Elevated Diastolic Blood Pressure Research Articles

The distribution of blood pressure and associated factors of the elderly with type 2 diabetes in Jiangsu Province

Objective: To investigate the distribution of blood pressure and analyze the associated factors of blood pressure of the elderly with type 2 diabetes in Jiangsu Province. Methods: The elderly over 60 years old participants with type 2 diabetes in the communities of Huai'an City and Changshu City, Jiangsu Province were selected in this study. They were divided into two groups: taking antihypertensive drugs and not taking antihypertensive drugs. The demographic characteristics, such as age and sex, and relevant factors were collected by questionnaire. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured by physical examination. The percentile of SBP and DBP in each age group of men and women were described. The kernel density estimation curve was used to show the blood pressure distribution. The trend of blood pressure with age was fitted by locally weighted regression. The logistic regression model was used to analyze relevant factors of blood pressure. Results: A total of 12 949 participants were included in this study, including 7 775 patients in the antihypertensive drug group and 5 174 patients in the group without antihypertensive drugs. The SBP of participants was concentrated at 140-160 mmHg, and their DBP was concentrated at 75-85 mmHg. There were significant differences in the distribution of blood pressure among the subgroups of body mass index (BMI) and rural areas whether taking antihypertensive drugs and not. For participants aged under 80 years old, the SBP showed an increasing trend with age and the DBP showed a decreasing trend with age. Age, BMI ≥24 kg/m2, fasting blood glucose ≥7.0 mmol/L, living in rural areas and no smoking were influencing factors of the elevated SBP; BMI ≥24 kg/m2, male, living in rural areas, no smoking, drinking alcohol and not receiving drug hypoglycemic treatment were influencing factors of the elevated DBP. Conclusion: The SBP of older diabetic adults in Jiangsu Province is at a high level, and the distribution of blood pressure is significantly different between men and women in taking antihypertensive drugs group. The SBP presents a rising trend and the DBP is decreasing at the age of 60-80 years. The blood pressure level of this population are mainly affected by age, BMI, urban and rural areas, smoking.

Stroke severity among ischemic stroke patients with elevated diastolic blood pressure

Aim: Understanding risk factors with elevated diastolic blood pressure (DBP) in acute ischemic stroke (AIS) is significant. Methods: Multivariable logistic regression was used to determine predictors of stroke severity in AIS patients, categorized by their DBP levels >80 mmHg and ≤80 mmHg. Results: AIS patients with DBP >80 mmHg that presents with a history of alcohol use (OR = 2.11, 95% CI: 1.116–3.988, p = 0.022), hypertension (OR = 1.572, 95% CI: 1.01–2.449, p = 0.035), and increasing heart rate (OR = 1.012, 95% CI: 1.012–1.022, p = 0.024) were associated with higher stroke severity Conclusion: Identified factors are independent predictors of higher stroke severity in AIS patients with elevated DBP.

Comparative Study of Gabapentin, Clonidine and Placebo in Alleviating the Hemodynamic Changes Due to Tracheal Intubation and Laryngoscopy.

Hemodynamic changes during laryngoscopy and tracheal intubation must be reduced for safe and effective anesthesia. The present study was conducted to compare the efficacy of oral clonidine, gabapentin and placebo in alleviating the hemodynamic changes due to tracheal intubation and laryngoscopy. This was a double-blinded randomized controlled trial conducted on 90 patients who were undergoing elective surgery and were randomized into three groups. Group I (n=30) received a placebo, group II (n=30) received gabapentin and group III (n=30) received clonidine as premedication before anesthesia induction.Patient heart rate and pressor response were recorded periodically and compared between the groups. There was no significant difference in the baseline heart rate (HR) and mean arterial pressure (MAP) between the groups. HR elevation was observed in all three groups and found to be significant (p=0.0001) but the increase was higher in the placebo (15 min: 80.80± 15.41) and lower in the clonidine group (15 min: 65.53± 12.43). The elevation in systolic and diastolic blood pressure was least and transient in the gabapentin group, as compared to placebo and clonidine group. Intra-operatively, the requirement of opioids was higher in the placebo as compared to clonidine and gabapentin (p < .001). Clonidine and gabapentin were effective in reducing the hemodynamic changes during laryngoscopy and intubation.

Associations between Lipid Levels and Intracerebral Hemorrhage

Background: Intracerebral hemorrhage (ICH) is a complex medical condition found to be associated with various factors, including advanced age, male gender, Asian ethnicity, tobacco use, hypertension, and chronic renal insufficiency. Despite the aforementioned associations, the relationship between lipid fractions and ICH remains ambiguous and has received limited attention in the literature, particularly with respect to Thai populations. Objective: To investigate the potential association between lipid levels and primary ICH. Materials and Methods: The present study employed a retrospective case-control design and enrolled 314 primary ICH cases presented at Rajavithi Hospital between 2012 and 2022. A control group of 366 subjects was established using an age-matching procedure and computer-generated randomization. Participants with coagulopathies or those receiving anticoagulant therapy were excluded. Statistical analysis was performed using binomial and multivariate logistic regression to evaluate the relationship between ICH and the various factors. Results: The present study identified six factors that were independently associated with ICH through bivariate analysis, including male gender (odd ratio [OR] 2.497, 95% confidence interval [CI] 1.829 to 3.407; p&lt;0.001), systolic blood pressure (SBP) (OR 1.023, 95% CI 1.016 to 1.029; p&lt;0.001), diastolic blood pressure (DBP) (OR 1.050, 95% CI 1.037 to 1.062; p&lt;0.001), total cholesterol (OR 0.994, 95% CI 0.991 to 0.998; p=0.001), high-density lipoprotein cholesterol (HDL) (OR 0.985, 95% CI 0.975 to 0.995; p=0.003), and low-density lipoprotein cholesterol (LDL) (OR 0.994, 95% CI 0.991 to 0.998; p=0.002). Multivariate logistic regression revealed five factors to be associated with ICH, including male gender (adjusted OR 1.904, 95% CI 1.293 to 2.803; p=0.001), elevated SBP (adj. OR 1.024, 95% CI 1.017 to 1.032; p&lt;0.001), elevated DBP (adj. OR 1.051, 95% CI 1.037 to 1.064; p&lt;0.001), decreased total cholesterol levels (adj. OR 0.993, 95% CI 0.988 to 0.997; p=0.001), and decreased LDL (adj. OR 0.994, 95% CI 0.990 to0.999; p=0.010). HDL was found to not be significantly associated with ICH (adj. OR 1.003, 95% CI 0.990 to 1.016; p=0.643). Conclusion: The results of the present study suggest that male gender and elevated levels of SBP and DBP were independently associated with ICH, as were decreased levels of total cholesterol and LDL. Keywords: Lipid; Cholesterol; LDL; HDL; Intracerebral hemorrhage

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Nitrite and nitrate intake from processed meat is associated with elevated diastolic blood pressure (DBP)

Processed meat consumption has been linked to high blood pressure (BP), a key risk factor for cardiovascular disease (CVD), but gaps remain with regards to the ingredients which contribute to this association. This study, therefore, aimed to examine the association between nitrite and nitrate intake from processed meat with diastolic (DBP) and systolic (SBP) blood pressure, while accounting for sodium intake. Dietary nitrite and nitrate intake from processed meat, assessed as total nitrite equivalent, was estimated for 1774 adult, processed meat consumers (≥18 years, 55.1% females) who had enrolled in the Hellenic National Nutrition and Health Survey (HNNHS). To avoid selection and reverse causality bias, associations with measured DBP and SBP were considered instead of self-reported data of hypertension presence. Participants were divided by tertile of dietary nitrite intake and by level of dietary guideline adherence for sodium (<1500; 1500-2300; ≥2300). Multiple regression models were used to examine associations with SBP and DBP, including an interaction term of nitrite with dietary sodium intake, for potential synergy. Overall, DBP increased by 3.05mmHg (95% CI: 0, 6.06), per tertile increase in nitrite intake and 4.41mmHg (95% CI: 0.17, 8.64) per level increase in sodium intake, when the interaction effect between nitrite and total sodium intakes was accounted for. By considering the significant synergistic effect of the two factors, DBP finally increased by 0.94 mgHg overall and 2.24 mgHg for subjects in the third tertile compared to those in the first. Also, a rise in total sodium intake of approximately 800mg, above 1500mg, caused a 2.30 mgHg increase in DBP. No significant correlations were found with SBP. Higher nitrite and nitrate intake from processed meats contributed to the increase of DBP, but the interaction effect with total sodium intake levels should be accounted for to properly interpret the findings.

Habitual Tea Consumption Increases the Incidence of Metabolic Syndrome in Middle-Aged and Older Individuals.

In middle-aged and elderly individuals, the relationship between tea consumption and incident metabolic syndrome (MetS) is still unclear. Therefore, this study intends to figure out the relationship between tea-drinking frequency and MetS in rural middle-aged and older Chinese residents. In the Northeast China Rural Cardiovascular Health Study, 3632 middle-aged or older individuals (mean age 57 ± 8, 55.2% men) without MetS were included at baseline during 2012-2013 and were followed up on between 2015-2017. Participants showing differential tea consumption frequency were divided into the following classes: non-habitual tea drinkers, occasional tea drinkers, 1-2 times/day drinkers, and ≥3 times/day drinkers. Data showed that non-habitual tea drinking was more common among women. The frequency of tea consumption was higher in ethnic groups other than Han and among singles, as well as in concurrent smokers and drinkers and individuals with primary or lower educational status. The increasing tea consumption was in line with baseline elevations in body mass index, systolic and diastolic blood pressure, high-density lipoprotein cholesterol (HDL-C), and AST/ALT ratio. Multivariate logistic regression analysis confirmed that occasional tea drinking increased the incidence of low HDL-C [OR (95% CI): 1.268 (1.015, 1.584)], high waist circumference [OR (95% CI): 1.336 (1.102, 1.621)], and MetS [OR (95% CI): 1.284 (1.050, 1.570)]. In addition, 1-2 times/day tea drinking increased the cumulative incidence of high TG [OR (95% CI): 1.296 (1.040, 1.616)], high waist circumference [OR (95% CI): 1.296 (1.044, 1.609)] and MetS [OR (95% CI): 1.376 (1.030, 1.760)]. We demonstrated that regular tea consumption is correlated with a greater incidence of metabolic disorders and MetS. Our findings may help clarify the contradictory association reported between tea drinking and MetS development in middle-aged and older residents of rural China.

Elevated late-life blood pressure may maintain brain oxygenation and slow amyloid-β accumulation at the expense of cerebral vascular damage.

Hypertension in midlife contributes to cognitive decline and is a modifiable risk factor for dementia. The relationship between late-life hypertension and dementia is less clear. We have investigated the relationship of blood pressure and hypertensive status during late life (after 65 years) to post-mortem markers of Alzheimer's disease (amyloid-β and tau loads); arteriolosclerosis and cerebral amyloid angiopathy; and to biochemical measures of ante-mortem cerebral oxygenation (the myelin-associated glycoprotein:proteolipid protein-1 ratio, which is reduced in chronically hypoperfused brain tissue, and the level of vascular endothelial growth factor-A, which is upregulated by tissue hypoxia); blood-brain barrier damage (indicated by an increase in parenchymal fibrinogen); and pericyte content (platelet-derived growth factor receptor β, which declines with pericyte loss), in Alzheimer's disease (n = 75), vascular (n = 20) and mixed dementia (n = 31) cohorts. Systolic and diastolic blood pressure measurements were obtained retrospectively from clinical records. Non-amyloid small vessel disease and cerebral amyloid angiopathy were scored semiquantitatively. Amyloid-β and tau loads were assessed by field fraction measurement in immunolabelled sections of frontal and parietal lobes. Homogenates of frozen tissue from the contralateral frontal and parietal lobes (cortex and white matter) were used to measure markers of vascular function by enzyme-linked immunosorbent assay. Diastolic (but not systolic) blood pressure was associated with the preservation of cerebral oxygenation, correlating positively with the ratio of myelin-associated glycoprotein to proteolipid protein-1 and negatively with vascular endothelial growth factor-A in both the frontal and parietal cortices. Diastolic blood pressure correlated negatively with parenchymal amyloid-β in the parietal cortex. In dementia cases, elevated late-life diastolic blood pressure was associated with more severe arteriolosclerosis and cerebral amyloid angiopathy, and diastolic blood pressure correlated positively with parenchymal fibrinogen, indicating blood-brain barrier breakdown in both regions of the cortex. Systolic blood pressure was related to lower platelet-derived growth factor receptor β in controls in the frontal cortex and in dementia cases in the superficial white matter. We found no association between blood pressure and tau. Our findings demonstrate a complex relationship between late-life blood pressure, disease pathology and vascular function in dementia. We suggest that hypertension helps to reduce cerebral ischaemia (and may slow amyloid-β accumulation) in the face of increasing cerebral vascular resistance, but exacerbates vascular pathology.

Abstract Number ‐ 271: Comorbidities: Severe Stroke in Thrombolysis for Ischemic Stroke with Elevated Diastolic Blood Pressure

Introduction Patients are at risk for different outcomes following stroke based on their diastolic blood pressure on admission. In this study, we determine differences in risk factors between patients with DBP &lt; 80 and &gt; = 80 mmHg and then determine which of these risk factors are associated with worsening neurologic outcomes after rtPA administration. Methods A retrospective analysis was performed by looking at demographics, history, and clinical factors that are known risk factors for acute ischemic stroke. Data were obtained from a stroke registry that includes patient data from between 2010 and 2016. Univariate analysis was performed based on presenting diastolic blood pressure group. Patients who did not receive rtPA were excluded from further study and then patients were further divided by NIHSS &gt; = 7 or &gt; 7. Logistic regression was used to further evaluate variables. Odds Ratios with 95% Confidence Intervals (C.I.) were calculated and used to predict worsening neurologic outcomes for stroke patients based on their blood‐pressure group. Results In the population of stroke patients with diastolic blood pressure &lt; 80 mmHg, increasing age (OR = 1.025, 95% C.I. = 1.011 – 1.039 . P‐value = &lt; 0.001), and elevated blood glucose levels (OR = 1.003, 95% C.I. = 1 – 1.006, P‐value = 0.03) were associated with worsening neurologic outcomes. In the diastolic blood pressure group &gt; = 80 mmHg, increasing age (OR = 1.026, 95% C.I. = 1.012 – 1.04. P‐value = &lt; 0.001), history of drug or alcohol abuse (OR = 2.11, 95% C.I. = 1.116 – 3.988, P‐value = 0.022), hypertension (OR = 1.572, 95% C.I. = 1.01 – 2.449, P‐value = 0.035), and increasing heart rate (OR = 1.012, 95% C.I. = 1.012 – 1.022, P‐value = 0.024) were associated with worsening neurologic outcomes. Conclusions This study found that there are significant differences in the clinical factors between patients with a DBP &lt; or &gt; = 80 mmHg with acute ischemic stroke and these groups also had different risk factors for severe stroke after rtPA administration. In both groups, increasing age was associated with worsening neurologic outcomes, while direct admission was associated with improving outcomes. In the DBP &lt; 80 mmHg group, elevated blood glucose levels were associated with worsening neurologic outcomes. In the DBP &gt; = 80 mmHg group, a history of alcohol or drug use and increased heart rate were associated with worsening neurologic outcomes.

Chronic kidney disease promotes cerebral microhemorrhage formation

BackgroundChronic kidney disease (CKD) is increasingly recognized as a stroke risk factor, but its exact relationship with cerebrovascular disease is not well-understood. We investigated the development of cerebral small vessel disease using in vivo and in vitro models of CKD.MethodsCKD was produced in aged C57BL/6J mice using an adenine-induced tubulointerstitial nephritis model. We analyzed brain histology using Prussian blue staining to examine formation of cerebral microhemorrhage (CMH), the hemorrhagic component of small vessel disease and the neuropathological substrate of MRI-demonstrable cerebral microbleeds. In cell culture studies, we examined effects of serum from healthy or CKD patients and gut-derived uremic toxins on brain microvascular endothelial barrier.ResultsCKD was induced in aged C57BL/6J mice with significant increases in both serum creatinine and cystatin C levels (p < 0.0001) without elevation of systolic or diastolic blood pressure. CMH was significantly increased and positively correlated with serum creatinine level (Spearman r = 0.37, p < 0.01). Moreover, CKD significantly increased Iba-1-positive immunoreactivity by 51% (p < 0.001), induced a phenotypic switch from resting to activated microglia, and enhanced fibrinogen extravasation across the blood–brain barrier (BBB) by 34% (p < 0.05). On analysis stratified by sex, the increase in CMH number was more pronounced in male mice and this correlated with greater creatinine elevation in male compared with female mice. Microglial depletion with PLX3397 diet significantly decreased CMH formation in CKD mice without affecting serum creatinine levels. Incubation of CKD serum significantly reduced transendothelial electrical resistance (TEER) (p < 0.01) and increased sodium fluorescein permeability (p < 0.05) across the endothelial monolayer. Uremic toxins (i.e., indoxyl sulfate, p-cresyl sulfate, and trimethylamine-N-oxide) in combination with urea and lipopolysaccharide induced a marked drop in TEER compared with the control group (p < 0.0001).ConclusionsCKD promotes the development of CMH in aged mice independent of blood pressure but directly proportional to the degree of renal impairment. These effects of CKD are likely mediated in part by microglia and are associated with BBB impairment. The latter is likely related to gut-derived bacteria-dependent toxins classically associated with CKD. Overall, these findings demonstrate an important role of CKD in the development of cerebral small vessel disease.

GWAS on retinal vasculometry phenotypes.

The eye is the window through which light is transmitted and visual sensory signalling originates. It is also a window through which elements of the cardiovascular and nervous systems can be directly inspected, using ophthalmoscopy or retinal imaging. Measurements of ocular parameters may therefore offer important information on the physiology and homeostasis of these two important systems. Here we report the results of a genetic characterisation of retinal vasculature. Four genome-wide association studies performed on different aspects of retinal vasculometry phenotypes, such as arteriolar and venular tortuosity and width, found significant similarities between retinal vascular characteristics and cardiometabolic health. Our analyses identified 119 different regions of association with traits of retinal vasculature, including 89 loci associated arteriolar tortuosity, the strongest of which was rs35131825 (p = 2.00×10-108), 2 loci with arteriolar width (rs12969347, p = 3.30×10-09 and rs5442, p = 1.9E-15), 17 other loci associated with venular tortuosity and 11 novel associations with venular width. Our causal inference analyses also found that factors linked to arteriolar tortuosity cause elevated diastolic blood pressure and not vice versa.

Prevalence and risk factors of retinal vein occlusion in the United States: The National Health and Nutrition Examination Survey, 2005 to 2008

Retinal vein occlusion (RVO) is a rare, vision-threatening vascular disorder. Due to limited recovery associated with RVO, prevention is essential. There is a significant discrepancy in previously reported epidemiological studies in the United States on the prevalence and risk factors of RVO. The purpose of this retrospective, cross-sectional study was to determine the prevalence and risk factors of RVO in adults ≥40 years of age in the US using the National Health and Nutrition Examination Survey (NHANES) 2005–2008. We collected information on the demographic characteristics, medical conditions, and ocular pathology of NHANES participants. We performed weighted analysis to estimate national prevalence rates and multivariate analysis to examine associated risk factors. The main outcome measures were the prevalence of RVO and the odds ratios of associated risk factors. We included 5559 participants and found 33 cases of RVO. The overall prevalence of RVO in the US was 0.50%. Age, per 10-year increase (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.31–2.92) and elevated diastolic blood pressure, per 10 mm Hg increase (OR 1.47; 95% CI, 1.10–2.12) were significant risk factors for RVO. Race, sex, glaucoma, elevated cholesterol, and self-reported history of diabetes, stroke, and heart disease were not significant risk factors. RVO is significantly associated with older age and elevated diastolic blood pressure. Our findings should alert clinicians to identify individuals at risk for RVO.

Blood pressure response to dynamic resistance exercise with different times under blood flow restriction on normotensive subjects: a randomized crossover trial

Introduction: Recommendations for time under blood flow restriction (BFR) during resistance training (RT) vary between 5 to 10 minutes, and beneficial effects on muscle mass and strength have already been reported. However, there exists the potential for longer times under restriction to produce greater acute activation of the exercise pressor reflex and subsequent sympathetic pathways leading to a greater hemodynamic response. Objective: To verify blood pressure responses to dynamic resistance exercise with different times (5 vs. 10 minutes) under blood flow restriction in normotensive subjects. Methods: In a randomized crossover trial design, twelve healthy and physically active male participants completed a training with BFR under the following protocols: control, BFR-5 minutes, BFR-10 minutes. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurements were taken by an experienced researcher immediately after each exercise set. Results: Both BFR-5 minutes and BFR-10 minutes induced acute elevations in SBP, DBP and heart rate (HR) as the sets progressed, without statistical differences between them. However, BFR-10 displayed a superior effect size for SBP and DBP compared to BFR-5 minutes. Conclusion: Based on the present study results, the time under BFR during resistance exercise does not affect blood pressure response in normotensive subjects.

Personal and Work-Related Burnout Is Associated with Elevated Diastolic Blood Pressure and Diastolic Hypertension among Working Adults in Chile.

We aimed at investigating the association of personal and work-related burnout with blood pressure and hypertension among working adults in Chile. We conducted a cross-sectional study among 1872 working adults attending the Hospital del Trabajador in Santiago, Chile, between September 2015 and February 2018. The Copenhagen Burnout Inventory was used to assess personal and work-related burnout. Blood pressure was measured by medical practitioners. Multivariable linear and logistic regressions were used to estimate the association of burnout status with systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension. After adjusting for confounders, participants with both types of burnout had a 1.66 (95% confidence interval [CI]: 0.02-3.30) mmHg higher mean DBP than those without burnout. The odds of isolated diastolic hypertension among the participants with only personal burnout and both types of burnout were 2.00-fold (odds ratio [OR] = 2.00; 95% CI: 1.21-3.31) and 2.08-fold (OR = 2.08; 95% CI: 1.15-3.78) higher than those without burnout. The odds of combined systolic/diastolic hypertension among the participants with only work-related burnout increased by 59% (OR = 1.59; 95% CI: 1.01-2.50) compared with those without burnout. Both work-related and personal burnouts were associated with increased DBP and odds of diastolic hypertension among working adults in Chile.

Exploring the Validity of Available Markers and Indices in the Diagnosis of Nonalcoholic Fatty Liver Disease (NAFLD) in People with Type 2 Diabetes in Saudi Arabia.

Nonalcoholic fatty liver disease (NAFLD) is common among Saudi patients with type 2 diabetes (T2DM). However, recommended clinical procedures to detect it are unavailable in many locations. Therefore, better and more available diagnostic biomarkers for NAFLD are needed. Various serum parameters were suggested, and algorithms that employ routine measurements in clinical practice have been developed for the prediction of fat stores in the liver in different populations. However, no such studies have been conducted on Saudis. We aimed to compare selected biochemical markers and calculated indices in T2DM patients diagnosed with NAFLD and patients without NAFLD to find the best markers associated with NAFLD. A cross-sectional study was employed to recruit 67 people with T2DM from endocrine outpatient clinics at King Abdul-Aziz University Hospital. NAFLD was detected by ultrasonography in 28 patients. Demographic information, anthropometric, and blood pressure (BP) measurements were taken. Fasting blood samples were obtained to measure glucose, glycated haemoglobin, lipid profile, liver function tests, and highly sensitive C-reactive protein. Fatty liver index, hepatic steatosis index, NAFLD-liver fat score, and triglyceride and glucose index were calculated. Following stepwise forward likelihood ratio regression with independent variables included in one model using binary logistic regression with age and waist circumference (WC) entered as covariates, elevated diastolic BP and low high-density lipoprotein- cholesterol remained significantly associated with NAFLD (p = 0.002 and 0.03, respectively). However, none of the investigated indices could be used to diagnose the disease adequately due to low specificity, even after calculating new cut-off values. Investigating novel markers and adjusting existing equations used to calculate indices to improve sensitivity and specificity in our population is needed.

Neuroimaging findings related to glymphatic system alterations in older adults with metabolic syndrome

ObjectiveThe glymphatic system is a glial-based perivascular network that promotes brain metabolic waste clearance. Reduced glymphatic flow has been observed in rat models of type 2 diabetes and hypertension, indicating the role of vascular risk factors in the glymphatic system. However, little is known about how vascular risk factors affect the human glymphatic system. The present study aims to assess the relationships between metabolic syndrome (MetS), a cluster of vascular risk factors, and the glymphatic system function using diffusion magnetic resonance imaging (MRI)-based measures of water diffusivity in the glymphatic compartments, including the brain interstitial space and perivascular spaces around the deep medullary vein. We hypothesized that vascular risk factors are associated with glymphatic dysfunction, leading to cognitive impairment in older adults. MethodsThis cross-sectional study assessed 61 older adults (age range, 65–82 years) who had participated in the Bunkyo Health Study, including 15 healthy controls (mean age, 70.87 ± 4.90 years) and 46 individuals with MetS (mean age, 71.76 ± 4.61 years). Fractional volume of extracellular-free water (FW) and an index of diffusion tensor imaging along the perivascular space (DTI-ALPS) were used as indirect indicators of water diffusivity in the interstitial extracellular and perivenous spaces of white matter, respectively. ResultsAfter adjusting for age, sex, years of education, total Fazekas scale, Pittsburgh sleep quality index (PSQI) score, and intracranial volume (ICV), a significantly (P = 0.030; Cohen's d = 1.01) higher FW was observed in individuals with MetS than in the healthy controls. Furthermore, individuals with MetS had a significantly (P = 0.031; Cohen's d = 0.86) lower ALPS index than the healthy controls, with age, sex, years of education, total Fazekas scale, PSQI score, ICV, fractional anisotropy, and mean diffusivity included as confounding factors. Higher FW was significantly associated with lower ALPS index (r = −0.37; P = 0.004). Multiple linear regression (MLR) with backward elimination analyses showed that higher diastolic blood pressure (BP; standardized β = 0.33, P = 0.005) was independently associated with higher FW, whereas higher fasting plasma glucose levels (standardized β = −0.63, P = 0.002) or higher Brinkman index of cigarette consumption cumulative amount (standardized β = −0.27, P = 0.022) were associated with lower ALPS index. The lower ALPS index (standardized β, 0.28; P = 0.040) was associated with poorer global cognitive performance, which was determined using the Japanese version of the Montreal Cognitive Assessment (MOCA-J) scores. Finally, partial correlation analyses showed a significant correlation between higher FW and lower MOCA-J scores (r = −0.35; P = 0.025) and between higher FW and higher diastolic BP (r = 0.32, P = 0.044). ConclusionThe present study shows the changes in diffusion MRI-based measures reflected by the higher FW and lower ALPS index in older adults with MetS, possibly due to the adverse effect of vascular risk factors on the glymphatic system. Our findings also indicate the associations between the diffusion MRI-based measures and elevated diastolic BP, hyperglycemia, smoking habit, and poorer cognitive performance. However, owing to the limitations of this study, the results should be cautiously interpreted.

СРЕДНЕСРОЧНОЕ ПРОГНОЗИРОВАНИЕ СКОРОСТИ ПРОСТОЙ ЗРИТЕЛЬНО-МОТОРНОЙ РЕАКЦИИ ПО ПАРАМЕТРАМ АРТЕРИАЛЬНОГО ДАВЛЕНИЯ И ВАРИАБЕЛЬНОСТИ СЕРДЕЧНОГО РИТМА

One of the symptoms of asthenia in space flight is a decrement of cognitive efficiency, memory and concentration. A demand exists for simple noninvasive methods to forecast appearance of cognitive shifts. It is hypothesized that blood pressure (BP) and heart rate variability (HRV) measured in the morning can predict the psychomotor reactions as at the time of measurement, so in the course of the day (medium-term prediction). The investigation involved 6 volunteers (29-44 y.o.) for a 120-day isolation study. The protocol included 5-min ECG and BP measurement soon after awakening, and HRV evaluation. The classic simple ocular-motor reaction (SOMR) test was performed before and then after midday. Regression analysis of reaction duration and stability showed that SOMR time correlated with the homeostatic parameters (BP, HR); stability of SOCM duration correlated both BP and HR, and parameters reflecting HR regulation processes. Elevated diastolic BP correlated with an increase of reaction duration irrespective of whether the test was performed before or in midday. Elevation of diastolic BP and autonomic balance shift toward the sympathetic activity in the morning correlated with a loss in SOMR stability no matter when the test was performed.

Effect of Isotonic Exercise on Cardiovascular Parameters in Medical Students with Different Body Mass Indices: A Cross-sectional Study

Introduction: Obesity is a known risk factor for hypertension. Baseline Heart Rate (HR) and blood pressure are known to scale linearly with Body Mass Index (BMI) values. Recent studies have reported an exaggerated acute response of blood pressure and HR to exercise. Aim: To assess the effect of isotonic exercise on cardiovascular parameters among individuals with different body mass indices in students at Osmania Medical College and look for any association between BMI and cardiovascular responses to isotonic exercise. Materials and Methods: A cross-sectional study was conducted in the Department of Physiology at Osmania Medical College, Hyderabad, Telangana, India, from January 2022 to December 2023, involving 100 healthy individuals with different body mass indices in the age group of 17 years-30 years. The subjects were divided into four groups based on their BMI. Baseline HR, Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) were measured for all participants. Subsequently, the participants performed isotonic exercise for three minutes. Post-exercise HR, SBP, and DBP were measured immediately. One-way ANOVA was used to determine the significance of HR, SBP, DBP, Mean Arterial Pressure (MAP), and Pulse Pressure (PP) among the different BMI groups. A p-value of &lt;0.05 was considered statistically significant. Results: A total of 100 subjects (28 males, 72 females) with a mean age of 18.64±0.92 years participated in the study. Significant differences were observed in pre-exercise HR (p=0.0002), SBP, DBP, and MAP (p&lt;0.001), and post-exercise HR, SBP, DBP, and MAP (p&lt;0.001) among the different BMI groups. Overweight and obese individuals showed an increased tendency for an exaggerated increase in HR. Changes in PP and MAP, affected by a combination of SBP and DBP, also showed statistical significance. Furthermore, there was an increased tendency for an exaggerated increase in blood pressure in the overweight and obese BMI groups. Conclusion: Individuals with higher BMI exhibit exaggerated increases in SBP, Mean and PP, as well as HR. Additionally, obese individuals demonstrated a significant elevation in DBP. The response of blood pressure and HR after exercise in overweight/obese individuals suggests a higher risk of developing hypertension and other cardiovascular diseases.

Эклампсия. Современный портрет

Hypertensive disorders consistently occupy one of the leading causes of maternal mortality. An important role in the diagnosis of eclampsia is given to MRI (magnetic resonance imaging) of the brain, which allows to identify a pathognomonic symptom of eclampsia, posterior reversible encephalopathy syndrome (PRES). Patients and methods. Six clinical cases of patients with eclampsia were retrospectively analyzed. Results. The result of the first screening showed a low risk of pre-eclampsia in 83.3% of patients, and only 16.7% were at risk. All patients developed the eclamptic episode in the third trimester of pregnancy, and they all had elevated diastolic blood pressure (above 110 mm Hg). In 66.7% of patients, systolic blood pressure was within the range of 180–200 mm Hg. There were no disorders of liver function and coagulation system, and platelet levels were within the normal range. According to the brain MRI, all patients were diagnosed with PRES without signs of cerebral circulation disorders. Conclusion. This study demonstrates that the causes and pathogenesis of eclampsia are still unknown. Perhaps we are talking about a new manifestation of the disease, or maybe the causes lie in the pathogenesis, which is not fully understood. Key words: hypertensive disorders of pregnancy, pre-eclampsia, posterior reversible encephalopathy syndrome, eclampsia, PRES

Albuminuria is associated with 24-hour and night-time diastolic blood pressure in urinary tract infection with renal scarring.

We aimed to detect complications and associated risk factors in patients with renal scarring (RS) secondary to recurrent urinary tract infections (UTI). Fifty patients with RS were compared with 25 patients without RS by means of, serum creatinine, 24- hour urinary creatinine clearance, and 24-hour urinary albumin levels. Office blood pressure (BP) examination and ambulatory BP monitoring (ABPM) were also performed. Vesicoureteral reflux was detected in 50 patients. Glomerular filtration rate (GFR) < 90 ml/min/1.73 m2 was observed in 5 patients with RS but in no patient without RS. Albuminuria was significantly higher in patients with bilateral RS and severe RS. Patients with albuminuria had a significantly lower GFR than those without. All patients with ambulatory hypertension (HT) were in the RS group, and 60% of those had isolated nocturnal HT. Compared to those without RS, patients with RS had significantly higher SDS values for all BP readings, 24-hour and nighttime systolic and diastolic BP loads with significantly lower systolic dipping. GFR was negatively correlated with diastolic BP SDS and diastolic BP load in patients with RS. Daytime diastolic BP load was significantly higher in those with severe RS than in those with mild RS. Isolated nocturnal HT could be an early sign of complications in RS of UTI. Albuminuria is related to increased BP and impaired renal function. Therefore, ABPM and assessing albuminuria should be a routine part of the follow-up. Diastolic BP elevations could be associated with worse outcomes in these patients.