to spironolactone, eplerenone exhibited a less pronounced effect on reducing diastolic blood pressure [-4.63 mmHg; 95% confidence interval (CI): -8.87 to -0.40 mmHg] and correcting serum potassium (-0.2 mg/dL; 95% CI: -0.37 to -0.03 mg/dL). Spironolactone presented a higher risk of gynecomastia compared with eplerenone (relative risk: 4.69; 95% CI: 3.58-6.14). The present NMA indicated that the blood pressure reduction and potassium-correcting effects of the three MRAs may demonstrate marginal differences, with confidence levels in the evidence being very low. Therefore, further research is needed to explore the efficacy of these MRAs, especially regarding their impact on mortality and cardiovascular outcomes. PROSPERO (CRD: 42023446811).

Selective Laser Trabeculoplasty – The First-line Treatment For Open-Aangle Glaucoma?!

The purpose of this nonrandomized study conducted at the Eye Clinic "Akhali Mzera" between October 2011 and November 2022 was to evaluate the intraocular pressure (IOP) reduction and side effects following selective laser trabeculoplasty (SLT). A total of 867 eyes of 558 patients with early to moderate primary open-angle glaucoma (POAG) or pseudoexfoliation glaucoma (PXG) phakic and pseudophakic were included in the study. The patients were treated with laser as primary therapy or adjunct laser with medication. The mean age of the study participants was 54.3 ± 5.2 years (range, 40 to 78 years) and 362 (64.9%) were males. The glaucoma diagnosis was POAG in 726 (83.7%) eyes and PXG in 141 (16.3%) eyes. Diabetes mellitus in 8% and systemic hypertension in 30% were noted. 736 eyes (84.9%) were on medications, and 130 (14.9%) eyes were treated with laser as primary therapy. Overall, the mean IOP after SLT was 17.8 ± 3.2mmHg, 18.8 ± 2.3 mmHg, and 23.4 ± 2.5 mmHg in the 12th month, 24th month, and 36th month respectively. About 20% of patients with POAG lost efficacy in 18 months post-treatment and in these eyes, the second SLT procedure was more effective than the first one. The number of drugs reduced from an average of 1.3 to an average of 1.0 was statistically significant with the inter-eye correlation. Those patients who were treated with laser as primary therapy with a baseline IOP of 25.4 mmHg ±2.9 mmHg had IOP reduction of 7.5 ± 3.1 mmHg at the last visit, and those who were on antiglaucoma medication with baseline IOP 23.9 ± 2.2 mmHg had IOP reduction of 4.8 ± 2.8 mmHg. IOP reduction at the last visit between POAG, and PXG was 6.5 mmHg and 7.9 mmHg, respectively. It was concluded that SLT is a safe and innovative technology that uses lasers to target only certain cells of the trabecular meshwork of the eye.

Cocoa effects on blood pressure, endothelial function, and inflammation: a systematic review

Hypertension has affected 1,13 billion people worldwide and is one of the main risk factors for cardiovascular disease, which has a high mortality rate. The aim of the study was to review the effect of cocoa on systolic and diastolic blood pressure in hypertensive patients, and its alterations in endothelial function and inflammation. We searched PubMed, Scopus, Science Direct, Lilacs and MedLine databases in August 2018. Inclusion criteria were limited to hypertensive individuals, cardiovascular diseases, intervention and randomized clinical studies; published since 2000 and in English, Spanish and Portuguese languages. A total of 433 articles were found in the search, which 13 met the inclusion criteria. The trials had a sample of 19 to 122 participants. The cocoa was offeredas chocolate bars and cocoa beverage. Chocolate bars doses ranged from 6 g to 100 g/ day and cocoa powder doses ranged from 5 g to 31 g/ day. Intervention ranged from 2 to 18 weeks. The results observed revealed a significant blood pressure-reducing effect of cocoa, an increase in flow-mediated dilation in the evaluation of endothelial function, and no changes in antioxidant and anti-inflammatory capacity were observed after intervention. The conclusion suggests that cocoa has a blood pressure lowering effect, but new studies are still required with hypertensive individuals so that their mechanisms are better evaluates and their efficacy proven.

Adapted Mindfulness Training for Interoception and Adherence to the DASH Diet

Hypertension is a major cause of cardiovascular disease, and although the Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure (BP), adherence is typically low. Mindfulness training adapted to improving health behaviors that lower BP could improve DASH adherence, in part through improved interoceptive awareness relevant to dietary consumption. To evaluate the effects of the Mindfulness-Based Blood Pressure Reduction (MB-BP) program on interoceptive awareness and DASH adherence. Parallel-group, phase 2, sequentially preregistered randomized clinical trials were conducted from June 1, 2017, to November 30, 2020. Follow-up was 6 months. Participants with elevated unattended office BP (≥120/80 mm Hg) were recruited from the population near Providence, Rhode Island. Of 348 participants assessed for eligibility, 67 did not meet inclusion criteria, 17 declined, and 63 did not enroll prior to study end date. In total, 201 participants were randomly assigned, 101 to the MB-BP program and 100 to the enhanced usual care control group, with 24 (11.9%) unavailable for follow-up. Outcome assessors and the data analyst were blinded to group allocation. Analyses were performed using intention-to-treat principles from June 1, 2022, to August 30, 2023. The 8-week MB-BP program was adapted for elevated BP, including personalized feedback, education, and mindfulness training directed to hypertension risk factors. Both MB-BP and control groups received home BP monitoring devices with instructions and options for referral to primary care physicians. The control group also received educational brochures on controlling high BP. The primary outcome was Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire scores (range 0-5, with higher scores indicating greater interoceptive awareness), and the secondary outcome was DASH adherence scores assessed via a 163-item Food Frequency Questionnaire (range 0-11, with higher scores indicating improved DASH adherence), all compared using regression analyses. Among 201 participants, 118 (58.7%) were female, 163 (81.1%) were non-Hispanic White, and the mean (SD) age was 60.0 (12.2) years. The MB-BP program increased the MAIA score by 0.54 points (95% CI, 0.35-0.74 points; P < .001; Cohen d = 0.45) at 6 months vs control. In participants with poor baseline DASH adherence, the MB-BP program also significantly increased the DASH score by 0.62 points (95% CI, 0.13-1.11 points; P = .01; Cohen d = 0.71) at 6 months vs controls. The intervention was also associated with a 0.34-point improvement in the DASH diet score in all MB-BP participants from baseline (95% CI, 0.09-0.59 points; P = .01; Cohen d = 0.27), while the control group showed a -0.04 point change in DASH diet score from baseline to 6 months (95% CI, -0.31 to 0.24 points; P = .78; Cohen d = -0.03). A mindfulness program adapted to improving health behaviors to lower BP improved interoceptive awareness and DASH adherence. The MB-BP program could support DASH dietary adherence in adults with elevated BP. ClinicalTrials.gov Identifiers: NCT03859076 and NCT03256890.

Reduced Pressure Effect on Smoke Layer Plug-Holing Behavior of Tunnel Fires with a Naturally Ventilated Vertical Shaft

Reduced Pressure Effect on Smoke Layer Plug-Holing Behavior of Tunnel Fires with a Naturally Ventilated Vertical Shaft

Study of Overlying Rock Structure and Intensive Pressure Control Technology of Island Longwall Panel in Extra-Thick Coal Seams

In response to the severe occurrence of mining pressure in the fully mechanized top coal caving face of the extra-thick coal seam and the problem of strong rock pressure caused by the remaining coal pillars in the mining area on the isolated island fully mechanized top coal caving face, taking the 8102 isolated island working face of Tongxin Coal Mine as the background and by using methods such as on-site measurement and numerical simulation experiments, the characteristics of roof mining in the island longwall panel of extra-thick coal seams were analyzed. Establishing a mechanical model for the mining stress and overlying rock stress arch of an isolated working face, the mechanical characteristics of the isolated working face under special conditions were obtained. The results show that the longwall panel no. 8102 has an asymmetric long-arm T-shaped covering layer structure before mining and a C-shaped covering rock structure during mining, which will exacerbate the degree of mining pressure manifestation in the working face. Directional high-pressure hydraulic fracturing was implemented in the gob of longwall panel no. 8102, and the pressure reduction effect of the advance support section of the gob was obvious, ensuring the safety of the working face.

Peptides derived from high voltage-gated calcium channel β subunit reduce blood pressure in rats.

The β subunits of high voltage-gated calcium channels (HGCCs) are essential for optimal channel functions such as channel gating, activation-inactivation kinetics, and trafficking to the membrane. In this study, we report for the first time the potent blood pressure-reducing effects of peptide fragments derived from the β subunits in anesthetized and non-anesthetized rats. Intravenous administration of 16-mer peptide fragments derived from the interacting regions of the β1 [cacb1(344-359)], β2 [cacb2(392-407)], β3 [cacb3(292-307)], and β4 [cacb4(333-348)] subunits with the main α-subunit of HGCC decreased arterial blood pressure in a dose-dependent manner for 5-8 min in anesthetized rats. In contrast, the peptides had no effect on the peak amplitudes of voltage-activated Ca2+ current upon their intracellular application into the acutely isolated trigeminal ganglion neurons. Further, a single mutated peptide of cacb1(344-359)-cacb1(344-359)K357R-showed consistent and potent effects and was crippled by a two-amino acid-truncation at the N-terminal or C-terminal end. By conjugating palmitic acid with the second amino acid (lysine) of cacb1(344-359)K357R (named K2-palm), we extended the blood pressure reduction to several hours without losing potency. This prolonged effect on the arterial blood pressure was also observed in non-anesthetized rats. On the other hand, the intrathecal administration of acetylated and amidated cacb1(344-359)K357R peptide did not change acute nociceptive responses induced by the intradermal formalin injection in the plantar surface of rat hindpaw. Overall, these findings will be useful for developing antihypertensives.

Potential of Allium sativum in blood pressure control involves signaling pathways: A narrative review

AbstractThe use of food products and functional foods to manage and treat several health conditions is expanding globally. Garlic (Allium sativum) consumption is commonly used for its potential therapeutic functions in numerous cardiometabolic disorders, including hypertension. The proposed blood pressure–reducing effects of garlic after its consumption influence several metabolic pathways, resulting in potentially beneficial health outcomes. The first postulated mechanism is nitric oxide (NO) activation, leading to vasodilation. Furthermore, garlic consumption was also shown to promote vasodilation by suppressing the renin–angiotensin–aldosterone system (RAAS) and the formation of prostaglandins, suppressing angiotensin‐converting enzyme activity. The mechanism of garlic‐related vasodilation is related to its high sulfur‐containing content associated with forming hydrogen sulfides (H2S). The H2S binds to and activates vascular ATP‐sensitive potassium channels (kATP), leading to hyperpolarization, which induces vasodilation. This review summarizes garlic's features and the mechanical paths that could contribute to blood pressure control.

Effect of Adapted Mindfulness Training in Participants With Elevated Office Blood Pressure: The MB-BP Study: A Randomized Clinical Trial.

Background Hypertension is a leading risk factor for cardiovascular disease. Despite availability of effective lifestyle and medication treatments, blood pressure (BP) is poorly controlled in the United States. Mindfulness training may offer a novel approach to improve BP control. The objective was to evaluate the effects of Mindfulness-Based Blood Pressure Reduction (MB-BP) versus enhanced usual care control on unattended office systolic BP. Methods and Results Methods included a parallel-group phase 2 randomized clinical trial conducted from June 2017 to November 2020. Follow-up time was 6 months. Outcome assessors and data analyst were blinded to group allocation. Participants had elevated unattended office BP (≥120/80 mm Hg). We randomized 201 participants to MB-BP (n=101) or enhanced usual care control (n=100). MB-BP is a mindfulness-based program adapted for elevated BP. Loss-to-follow-up was 17.4%. The primary outcome was change in unattended office systolic BP at 6 months. A total of 201 participants (58.7% women; 81.1% non-Hispanic White race and ethnicity; mean age, 59.5 years) were randomized. Results showed that MB-BP was associated with a 5.9-mm Hg reduction (95% CI, -9.1 to -2.8 mm Hg) in systolic BP from baseline and outperformed the control group by 4.5 mm Hg at 6 months (95% CI, -9.0 to -0.1 mm Hg) in prespecified analyses. Plausible mechanisms with evidence to be impacted by MB-BP versus control were sedentary activity (-350.8 sitting min/wk [95% CI, -636.5 to -65.1] sitting min/wk), Dietary Approaches to Stop Hypertension diet (0.32 score [95% CI, -0.04 to 0.67]), and mindfulness (7.3 score [95% CI, 3.0-11.6]). Conclusions A mindfulness-based program adapted for individuals with elevated BP showed clinically relevant reductions in systolic BP compared with enhanced usual care. Mindfulness training may be a useful approach to improve BP. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03256890 and NCT03859076.

The effect of urgent blood pressure reduction on left atrial strain in patients with hypertensive attack : Blood pressure lowering affects LA strain.

Left atrial (LA) strain is a robust measure of LA function and is a useful parameter to assess left ventricular filling pressure. While initially considered as a "load-independent" parameter of LA function, later studies have found that acute changes in LA preload may affect LA reservoir and contractile strains. Acute alterations in blood pressure (BP) induces a change in left ventricular (LV) filling pressure without imposing a volume load, thus providing an opportunity to assess the effects of the change in LA afterload on LA mechanics. This study aims to understand the effect of acute BP changes on LA strain. A total of 40 patients admitted to the emergency department with hypertensive urgency were included. All patients underwent a comprehensive echocardiographic examination including measurement of LA reservoir, conduit and contractile strains. A repeat set of measurements were obtained after BP lowering. Average drop in mean BP following intervention was 18.1 ± 5.4%. LV end-systolic and end-diastolic volumes, as well as maximum and minimum LA volumes were decreased significantly after BP reduction. The absolute increases in reservoir and contractile strains were 2.3 ± 4.7% (7.9% ± 13.8% relative to baseline) and 2.5 ± 3.3% (13.5 ± 19.0% relative to baseline), respectively, with both changes being statistically significant (p = 0.003 for reservoir and p < 0.001 for contractile strains). There were no significant changes in conduit strain after BP intervention (p = 0.79). The change in both LA reservoir and contractile strains were more evident in those with a previous diagnosis of hypertension and those with a smaller degree of change in mean BP after intervention. In patients with an acute hypertension, lowering BP leads to an acute improvement in LA reservoir and contractile strains. Thus, acute changes in systemic BP should be considered when LA mechanics are evaluated.

Chronic Effects of Apelin on Cardiovascular Regulation and Angiotensin II-Induced Hypertension.

Apelin, by stimulation of APJ receptors, induces transient blood pressure (BP) reduction and positive inotropic effects. APJ receptors share high homology with the Ang II type 1 receptor; thus, apelin was proposed to play a protective role in cardiovascular disease by antagonizing the actions of Ang II. In this regard, apelin and apelin-mimetics are currently being studied in clinical trials. However, the chronic effect of apelin in cardiovascular regulation has not been fully investigated. In the current study, blood pressure (BP) and heart rate (HR) were recorded using a telemetry implantation approach in conscious rats, before and during chronic subcutaneous infusion of apelin-13, using osmotic minipumps. At the end of the recording, the cardiac myocyte morphology was examined using H&E staining, and cardiac fibrosis was evaluated by Sirius Red in each group of rats. The results demonstrated that the chronic infusion of apelin-13 did not change either BP or HR. However, under the same condition, the chronic infusion of Ang II induced significant BP elevation, cardiac hypertrophy, and fibrosis. Co-administration of apelin-13 did not significantly alter the Ang II-induced elevation in BP, changes in cardiac morphology, and fibrosis. Taken together, our experiments showed an unexpected result indicating that the chronic administration of apelin-13 did not alter basal BP, nor did it change Ang II-induced hypertension and cardiac hypertrophy. The findings suggest that an APJ receptor biased agonist could be a better therapeutic alternative for treatment of hypertension.