Fall In Blood Pressure Research Articles

TO STUDY THE EFFICACY OF PROPHYLACTIC INTRAVENOUS PHENYLEPHRINE IN PROPOFOL-INDUCED HYPOTENSION DURING INDUCTION OF GENERALANAESTHESIA

INTRODUCTION :Hypotension is the most common complication during induction of general anesthesia. Hypotension is the decrease in systolic blood pressure below the normal accepted value, that is less than 90mm of Hg or decrease in mean arterial pressure of less than 65 mmHg. It is asymptomatic while induction of anesthesia and recognition requires proper predictors on multipara monitors like systolic blood pressure and mean arterial blood pressure. To prevent hypotension many methods like co-loading with intravenous crystalloids, vasopressors have been tried. In our study we are using prophylactic intravenous phenylephrine to prevent fall in blood pressure and to measure the SBPand MAPafter induction of anaesthesia and intubation in the study and control group. (At 5 minutes, 10 minutes, and 15 minutes)” METHODOLOGY-The study was conducted at “Dr. D. Y. Patil medical college, hospital, and research institute” from March 2021 to August 2022 after institutional ethical approval. Total of 120 patients were selected and were divided into two groups, the study group (n =60) the control group (n =60). Routine systematic preoperative assessment and investigation were performed according to the study protocol. RESULTS- SBP was observed to be signicantly declined in the “control group” compared to the “study group” when observed at 10min and 15min time intervals. MAPwas found to be effectively reduced in the “control group compared to the “study group” when observed at 10 min and 15min time intervals. CONCLUSION-From the study it was concluded that the “prophylactic intravenous phenylephrine is effective in preventing fall in blood pressure associated with propofolinduced hypotension at the time of induction during general anaesthesia”

Anaesthetic management of foetus in foetu: A rare entity.

Sir, Foetus in foetu (FIF) is a congenital condition in which a malformed, parasitic foetus is located in the body of its twin. The incidence is 1 in 5,00,000 live births.[1] It was first described in the 1800s by Johann Friedrich Meckel. Less than 200 cases of foetus in foetu have been reported till now.[2] During the developmental stages, there is absence of independent circulatory systems, so the parasite undergoes the stage of primitive streak and it develops vertebral body and organ arranged around an axis differentiating it from a foetiform teratoma.[3] Teratoma is a differential diagnosis which is a type of germ cell tumour. Different organs seen in FIF are vertebral column (91%), limbs (82.5%) and central nervous system (55.8%).[4] 1 ½-year-old, 9-kg child presented with palpable mass in abdomen since birth, constipation and difficulty in passing urine since 3 months. Birth history was insignificant, child was immunised and had achieved milestones for age. General and systemic examination were normal except that a large, and painless mass of the size of a sweet lemon was felt per abdomen. Blood investigations, chest X-ray and echocardiography were normal. Beta-human chorionic gonadotropin and alpha-foetoprotein were negative. Abdominal sonography showed a retroperitoneal mass of 12×8×10 cm in the right suprarenal region extending to the right lumbar region, crossing the midline suggestive of teratoma or FIF. Computerised tomography (CT) abdomen showed a FIF in the retroperitoneal aortocaval region—a well-organised teratoma causing compression over the abdomen [Figure 1].Figure 1: CT Abdomen showing massNil by mouth status and consent was checked. Plan was general anaesthesia plus epidural analgesia. All standard American Society of Anesthesiologists (ASA) monitors attached. Pre-oxygenation was done, and premedication was given. Induction was done with intravenous (IV) propofol (2 mg/kg), IV fentanyl (2 µg/kg) and IV atracurium (0.5 mg/kg), intubated with 4.5 mm uncuffed endotracheal tube and maintained on atracurium, sevoflurane using pressure control mode. Right internal jugular vein was cannulated with 5F 8 cm triple lumen under ultrasonography guidance and fixed at 8 cm. Right radial artery was cannulated for arterial blood pressure (ABP). 19G epidural catheter was placed in left lateral position at L1-L2 space, fixed at 5 cm using saline technique. Infusion with Inj. Ropivacaine 0.2% was started at 2 ml/h and adjusted according to haemodynamics for adequate analgesia. 10F Ryles tube was inserted. Intraoperatively, it was found that the mass was adhered to the surrounding structures, inferior vena cava and aorta [Figure 2]. This led to increased blood loss during dissection causing fall in blood pressure and tachycardia. Beat-to-beat monitoring was done with ABP and central venous pressure; accordingly, fluid was replaced. Blood loss was replaced with packed red blood cells 15 ml/kg. Total fluid given was 900 ml crystalloids, blood loss was 200 ml and urine output was 300 ml. Body temperature was kept normal throughout the procedure. After 5 h duration of surgery, arterial blood gases were normal and patient was extubated uneventfully.Figure 2: Mass of foetus in foetuThe child was shifted to the paediatric intensive care unit for observation. Epidural 0.1% ropivacaine infusion was continued for analgesia and the child was discharged on day 15. The histopathology report showed FIF. FIF has been explained by two theories ‘Parasitic twin theory’ states that a normal foetus becomes enveloped inside the twin partner becoming dependent on its blood supply. As per ‘Teratoma theory’, it is a highly differentiated form of mature teratoma.[5] Conjoined twinning happens when the twinning event occurs at the primitive streak stage of development, 13–14 days after fertilisation, and is associated with the monoamniotic monochorionic type of placentation.[3] The presence of vertebral column differentiates between teratoma and FIF, and its presence was confirmed via CT abdomen in our case. FIF should be differentiated from a teratoma as teratoma has malignant potential.[6] According to Willis definition, FIF should have (a) separate vertebral column, symmetrical development around its axis, and (b) the organs should have developed in an organised manner with some degree of maturation,[3] all of which were present in our case. Meticulous preoperative optimisation, vigilant intraoperative monitoring and good post-operative care led to successful outcome of this rare and complicated case. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Higher fasting fibroblast growth factor 21 was associated with a greater decline in postprandial blood pressure

BackgroundA fall in blood pressure (BP) following a meal is well known and is usually a transient phenomenon, due to appropriate cardiovascular adjustments. Older individuals and those with high BP experience a greater postprandial fall that can manifest as postprandial hypotension (PPH). Fibroblast growth factor 21 (FGF21) is positively associated with BP, and is known to increase after meal ingestion. We explored whether fasting FGF21 or its postprandial change would be associated with meal induced BP change, after accounting for several covariates. MethodsEighty-three Western Australian adults were studied. Supine resting BP was recorded and an oral glucose test was administered. Serial measurements of systolic BP (SBP) and diastolic BP (DBP) were then made in duplicate every 30 min up to 120 min. Fasting and 120 min blood samples were analysed for FGF21 and clinical chemistry. Multiple linear regression analyses of the incremental area under curve of postprandial SBP and DBP was conducted on 12 known determinants. ResultsThe final parsimonious model based on backward regression of postprandial SBP included fasting SBP, gender, fasting insulin and fasting FGF21 (β = −0.009 (95% confidence interval (CI): 0.017, −0.002, P = 0.015)). For postprandial DBP these included fasting DBP, gender, fasting glucose, fasting insulin and fasting FGF21 (β = −0.005; 95% CI: 0.010, −0.001, P = 0.021). ConclusionsA higher fasting FGF21, independent of glucose and insulin, was associated with a greater postprandial decline in SBP and in DBP.

Effectiveness Of Saddle Block Vs Spinal Anaesthesia In Turp: An Open Label Randomized Control Trial.

One of the most frequent diseases among male gender is benign prostatic hyperplasia. Transurethral resection of the prostate (TURP) is a minimally invasive procedure for resection of prostate through endoscopic technique. Recently there was a debate on role of saddle block in TURP. There we aimed to determine the effectiveness of spinal anaesthesia versus saddle block in terms of hemodynamic stability and vasoprbessor requirement in TURP. This open label randomized control trial was performed at Hamdard University Hospital, Karachi, Pakistan, during 1st October, 2021 to 31st March, 2022. Male patients of age 45-65 years requiring TURP, with well controlled diabetes and hypertension of ASA grade I-II were included into the study and randomly assigned into two study groups. Patients' parameters including blood pressure, heart rate, mean arterial pressure and oxygen saturation (SPO2) were measured at baseline and intraoperative at every fifth minute interval till surgery completion. Patients' other parameters including age, surgery duration and comorbidity were also recorded. Total 60 patients with 30 patients in each group were enrolled into the study. Maximum fall in systolic blood pressure, diastolic blood pressure, pulse rate and mean arterial pressure from baseline was significantly lower in patients receiving saddle block anaesthesia than spinal anaesthesia. Maximum fall in SPO2 was not significantly different among two study groups. Maximum fall in all parameters excluding SPO2 was significant between two groups for initial 20 minutes of the procedure. No statistically significant maximum fall was seen for all of the parameters beyond 20 minutes of the procedure. Vasopressor consumption was significantly lower in saddle block group than spinal anaesthesia. Application of saddle block anaesthesia is effective for TURP procedure with controlled hemodynamic status than spinal anaesthesia. Moreover, saddle block requires less vasopressor consumption than spinal anaesthesia technique.

COMPARATIVE STUDY OF ETOMIDATE AND PROPOFOL FOR INDUCTION OF GENERAL ANESTHESIA IN ELDERLY PATIENTS

Introduction: An ideal induction agent for general anesthesia should have hemodynamic stability, minimal respiratory side effect and rapid recovery. Presently etomidate and propofol are popular rapid acting inducing agents. Material and methods: After obtaining informed written consent from patients this prospective, randomized, double blind study was conducted in 100 patients of ASA grade 3 and 4 posted for elective surgeries under general anaesthesia. They were divided into two groups of 50 in each group based on random number as group A and group B. The patients in Group A given Inj. Propofol and the patients in Group B received Inj. Etomidate. Parameters such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and spo2 were monitored continuously and recorded. Incidence and degree of pain of myoclonic movements were recorded. Demographic variables such as age Result: , gender, weight and ASA grade were comparable no significant difference existed between both the groups.Baseline mean heart rate, mean systolic blood pressure and mean diastolic blood pressure were comparable in both the Groups. (P>0.05)Significant (P<0.05) fall in mean systolic blood pressure, mean diastolic pressure and mean arterial pressure was observed immediately after induction, at 2, 5, 10 minutes up to 30 minutes in group A (propofol) compare to group B (etomidate). After then no significant difference seen in mean systolic pressure, mean diastolic pressure and mean arterial pressure. Etomidate was found ideal for its hemodynamic stability when compared to Propofol Conclusion: along with less incidence of pain on injection, the only drawback being high incidence of myoclonus elderly patient

Rare dizziness, syncope, loss of consciousness, seizure, and risk of falling after vaccination

<abstract> <p>Some individuals experience dizziness, syncope (temporary loss of consciousness caused by a fall in blood pressure), seizure, and similar rare adverse events after vaccination. Sudden impacts to alertness, consciousness, ability to talk, vision, or balance may pose rare risks for some vaccinees for a few days post vaccination. Herein, the Vaccine Adverse Event Reporting System (VAERS) database is examined for relevant adverse events. These adverse events exhibit a consistent pattern of onset soon after vaccination consistent with other reported reactogenicity adverse events. The onset of these adverse events soon after vaccination provides supportive evidence to reject the hypothesis that the majority of these adverse events represent background occurrences unrelated to vaccination. The immediate onset timing of these adverse events represent a pattern that warrants further study. The observed onset pattern for multiple unrelated vaccines are consistent with the possible etiology of innate immune responses to vaccination as causative for these observed adverse events. Cautionary avoidance of some activities immediately following vaccination may reduce accidental injuries.</p> </abstract>

PS-C31-3: PREVALENCE OF A FALL OR RISE IN BLOOD PRESSURE FROM A SITTING TO A STANDING POSITION IN TREATED HYPERTENSIVE PATIENTS

Objective: It is known that blood pressure (BP) fluctuates with positioning of an individual. Usually BP falls when changing from lying to standing position which can cause orthostatic/postural hypotension. However, studies have also shown that BP rises in certain individuals from lying to standing position. Studies have also shown that rises are associated with increasing age, obesity and presence of diabetes. While the prevalence of orthostatic/postural hypotension is known, prevalence of rise in BP upon standing is not well documented. It is important to identify falls or rise in BP upon standing as orthostatic/postural hypotension is associated with increased risk of falls while a rise in BP is associated with increased risk of cardiovascular events (CV). The aim of our study is to examine the proportion of patients whose BP rises or falls upon standing amongst hypertensive patients. We also examined the association of age, diabetic status, obesity and CV with rises of BP upon standing. Materials and Methods: This is a cross sectional study of hypertensive patients in a primary care clinic. Demographic data was collected with weight and height measured. Sitting BP was taken twice after 5 minutes rest, standing BP was taken after 5 minutes of standing. Any fall or rise in BP from sitting to standing was categorized as fallers and risers respectively. Results: 1736 patients were recruited into this study,734 were invited to have their standing BP done. Mean age was 66.0 ± 9.9years, mean sitting systolic blood pressure (SBP) was 144.4 ± 19.1mmHg, mean sitting diastolic blood pressure (DBP) was 82.4 ± 10.9mmHg, mean sitting heart rate (HR) was 71.4 ± 12.6 min−1. Mean standing SBP was 146.0 ± 19.7mmHg, mean standing HR was 74.1 ± 13.3mins−1. Mean BMI was 27.1 ± 5.5 kg/m2, of which 69.5% (n = 437) were female, 51.6% (n = 379) were diabetic, and 25.3% (n = 378) were obese. Percentage of patients 65 years and older was 58.5% (n = 428). 22.5% (n = 164) of the patients also had prior CV events. The proportion of risers and fallers upon standing was 44.5% and 52.8% respectively. There was no significant difference between the proportion of risers and fallers with increasing age(p = 0.312) or diabetic status (p = 0.406). However, it was statistically significant associated with obesity (BMI of 30 kg/m2 or more)(p = 0.038). Conclusion: Although BP usually drops upon standing, our study showed more than half of treated hypertensives had a rise in their standing BP. There was association of risers/fallers with obesity but not with age or diabetes.

Blood Pressure Response to Treadmill Stress TestingInterpretation and Critical Appraisal

A progressive and sustained decrease in systolic blood pressure on the continuation of exercise suggests severe left ventricular dysfunction irrespective of the cause. A transient decrease in systolic blood pressure followed by a normal increase in the continuation of exercise does not have any clinical significance. Failure of systolic blood pressure to increase commensurate to an increase in workload suggests the failure of adequate increase in left ventricular stroke volume with increasing workload. At present there is no consensus about the definition and significance of the exaggerated increase in systolic blood pressure during exercise. This is because different authors have used different criteria for defining abnormal response. An increase in diastolic blood pressure by 10 mm Hg over resting diastolic blood pressure or peak diastolic blood pressure of 110 mm Hg is significant and may be associated with a future risk of hypertension at rest. There is no consensus about the magnitude of the fall in systolic blood pressure during the initial few minutes of recovery. A paradoxical increase rather than a decrease in systolic blood pressure during recovery may be associated with coronary artery disease. Correct auscultatory measurement of blood pressure at peak exercise is difficult. Therefore, some authorities recommend the evaluation of blood pressure at a submaximal workload. This area needs further evaluation.

PS-P04-7: ALERTING REACTION OF BLOOD PRESSURE AND AGE: MAY MEASUREMENT MONTH 2019

Objective: The extent of the alerting reaction on systolic blood pressure (BP) measurements has been shown to be related to age and the magnitude of the first reading, with implications for the monitoring and diagnosis of hypertension. We investigated the effects of age on the direction and magnitude of change in both systolic and diastolic BP from the first to subsequent readings, using data from the May Measurement Month (MMM) global BP screening campaign in 2019. Design and method: We examined the relationship between the value of the first reading (BP1) and the change in BP from BP1 to the average (BPA) of the second (BP2) and third readings (BP3) taken at 1 minute intervals in participants with three BP readings. Mixed effects regression models were fit, stratified by age, and using random intercept for country of screening site to account for clustering. This approach was repeated for diastolic and systolic BP. Results: Of the 1,133,008 participants with three BP readings, 58.7% had a decrease in systolic and 54.2% a decrease in diastolic BP from BP1 to BPA. Above an age dependent threshold value in BP1, a higher BP1 was associated with a greater decrease from BP1 to BPA. Older participants on average exhibited relatively smaller changes in systolic BP from systolic BP1 to systolic BP2 for equivalent values of systolic BP1 than younger age groups (Fig.1A). The average difference between diastolic BP1 and diastolic BPA showed a “U shaped” interaction with age such that the largest difference was observed in the youngest and oldest age groups and the smallest difference in those aged 40 to 49 and 50 to 59 years (Fig.1B). These patterns of BPV across values of BP1 and age persisted when the models were adjusted for antihypertensive medication or sex, or if the difference in BP from BP1 to BP2 or BP3 were used as the outcome. Conclusions: Age had a significant and differential modifying effect on the fall in systolic and diastolic BP from first to subsequent readings taken on a single occasion. These results could reflect age related variation in homeostatic capabilities to regulate BP following an initial stress response or differential sizes of alerting response by age. This highlights the importance of taking multiple BP readings when assessing BP, particularly in younger individuals, to avoid overestimation and overdiagnosis.

1: ULTRASOUND SCREENING FOR VOCAL CORD DYSFUNCTION AFTER CONGENITAL HEART SURGERY IN CHILDREN

Introduction: Vocal cord dysfunction (VCD) is a common complication following congenital cardiac surgery. VCD is more frequently diagnosed in aortic arch repairs due to the risk of recurrent laryngeal nerve injury. We previously identified VCD as a key variable in feeding dysfunction leading to increased resource utilization in children with congenital heart surgery. The current diagnostic to identify VCD is Fiberoptic Endoscopy (FOE), however, Vocal Cord Ultrasound (VCUS) has been described as a screening tool to identify VCD in high-risk populations. We describe the performance of VCUS versus FOE in children following congenital cardiac surgery. Methods: Patients undergoing surgeries known to be associated with VCD were prospectively included. Patients underwent evaluation with FOE per our institutional protocol once they were weaned off of positive pressure ventilation. In addition to the FOE, four operators performed a bedside VCUS on high-risk patients. The results of the VCUS were compared against FOE for both diagnostic yield and patient tolerance. Patient tolerance was defined as changes in vital signs (i.e. bradycardia defined as heart rate < 100bpm, hypoxia defined as SpO2 decrease >10%, hypotension defined as fall in blood pressure by >10 mmHg, and respiratory distress defined as rate increase by 10. Results: Over two months, we screened 13 patients, of which 12 patients received FOE and VCUS. Eight patients (61%) were diagnosed with VCD by FOE. Qualitative interpretation of VCUS, with performers blinded to FOE results, had 100% sensitivity and specificity vs. FOE. VCUS had a lower incidence of respiratory distress (1 vs. 5, p=0.03) and hypoxia (0 vs. 2, p=0.06). No patients had bradycardia or hypotension. Conclusions: Preliminary data indicates that VCUS is very specific and sensitive in screening for VCD. In addition, VCUS was well tolerated by patients with a low incidence of complications. Further investigation is necessary to determine if VCUS can replace FOE as a screening tool for VCD in children following congenital cardiac surgery. Implementation of VCUS as the primary screening tool may prove important in resource-limited centers.

A Comparison of Hemodynamic Changes Between the Use of Etomidate and Propofol as Induction Agents for Anesthesia in Daycare Surgeries.

Background and objective The development of modern anesthetic agents has made it possible to conduct pain-free surgical procedures. The role of the anesthetist in choosing a suitable anesthetic agent to provide a good anesthetic and sedative effect is very important in any surgical procedure. There is always a degree of risk involved as the hemodynamic parameters may be altered. This study aimed to compare the hemodynamic changes and respiratory effects between the use of etomidate and propofol for the induction of general anesthesia (GA) as well asto compare the side effects of both drugs in daycare surgeries. Methods The study was a parallel-design, randomized, double-blinded control trial conducted over a period of three years among patients undergoing elective daycare surgeries under GA. The patients were classified into two groups depending on the type of drug received: Group A or the propofol group and Group B or the etomidate group.Randomization was done by computer-generated random number generator software. A total of 174 patients were selected (87 in each group) at a ratio of 1:1. A baseline evaluation of the hemodynamic parameters was done followed by continuous monitoring. Results The age, weight, and gender distribution of the patients in both groups were comparable. Significant hemodynamic changes were observed following induction in Group A. The fall in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MABP) in Group A following induction was found to be statistically significant (p<0.00). The rise in heart rate was almost similar in both groups, with Group A demonstrating a slightly higher rate. There were fewer signs of respiratory depression in Group B. The major side effects observed after induction were myoclonus, which was more prevalent in Group B patients (21.84%), and pain at the injection site, which was observed more frequently in Group A (17.1%). Conclusion Based on our findings, etomidate is a drug with better hemodynamic stability and less pain at the site of injection compared to propofol. Hence, it may be a better induction agent in daycare surgeries.

L’hypotension orthostatique : mise au point sur une pathologie fréquente parfois méconnue

Orthostatic hypotension is a frequent pathology especially in older adults and inhospital patients. Prevalence is increasing with age, and is about 30% of patients older than 65 years. Orthostatic hypotension is defined as a fall in blood pressure of at least 20 mmHg systolic or 10 mmHg diastolic when standing or during head-up tilt testing. Orthostatic hypotension is significantly associated with several adverse outcomes such as falls, neurodegenerative disease, cardiovascular outcomes (such as stroke or heart failure), and mortality. Different mechanisms may be involved in pathogeny especially medications. Etiological work up will evaluate cardiac response when standing. Neurogenic orthostatic hypotension is characterized by a cardiovascular autonomic failure due to central or peripheral nervous system disorders. Non-neurogenic orthostatic hypotension is primarily caused by hypovolemia. Therapeutic management is based on non-pharmacological therapies, especially legs venous compression, even if evidence for effectiveness is lacking. Pharmacological therapies may be necessary for neurogenic orthostatic hypotension.

Effects of blood pressure lowering for the prevention of dementia: meta‐analysis of individual patient data from five seminal randomised controlled trials involving 28008 participants

AbstractBackgroundObservational studies indicate U‐shaped associations of blood pressure (BP) and incident dementia in older age, but randomised controlled trials of BP lowering treatment show mixed results on this outcome in hypertensive patients. We undertook a pooled individual participant data analysis of five seminal double‐blind placebo‐controlled randomised trials to better define the effects of BP lowering treatment for the prevention of dementia and cognitive decline.MethodsMultilevel logistic regression was used to evaluate the treatment effect on incident dementia. Effect modification was assessed for key population characteristics including age, baseline systolic BP, sex, and presence of prior stroke. Mediation analysis was used to quantify the contribution of trial medication and changes in systolic and diastolic BP on risk of dementia.ResultsThe total sample included 28,008 individuals recruited from 20 countries. After a median follow‐up of 4.3 years, there were 861 cases of incident dementia. Multilevel logistic regression reported an adjusted odds ratio 0.87 (95% confidence interval 0.75, 0.99) in favour of antihypertensive treatment reducing risk of incident dementia with a mean BP lowering of 10/4mmHg. Further multinomial regression taking account of death as a competing risk found similar results. There was no effect modification by age or sex. Mediation analysis confirmed the greater fall in BP in the actively treated group was associated with a greater reduction in dementia risk.ConclusionUsing data from double‐blind placebo‐controlled clinical trials, we provide evidence in the first single‐stage individual participant meta‐analysis to support benefits of antihypertensive treatment in late‐mid and later life to lower the risk of dementia. Questions remain as to the potential for additional BP lowering in those with already well‐controlled hypertension and of antihypertensive treatment commenced earlier in the life‐course to reduce the long‐term risk of dementia.

Sindroma Kardiorenal

Cardiorenal syndrome (CRS) atau sindroma kardiorenal merupakan suatu kondisi dimana terjadi penyakit ginjal dan penyakit jantung secara bersamaan yang progresifitasnya terjadi dengan cepat. Pada kasus dimana penyakit jantung merupakan penyakit primer, yang terjadi adalah gangguan dinamika kardioavaskular, aktivasi neurohormonal dan faktor inflamasi yang terlibat dalam awal-mulanya perburukan fungsi ginjal dan penyakit ginjal yang progresif.Sepsis adalah “respons sistemik terhadap infeksi yang telah terdokumenetasi atau masih dicurigai dan terjadi disfungsi satu organ”; terdiri dari hipotermia/hipertermia, takikardia, takipnea, infeksi, dan disfungsi organ akhir akibat hipoperfusi. Sepsis yang lebih modern didasari konsep SIRS, sebuah istilah yang mendeskripsikan kompleks imun sebagai respons infeksi dan digunakan untuk menggambarkan ciri klinis yang berkaitan dengan respons tersebut. Penggunaan klinis SIRS menggambarkan kekacauan laju nafas, frekuensi denyut jantung, temperature, dan jumlah leukosit. Jika ada 2 dari 4 kriteria di bawah ini, SIRS bisa ditegakkan: nafas &gt; 20 kali per menit atau PaCo2 &lt;32 mmHg, frekuensi nadi &gt;90 kali per menit, suhu &gt;38o C atau &lt;36o C, dan leukosit &gt;12,000/mm3 atau &lt;4,000/mm3.CRS sepsis adalah disfungsi renal dan kardiak yang terjadi bersamaan dalam sebuah kondisi sistemik primer yang mempengaruhi kedua organ. “Tuntutan iskemik” jantung didasarkan pada alasan meningkatnya kebutuhan oksigen berkaitan dengan respons sepsis (misalnya takikardia, peningkatan curah jantung) yang mengarah kepada cedera iskemik. Disfungsi renal dapat dilihat selama sepsis berat dan merupakan bagian dari gambaran klinis syok septik dan kegagalan multi organ.

Pathophysiology, Diagnosis, and Management of Hypertension in the Elderly.

There is a high prevalence of systemic arterial hypertension in the elderly; 70% of adults >65 years have this disease. A key mechanism in the development of hypertension in the elderly is increased arterial stiffness. This accounts for the increase in systolic blood pressure and pulse pressure and fall in diastolic blood pressure (isolated systolic hypertension) that are commonly seen in the elderly, compared with younger persons. The diagnosis of hypertension is made on the basis of in-office blood pressure measurements together with ambulatory and home blood pressure recordings. Lifestyle changes are the cornerstone of management of hypertension. Comprehensive guidelines regarding blood pressure threshold at which to start pharmacotherapy as well as target blood pressure levels have been issued by both European and American professional bodies. In recent years, there has been considerable interest in intensive lowering of blood pressure in older patients with hypertension. Several large, randomized controlled trials have suggested that a strategy of aiming for a target systolic blood pressure of <120 mm Hg (intensive treatment) rather than a target of <140 mm Hg (standard treatment) results in significant reduction in the incidence of adverse cardiovascular events and total mortality. A systolic blood pressure treatment of <130 mm Hg should be considered favorably in non-institutionalized, ambulatory, free living older patients. In contrast, in the older patient with a high burden of comorbidities and limited life expectancy, an individualized team-based approach, based on clinical judgment and patient preference should be adopted. An increasing body of evidence for older adults with hypertension suggests that intensive blood pressure lowering may prevent or at least partially prevent cognitive decline.

Clinical evaluation of perfusion index (PI) as a predictor of post spinal hypotension in lower segment caesarean section (LSCS)

Hypotension is a common complication, subsequently spinal anaesthesia in lower segment caesarean section, which can cause adverse maternal &amp; foetal outcomes. A new decisive research area in obstetric anaesthesia is prevention &amp; early treatment of spinal hypotension to improve maternal &amp; foetal outcomes. A novel parameter, Perfusion index (PI) is tried during sub arachnoid block for predicting hypotension in lower segment caesarean section (LSCS). In this study, 60 parturient belonging to ASA status 1 or 2 with apparent pregnancies scheduled for elective LSCS received spinal anaesthesia with 2ml of 0.5% heavy bupivacaine by using an orange (25G) Quincke needle at L3-L4 or L4-L5 interspinous space. Haemodynamics &amp; perfusion index were recorded at regular intervals. Baseline perfusion index was correlated with degree of hypotension by using Receiver Operative Characteristic curve. Baseline perfusion index &amp; other parameters were correlate by Karl Pearson correlation method. : In our study 34.5% incidence of hypotension among study theme &amp; momentous correlation between fall in systolic blood pressure from baseline &amp; baseline perfusion index (r = 0.436; P &amp;#60; 0.05). The optimal utmost point for perfusion index was found to be 3.5 with a sensitivity of 37% &amp; specificity of 97%. A higher incidence of hypotension was found in Parturient having baseline perfusion index more than 3.5 following sub arachnoid block in elective LSCS.

Blood pressure lowering and prevention of dementia: an individual patient data meta-analysis.

Observational studies indicate U-shaped associations of blood pressure (BP) and incident dementia in older age, but randomized controlled trials of BP-lowering treatment show mixed results on this outcome in hypertensive patients. A pooled individual participant data analysis of five seminal randomized double-blind placebo-controlled trials was undertaken to better define the effects of BP-lowering treatment for the prevention of dementia. Multilevel logistic regression was used to evaluate the treatment effect on incident dementia. Effect modification was assessed for key population characteristics including age, baseline systolic BP, sex, and presence of prior stroke. Mediation analysis was used to quantify the contribution of trial medication and changes in systolic and diastolic BP on risk of dementia. The total sample included 28 008 individuals recruited from 20 countries. After a median follow-up of 4.3 years, there were 861 cases of incident dementia. Multilevel logistic regression reported an adjusted odds ratio 0.87 (95% confidence interval: 0.75, 0.99) in favour of antihypertensive treatment reducing risk of incident dementia with a mean BP lowering of 10/4 mmHg. Further multinomial regression taking account of death as a competing risk found similar results. There was no effect modification by age or sex. Mediation analysis confirmed the greater fall in BP in the actively treated group was associated with a greater reduction in dementia risk. The first single-stage individual patient data meta-analysis from randomized double-blind placebo-controlled clinical trials provides evidence to support benefits of antihypertensive treatment in late-mid and later life to lower the risk of dementia. Questions remain as to the potential for additional BP lowering in those with already well-controlled hypertension and of antihypertensive treatment commenced earlier in the life-course to reduce the long-term risk of dementia. Class I evidence in favour of antihypertensive treatment reducing risk of incident dementia compared with placebo.

“A comparative study of Nebivolol plus Amlodipine and Atenolol plus Amlodipine on blood pressure and heart rate in patients of essential hypertensive patients”

Objectives: Study was conducted to compare the evaluation of efficacy and safety of Nebivolol plus Amlodipine combination with Atenolol plus Amlodipine combination in hypertensive patients.Materials and Methods: A Prospective Observational study was conducted at tertiary care teaching hospital which included a total 334 patients with essential hypertension. The demographic and baseline data, Blood pressure and Heart rate of the patients were recorded. After baseline investigation patients were randomly divide into 2 groups. All patients were subsequently monitored and reassessed at 4th-week, 8th week and 12th weeks of interval during each follow-up.Results: Nebivolol plus Amlodipine group include a total 169 patients in which 129 patients were males and 40 patients were females with mean age 46.89 ±12.48 years, Atenolol plus Amlodipine group include a total 165 patients in which 111patients were males and 54 patients were females with mean age 48.19±12.14 years. Patients were receiving Nebivolol plus Amlodipine and Atenolol plus Amlodipine showed a significant fall in systolic blood pressure (SBP), Diastolic blood pressure (DBP) and Heart rate at the end of 4th, 8th and 12th weeks of interval as compared to their baseline data.Conclusion: A Study revels that Reduction of blood pressure and Heart rate were similar in both treatment groups (Nebivolol plus Amlodipine and Atenolol plus Amlodipine).(P- value &gt;0.05)

Effects of Psidium guajava L. leaves extract on blood pressure control and IL-10 production in salt-dependent hypertensive rats

Psidium guajava (guava) leaves extract displays anti-hypertensive properties by mechanisms not yet fully understood. Here, we investigated whether sympathetic drive and immune signaling mechanisms are involved with the antihypertensive effect of the guava extract in a model of salt-dependent hypertension. Raw guava extract (rPsE) was characterized by colorimetric and UPLC-MS techniques. Two doses of rPsE (100 and 200 mg/kg) were evaluated for anti-hypertensive effect using a suspension system (PsE). Weaned male Wistar rats were put on a high-salt diet (HSD, 0.90 % Na+) for 16 weeks and received gavages of PsE for the last 4 weeks. Blood pressure (BP) was measured at the end of treatment in conscious rats. The neurogenic pressor effect was assessed by ganglionic blockade with hexamethonium. Autonomic modulation of heart rate was evaluated by spectral analysis. The effects of orally administered PsE on lumbar sympathetic nerve activity (LSNA) were assessed in anesthetized rats. Blood IL-10, IL-17A, and TNF were measured. The increased neurogenic pressor effect of HSD rats was reduced by PsE 100 mg/kg, but not by 200 mg/kg. PsE (200 mg/kg) administration in anesthetized rats produced a greater fall in BP of HSD rats compared to standard salt diet (SSD) rats. PsE hypotensive response elicited an unproportionable increase in LSNA of HSD rats compared to SSD rats. PsE (200 mg/kg) increased plasma concentrations of IL-10 but had no effect on TNF or IL-17A. Our data indicate that the antihypertensive effects of PsE may involve autonomic mechanisms and immunomodulation by overexpression of IL-10 in salt-dependent hypertensive rats.

Early Left Ventricular Dysfunction and Non-Dipping: When Ejection Fraction is Not Enough. A Meta-Analysis of Speckle tracking Echocardiography Studies.

There is evidence that a reduced nocturnal fall in blood pressure (BP) entails an increased risk of hypertensive-mediated organ damage (HMOD) and cardiovascular events. Most studies focusing on left ventricular (LV) systolic function, assessed by conventional LV ejection fraction (LVEF) in non-dippers compared to dippers failed to detect significant differences. To provide a new piece of information on LV systolic dysfunction in the non-dipping setting, we performed a meta-analysis of speckle tracking echocardiography (STE) studies investigating LV global longitudinal strain (GLS), a more sensitive index of LV systolic function. A computerized search was performed using PubMed, OVID, EMBASE, and Cochrane library databases from inception until 31 July, 2022. Full articles reporting data on LV GLS and LVEF in non-dippers and dippers were considered suitable. A total of 648 non-dipper and 530 dipper individuals were included in 9 studies. LV GLS was worse in non-dipper than in their dipper counterparts (-18.4 ± 0.30 vs. -20.1 ± 0.23%, standard means difference [SMD]: 0.73 ± 0.14, confidence interval [CI]: 0.46/1.00, P < 0.0001) whereas this was not the case for LVEF (61.4 ± 0.8 and 62.0 ± 0.8%, respectively), SMD: --0.15 ± 0.09, CI: -0.32/0.03, P = 1.01). A meta-regression analysis between nighttime systolic BP and myocardial GLS showed a significant, relationship between these variables (coefficient 0.085, P < 0.0001). Our findings suggest that early changes in LV systolic function not detectable by conventional echocardiography in the non-dipping setting can be unmasked by STE; implementation of STE in current practice may improve the detection of HMOD of adverse prognostic significance in individuals with altered circadian BP rhythm.