Higher Systolic Pressure Research Articles

Different Impacts of Cardiovascular Risk Factors on Arterial Stiffness versus Arterial Wall Thickness in Japanese Patients with Type 2 Diabetes Mellitus.

We statistically investigated whether the impact of cardiovascular risk factors on arterial stiffness would be different from that on arterial wall thickness. We analyzed 1648 Japanese type 2 diabetic patients. Arterial stiffness was evaluated by pulse wave verbosity (PWV) and wall thickness was assessed with carotid intima-media thickness (IMT) by ultrasonography. We developed a common regression model to PWV and IMT by extending the linear mixed model and statistically detected the difference in the impact of cardiovascular risk factors between the two indices. There was a significant correlation between PWV and IMT (r=0.365, p ＜ 0.001). Sex, diabetic duration, hemoglobin A1c levels, and the presence of retinopathy and cardiovascular disease were comparable independent risk factors for elevated PWV and IMT. On the other hand, the impact of age, systolic blood pressure, and low- and high-density lipoprotein cholesterol levels were significantly different between the two measurements (all p ＜ 0.05). Cholesterol levels were significantly associated with IMT but not with PWV. Age and systolic blood pressure had a significant impact on both measurements, but the impact on PWV was significantly greater than that on IMT. Indeed, patients with low IMT but with advanced age and high systolic pressure had high PWV, whereas patients with low PWV but with impaired cholesterol levels had high IMT. The extended linear mixed model statistically confirmed that the impact of cardiovascular risk factors on elevated PWV and IMT were not identical in Japanese patients with type 2 diabetes mellitus.

Relationship between serum retinol-binding protein 4 and non-alcoholic fatty liver disease in schizophrenia

Objective To investigate the serum retinol-binding protein 4 (RBP4) level in olanzapine-treated schizophrenia with non-alcoholic fatty liver disease (NAFLD) via a case-control study and to explore its relationship with NAFLD. Methods Schizophrenia receiving olanzapine treatment, with or without NAFLD were enrolled as cases (n=60) or controls (n=60). The serum retinol-binding protein 4, metabolic syndrome component including body mass index (BMI), waist-to-hip ratio (WHR), fasting plasma glucose (FPG), total cholesterol (TG), total glycerin (TC) and blood pressure were assayed. TyG index, CT value ratio of liver and spleen were used for insulin resistance or NAFLD diagnosis and severity assessment respectively. Results The serum level of RBP4 was significantly higher in cases than that in controls ((70±13)mg/L vs (52±12)mg/L ; t=4.943, P<0.01) and the same result was showed after influencing factor adjustment thru covariance analysis (F=16.797, P<0.01). Moreover, cases had significantly higher TyG index, BMI, WHR, FPG, TG and systolic pressure (t=2.383-4.300, P<0.05-0.01). Cases with severe or moderate NAFLD had significantly elevated serum RBP4 level compared with mild cases((79±16)mg/L, (72±8)mg/L vs (63±9)mg/L, d=16.2, 9.9; P<0.01, 0.05). A significantly negative correlation between RBP4 level and the CT value ratio of liver and spleen (r=-0.244, P<0.05), and a significantly positive correlation between RBP4 level and TyG index, BMI, WHR, TG(r=0.197-0.244, all P<0.05) were observed. The partial coefficient between RBP4 level and CT value of liver and spleen was significant with influence adjusted(r=-0.453, P<0.01). Logistic regression showed that serum RBP4 level(β=0.105, P<0.01)and TyG index, hyperlipidemia, obesity, central obesity or high blood pressure (β=1.288-9.711, P<0.05-0.01) were closely associated with NAFLD. Conclusion A heighten serum RBP4 level may be one of NAFLD risk factors in schizophrenia treated with olanzapine. Key words: Retinol-binding protein 4; Non-alcoholic fatty liver disease; Schizophrenia; Metabolic syndrome

The expression and correlation of intermediate conductance calcium-activated potassium channels in cavernous tissue of spontaneously hypertensive rats

Objective Intermediate conductance calcium-activated potassium channels (IKCa),one of the key material of the endothelium-derived hyperpolarizing factor (EDHF) passway.To detect the expression of IKCa and explore hypertension impact IKCa expression in cavernous tissue of spontaneously hypertensive rats.Methods Male spontaneously hypertensive rats (SHR) (n =20) and normotensive Wistar Kyoto rats (WKY,n =10) were studied,Systolic blood pressure (SBP) was measured by noninvasive blood pressure instrument and erectile function was tested by injecting with apomorphine (APO),the rats were divided into 3 groups,namely hypertensive with erectile dysfunction (HBP-ED)group (n =13),hypertensive (HBP) group (n =7) and control group (n =10).The expression of IKCa gene mRNA and protein was assessed by Western blotting and reverse transcription-polymerase chain reaction (RT-PCR).Results Versus the WKY group,SHR group showed a higher systolic blood pressure [(202.43 ±9.89)vs.(127.21 ± 3.48) mmHg (1 mmHg =0.133 k Pa),P ＜ 0.01].The expressions of IKCa protein and mRNA were the highest in the control group and the lowest in HBP-ED group.Conclusion The erectile function of penis is impacted seriously by hypertension,which may be related to the decreased expression of IKCa in cavernous tissue of spontaneously hypertensive rats. Key words: Hypertension ; Penis erection ; Corpus cavernosum; Intermediate conductance calcium-activated potassium channels

Cardiac biomarkers at high altitude.

Classically, biomarkers such as the natriuretic peptides (NPs) BNP/NT-proBNP are associated with the diagnosis of heart failure and hs-cTnT with acute coronary syndromes. NPs are also elevated in pulmonary hypertension. High pulmonary artery systolic pressure (PASP) is a key feature of high altitude pulmonary edema (HAPE), which may be difficult to diagnose in the field. We have previously demonstrated that NPs are associated with high PASP and the presence of acute mountain sickness (AMS) in a small cohort at HA. We aimed to investigate the utility of several common cardiac biomarkers in diagnosing high PASP and AMS. 48 participants were assessed post-trekking and at rest at three altitudes: 3833 m, 4450 m, and 5129 m. NPs, hs-cTnT and hsCRP, were quantified using immunoassays, PASP was measured by echocardiography, and AMS scores were recorded. Significant changes occurred with ascent in NPs, hs-cTnT, hsCRP (all p<0.001) and PASP (p=0.006). A high PASP (≥40 mm Hg) was associated with higher NPs, NT-proBNP: 137±195 vs. 71.8±68 (p=0.001); BNP 15.3±18.1 vs. 8.7±6.6 (p=0.001). NPs were significantly higher in those with AMS or severe AMS vs. those without (severe AMS: NT-proBNP: 161.2±264 vs. 76.4±82.5 (p=0.008)). The NPs correlated with hsCRP. cTnT increased with exercise at HA and was also higher in those with a high PASP (13.8±21 vs. 7.8±6.5, p=0.018). The NPs and hs-cTnT are associated with high PASP at HA and the NPs with AMS.

Abstract 11414: Temporary Right Ventricular Mechanical Support in Addition to a Left Ventricular Assist Device: When is It Required and When is Its Removal Feasible?

Background: Right ventricular failure (RVF) before, during and after left ventricular assist device (LVAD) insertion is associated with high mortality. Thus, preoperative (preop) distinction between impaired RVs with and without the potential for recovery during RV afterload reduction by an LVAD is paramount. During biventricular support, RV recovery allowing RVAD removal can occur after unloading by a temporary device but preop prediction of recovery, its postoperative (postop) assessment and the timing of RVAD removal are challenging. We analyzed these issues to improve preop decision making. Methods: To assess the predictability of RV recovery during LVAD or LVAD+RVAD support allowing RVF free outcome without RVAD, prospectively gathered data on preop RV size, shape and function, tricuspid regurgitation and pulmonary hemodynamics were tested for relationship with postop RV function. Right heart catheterization and echo variables collected during short stops of the RV pump were used to test the predictability of weaning success from RV support. Results: Of 283 evaluated pts (preop RVEF ≤ 30%), 235 received an LVAD (group A) and 48 LVAD+RVAD (group B). We compared in group A the preop data from pts with and without postop RVF and in group B those from pts with and without RV recovery during biventricular support. We found less altered RV size and shape, higher velocity of RV systolic wall motion and myocardial shortening and higher systolic pressure gradients between RV and right atrium in pts with no RVF during LVAD support and also in those with RVAD-promoted RV recovery (p &lt; 0.01). Combined assessment of myocardial velocity of shortening and RV size and geometry in relation to RV load showed the highest predictive values (83-97%) for preop distinction between impaired RVs with and without the potential to remain free from RVF after LVAD insertion or the potential to recover during RVAD support, and also for postop distinction between unloading promoted RV recovery with and without the potential to remain stable after RVAD removal. Conclusions: Preoperative assessment of RV ability to improve during LVAD ± temporary RVAD support and prediction of weaning results before RVAD removal can be improved by evaluation of RV size, shape and function in relation to RV load.

Novel dual endothelin receptor antagonist macitentan reverses severe pulmonary arterial hypertension in rats.

The efficacy of endothelin (ET) receptor antagonist bosentan in patients with severe pulmonary arterial hypertension (PAH) remains limited, partly because its higher doses for potential blockade of ET receptors have never been tested due to liver dysfunction. We hypothesized that rigorous blockade of ET receptors using the novel dual ET receptor antagonist macitentan would be effective in treating severe PAH without major side effects in a preclinical model appropriately representing the human disorder. In normal rats, 30 mg·kg·d of macitentan completely abolished big ET-1-induced increases in right ventricle (RV) systolic pressure. Adult male rats were injected with SU5416, a vascular endothelial growth factor blocker, and exposed to hypoxia for 3 weeks and then to normoxia for an additional 5 weeks (total 8 weeks). In intrapulmonary arterial rings isolated from rats with severe PAH, macitentan concentration dependently inhibited ET-1-induced contraction. Long-term treatment with macitentan (30 mg·kg·d, from week 3 to 8) reversed the high RV systolic pressure with preserved cardiac output. Development of RV hypertrophy, luminal occlusive lesions and medial wall thickening were also significantly improved without increasing serum levels of liver enzymes by macitentan. In conclusion, efficacious blockade of ET receptors with macitentan would reverse severe PAH without major adverse effects.

NuMED Covered Cheatham-Platinum Stent™ for the treatment or prevention of right ventricular outflow tract conduit disruption during transcatheter pulmonary valve replacement.

Retrospectively assess the frequency of right ventricular outflow tract (RVOT) conduit disruption during transcatheter pulmonary valve replacement (TPVR) and the effectiveness and safety of NuMED Covered Cheatham-Platinum Stents™ (CCPS) for its prevention or treatment. There have been no published reports to date describing the safety and effectiveness of covered stents to prevent or treat RVOT conduit disruption during TPVR. Data regarding 251 TPVR procedures performed at multiple US investigational sites were retrospectively reviewed to explore the incidence and potential predictors of conduit disruption. In addition, data on the use of 69 CCPS implanted in 50 patients during TPVR was reviewed. The overall incidence of conduit disruption requiring intervention was 6%. The only predictor identified was a very elevated RVOT conduit systolic pressure gradient. A pre-existing conduit tear was present in nine, while 31 developed tears after conduit dilation and three, after TPVR. The CCPS was used prophylactically in seven. Conduit tears were prevented or repaired in 49/50 patients. No CCPS-related acute complications were reported. At 6-month follow-up, no patient had more than mild pulmonary regurgitation and the mean Doppler RVOT gradient (12.7 ± 5.8 mm Hg) comparing favorably with that reported in the Melody TPV® IDE trial (20.0 ± 8.6 mm Hg). CCPS implantation can successfully treat RVOT conduit disruption without negative impact on the TPV function. This retrospective analysis suggests high RVOT conduit systolic pressure gradient is a risk factor for conduit tears during TPVR.

Risk of High Blood Pressure in Undernourished and overnourished Adolescents from Urban Population in India

The objective of the study was to examine the risks for high blood pressure associated with under nutrition and over nutrition among adolescents, as both forms of malnutrition coexist in India owing to nutritional transition. Adolescents (9-16 yrs) from schools catering to Lower Socio Economic class (LSE; 943 boys, 1000 girls) and High Socio Economic class (HSE; 867 boys, 1042 girls) were measured for weight, height, sitting height, body fat, skin folds and blood pressure. Results revealed that high prevalence of overweight in adolescents from HSE class compared to that in LSE (24.1% vs 2.2% in boys and 20.8% vs 3.9% in girls; p<0.01 for both) indicated risk for High Systolic Blood Pressure (HSBP) while high prevalence of stunting in LSE class (20.8% in boys and 11.8% in girls) indicated risk for High Diastolic Blood Pressure (HDBP). Leg height to height ratio showed significant inverse association with blood pressure levels. In LSE class, prevalence of HDBP was significantly higher than prevalence of HSBP in each quartile of BMI, body fat and skin folds. Increase in systolic blood pressure per unit increase of BMI, was higher in adolescents from LSE class (1.99 mmHg in boys and 1.03 mmHg in girls) compared to those in HSE class (0.91 mmHg in boys and 0.52 mmHg in girls) and this was also true for diastolic blood pressure. Implications of increase in BMI are serious for undernourished children than better nourished children. The observation therefore, underscores the need for planning strategies for preventing adiposity in adolescents from urban as well as rural and poor sections of Indian population.

Multiple endocrine neoplasia type 2B：4 cases report and literature review

Objective To investigate the clinical characteristics and diagnostic methods of multiple endocrine neoplasia （ MEN） 2B. Methods The clinical data collected from 4 cases with multiple endo-crine neoplasia type 2B, who had been diagnosed and treated from July .1980 to Jan.2012, were retrospec-tively analyzed.Of the 4 patients, 3 males were diagnosed at the age of 14, 24, 21, respectively, and 1 fe-male was diagnosed at age of 23.Two cases had the first diagnosis of thyroid mass during the physical exami-nation, and the adrenal tumors and hypertension were first diagnosed in other two cases , respectively.All four cases had multiple mucosal neuromata .Of whom, three cases had medullary thyroid carcinoma and pheochromocytoma , two cases had Marfan syndrome figure , and one case had pheochromocytoma and Marfan syndrome.Two cases were accompanied by paroxysmal hypertension , and the highest systolic blood pressure was over 200 mmHg （1 mmHg=0.133 KPa）.Two cases of pheochromocytoma were found during follow up . Three cases had bilateral adrenal tumors .The thyroid mass was diagnosed by ultrasonography , and the pheo-chromocytoma was confirmed by ultrasonography , CT and 24-hour urine catecholamine test .Adrenalectomy and thyroidectomy were carried out during the treatment process .To clarify the RET mutation status , exons and adjacent introns from 10th to 16th of RET proto-oncogene were sequenced in two patients . Results Gene analysis of two cases confirmed the activating mutation at the sites of 918 in exon 16 of RET proto-on-cogene in which methionine was replaced by threonine （ ATG-ACG） .Among the 3 cases with medullary thy-roid carcinoma , two patients were treated by total thyroidectomy and neck lymphadenectomy , one was opera-ted by subtotal thyroidectomy .For the treatment of pheochromocytoma , adrenal tumor resection was carried out in 3 cases, but not in the other one .Patients were followed up for 2 to 15 years postoperatively , 1 case without tumor recurrence and metastasis , 2 cases with multiple metastases . Conclusions The diagnosis of multiple endocrine neoplasia type 2B mainly depends on endocrine tests , ultrasonography and CT .Surgery is the primary treatment .When pheochromocytoma coexists with other tumors , pheochromocytoma should be re-moved first . Key words: Multiple endocrine neoplasia; Pheochromocytoma; Thyroid tumor

Hypertension in Primary Open Angle Glaucoma

The impact of vascular factors in POAG is well known and controversial. Some reports have shown high blood pressure in POAG, some low systolic blood pressure and some described no difference in blood pressure between POAG and controls. However decreased ocular perfusion pressure was found in most of the studies. Our study aims to assess the role of hypertension in POAG . It was cross-sectional case-control hospital based study carried out from 1st June 2012 to 1st June 2013. There were 40 cases and 100 controls included in the study. The role of hypertension were compared with those hypertensive patients with glaucoma (cases) and hypertensive patients without glaucoma (controls). Age above 50 years (odds ratio: 4.827 with 95% CI 1.862-12.517), male genders (odds ratio: 3.10 with 95% CI 1.356-7.146) and low diastolic perfusion pressure (odds ratio: 3.857 with 95% CI 1.362-11.224) showed strongly positive association with POAG. High systolic blood pressure (odds ratio: 1.476 95% CI 0.627-3.476), high diastolic blood pressure (odds ratio: 1.348 95% CI 0.587-3.096) and low systolic perfusion pressure (odds ratio: 1.8661 with 95% CI 0.649- 5.335) were weakly associated with glaucoma in our study. Age above 50 years, male gender and low diastolic perfusion pressure were strong risk factor for the development of POAG.

Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: a meta-analysis.

BackgroundRebleeding is a serious complication of aneurysmal subarachnoid hemorrhaging. To date, there are conflicting data regarding the factors contributing to rebleeding and their significance.MethodsA systematic review of PubMed and Embase databases was conducted for studies pertaining to aneurysmal subarachnoid hemorrhage (aSAH) and rebleeding in order to assess the associated risk factors. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated from fourteen studies comprised of a total of 5693 patients that met the inclusion criteria.ResultsHigher rebleeding rates were observed < 6 h after the initial aSAH (OR = 3.22, 95% CI = 1.46–7.12), and were associated with high systolic blood pressure (OR = 1.93, 95% CI = 1.31–2.83), poor Hunt-Hess grade (III–IV) (OR = 3.43, 95% CI = 2.33–5.05), intracerebral or intraventricular hematomas (OR = 1.65, 95% CI = 1.33–2.05), posterior circulation aneurysms (OR = 2.15, 95% CI = 1.32–3.49), and aneurysms >10 mm in size (OR = 1.70, 95% CI = 1.35–2.14).ConclusionsAneurysmal rebleeding occurs more frequently within the first 6 hours after the initial aSAH. Risk factors associated with rebleeding include high systolic pressure, the presence of an intracerebral or intraventricular hematoma, poor Hunt-Hess grade (III-IV), aneurysms in the posterior circulation, and an aneurysm >10 mm in size.

Salt taste sensitivity thresholds in adolescents: are there any relationships with body composition and blood pressure levels?

The aim of this study was to identify the salt taste sensitivity thresholds and relationships with body composition and blood pressure levels in a cross-sectional study of adolescents. Blood pressure and body composition were measured with a digital device and by anthropometry, respectively. The salt taste sensitivity threshold was measured with 9 solutions with different sodium chloride concentrations to assess the sensitivity to saltiness. The solutions (4, 8, 15, 30, 60, 120, 250, 500 and 1000 mmol/L sodium chloride) were served in increasing concentrations until the taste was correctly identified. The taste sensitivity threshold was then classified as normal or high. In total, 421 adolescents (55.6% female), with an average age of 15.8 ± 0.91 years, were evaluated. The median threshold was 30 mmol/L, and 36.1% had a high threshold. The high blood pressure prevalence was 12.6%, and 25.5% of the subjects were overweight. When the mean systolic and diastolic blood pressure levels were compared between the normal and increased threshold groups after adjusting for gender, age, sedentary lifestyle and body mass index, only diastolic blood pressure showed a statistically significant effect (P < 0.0001) between the groups. The effect of a high threshold on body composition after adjusting for gender, age and physical inactivity was not significant (P = 0.177). There was no relationship between a high threshold and systolic pressure or body composition in the evaluated adolescents; therefore, only diastolic blood pressure was affected.

Computed tomography correlates with cardiopulmonary hemodynamics in pulmonary hypertension in adults with sickle cell disease.

Our objective was to determine whether computed tomography angiography (CTA) measurements of pulmonary artery size can noninvasively assess hemodynamics and diagnose pulmonary hypertension (PH) secondary to sickle cell disease (SCD). Twenty SCD patients with confirmed PH were compared with 20 matched controls. Diameters of the pulmonary artery trunk and branches were measured with CTA and a semiautomatic segmentation algorithm. Measurements were normalized by body size and correlated (Spearman rank) with hemodynamic markers from right-heart catheterization. Receiver operating characteristic (ROC) curves were used to investigate the role of pulmonary artery sizes in diagnosing PH. Analysis of pulmonary artery sizes adjusted for body surface area (BSA) resulted in the most significant discrimination between subjects with PH secondary to SCD and controls (P < 0.001); PH was diagnosed accurately with an area under the ROC curve of 0.99. There was significant correlation between pulmonary artery sizes and body mass index (BMI) and BSA only in controls (r = 0.46-0.68, P < 0.04 for all). The most significant correlations with hemodynamic markers were found between BMI-adjusted pulmonary artery sizes and high systolic pulmonary arterial pressure, high pulmonary vascular resistance, high systemic vascular resistance, and low cardiac output (r = 0.47, 0.62, 0.61, and 0.66, respectively; P < 0.04 for all). BMI-adjusted CTA measures of the pulmonary artery relate to high pulmonary vascular resistance and reduced cardiac output in patients with SCD and PH. CTA with quantitative image analysis is a powerful noninvasive diagnostic tool for PH in SCD and shows promise as estimator of hemodynamic markers.

White rice consumption is a risk factor for metabolic syndrome in Tehrani adults: a prospective approach in Tehran Lipid and Glucose Study.

Consumption of white rice has been proposed as a dietary risk factor for development of metabolic disorders and type 2 diabetes, especially in populations who consume white rice as a staple food. In this study, we investigated the association between consumption of white rice and the occurrence of metabolic syndrome in Tehrani adults after 3 years of follow-up. This longitudinal study was conducted within the framework of the Tehran Lipid and Glucose Study on 1476 adults, aged 19-70 years. Dietary intakes were measured using a validated semi-quantitative food frequency questionnaire at baseline. Biochemical and anthropometric measurements were assessed and documented at baseline (2006-2008) and again 3 years later (2009-2011). Multiple logistic regression models were used to estimate the occurrence of the MetS in each quartile of white rice consumption. The mean age of participants was 37.8 ± 12.3 years, and mean BMI was 26.0 ± 4.5 Kg/m2 at baseline. Participants in the highest quartile of white rice consumption were significantly younger, had lower HDL-C levels, and higher systolic and diastolic blood pressures at baseline (P < 0.01). Higher consumption of white rice was also accompanied by higher increase in serum triglyceride levels after the 3-year follow-up (9.9 ± 2.3 vs. 8.2 ± 2.3%, P < 0.01). After adjustment for all potential confounders, the risk of metabolic syndrome in the highest quartile of white rice consumption compared with the lowest, was 1.66 (95% CI: 1.04-2.66). Moreover, participants with central obesity, low physical activity or low-fiber diet had greater risk of metabolic syndrome if white rice constituted ≥25.6% of total energy. We demonstrated that higher consumption of white rice may be a risk factor for development of metabolic syndrome among Iranian adults.

Nutritional characteristics of chronic fatigue syndrome in Korean college students (628.16)

This study was conducted to investigate the relationship nutritional characteristics and chronic fatigue in college students in Korea. Total subjects were 130 students which numbers of male and female were sixty respectively. The measurement for chronic fatigue was Korean version of Fatigue Assessment Instrument (FAI). And blood pressure and body fat contents etc. were analyzed. In the case that the average BMI was 21, the group with high systolic pressure showed lower FAI scores than the group with low systolic pressure. The same pattern was showed in diastolic pressure and % body fat except blood glucose level. Moreover the sleep tended to be longer in the high systolic pressure group even though there was no significant difference. Between the group that BMI was under 18.9 and the group BMI was over 24, the former group showed higher FAI scores than the latter. The results might suggest that some increase of blood pressure and body fat could alleviate the chronic fatigue syndrome in adults.Grant Funding Source: Kyungnam University

Meta-Analysis of Clinical Efficacy of Sildenafil, a Phosphodiesterase Type-5 Inhibitor on High Altitude Hypoxia and Its Complications

High altitude illness can be life-threatening if left untreated. Acute mountain sickness and high altitude pulmonary hypertension are two syndromes of high altitude illness. Recent clinical studies showed the beneficial effects of phosphodiesterase type 5 (PDE-5) inhibitors on the treatment of pulmonary hypertension. In this report, we performed a meta-analysis to evaluate the clinical efficacy of PDE-5 inhibitors on high altitude hypoxia and its complications. Randomized controlled trials evaluating the efficacy of PDE-5 inhibitor in the setting of high altitude were identified by searching Cochrane Central Register of Controlled Trials (September 2013), PubMed (from 1990 to September 2013), and EMBASE (from 1990 to September 2013). Extracted outcomes from selected studies for meta-analysis included arterial oxygen saturation, pulmonary artery systolic pressure, heart rate, and Lake Louise Consensus AMS symptom score. Weighted mean differences with 95% confidence intervals were presented for the continuous outcomes. Five clinical trials that met the selection criteria were identified for the meta-analysis. All of these studies used sildenafil as the PDE-5 inhibitor. A total of 60 subjects received sildenafil, and 72 subjects were given placebo. In accordance with previous report, short-term treatment with sildenafil (1-2 days) significantly reduced pulmonary artery systolic pressure at rest (MD -4.53; 95% CI -6.72, -2.34; p<0.0001). However, treatment with sildenafil (1-2 days) did not improve oxygen saturation after exposure to high altitude (MD 0.07; 95% CI -1.26, 1.41; p=0.91). Moreover, no significant difference was observed in heart rate between sildenafil and placebo-treated group (MD 6.95; 95% CI -3.53, 17.43; p=0.19). AMS score did not improve after treatment at different time points. Short-term treatment with sildenafil can attenuate the altitude-induced high pulmonary systolic arterial pressure, but has no significant beneficial effects on arterial oxygen saturation, heart rate, and acute mountain sickness.

Cardiovascular protection by -blockade in hypertensive haemodialysis patients: the Hypertension in Haemodialysis Patients Treated With Atenolol or Lisinopril (HDPAL) trial

In the pioneer years of chronic haemodialysis (HD), hypertension was recognized as the main undisputable cause of death in end-stage kidney disease (ESKD) patients [1]. Nearly a halfcentury later, sparse data in various countries indicate that control of hypertension in the HD population still remains a major unmet clinical need worldwide. In the USA, the prevalence of hypertension exceeds 80% [2], in Great Britain it is about 50% [3] and in Italy about 70% [4]. Progress in this area has been in part hindered by the ‘reverse epidemiology’ scenario that characterizes the HD population. Uncertainty about blood pressure (BP) targets and methods of measurement is such that the Renal Association guidelines cautiously state that ‘It would be sensible to avoid sustained BP extremes and, in order to try to provide some guidance, we suggest that systolic blood pressure during the interdialytic period on HD and for peritoneal dialysis (PD) patients should not regularly exceed >160 mmHg’ [3]. Low pre-dialysis BP rather than high BP is associated with death risk. Furthermore, in sharp contrast to a large meta-analysis in individuals in the general population without a background of cardiovascular events [5], the pre-dialysis relationship between BP and death risk in end-stage kidney disease (ESKD) is definitely non-linear [6]. However, peri-dialytic BP measurements are inherently inadequate metrics of the BP burden because measurements before dialysis overestimate the underlying average BP while post-dialysis BP underestimates the same parameter. In studies applying ambulatory blood pressure monitoring (ABPM) in the HD population without severe heart failure, the link between BP and clinical outcomes is comparable with that registered in the general population with the same technique [7]. Indeed, high average ambulatory systolic pressure [8] and nocturnal systolic hypertension [9] during the dialysis intervals are strong death predictors in HD patients. Notwithstanding the public health relevance of the problem and the peculiar risk profile of the ESKD population, the number of randomized, controlled trials (RCTs) testing antihypertensive drugs in dialysis patients is very limited indeed. A meta-analysis performed in 2009 [10] identified only eight randomized trials. Of these, one was performed in patients on peritoneal dialysis, two dealt with normotensive or hypotensive patients affected by left ventricular systolic dysfunction or heart failure and another trial (FOSIDIAL) selected patients with left ventricular hypertrophy (LVH), independent of BP [11]. After this meta-analysis, the OCTOPUS trial was published [12]. Thus, we have just four relatively small RCTs specifically focusing on drug treatment of hypertension in HD patients without severe heart failure (NYHA class III or IV) (Fig. 1). Of these trials, one tested a calcium antagonist (amlodipine) [13] and three various angiotensin II receptor blockers (ARBs): candesartan in the first [14]; candesartan, losartan or valsartan in the second [15] and olmesartan in the third [12]). In trials testing ARBs, the antihypertensive effect of these drugs was comparable with that achieved by other drugs. Nonetheless, of these three trials, two documented a reduction in the risk of cardiovascular events (−47% [3] and −71% [4]). If we consider also the FOSIDIAL trial where about half of the patients were hypertensive, the combined analysis (random-effects) of trials based on ARBs and angiotensin-converting enzyme inhibitors (ACEi) shows a 31% risk reduction [RR: 0.69, 95% confidence interval (95% CI) 0.45–1.05, P = 0.086], which just fails to achieve statistical significance. Because BP in patients randomized to ACEi or ARBs in these trials was almost identical to that in patients randomized to other drugs, the apparent benefit of ACEi or ARBS appears attributable to the interference with angiotensin II effects on the cardiovascular system beyond vasoconstriction. These results are similar to those of a recent meta-analysis reporting a substantial, BP-independent, benefit of ACEi and ARBs in over 100 000 high-risk patients without heart failure [16] most of whom were hypertensive. IN F O C U S

2D Echocardiographic features in low T3 syndrome in chronic heart failure

Background: Thyroid abnormalities are common in chronic heart failure. Severity of heart failure rises by several fold in patients with thyroid dysfunction. Objectives: The purpose of this prospective study is to determine the correlation between low T3 syndrome and chronic heart failure with 2D echocardiography features &amp; predicting the severity of chronic heart failure. Methods: In this descriptive, prospective cross sectional study, all patients who presented to the department of medicine with chronic heart failure during this study period of 12 months from January 2010-December 2011 in K.R.Hospital, Mysore were included. Patients were grouped into Low T3 chronic heart failure, hypothyroid chronic heart failure and chronic heart failure. Results: Mean age of low T3 chronic heart failure patients was higher than other two groups [60.50±6.15(SD) years, Systolic dysfunction on 2D Echo was more in low T3 dilated cardiomyopathy (20%), Diastolic dysfunction on 2D Echo was more in low T3 dilated cardiomyopathy group (30%), Pericardial effusion was seen in more number of patients with low T3 dilated cardiomyopathy (10%). Global hypokinesia was seen in more number of patients with low T3 dilated cardiomyopathy (30%). Segmental hypokinesia was seen in more number of patients with low T3 dilated cardiomyopathy (3%). Mean ejection fraction was seen in more number of patients with low T3 dilated cardiomyopathy [36.78±5.08 (SD) %]. Mean ejection fraction was lower in low T3 dilated cardiomyopathy [34.8±3.293 (SD) %].The high pulmonary artery systolic pressure was seen in more number of patients in low T3 dilated cardiomyopathy (70%). Conclusion: There is significant percentage of chronic heart failure patients having low T3 alone as biochemical parameter. It is important to recognize patients with chronic heart failure as it is associated with increased severity of heart failure. Asian Journal of Medical Science, Volume-5(3) 2014: 35-39 http://dx.doi.org/10.3126/ajms.v5i3.9522

The 6-min walk test: an independent correlate of elevated tricuspid regurgitant jet velocity in children and young adult sickle cell patients

Elevation of echocardiography-determined tricuspid regurgitant jet velocity (TRV) predicts high systolic pulmonary artery pressure. The present study tested the hypotheses that elevated tricuspid regurgitant jet velocity is associated with both hemolysis and hypoxia and abnormal 6-min walk test (6MWT) results. This study aims to correlate elevated TRV with different clinical laboratory findings and 6MWT and to find the independent predictors of increased TRV. A prospective study of 80 patients aged 5-25years old with sickle cell disease (SCD) under basal conditions and 40 matched controls was conducted. Hemolytic analysis was assessed by the levels of lactate dehydrogenase, serum bilirubin, and reticulocyte count. Oxygen saturation determination using pulse oximeter and 6MWT were done. The overall prevalence of elevated TRV (≥2.5m/s) was 28.75%. Associated risk factors were older age (r = 0.28, p = 0.01), longer duration of disease (r = 0.25, p = 0.025), higher reticulocytic count (r = 0.344, p = 0.002), lower O2 saturation (r = -0.574, p = 0.0001), and shorter walked distance in 6MWT (r = -0.75, p = 0.0001). By multivariate logistic analysis, only the distance walked during 6MWT was the independent correlate of elevated TRV (odds ratio = 0.85; 95% CI = 0.74 to 0.98 p = 0.033). The study provides evidence for independent association of TRV with abnormal 6MWT results. The 6-min walk test can be used as noninvasive adjuvant tool for functional capacity assessment of SCD patients with elevated TRV.

Increased levels of asymmetric dimethylarginine are associated with pulmonary arterial hypertension in HIV infection

To examine the relationship between asymmetric dimethylarginine (ADMA) and HIV-associated pulmonary arterial hypertension (PAH). HIV infection is an independent risk factor for PAH, but the underlying pathogenesis remains unclear. Chronic inflammation resulting in nitric oxide-mediated endothelial dysfunction is a key mechanism underlying other types of PAH. ADMA is an endogenous inhibitor of endothelial nitric oxide synthase. Among uninfected individuals, ADMA is associated with PAH and predicts disease-related mortality. We measured ADMA, high sensitivity C-reactive protein, interleukin-6 (IL-6), D-dimer, and pulmonary artery systolic pressure (PASP) using echocardiography in HIV-infected individuals. Right heart catheterization (RHC) was performed in individuals with a PASP at least 30 mmHg. We performed multivariable analysis to identify factors associated with high PASP by echocardiogram and PAH by RHC. Among 214 HIV-infected individuals, the median age was 50 years, 82% were men, 71% were on antiretroviral therapy, and 4.2% carried a prior diagnosis of PAH. ADMA and IL-6 were associated with increased values of PASP following multivariable adjustment (7.2% per 0.1 μmol/l, P = 0.0049 and 3.9% per doubling, P = 0.027, respectively). In adjusted analysis among the 85 participants who underwent RHC, ADMA and IL-6 were associated with higher values of mean PAP (14.2% per 0.1 μmol/l, P = 0.0014 and 5.8% per doubling, P = 0.038, respectively). However, only ADMA was associated with PAH (prevalence ratio = 1.74, P = 0.029). Elevated levels of ADMA are independently associated with PAH among HIV-infected individuals. Our findings suggest that chronic HIV-associated inflammation leading to an accumulation of ADMA and subsequent nitric oxide-mediated endothelial dysfunction may represent a novel mechanism for HIV-associated PAH.