Increase In Systolic Blood Pressure Research Articles

Abstract 17255: Local Gunfire Exposure is Associated With Acutely Increased Blood Pressure on the South Side of Chicago

Hypertension is a leading risk factor for cardiovascular disease, which is especially prevalent among minority urban patients. Our group and others have previously shown that socio-environmental factors such as crime and poverty raise cardiovascular risk. However, the acute effects of local urban gunfire on patients’ blood pressure are unknown. We hypothesized that local gunfire in our South Side Chicago community was temporally associated with an acute rise in blood pressure for nearby patients. We performed a retrospective cohort study including 7,564 patients aged 18-104 who completed two or more outpatient clinic visits within 1 year at our academic tertiary-care center on the South Side of Chicago. We included 41,554 pre-pandemic clinic visits and recorded the blood pressure for each visit. Local gunfire was measured using ShotSpotter®, a network of microphones installed throughout the South Side of Chicago, which locates gunshots using auditory triangulation. Datasets of gunfire incidents are publically available from ShotSpotter® including date/time and geolocation of incidents. We focused on incidents that occurred within 1 km of each patient’s address and between two clinic visit dates (33 days, on average). Our primary outcome was the change in systolic blood pressure between the two clinic appointments. We excluded patients whose antihypertensive regimen was changed at the first appointment. Next, we utilized a multivariate regression model to assess the relationship between incidents of gunfire and seasonally-adjusted changes in blood pressure. Between-visit gunshot exposure ranged from 1 to 1,793 per patient. We found that each incident of gunfire was associated with a statistically significant acute increase in systolic blood pressure (0.0033 mmHg increase per gunfire incident [0.0022, 0.0044], p<0.0001). Results were similar regardless of whether total round count or total gunfire incidents were considered. In this study of urban patients, incidence of gunfire within 1 km of a patient’s address was associated with an acute rise in blood pressure over approximately 1 month. These findings implicate the adverse impact of local gunfire exposure and environmental stress on blood pressure in adults on the South Side of Chicago.

Association between atmospheric air temperature and blood pressure among adult population in different seasons

BACKGROUND: The prevalence of hypertension in the Arkhangelsk region is steadily increasing. Despite the progress in the diagnostics and the availability of treatment, a half of the population are unaware of their hypertension and its potential consequences, and consequently, do not adhere to the prescribed medications. This lack of awareness, coupled with the challenging climatic conditions of the northern regions, can significantly increase the risk of acute myocardial infarctions and strokes among young adults.
 AIM: To study the association between atmospheric air temperature and blood pressure among the adult population in Arkhangelsk.
 MATERIAL AND METHODS: For the purpose of this study we used blood pressure data obtained from 2342 participants individuals aged 3569 years who participated in the Know your heart study in Arkhangelsk from November 1, 2015 to October 31, 2017. Every blood pressure measurement was linked to the time-corresponding readings of atmospheric air temperature recorded by the city meteorological station. The effect of the temperature on blood pressure was assessed using linear regression analysis separately for the warm (April 16October 15) and the cold (October 16April 15) seasons.
 RESULTS: In the warm season, in the group of participants without hypertension and in those with treated arterial hypertension, high values of atmospheric air temperature (17.526.5 С) relative to the average level (8.812.2 С) were associated with a decrease in systolic blood pressure at 7.9 mm Hg (p=0.004) and 8.5 mm Hg (p=0.012), respectively, and diastolic blood pressure by 5.1 mm Hg (p=0.002) and 4.5 mm Hg (p=0.021), respectively. In the group of participants with untreated arterial hypertension, changes in ambient air temperature above (12.317.2 С) and below (6.08.7 С) the average level for this period were associated with an increase in systolic blood pressure by 11.7 mm Hg (p=0.044) and 16.9 mm Hg (p=0.004), and diastolic blood pressure by 8.9 mm Hg (p=0.018) and 13.8 mm Hg (p 0.001), respectively. In the cold season, no effect of air temperature on blood pressure was found in persons without arterial hypertension. In persons with treated arterial hypertension, an increase in air temperature in the cold season to the levels of (1.31.1 С) relative to the average level (3.91.4 С) were associated with lower systolic blood pressure by 8.5 mm Hg (p=0.001).
 CONCLUSION: The results of the study demonstrate the association between the atmospheric air temperature and blood pressure. Patients with untreated hypertension are more susceptible to fluctuations in blood pressure parallel to changes in ambient air temperature.

Hemodynamic Effects of the Osmopressor Response: A Systematic Review and Meta-Analysis.

Background Rapidly consuming water may offer practical orthostatic hypotension therapy. However, its efficacy across disorders remains uncertain. This study aims to assess the impact of rapid 350- to 500-mL water intake on systolic and diastolic blood pressure (BP) and heart rate (HR) through a systematic review and meta-analysis. Methods and Results We systematically reviewed MEDLINE and Embase up to June 2023, including randomized controlled trials and prospective cohort studies. Using random-effects meta-analysis, we calculated pooled mean differences (MDs) for maximum hemodynamic effects of rapid 350- to 500-mL water bolus consumption. Participants with orthostatic hypotension experienced increased systolic BP (MD, 24.18 [95% CI, 15.48-32.88]) and diastolic BP (MD, 11.98 [95% CI, 8.87-15.09]) with decreased HR (MD, -3.46 [95% CI, -5.21 to -1.71]). Similar results were observed in multiple system atrophy and pure autonomic failure subgroup analysis. Healthy participants showed modest increases in systolic BP (MD, 2.33 [95% CI, 1.02-3.64]) and diastolic BP (MD, 2.73 [95% CI, 1.15-4.30]), but HR changes were not significant (MD, -2.06 [95% CI, -5.25 to 1.13]). Water had no significant hemodynamic effects in patients with seated or supine postural tachycardia syndrome, although standing effects were unassessed. Our data do not exclude water's potential standing effect in postural tachycardia syndrome. Conclusions In patients with orthostatic hypotension, rapid water intake elevated short-term systolic BP and diastolic BP, with mild HR reduction when seated or supine. Healthy participants exhibited similar but milder effects. However, patients with postural tachycardia syndrome did not experience these changes in seated or supine positions. Further research is needed to evaluate the promising impact of rapid water ingestion on patients with postural tachycardia syndrome in a standing position, which was not addressed in our study.

Impact of Excessive Increase in Systolic Blood Pressure after Exercise on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction.

Although the clinical outcomes for patients with ST-elevation myocardial infarction (STEMI) have improved significantly, some patients still experience poor clinical outcomes. The available risk classifications focus on the short-term outcomes, and it remains important to find high-risk features among patients with STEMI. In Japan, the 200 m walk electrocardiogram (ECG) test is widely performed before discharge. The purpose of this study was to investigate the association between the excessive increase in systolic blood pressure (SBP) following a 200 m walk and the long-term clinical outcomes in patients with STEMI. We included 680 patients with STEMI and divided those into an excessive increase in SBP group (n = 144) and a non-excessive increase in SBP group (n = 536) according to the SBP increase after a 200 m walk ECG test. We defined an excessive increase in SBP as SBP ≥ 20 mmHg either just after or 3 min after a 200 m walk ECG test. The primary endpoint consisted of major cardiovascular events (MACE), defined as the composite of all-cause death, non-fatal myocardial infarction, readmission for heart failure, and ischemia-driven target vessel revascularization. The median follow-up duration was 831 days. MACE was more frequently observed in the excessive increase in SBP group (24.3%) than in the non-excessive increase in SBP group (15.1%). Multivariate Cox hazard analysis revealed that the excessive increase in SBP was significantly associated with MACE (HR 1.509, 95% CI: 1.005-2.267, p = 0.047) after controlling for multiple confounding factors. An excessive increase in SBP after the 200 m walk ECG test was significantly associated with MACE in patients with STEMI. The 200 m walk ECG test is simple and low-cost, but may help to identify high-risk patients with STEMI.

Anthropometric indexes for predicting high blood pressure in Turkish adults.

It is controversial which anthropometric indexes are the best in predicting the risk of hypertension and how anthropometric measurements are related to blood pressure (BP). This study aimed to evaluate the relationship between BP and anthropometric indexes and to determine the best predictors for hypertension risk. This cross-sectional study was conducted with 415 consecutive participants (161 men, mean age: 33.4 years) aged 18-88 years in Istanbul, Turkey. Weight, height, waist circumference (WC), and neck circumference (NC) and BP were measured by well-trained personnel. Waist-to-height ratio (WHtR) and body mass index (BMI) were calculated. Pearson correlation, linear regression, and multivariate analyses were used to assess the relationship between anthropometric measurements and SBP, DBP, using the Statistical Package for the Social Sciences version 23.0. The systolic BP (SBP) and diastolic BP (DBP) were related to weight, WC, NC, BMI, and WHtR (P < 0.05). Linear regression analyses showed BMI and WC as independent risk factors for SBP with an increase by 1.11 mmHg in men (P = 0.036) and 1.59 mmHg in women (P = 0.001) in SBP when BMI increased 1 unit, while SBP increases by 0.2 mmHg when WC increases by 1 unit regardless of gender (P = 0.013). Our results showed that BMI and WC are related to BP and important predictors of hypertension risk. Therefore, the uses of BMI and WC are recommended as screening tools for the prediction of hypertension risk among Turkish adults.

Aktifitas Fisik Menjadi Faktor Dominan Kejadian Hipertensi pada Pasien Rawat Jalan di Puskesmas Kecamatan Cipayung Periode Januari-April Tahun 2023

Hypertension is an increase in systolic blood pressure exceeding 140 mmHg and diastolic blood pressure exceeding 90 mmHg. The long-term impact of high blood pressure can lead to damage to various organs such as the heart, kidneys, and brain. In 2019, 34 percent of the population in Jakarta experienced the risk of hypertension, both mild and severe. Based on data from the Cipayung District Health Center in 2022, hypertension ranked first among the top 10 most frequently visited diseases on a monthly basis. This research aims to study and explain the relationship between lifestyle and the occurrence of hypertension in outpatients at the Cipayung District Health Center during the period of January-April 2023. The study design of this research is cross-sectional. Data collection is sourced from secondary data obtained from the medical records of the Cipayung District Health Center. The population in this study consists of outpatients who visited the Cipayung District Health Center with data collected from January to April 2023, totaling 1152 individuals, and all of them were analyzed.&#x0D; Based on the analysis results, it is known that age, gender, education level, physical activity, and salt consumption significantly influence the occurrence of hypertension. Physical activity is the most dominant risk factor influencing the occurrence of hypertension with an odds ratio of 29.714 and a 95% confidence interval of 19.543 - 45.178. Therefore, it is expected that the health center can enhance health promotion efforts and interventions targeting at-risk groups to prevent hypertension in the Cipayung Health Center area. Additionally, establishing sports clubs and healthy Diet Community Kitchens that can be participated in by the community can be beneficial. Increasing community engagement in healthy living can also reduce the risk of hypertension in the population.&#x0D; &#x0D; Keywords : Hypertension, Physical Activity, Health Center, Cipayung

Predictive Value of Non-Invasive Intracranial Pressure Monitoring in Profoundly Impaired Traumatic Brain Injury Patients

Introduction: Trauma brain injury is an emergency condition that requires immediate precise first aid to reduce mortality rates and prevent secondary complications. Severe head injuries can lead to intracranial bleeding, thereby affecting hemodynamics. Monitoring the increase in intracranial pressure aims to mitigate the severity of head injury in patients, reducing deaths caused by brain edema. The significance of assessing the Glasgow Coma Scale (GCS) in relation to increased intracranial pressure is to determine conditions that could exacerbate physiological conditions due to head injury. The objective of this study is to determine changes in intracranial pressure among severe head injury patients. Methods: This research employs a descriptive study with a retrospective approach. Patient data were sourced from medical records of individuals treated at RS PKU Muhammadiyah Gombong, diagnosed with severe head injuries during the last year from January to December 2022. A total of 180 severe head injury patients' data were collected. Results: Research findings reveal that patients with head injuries experienced an increase in systolic blood pressure (33.3%), a decrease in pulse rate (30.5%), and a temperature within the normal range (78.9%). Conclusion: However, not all severe head injury patients exhibited elevated blood pressure, reduced pulse rate, or decreased oxygen saturation. All head injury patients experienced a decreased level of consciousness with a GCS score of less than 8.

MiRNA-92a-3p mediated the association between occupational noise exposure and blood pressure among Chinese adults

Evidence on the association between occupational noise exposure and blood pressure is inconsistent, and the underlying mechanism remains unknown. This study aimed to evaluate the association between occupational noise exposure and blood pressure, and explore the potential role of miRNAs in the association. A total of 894 subjects from two companies in Wuhan, China were included. Occupational noise exposure was assessed using cumulative noise exposure (CNE), and six candidate plasma miRNAs (miR-92a-3p, miR-21-5p, miR-200a-3p, miR-200b-3p, miR-200c-3p, and miR-1-3p) which were not only associated with blood pressure/hypertension but also related to oxidative stress were selected according to previous studies and tested. A linear dose-response relationship was found between occupational noise exposure and blood pressure, including systolic blood pressure (SBP) and diastolic blood pressure (DBP). Each 1-unit increase in CNE levels was significantly associated with a 0.130 (95 % confidence interval [CI] = 0.026, 0.234) unit increase in SBP and a 0.141 (95 % CI = 0.063, 0.219) unit increase in DBP. However, the association between occupational noise and hypertension is not statistically significant (P > 0.05). In the meanwhile, occupational noise exposure was negatively associated with miRNA-92a-3p (β = −0.019, 95 % CI = −0.032, −0.006) and miRNA-21-5p (β = −0.031, 95 % CI = −0.052, −0.010), and miRNA-92a-3p mediated 24.66 % of the association between occupational noise exposure and DBP. In addition, bilateral high-frequency hearing loss was not only positively associated with occupational noise exposure (OR = 1.974, 95 % CI = 1.084, 3.702) but also DBP (β = 2.546, 95 % CI = 0.160, 4.932). Our study suggests that occupational noise exposure is positively associated with SBP and DBP, and miRNA-92a-3p partially mediate the association between occupational noise exposure and DBP.

Cardiometabolic sex differences in adults born small for gestational age.

This study aimed to assess the cardiometabolic sex similarities and differences in adults born small for gestational age. This study was an ambispective cohort study from a birth registry in Barcelona, Spain, including 523 adult participants (20-40 years-old) subdivided as born small for gestational age (SGA, if birth weight <10th centile) or adequate fetal growth for gestational age (AGA). Cardiometabolic health was assessed by echocardiography, electrocardiogram, blood pressure measurement, vascular ultrasound, anthropometric measurements, and serum glycemia and lipid profile. Stratified analyses by sex were performed by estimation of adjusted absolute difference (AAD) using inverse probability weighting. Compared with AGA, the stratified analyses by sex showed a more pronounced reduction in ejection fraction [AAD: female -1.73 (95% CI -3.2 to -0.28) vs. male -1.33 (-3.19 to 0.52)] and increment in heart rate [female 3.04 (0.29-5.8) vs. male 2.25 (-0.82 to 5.31)] in SGA females compared with SGA males. In contrast, a more pronounced reduction in PR interval [female -1.36 (-6.15 to 3.42) vs. male -6.61 (-11.67 to -1.54)] and an increase in systolic blood pressure [female 0.06 (-2.7 to 2.81) vs. male 2.71 (-0.48 to 5.9)] and central-to-peripheral fat ratio [female 0.05 (-0.03 to 0.12) vs. male 0.40 (0.17-0.62)] were mainly observed in SGA male compared with SGA female. Sex differences were observed in the effect of SGA on cardiometabolic endpoints with female being more prone to cardiac dysfunction and male to electrocardiographic, vascular, and metabolic changes. Future research including sex-stratification data is warranted.

Real-time dual prediction of intradialytic hypotension and hypertension using an explainable deep learning model

Both intradialytic hypotension (IDH) and hypertension (IDHTN) are associated with poor outcomes in hemodialysis patients, but a model predicting dual outcomes in real-time has never been developed. Herein, we developed an explainable deep learning model with a sequence-to-sequence-based attention network to predict both of these events simultaneously. We retrieved 302,774 hemodialysis sessions from the electronic health records of 11,110 patients, and these sessions were split into training (70%), validation (10%), and test (20%) datasets through patient randomization. The outcomes were defined when nadir systolic blood pressure (BP) < 90 mmHg (termed IDH-1), a decrease in systolic BP ≥ 20 mmHg and/or a decrease in mean arterial pressure ≥ 10 mmHg (termed IDH-2), or an increase in systolic BP ≥ 10 mmHg (i.e., IDHTN) occurred within 1 h. We developed a temporal fusion transformer (TFT)-based model and compared its performance in the test dataset, including receiver operating characteristic curve (AUROC) and area under the precision-recall curves (AUPRC), with those of other machine learning models, such as recurrent neural network, light gradient boosting machine, random forest, and logistic regression. Among all models, the TFT-based model achieved the highest AUROCs of 0.953 (0.952–0.954), 0.892 (0.891–0.893), and 0.889 (0.888–0.890) in predicting IDH-1, IDH-2, and IDHTN, respectively. The AUPRCs in the TFT-based model for these outcomes were higher than the other models. The factors that contributed the most to the prediction were age and previous session, which were time-invariant variables, as well as systolic BP and elapsed time, which were time-varying variables. The present TFT-based model predicts both IDH and IDHTN in real time and offers explainable variable importance.

Particulate Air Pollution and Blood Pressure: Signaling by the Arachidonate Metabolism.

Short-term exposure to ambient particulate matter (PM) can raise blood pressure, but the underlying mechanisms are unclear. We explored whether arachidonate metabolites serve as biological intermediates in PM-associated prohypertensive changes. This panel study recruited 110 adults aged 50 to 65 years living in Beijing, China. The participants' blood pressure, arterial stiffness, and cardiac and endothelial function were measured up to 7 times. The serum concentrations of arachidonate metabolites were quantified by targeted lipidomics. Ambient concentrations of fine PM (PM2.5), black carbon, and accumulation mode particles were continuously monitored at a station and their associations with the health indicators were evaluated. Interquartile range increases in 25 to 96-hour-lag exposure to PM2.5, black carbon, and accumulation mode particles were associated with significant increases in systolic blood pressure (brachial: 0.8-3.2 mm Hg; central: 0.7-2.8 mm Hg) and diastolic blood pressure (brachial, 0.5-1.5 mm Hg; central, 0.5-1.6 mm Hg). At least 1 pollutant was associated with increases in augmentation pressure and heart rate and decreases in reactive hyperemia index and ejection time. The serum concentrations of arachidonate were significantly increased by 3.3% to 14.6% in association with PM exposure, which mediated 9% of the PM-associated increases in blood pressure. The levels of eicosanoids from the cytochrome P450, cyclooxygenase, and lipoxygenase pathways changed with PM exposure, and those from the cytochrome pathway significantly mediated the association between PM exposure and blood pressure. Short-term exposure to particulate air pollution was associated with a prohypertensive change in adults, which was in part mediated by alteration of arachidonate metabolism.

Hemodynamic changes following injection of local anesthesia with vasoconstrictor agent in controlled hypertensive patients

Local anesthesia is considered the most commonly used in dentistry. Vasoconstrictors are added to its composition to maximize its advantages. However, it is considered a tourniquet and acts on beta 1 and 2 receptors. This causes augmentation of heart rate and blood pressure. This study aimed to evaluate the safety of vasoconstrictors during simple tooth extraction in controlled hypertensive patients by monitoring the changes in blood pressure, heart rate and oxygen saturation. A prospective clinical study was carried out in a control group (normotensive patients n=60) and study group (hypertensive patients) (n=60). The following hemodynamic parameters (blood pressure [diastolic and systolic], heart rate and oxygen saturation) were monitored at four different time points (before infiltration of local anesthesia (R1), after 3 minutes of local anesthesia (R2), immediately after extraction (R3) and 25 minutes after local anesthesia infiltration (R4). One carpule of local anesthesia for each patient was provided in the form of lidocaine 2% with adrenaline as vasoconstrictor 1/100,000; (3) Results: Mean heart rate increased from one to four beats per minute in all groups, but the increment was lesser in hypertensive group. The increase of systolic blood pressure in hypertensive patients during (R2, R3 and R4) was significantly lower than in the normotensive group (p&lt;0.001). The diastolic blood pressure reading fell in the hypertensive group more than in the normotensive group during (R2, R3 and R4). No changes in oxygen saturation were recorded between both groups; (4) Conclusions: no adverse effects in well-controlled hypertensive patients were seen during simple tooth extraction. One carpule of local anesthesia with 1\100,000 adrenaline does not induce blood pressure augmentation in hypertension patients included in this study. The changes in heart rate were within the safe limits. Keywords: local anesthesia, adrenaline, vasoconstrictors, hypertensive patients, hemodynamic changes.

Physiological and psychological stress response of blood donors during the blood donation process.

Blood donation can be a potentially stressful event, leading to the activation of an acute stress response. Knowing and identifying potential stressors could help in optimizing the donation experience. The present study aimed to measure the physiological and psychological stress changes before, during and after blood donation. Physiological and psychological stress response was assessed in 70 blood donors. To evaluate physiological stress response, pulse rate, respiratory rate, blood pressure (BP), beat-to-beat BP and lead II electrocardiogram were recorded. Baroreflex sensitivity was calculated using the available software. Psychological stress response was assessed using the State-Trait Anxiety Inventory scale. A significant increase in systolic blood pressure, diastolic blood pressure and mean arterial pressure was observed in the pre-donation period (p < 0.001). Among the time-domain parameters, SDSD (standard deviation of differences between adjacent respiratory rate intervals) and RMSSD (root mean square of the successive differences) were significantly lower during the post-donation period (p < 0.005, p < 0.007, respectively). Among the frequency-domain parameters, LF nu (relative power of the low-frequency band in normalized units), HF nu (relative power of the high-frequency band in normalized units) and LF% (relative power of the low-frequency band in percentage) were significantly lower before donation compared to during donation (p < 0.001, p < 0.001 and p < 0.012, respectively). LF nu, LF% and LF/HF ratio were also significantly lower during donation compared to after donation (p < 0.05, p < 0.016 and p < 0.042, respectively). Baroreflex sensitivity was also statistically higher during the pre-donation period. State score was significantly higher among the blood donors during the pre-donation period. Physiological and psychological stress is experienced by blood donors during the pre-donation period. A pre-donation informative conversation should be carried out with each blood donor and potential stressors should be identified in each.

Evaluation of Pain During Endotracheal Aspiration in Intensive Care Patients Diagnosed with COVID-19

BackgroundEndotracheal aspiration, a procedure that is particularly painful for intensive care patients, has received little attention in terms of pain evaluation specifically among intubated patients with COVID-19 in intensive care. AimThe study aims to assess the level of pain experienced by intubated intensive care patients diagnosed with COVID-19 during an endotracheal aspiration procedure. MethodThe study population was composed of patients admitted to the COVID-19 intensive care unit of the specified hospital between February and March 2021. Of the 56 patients admitted during that period, 47 were contacted and participated in the study. These 47 intubated and sedated patients were evaluated for 94 different expressions of pain during endotracheal aspiration twice a day before and during the procedure. Data were collected using the patient descriptive information form, the Non-Verbal Pain Scale for adults and data observation record form. ResultsIn the study, pain behavior was observed in 54.2% (n = 51) of the 94 observations. The patients were found to experience mild pain with an average score of 3.6 ± 1.07 on the Non-Verbal Pain Scale. The mean pain score before the procedure was found to be significantly different from the mean pain score during the procedure (p < .05), with an increase in pain during the procedure. During the procedure, 33.3% (n = 17) of the patients had a 10% decreased SpO2, and 29.4% (n = 15) had an increase in systolic blood pressure (>20), pulse (>20), and respiration (>10). Additionally, 21.5% (n = 11) of the patients experienced severe incompatibility with the ventilator, and 15.68% had muscle tension. ConclusionsThe study findings showed that nonverbal pain scores of sedated and intubated intensive care patients diagnosed with COVID-19 increased during endotracheal aspiration, accompanied by physiologic pain indicators. Effective pain management should be a priority for nurses. It is important to remember that patients with COVID-19 in the intensive care unit may experience pain while sedated and intubated. A holistic approach should be adopted for the evaluation and relief of pain in these patients. Intensive care nurses should consider physiologic and nonverbal behavioral pain indicators when evaluating pain in patients diagnosed with COVID-19.

Coexistence of hypertension with diabetes mellitus and its pharmacotherapy

Diabetes mellitus and hypertension are common comorbidities, as hypertension is reported to be twice as frequent in diabetic patients as people who are non- diabetics. In diabetic condition, the risk and progression of cardiac disease, peripheral vascular disease, stroke, retinopathy, and nephropathy is greatly increased in the presence of hypertension. Persistent increase in blood pressure termed hypertension, can be either primary hypertension (essential hypertension) or secondary hypertension in nature. Primary or essential hypertension is characterized by elevated blood pressure caused by inherited factors which are characteristic of essential hypertension whereas identifiable causes such as chronic kidney diseases, endocrine disorders, constriction of the kidney arteries, or the use of drugs are among the etiology of secondary hypertension. Diabetes causes hyperinsulinemia which increases the risk of hypertension. This condition increases the amount of sodium that the body absorbs. It also promotes the stimulation of the sympathetic nervous system. Treatment of both conditions is crucial as they are considered risk factors for coronary artery disease, cerebrovascular disease, renal failure and congestive heart failure. In any age group, a considerable increase in systolic blood pressure causes a significant increase in cardiovascular disease. To achieve sufficient blood pressure control, most people with hypertension and diabetes require more than one medication. This review is aimed to discuss hypertension and diabetes mellitus comorbidities and their treatment.

Analisis Faktor Yang Memengaruhi Kejadian Hipertensi Pada Lansia Di Poli Penyakit Dalam RSUD Dr.R.M.Djoelham Binjai

According to the American Heart Association or AHA, hypertension is a silent killer, with symptoms that can vary from individual to individual and are almost the same as symptoms of other diseases. Hypertension is a risk factor for various cardiovascular diseases and stroke. According to the AHA, hypertension is a disease that occurs due to an increase in systolic blood pressure&gt; 140 mmHg or diastolic blood pressure&gt; 90 mmHg.&#x0D; This type of research uses a descriptive analytic survey with a cross sectional design. The population in this study were all elderly (≥60 years) hypertensive patients at the Internal Medicine Polyclinic totaling 156 people, while the sample numbered 156 people by means of total sampling. Data analysis was performed using univariate, bivariate and multivariate analysis.&#x0D; Based on the results of the chi-square test it is known that the incidence of hypertension affects smoking, obesity, low-fiber diet, excessive salt consumption and lack of physical activity p = 0.000, meaning that there is an effect of smoking, obesity, low-fiber diet, excessive salt consumption and lack of physical activity on hypertension incident. From the results of multivariate analysis it is known that the most influential variable in this study is obesity with an OR value of 62,850.&#x0D; The conclusion in this study is that obesity is the dominant factor influencing the incidence of hypertension in the Internal Medicine Polyclinic at Dr.R.M.Djoelham Binjai Hospital. In order to reduce the prevalence of hypertension, it is hoped that the Patients of the Internal Medicine Polyclinic at Dr, R.M.Djoelham Binjai Hospital will apply hypertension management with a healthy lifestyle so that diabetics can have controlled blood pressure levels.

FRI211 Recurrent Hypertensive Crises In A Patient With A Large Pheochromocytoma; A Complicated Intensive Care Unit Course

Abstract Disclosure: S. Sokoloff: None. A. Iwamaye: None. Introduction: Hypertensive crisis is a well-known complication of surgery in patients with pheochromocytomas. However, as demonstrated in this case, these crises can be triggered by even routine intensive care unit procedures if sufficient alpha blockade has not been achieved. Thus, prevention of these episodes in the critical care setting presents a therapeutic challenge. Case: A 47-year-old female with a medical history of hypertension and intraductal papilloma presented for right lumpectomy for recent increase in papilloma size. General anesthesia and a laryngeal mask airway (LMA) were used. Intraoperatively, hypertensive crisis developed with systolic blood pressure of three hundred and oxygen saturation of forty percent. Hypoxia persisted after LMA was exchanged for endotracheal intubation and ECMO initiation was necessary to restore oxygenation. The patient was admitted to the Intensive Care Unit and blood pressure normalized postoperatively. Echo showed normal ejection fraction with an incidental finding of a peri-hepatic mass. This prompted evaluation for pheochromocytoma, which was biochemically confirmed with plasma free metanephrine and normetanephrine of 13,900 (&amp;lt;= 57 pg/mL) and 2,560 (&amp;lt;= 148 pg/mL), respectively. Abdominal CT-scan showed an 8.0 x 7.0 x 8.0 cm right adrenal mass. MIBG showed increased activity in the mass without evidence of metastatic disease. Doxazosin was initiated for alpha blockade. One week postoperatively, ECMO was weaned off and the patient was extubated. Shortly after extubation, a second hypertensive crisis occurred with an increase in systolic blood pressure to over two hundred and a decrease in oxygen saturation to forty percent. Re-intubation was unsuccessful and cricothyrotomy was required. Both nitroprusside and clevidipine failed to reduce blood pressure and a labetalol infusion was necessary to end the episode. The patient underwent surgery for cricothyrotomy to tracheostomy conversion two days later. By that point, labetalol had been weaned off and doxazosin had been titrated to three mg every twelve hours. A titratable IV phentolamine infusion was used for further alpha blockade intra-operatively and normotension was maintained. Over the next two weeks, adequate alpha blockade was achieved with titration of doxazosin dosage to thirteen mg two times daily. Uncomplicated adrenalectomy was then completed. Pathology showed a pheochromocytoma with retained SDHB, focal positivity for ACTH, and without capsular or vascular invasion. Conclusion: Routine critical care procedures such as extubation can trigger hypertensive crises in patients with pheochromocytomas. These episodes may be resistant to multiple intravenous anti-hypertensive agents. Titratable intravenous phentolamine can be used as a precautionary measure during necessary procedures if adequate alpha blockade with oral agents has not yet been achieved. Presentation: Friday, June 16, 2023

GAMBARAN PENGGUNAAN COMPLEMENTARY ALTERNATIVE MEDICINE (CAM) PADA PASIEN HIPERTENSI DI WILAYAH KERJA PUSKESMAS BLAHBATUH II

Hypertension is an increase in a person's systolic blood pressure ≥ 140 mmHg and diastolic ≥ 90 mmHg. The importance of hypertension sufferers to control blood pressure to prevent cardiovascular risk, one of which is the non-pharmacological alternative of Complementary Alternative Medicine (CAM). This study aims to describe the use of CAM in hypertensive patients in the working area of ​​the Blahbatuh II Health Center. This research method is a non-experimental quantitative descriptive study with a cross-sectional method. The results of this study found that the most use of CAM for the treatment of hypertension in the working area of ​​the Blahbatuh II Health Center were women (59.6%), aged 56-65 years (51.4%), high school education (42.2%), most of them not working/household (33.9%), income ≤ Rp. 2,627,000 (39.4%), suffer from hypertension for 1-5 years (76.1%), have no family history of hypertension (56.9%), hypertension medication, namely amlodipine (52.3%), drinking schedule every day (45.9%). Respondents used CAM since diagnosis (66.1%), CAM was combined with conventional drugs (62.5%) and was recommended by the family (45.8%), the reason that using CAM was very trusting CAM (47.2%), and the reasons for not using CAM were the reasons doctors did not recommend (54.1%), felt a positive effect (94.4%) and were satisfied (94.4%) using CAM. The most common types of CAM were biological therapy in the form of herbs (56.9%), the frequency of using CAM once a day (45.8%), the types of plants used were celery and starfruit (19.5%), plant parts namely leaves (41.5%), the method of processing is boiled first (61%), with a dose of one glass (48.8%) and the use of herbal medicine is taken orally (80.5%). The conclusion of this study was that the sociodemographic characteristics of the use of CAM were mostly aged 56-65 years (51.4%), female sex (59.6%), last education SMK/SMA (42.2%), and the use of CAM was mostly used since suffering from hypertension as many (66.1%) of respondents with the most types of CAM namely biological therapy in the form of herbs (56.9%).

Family history of hypertension enhances age-dependent rise in blood pressure, a 15-year follow-up, the Tampere adult population cardiovascular risk study.

A family history (FH) of hypertension is known to predispose to high blood pressure. We wanted to study whether it associates with blood pressure and hypertension in the Tampere adult population cardiovascular risk 15-year longitudinal study. A 50-year-old Finnish cohort having hypertension and their controls was examined retrospectively. The groups were combined and stratified to 396 subjects with a positive FH of hypertension and 384 with a negative FH. A 15-year follow-up was done from their periodic health examinations at the ages of 35-, 40-, 45-, and 50 years. In follow-up from the age of 35 years, systolic blood pressure (P < .001), diastolic blood pressure (P < .001), and the annual increase of systolic blood pressure (P < .010) were higher in the group with positive FH, compared to the negative FH group. Positive FH associated with diagnosed hypertension by the age of 50 years (OR 3.52, P < .001). The FH groups were not associated with body mass index. Our findings show that the prevalence of hypertension at the age of 50 years was significantly higher in those with a positive FH of hypertension. Asking about FH can provide the clinician with a simple instrument for recognition of subjects at risk of hypertension for closer monitoring at a younger age.

The Relationships Between Blood Pb Levels and Blood Pressure Among Lead-Exposed Workers in China: A Repeated-Measure Study.

To explore the differences in the increase of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in 3 consecutive years among lead (Pb) workers. Four hundred forty-eight Pb workers were enrolled in this repeated-measure study. Blood Pb, SBP, and DBP were measured in 2015 to 2017. Repeated measure of analysis of variance was used to compare the differences in the increase of SBP and DBP. The mean SBP values were 124.0/125.5/126.9 mm Hg, and the mean DBP values were 75.4/77.4/77.8 mm Hg from 2015 to 2017. The differences in the increase of SBP and DBP were 2.94/2.42 mm Hg during the 3-year period. The average annual increase of SBP or DBP showed an upward trend in different Pb dose groups ( F = 4.904, P = 0.002; F = 3.612, P = 0.013). Lead exposure caused average annual increases in SBP and DBP with 0.98 and 0.81 mm Hg, which provided basic data for health surveillance.