Fall In BP Research Articles

Abstract P428: Angiotensin II vascular abnormalities in 32.5% of 3322 patients with essential hypertension(EH): Use of angiotensin II analogue, saralasin.

Introduction: Renin-AII abnormalities in EH were documented by infusing saralasin , the AII analogue:patients with a abnormal fall in mean BP(<=-8mmHg) indicating a “angiotensinogenic” component to their hypertension and those with a abnormal rise in mean BP(>=8mmHg) indicating, as previously reported, an increased AII vascular sensitivity. Methods: Pa tients tested for secondary HBP in a 1-day BP study with recumbent BP by Arteriosonde, infusion of Lasix, recumbent for 1 hr, stand for 2 hours, measure renin(ng/ml/hr), recumbent for 1/2 hr, infusion of saralasin for 1/2 hr, infusion of 2 l of 0.9%NS over 4 hr and measurement of plasma aldosterone and cortisol. Patients with secondary causes of hypertension, those age<18, those with renal insufficiency, vascular abnormalities (eg diabetes, ASHD) were excluded. Data is now stored using excel 365. Linear regression was calculated using GraphPad Prism version 10.0.0 for Windows, www.graphpad.com. Results: 3691 adults(mean age = 43.4±0.2, 46.3% female) with EH of whom 3322 received saralasin: “Angiotensinogenic” HBP occurred in 12.9% of EH and they were younger[p=.0012,t=3.2]than the EH group, and had a high renin(nl:1.7-6.6). The saralasin-induced fall in BP was -15.6±.6/-13.0±.3. Saralasin increased the % of SBP that was <=130 from 28.1% to 54.7%. Saralasin induced an abnormal BP rise in 19.6% of patients who were older with low renin. There was a significant linear correlation with log 10 of renin for 3322 patients with EH for Δ Mean BP with saralasin[ΔMBP = -9.3*(log renin) + 4.3] (p<.0001,f=1056, r=-.50). Results were similar in 1463 patients on no BP meds. [ΔMBP=-9.5*(log renin) +4.46](p<0.0001,f=470,r=-.50). 12.5% were "angiotensinogenic", 16.7% pressor responders. Conclusions: EH has a significant “angiotensingenic” component (12.9%) and increased AII vascular sensitivity(19.6%), both of which may contribute to their HBP. table: three saralasin groups(BP fall, rise,no Δ) as in abstract(data are mean+se) Change in mean BP to ------------ #(%) -------- initial BP ------- post lasix BP ---- saralasin BP -- Age(yr) - renin i nfusion of saralasin (1)<= -8 mmHg ---- 430(12.9%) -- 160±2*/99±1* --- 147±1*/96±1* ---- 132±1*/83±1* --- 41.1±.7* ---8.1±.4* (2)>=+8 mmHg---- 651(19.6%) -- 170±1 & /103+1 & - 142±1 & /90±1 ns1 160±1 & /101±1 & - 50.2±.5 & --- 1.5±.1 & (3)>8,<-8 mmHg-2241(67.5%) - 155±1 @ /98±1 ! --- 137±1 @ / 90±1 @ - 138±1 @ /90±1 @ - 41.3±.9 ns2 - 3.4±.1 @ ___________________________________________ *p<.00001(1v2), & p<.0001(2v3), @ p<.0001(1v3), ! p=ns(1v3), ns1 (2v3), ns2 (1v3)

Abstract P210: IDENTIFICATION OF ALAMANDINE-(1-5) AS A NEW ANTI-HYPERTENSIVE PEPTIDE OF THE RENIN-ANGIOTENSIN SYSTEM

It is currently accepted that angiotensin-(1-7) [Ang-(1-7)] and alamandine [Ala 1 -Ang-(1-7)] are members of the counterregulatory axis of the renin-angiotensin system (RAS). Both peptides can undergo hydrolysis by angiotensin-converting enzyme and form Ang-(1-5) and Alamandine-(1-5), respectively. Recently, we have shown that Alamandine-(1-5) is present in human and mice circulation. Here, we evaluated the cardiovascular effects induced by intravenous (i.v.) administration of these peptides in conscious normotensive Wistar (n=6 for each peptide) and spontaneously hypertensive rats (SHR) (n=6 for each peptide). After a period of one hour for stabilization of the cardiovascular parameters, Alamandine-(1-5) or Ang-(1-5) were injected at a dose of 3µg/ 100g of b.w. A similar volume (0.1 ml/ 100g b.w.) of sterile saline was injected into SHR and Wistar rats for control. Alamandine-(1-5) injection produced a progressive decrease in systolic blood pressure (SBP, SHR, reaching -33±3.0 mmHg six hours after injection (Baseline SBP: 208±8 mmHg before and 175±10 mmHg, six hours after the injection). In contrast, SBP did not significantly change after the administration of Ang-(1-5) (Baseline SBP: 198±13 mmHg before and 199±8 mmHg six hours after injection). There was no significant change in heart rate (HR) in SHR after Alamandine-(1-5) (Baseline HR: 342±14 beats/min before and 341±18.8 beats/min after six hours) or after Ang-(1-5) (Baseline HR: 333±18 beats/min before and 326±19 beats/min after six hours). Alamandine-(1-5) injection in Wistar rats produced only small changes in BP (Baseline SBP: 109±10 mmHg before injection and 99±11 mmHg six hours after injection, p<0.05). No differences were observed for Ang-(1-5) injection in Wistar rats (Baseline SBP: 118±8 mmHg before injection and 115±9 mmHg six hours after injection) or in HR for Alamandine-(1-5) or Ang-(1-5). Saline injection did not change BP or HR in SHR or in Wistar rats. These results show that Alamandine-(1-5), but not Ang-(1-5), triggers a long-lasting fall in BP in hypertensive animals. These data indicate that we have identified a new vasodilatory peptide of the RAS, increasing our understanding of the complexity of this system and opening a possibility for future development of a new pharmacological target for hypertension treatment.

Fast, furious, and gassy: Etna's explosive eruption from the mantle

The 3930 BP Fall Stratified (FS) eruption at Mt. Etna is a rare example of a highly explosive eruption of primitive (picritic) magma directly from the mantle. The eruption produced ash plumes up to an estimated 20 km height, leading to a volcanic explosivity index (VEI) 4 (subplinian). Given its volatile-rich and primitive nature, the FS magma may have ascended rapidly from great depths to avoid fractionation and mixing within the extensive plumbing system beneath Etna. To determine the pressures from which the FS magma derived, we perform rehomogenization experiments on melt inclusions hosted in Fo90–91 olivines to resorb shrinkage bubbles and determine the initial H2O and CO2 in the melt. With measured CO2 concentrations of up to 9600 ppm, volatile solubility models yield magma storage pressures of 630–800 MPa. These correspond to depths of 24–30 km, which are comparable to the seismologically estimated Moho. Therefore, the magma's high CO2 concentration must come from carbon in the mantle (likely from subducted carbonates), as opposed to assimilation of shallow (<10 km) crustal carbonates.Diffusion modeling of H2O and forsterite zonation profiles in clear, euhedral, and crystallographically oriented olivines indicates rapid ascent of magma directly from its source region to the surface. Forsterite profiles exhibit a narrow rim of growth zoning but no detectable diffusional zoning, reflecting maximum ascent times of 1–5 days. Eighteen measured H2O profiles result in remarkably uniform decompression rates of 0.47 MPa/s (95% confidence interval of 0.16–1.28 MPa/s), which is among the fastest measured for basaltic-intermediate magmas. These decompression rates indicate that the final stage of magma ascent over the region in which H2O degasses (between the surface and ∼ 15 km) occurred extremely fast at ∼ 17.5 m/s. This eruption may provide a link between primary magma composition and eruption intensity: we propose that the unusually explosive nature of this picritic eruption was driven by high H2O and CO2 concentrations, which led to continuously rapid ascent without stalling, all the way from the Moho.

Morphodynamics and morpotectonics of the varzuga river mouth area (terskiy coast of the white sea) in the late glacial and holocene

The Late- and post-glacial history of the development of the White Sea coastal zone in the area of the Varzuga River mouth is considered as a result of the interaction of endogenous and exogenous factors of coastal morpholithogenesis. Based on geomorphological investigations, study of Holocene deposits by lithostratigraphic, diatom and radiocarbon analyses, as well as collection and analysis of published data, new results on the area’s relief development for ~13 cal ka BP have been obtained. The features of the regional hierarchical morphostructure and local post-glacial tectonics of the territory — the spatial relationships of blocks and the speed of vertical movements – were determined. The superimposed linear Nizhnevarzugskaya depression, which determined the configuration of the Varzuga River estuary in the late and postglacial time, was identified for the first time. The influence of the spatial ratio of blocks and differentiated postglacial uplift on the coastal morpholithogenesis was established. The course of changes in the relative sea level (RSL), development conditions and morphodynamics of the open coast and the estuary of the Varzuga River were reconstructed and new data on the rhythms of coastal morpholithogenesis processes (coastal, estuarine, and aeolian) obtained. Three stages of the coastal zone development were identified, corresponding to regional rhythms of changes in the relative sea level and climate: (I) Late Glacial transgression and Early Holocene regression (~12–9.8 cal ka BP), (II) Middle Holocene Tapes transgression (7.8–4.9 cal ka BP), (III) Late Holocene regression (after 4.9 cal ka BP). The upper marine boundary of the Late Glacial transgression is traced at the elevation of ~54–55 m a. s. l. to the west of the Nizhnevaruzgskaya depression, — ~39–40 m a. s. l. to the east of it, and — 22–25 m a. s. l. in the depression. The shores of lower morphostructural blocks were probably blocked by dead ice up until ~10.2–9.8 cal ka BP. During the Tapes transgression, the RSL reached a maximum (~7.8–7.6 cal ka BP; ~20 m a. s. l.), and by 4.9 cal ka BP fall to ~15 m a. s. l. The prevailing directions of sediment fluxes, winds and wave approach became similar to those of today. However, the main source of the coastal zone sedimentary supply was the erosion of glaciofluvial sediments and the input of sands from the seabed. In the interval of ~4.9–1.7 cal ka BP, the RSL decreased to ~5 m a. s. l. The sediment runoff of the Varzuga River became the main source of feeding the coastal zone.

DAY-TO-DAY REPRODUCIBILITY OF NOCTURNAL BLOOD PRESSURE FALL (DIPPING) EVALUATED WITH WEARABLE AND HOME DEVICES IN HYPERTENSIVE PATIENTS

Objective: Non-dipping status has been associated with increased risk of heart failure and cardiovascular events. However, its reproducibility when evaluated by means of ambulatory blood pressure monitoring (BPM) is often suboptimal. Wearable devices (WD) and home BPM devices equipped with nocturnal measurement function (HBPMN) offer the opportunity of estimating dipping status over different days thus potentially increasing precision owing to statistical averaging. We aimed to determine the reproducibility of nocturnal BP dipping estimated through a combined use of WD and HBPMN devices for daytime and night-time BP estimation within one week. Design and method: We recruited treated and untreated adult patients with hypertension. Patients underwent one week of home BP monitoring through a HBPMN device (NightView, OMRON Healthcare, HEM9601T-E3) and with an oscillometric WD (HeartGuide, OMRON Healthcare, HEM-6411T-MAE). Patients were asked to measure BP over one week with WD according to ESH-HBPM guidelines for daytime measurements and with HBPMN according to standard device settings for night-time measurements. Interclass correlation coefficient (ICC) was calculated to evaluate reproducibility. Results: 76 patients were included in the study. The main characteristics are summarised as follows: age (61±11.84 years), 32 (42%) females, BMI (28.12±4.90 Kg/m2). Most of them (98%) were treated hypertensives. Office systolic and diastolic BP were 134±4.43 mmHg and 80±4.84 mmHg, respectively. The average one-week systolic BP dipping was 16.14±9.44%. When we considered patients who had dipping assessment over at least the first 5 days (37 patients), intra-individual variability in the categorical definition of dipping status was observed (Figure 1) with a suboptimal reproducibility of average nocturnal BP fall (ICC 0.60). Conclusions: Nocturnal BP dipping estimated as continuous variable through the combined use of WD and HBPMN exhibits suboptimal reproducibility resulting in a variable day-by-day classification of patients according to their dipping status. Whether this reflects technical issues, or rather depends on the physiological variability of BP and sleeping patterns needs to be determined by future studies.

Comparison of hemodynamic changes in normotensive and preeclamptic parturients undergoing cesarean section under spinal anesthesia: A prospective observational study

Abstract Background and Aims: The safety of subarachnoid block (SAB) was established in preeclamptic parturients, but most of studies are of low quality. The study aimed to compare the hemodynamic parameters, phenylephrine requirement, and the neonatal outcome between normotensive and preeclamptic parturients undergoing cesarean section. Methods: This prospective observational study was conducted in 100 parturients, aged between 18 and 35 years, American Society of Anesthesiologists II/III scheduled for elective cesarean section under SAB. The heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) were recorded at the baseline, before SAB, and every 2 min till 30 min and then every 5 min till the end of the surgery. Phenylephrine was administered in a bolus of 50 μg when the MBP falls by 20% from the baseline. Neonatal outcomes were measured with the umbilical artery pH and APGAR scores at 1 and 5 min. The Statistical Package for the Social Science (SPSS) 26 was used for analysis. Results: The percentage fall in DBP and mean arterial BP from baseline was statistically significant between groups (26.83% ± 9.58% vs. 20.06% ± 14.17% and 24.90% ± 6.49% vs. 20.11% ± 9.75%). The mean requirement of phenylephrine was higher in the normotensive group than the preeclamptic (95.16 ± 41.54, 68.42 ± 31.14) (P &lt; 0.001). The umbilical artery pH and APGAR scores at 1 and 5 min were comparable in both the groups. Conclusion: The incidence of hypotension was less in preeclamptic and required less phenylephrine compared to normotensives, with comparable neonatal parameters in parturients undergoing cesarean section under spinal anesthesia.

Associations of age-adjusted coefficient of variation of R-R intervals with autonomic and peripheral nerve function in non-elderly persons with diabetes.

Early diagnosis of diabetes-associated cardiac autonomic neuropathy using the coefficient of variation of R-R intervals (CVRR) may improve outcomes for individuals with diabetes. The present study examined the associations of decreased CVRR at rest and during deep breathing (DB) with other autonomic nerve function parameters. The electronic records of 141 inpatients with diabetes (22-65 years) admitted to our hospital between March 2015 and March 2019 were analyzed retrospectively. After assessment by exclusion criteria, 51 inpatients were included. All inpatients were assessed for peripheral and autonomic nerve function, clinical characteristics, and physical abilities. Inpatients with decreased CVRR at rest (n = 9 (17.6%)) and during DB (n = 12 (23.5%)) had a longer duration of known diabetes, a higher prevalence of diabetic retinopathy, lower body mass index (BMI), skeletal mass index (SMI), and knee extension strength, and a higher proportion of impaired standing balance. Decreased CVRR at rest was associated with a greater fall in diastolic BP from supine to standing, higher resting HR, longer QTc, longer time of voiding, and sensory symptoms. Decreased CVRR at rest and during deep breathing was associated with lower BMI, SMI, and knee strength and a higher proportion of impaired standing balance among non-elderly inpatients with diabetes. Decreased CVRR at rest appeared more strongly associated with a greater orthostatic BP decline, higher resting heart rate, longer QTc, lower urinary tract dysfunction, and sensory symptoms than a decreased CVRR during deep breathing.

TCT-90 Body Mass Index as a Predictor of Improvement in the Nocturnal BP Fall After Renal Denervation in Diabetic Patients With Resistant Hypertension

TCT-90 Body Mass Index as a Predictor of Improvement in the Nocturnal BP Fall After Renal Denervation in Diabetic Patients With Resistant Hypertension

NOVEL TECHNIQUE OF SHORT-ACTING SPINAL ANAESTHESIA FOR FRACTURE NECK OF FEMUR SURGERY ALLOWING EARLY MOBILIZATION, REDUCING MORBIDITY AND MORTALITY, AND IMPROVING OVERALL FUNCTIONAL OUTCOME

Prompt mobilisation after the Fracture neck of femur surgery is one of the important key performance index (‘KPI caterpillar charts’ 2021) affecting the overall functional outcome and mortality. Better control of peri-operative blood pressure and minimal alteration of renal profile as a result of surgery and anaesthesia may have an implication on early post-operative mobilisation.Aim was to evaluate perioperative blood pressure measurements (duration of fall of systolic BP below the critical level of 90mmHg) and effect on the post-operative renal profile with the newer short acting spinal anaesthetic agent (prilocaine and chlorprocaine) used alongside the commonly used regional nerve block. 20 patients were randomly selected who were given the newer short acting spinal anaesthetic agent along with a regional nerve block between May 2019 and February 2020. Anaesthetic charts were reviewed from all patients for data collection. The assessment criteria for perioperative hypotension: Duration of systolic blood pressure less than 90 mm of Hg and change of pre and post operative renal functions.Only one patient had a significant drop in systolic BP less than 90mmHg (25 minutes). 3 other patients had a momentary fall of systolic BP of less than 5 minutes. None of the above patients had mortality and had negligible change in pre and post op renal function. Only one patient in this cohort had elevation of post-operative creatinine levels but did not have any mortality. Only 1 patient died on day 3 post operatively who had multiple comorbidities and was under evaluation for GI cancer. Even in this patient the peri-operative blood pressure was well maintained (never below 90mmHg systolic) and post-operative renal function was also shown to have improved (309 pre-operatively to 150 post-operatively) in this patient.The use of short-acting spinal anaesthesia has shown to be associated with a better control of blood pressure and end organ perfusion, less adverse effects on renal function leading to early mobilisation and a more favourable patient outcome with reduced mortality, earlier mobilisation, shorter hospital stay and earlier discharge in this elderly patient cohort.

Improvement in Hypertension Control Among Adults Seen in Federally Qualified Health Center Clinics in the Stroke Belt: Implementing a Program with a Dashboard and Process Metrics.

Attain 75% hypertension (HTN) control and improve racial equity in control with the American Medical Association Measure accurately, Act rapidly, Partner with patients blood pressure (AMA MAP BP™) quality improvement program, including a monthly dashboard and practice facilitation. Eight federally qualified health center clinics from the HopeHealth network in South Carolina participated. Clinic staff received monthly practice facilitation guided by a dashboard with process metrics (measure [repeat BP when initial systolic ≥140 or diastolic ≥90 mmHg; Act [number antihypertensive medication classes prescribed at standard dose or greater to adults with uncontrolled BP]; Partner [follow-up within 30 days of uncontrolled BP; systolic BP fall after medication added]) and outcome metric (BP <140/<90). Electronic health record data were obtained on adults ≥18 years at baseline and monthly during MAP BP. Patients with diagnosed HTN, ≥1 encounter at baseline, and ≥2 encounters during 6 months of MAP BP were included in this evaluation. Among 45,498 adults with encounters during the 1-year baseline, 20,963 (46.1%) had diagnosed HTN; 12,370 (59%) met the inclusion criteria (67% black, 29% white; mean (standard deviation) age 59.5 (12.8) years; 16.3% uninsured. HTN control improved (63.6% vs. 75.1%, p<0.0001), reflecting positive changes in Measure, Act, and Partner metrics (all p<0.001), although control remained lower in non-Hispanic black than in non-Hispanic white adults (73.8% vs. 78.4%, p<0.001). With MAP BP, the HTN control goal was attained among adults eligible for analysis. Ongoing efforts aim to improve program access and racial equity in control.

Review on Analgesic activity using Tail Immersion Method

An analgesic, or painkiller, is any member of the group of drugs used to achieve analgesia-relief from pain. Analgesic drugs act in various ways on the peripheral and central nervous systems. They are distinct from anesthetics, which reversibly eliminate sensation, and include Ibuprofen, the non-steroidal anti-inflammatory drugs [NSAIDs] such as the salicylates, and opioid drugs such as morphine and opium. In choosing analgesics, the severity and response to other medication determines the choice of agent; the World Health Organization [WHO] pain ladder specifies mild analgesics as its first step. Analgesia/Pain is ill-defined unpleasant sensation evoked by stimulus [external / internal] – the most important symptom giving warning signal and primarily protective in nature. Analgesia due to blockade of pain nerve sensitizing mechanism induced by bradykinin, TNFα, ILs. An analgesic is a drug that selectively relieves pain by acting in the CNS or on peripheral pain mechanisms, without significantly altering consciousness. Pain is a warning signal, primarily protective in nature, but causes discomfort and suffering; may even be unbearable and incapacitating. Excessive pain may produce other effects- sinking sensation, apprehension, sweating, nausea, palpitation, rise or fall in BP, tachypnoea. Analgesics relieve pain as symptoms, without affecting it’s causes.

Evaluation of blood Pressure changes on exposure to sound frequencies in the youths of different ethnicity

Objectives: To analyse the effect of exposure to different sounds of various frequencies on the blood pressure level of participants. Methods: Present study involved 160 medical students belonging to four ethnic races (Malay, Chinese, Malaysian Indians, Sri Lankans). Informed consent and the record of normal blood pressure was obtained before the study. Participants were exposed to three different sounds (Traffic sounds of high noise frequency; Waterfall sound of moderate noise frequency; Night sound in woods of low noise frequency) with specified intervals. The systolic (SBP) and diastolic blood pressure (DBP) of all the participants were recorded after each exposure. Data of SBP and DBP was analysed statistically by repeated measures ANOVA using SPSS. Results: Results showed statistically significant (p&lt;0.001) difference in the average SBP, DBP values from pre to post assessment in all different exposed sounds. While a significant difference (p&lt;0.01) in the mean SBP values were noted for sound 1 and sound 3; the similar difference (p&lt;0.05) in the average DBP values was noted only for sound 3 between the ethnicities. Data showed a rise in BP for sound 1 in all ethnicities except Malays, fall in BP upon the exposure to sound 2 and 3 among all the ethnicities. Conclusion: Exposure to different sounds was found to have a remarkable effect on individual’s blood pressure. However, its comparison with ethnicities is quite variable. Adverse effects of various sound exposures on the blood pressure levels of student population is crucial in terms of their curricular and physiological activities. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 825-828

The effect of daily UVA phototherapy for 2 weeks on clinic and 24-h blood pressure in individuals with mild hypertension

Latitude and season determine exposure to ultraviolet radiation and correlate with population blood pressure. Evidence for Vitamin D causing this relationship is inconsistent, and temperature changes are only partly responsible for BP variation. In healthy individuals, a single irradiation with 20 J/cm2 UVA mobilises NO from cutaneous stores to the circulation, causes arterial vasodilatation, and elicits a transient fall in BP. We, therefore, tested whether low-dose daily UVA phototherapy might be an effective treatment for mild hypertension. 13 patients with untreated high-normal or stage 1 hypertension (BP 130-159/85-99 mm Hg), confirmed by 24-h ambulatory blood pressure (ABP), were recruited. Using home phototherapy lamps they were either exposed to 5 J/cm2 full body UVA (320–410 nm) radiation each day for 14 days, or sham-irradiated with lamps filtered to exclude wavelengths <500 nm. After a washout period of 3 ± 1 week, the alternate irradiation was delivered. 24-h ABP was measured on day 0 before either irradiation sequence and on day 14. Clinic BP was recorded on day 0, and within 90 min of irradiation on day 14. There was no effect on 24-h ABP following UVA irradiation. Clinic BP shortly after irradiation fell with UVA (−8.0 ± 2.9/−3.8 ± 1.1 mm Hg p = 0.034/0.029) but not sham irradiation (1.1 ± 3.0/0.9 ± 1.5 mm Hg). Once daily low-dose UVA does not control mildly elevated BP although it produces a transient fall shortly after irradiation. More frequent exposure to UVA might be effective. Alternatively, UVB, which photo-releases more NO from skin, could be tried.

Renal Transplantation in Pure Autonomic Failure.

Renal Transplantation in Pure Autonomic Failure.

Beta Blockers can Mask not only Hypoglycemia but also Hypotension

Beta-adrenergic (β-AR) receptor blockers (BBs) are an essential class of drugs as they have numerous indications. On the other hand, they have numerous unwanted effects that decrease the compliance, adherence, and persistence of this very useful group of drugs. The paper aims to analyze the possibility that an unnoticed side effect may contribute to a less favorable pharmacologic profile of BBs, e.g., a diminished reaction to a sudden fall in BP. We searched two medical databases for abstracts and citations (Medline and SCOPUS). Moreover, we searched the internet for drug prescription leaflets (of the individual BBs). Whichever cause of stress is considered, the somatic manifestations of stress will be (partially) masked if a patient takes BB. Stress-induced hypercatecholaminemia acts on β-AR of cardiomyocytes; it increases heart rate and contractility, effects suppressed by BBs. The answers of the organism to hypoglycemia and hypotension share the main mechanisms such as sympathetic nervous system activation and hypercatecholaminemia. Thus, there is a striking analogy: BBs can cover up symptoms of both hypoglycemia (which is widely known) and of hypotension (which is not recognized). It is widely known that BBs can cause hypotension. However, they can also complicate recovery by spoiling the defense mechanisms in hypotension as they interfere with the crucial compensatory reflex to increase blood pressure in hypotension. Beta blockers can cause hypotension, mask it, and make recovery more difficult. This is clinically important and deserves to be more investigated and probably to be stated as a warning.

Increased blood pressure variability is associated with probable rapid eye movement sleep behaviour disorder in elderly hypertensive patients

Purpose An increased blood pressure variability (BPV) has been reported to be associated with older age and cognitive dysfunction; however, associations between increased BPV and rapid eye movement sleep behaviour disorder (RBD) has not been thoroughly investigated in patients without clinical Lewy body diseases. Materials and methods In frailty outpatient clinic, we evaluated ambulatory BP, RBD screening questionnaire (RBDSQ), and beat-to-beat heart rate variability during positional change from sitting to standing in 112 elderly hypertensive patients. Results The mean age was 81.2 ± 6.3 years (68% male). There were 15 patients who had probable RBD (RBDSQ scores ≥ 5). Patients with RBD had a greater body mass index, coefficient of variation (CV) in 24-h diastolic BP (23.5 ± 6.1 versus 18.7 ± 5.8, p = 0.005), awake diastolic BP (23.0 ± 7.7 versus 18.6 ± 6.2, p = 0.017), and nocturnal systolic BP (14.9 ± 5.5 versus 12.0 ± 4.4, p = 0.025) compared with those without RBD, while systolic BP, diastolic BP, and cognitive function did not differ significantly between patients with and without RBD. Patients with RBD exhibited larger orthostatic BP fall compared with patients without RBD (−4.9 ± 11.0 versus 7.5 ± 11.8, p = 0.009) and lower CV of R–R intervals while standing (1.3 ± 0.6 versus 2.4 ± 1.5, p = 0.039). Multiple regression analysis revealed that patients with RBD had significantly greater CV of nocturnal systolic BP independent of age, sex, BMI, history of diabetes and dyslipidaemia, and use of antihypertensive drugs (p = 0.008). Conclusion An increased BPV in ambulatory BP, associated with autonomic dysfunction, can be observed in patients with probable RBD even in elderly patients without clinical presentation of Lewy body diseases.

Neural Network-Based Approach for Evaluating College English Teaching Methodology

A fair and scientific method of evaluating collegiate English instruction is currently lacking. Traditional methods are commonly used to evaluate the quality of college English education in terms of the standard statistical analysis evaluation model. As the evaluation of English teaching is a nonlinear issue, the above strategies have achieved some good results but have certain limitations. They are not scientific and objective in the selection of evaluation indicators, or in the setting of evaluation index weights, and there is a certain degree of subjectivity. Artificial neural network (ANN) is widely used in massive fields due to its characteristics of nonlinear processing, adaptive learning, and high fault tolerance. As a kind of neural network, BP neural network has strong nonlinear mapping ability, so it is feasible and scientific to solve the nonlinear relationship of college English teaching evaluation (ETE). Therefore, in this work, we first designed an ETE system index. Then, a strategy of college ETE with BP network is designed, which can carry out high-performance modeling for the designed teaching evaluation index. In order to alleviate the issue of slow convergence speed for BP network and fall into local optimum, this work also combines particle swarm algorithm with BP network to further improve network performance. Massive experiments have proved the reliability and effectiveness of this work.

Therapeutic Methylprednisolone and Infimab Decrease the Severity of Organ Dysfunction in Pancreatic Duct Ligation Model of Severe Acute Pancreatitis in Wistar Rats

Introduction: There is no standardized, widely used model of severe acute pancreatitis (SAP) with organ failure. This may limit drug development in SAP. Dysregulated and hyperimmune responses are the root cause for organ failure in SAP. We established a rat model of SAP with organ failure and evaluated directly translatable, clinically relevant parameters of organ dysfunction. We also evaluated the effects of therapeutic administration of methylprednisolone (MP) and TNF-α antibody infimab (Infliximab biosimilar) on the severity of experimental SAP induced by the ligation of the main pancreatic duct in rats. Methods: SAP was induced in adult male Wistar rats (250-350 g) by ligating the main pancreatic duct proximal to the biliopancreatic junction. One-hour after the procedure, therapeutic medication was administered intraperitoneally. Experiments were done in duplicate(batches of 3 rats/group) in sham surgery, SAP, SAP+MP, and SAP+infimab groups. At 0 (pre-intervention) and 48 hours (post-intervention), invasive BP, heart rate, serum amylase, lactate, paO2, SpO2, pH, renal and liver function were measured. Rats were sacrificed at 48 hours and the harvested pancreas, kidney and lung tissues were assessed histopathologically. Results: There was a significant increase in serum amylase level (p=0.019) and histopathological scores (p=0.003) in the SAP group as compared to sham surgery with no significant effect of either MP or Infimab (amylase:p = 0.211, histopathological score:p = 0.103). Both MP and Infimab significantly prevented a fall in BP and decrease in SpO2 following induction of SAP compared to the vehicle control (Table1). Conclusions: Therapeutic administration of MP or Infimab ameliorates the systemic inflammation and organ dysfunction associated with SAP in rats.Tabled 1EP02A-024SAP (Vehicle control)SAP + IP MethylprednisoloneSAP + IP Infimabp value for between group comparison of change following intervention (vehicle control vs MP vs Infimab )Change* following Interventionp value of change*Change following Interventionp value of change*Change* following Interventionp value of change*Amylase (IU/L)2681 (1072 to 3753)0.0043260 (1490 to 9960)0.0621457.5 (370 to 2350)0.0310.211Mean BP (mmHg)-15.4 (-17 to -13.4)0.004-3.6 (-6 to 6)0.688-19.3 (-28.6 to -3.9)0.0940.023Heart Rate (beats/min)-47 (-57.1 to -36.5)0.004-6.4 (-31.3 to -2.3)0.313-15.1 (-37.3 to 1.8)0.4380.133Blood Lactate (mmol/L)2.3 (0.7 - 2.7)0.0091.8 (1.2 - 2.3)0.0312.05 (0.2 - 2.3)0.0630.845SpO2 (%)-3.5 (-9.5 to -1.9)0.008-0.5 (-5.9 to 2.9)0.688-0.4 (-0.2 to 0)0.5840.176pO2 (mmHg)-5 (-31.9 to -0.9)0.074-3.7 (-65.6 to 9.5)0.563-6.7 (-16.1 to 1.9)0.2190.786*change refers to difference between the pre - intervention and post - intervention values Open table in a new tab *change refers to difference between the pre - intervention and post - intervention values

Renal Denervation in Combination With Angiotensin Receptor Blockade Prolongs Blood Pressure Trough During Hemorrhage.

Majority of patients with hypertension and chronic kidney disease (CKD) undergoing renal denervation (RDN) are maintained on antihypertensive medication. However, RDN may impair compensatory responses to hypotension induced by blood loss. Therefore, continuation of antihypertensive medications in denervated patients may exacerbate hypotensive episodes. This study examined whether antihypertensive medication compromised hemodynamic responses to blood loss in normotensive (control) sheep and in sheep with hypertensive CKD at 30 months after RDN (control-RDN, CKD-RDN) or sham (control-intact, CKD-intact) procedure. CKD-RDN sheep had lower basal blood pressure (BP; ≈9 mm Hg) and higher basal renal blood flow (≈38%) than CKD-intact. Candesartan lowered BP and increased renal blood flow in all groups. 10% loss of blood volume alone caused a modest fall in BP (≈6-8 mm Hg) in all groups but did not affect the recovery of BP. 10% loss of blood volume in the presence of candesartan prolonged the time at trough BP by 9 minutes and attenuated the fall in renal blood flow in the CKD-RDN group compared with CKD-intact. Candesartan in combination with RDN prolonged trough BP and attenuated renal hemodynamic responses to blood loss. To minimize the risk of hypotension-mediated organ damage, patients with RDN maintained on antihypertensive medications may require closer monitoring when undergoing surgery or experiencing traumatic blood loss.

SERUM CONC. OF ANTIHYPERTENSIVE DRUGS MAY REVEAL NON-ADHERENCE IN PATIENTS CONSIDERED TO HAVE TRUE TREATMENT RESISTANT HYPERTENSION ASSESSED BY DIRECTLY OBSERVED THERAPY

Objective: Detecting non-adherence is challenging. Both directly observed intake of antihypertensive medication (DOT) followed by 24 hour-ambulatory blood pressure monitoring and serum conc. measurements of antihypertensive drugs are objective methods considered reliable in revealing drug non-adherence. We aimed to investigate whether serum conc. offers additional information regarding drug adherence compared to DOT in patients with assumed true treatment resistant hypertension. Design and method: Patients referred for renal denervation (RDN) were thoroughly investigated and tested for adherence. 19 patients were defined as true treatment resistant when their daytime systolic BP remained high (&gt; 135 mmHg) after DOT. Blood samples were collected at baseline, 6 months and 3 years after RDN and analyzed using ultra high pressure liquid chromatography-tandem mass spectrometry. Partial non-adherence was defined as at least one undetectable drug (but not all)and non-adherence as no detectable drugs in serum. Results: Ten out of 56 blood samples (17.9%) showed too low levels of one or more drug to be compatible with drug adherence. Six patients were redefined as either non-adherent or partially non-adherent based on their serum conc. results. Their systolic BPs are shown in the Figure. Three of these six patients went through a renal denervation procedure, while the remaining three were randomized to control. One of two patients considered to be RDN responders, became adherent to medication after six months which may have contributed to the fall in BP. At the 3 years visit none of the five antihypertensive agents prescribed were detected, and the patient́s BP was again elevated. Conclusions: Non-adherence was revealed in more patients when serum conc. measurements of antihypertensive drugs were added to directly observed therapy. Serum conc. measurement is objective and quantitative, and since some antihypertensive drugs require regular intake over a certain period of time to have maximal effect, they may offer important additional information.