Initial Blood Pressure Level Research Articles

Altered renal medullary blood flow: A key factor or a parallel event in control of sodium excretion and blood pressure?

In the context of the ongoing debate on the mechanism of blood pressure (BP) regulation and pathophysiology of arterial hypertension ("renocentric" vs "neural" concepts), attention is focused on the putative regulatory role of changes in renal medullary blood flow (MBF). Experimental evidence is analysed with regard to the question whether an elevation of BP and renal perfusion pressure (RPP) is likely to increase MBF due to its impaired autoregulation. It is concluded that such increases have been clearly documented only in rats with extracellular fluid volume expansion. A possible translation of this finding to BP regulation in health and hypertension in humans may only be a matter of speculation. Within the "renocentric" theory, the key event leading to restoration of initial BP level is pressure natriuresis. Its relation to elevation of renal interstitial hydrostatic pressure and to the phenomenon of "wash-out" of renal medullary solutes by increasing MBF is discussed. We also assessed the validity of data supporting the putative mechanism of short-term restoration of elevated BP owing to the release of a vasodilator lipid (medullipin) by the medulla. The structure of the proposed medullary lipid is still undefined, and there is no sound evidence on its mediatory role in lowering elevated BP level. In conclusion, MBF change can hardly be regarded as a crucial event in the regulation of BP: it can be involved in the control of sodium excretion and BP only in some circumstances, although its contributory role cannot be excluded.

Effects of blood pressure level management on maternal and perinatal outcomes in pregnant women with mild to moderate gestational hypertension.

This study aims to investigate the effects of blood pressure control level on maternal and perinatal outcomes in pregnant women with mild to moderate gestational hypertension (GHp). A total of 344 pregnant women who initially diagnosed as mild to moderate gestational hypertension were recruited in this study. They were divided into 4 groups according to the stabilized blood pressure level (BPL) during pregnancy. The clinical parameters and the incidence of adverse pregnancy outcomes were compared among the four groups. The association between blood pressure levels and relative factors were analyzed using the χ2 test. Multivariate logistic regression analysis was adopted for risk factors associated with adverse pregnancy outcomes. The results showed the prevalence of obesity was significantly associated with blood pressure levels of mild-moderate GHp pregnant women (p = 0.029). The incidence of severe GHp, SPE in group A, group B, and group C were statistically significant (p < 0.001, p = 0.041, respectively). In the patients who used drugs to control BPL, the incidence of severe GHp has a significant association with the initial blood pressure levels (p = 0.004). However, no significant difference was found in the incidence of sPE, PE + Upro, and SGA (all p > 0.05). Multivariate logistic regression analyses results showed that the gestational factor BPL was an independent risk factor for the incidence of sGHp. The AMA, primigravida, gestational BPL, and edema were risk factors for the incidence of preeclampsia with proteinuria. To the incidence of sPE, gestational BPL is the independent risk factor. Finally, preeclampsia anamnesis and FGR trend are the high-risk parameters to the incidence of SGA. Timely management and control of blood pressure in pregnant women with mild to moderate GHp were beneficial to reduce the occurrence of severe GHp and sPE, but the incidence of SGA does not affected.

How to reach the target blood pressure level according to the 2018 European recommendations? Reserve possibilities of phytomolecules

The article highlights the prevalence of arterial hypertension (AH). Attention is paid to the classification of hypertension and target blood pressure (BP). The classification of hypertension according to the level of blood pressure, the presence of cardiovascular risk factors, target organ damage and / or the presence of associated diseases helps to optimize individual treatment. Correction of treatment is also carried out depending on the initial level of blood pressure and comorbid pathology. Attention is focused on the need for the appointment in many cases, immediately combined antihypertensive therapy. Such drugs, in addition to many well-known tableted drugs, are also drugs of plant origin. On the example of the herbal preparation Neocardil, from the standpoint of evidence, the place of flavonoids in the treatment of patients with hypertension is considered.

Is there a blood pressure lowering effect of MRAs in heart failure? An overview and meta-analysis.

Although mineralocorticoid antagonists (MRAs) have been proposed as effective fourth-line blood pressure (BP) lowering agents in resistant hypertension, this effect in heart failure is undetermined. In this synthesis of heart failure randomized controlled trials (RCTs), we evaluated the extent of BP lowering following MRA treatment against placebo. We searched Medline and the Cochrane Collaboration Library databases from 1991 to September 2016 for RCTs, in which MRAs were compared with placebo. The quality of RCTs was assessed with Cochrane risk of bias tool. Outcomes were the extent of systolic and diastolic BP lowering. We included seven studies (13,354 patients, 65.8% males, mean age of 66.3years, mean follow-up period of 9.4months, mean baseline BP of 123.5/75.0mmHg) of MRAs compared with placebo. MRAs were not significantly associated with systolic - 1.8 (95% CI: - 8.0, 4.4) mmHg or diastolic - 0.3 (95% CI: - 3.4, 2.7) mmHg, BP reduction. Although systolic BP was not lowered by spironolactone, diastolic BP was lowered by - 3.0 (95% CI: - 3.4, - 2.6) mmHg. Eplerenone treatment did not significantly lowered systolic [- 0.04 (95% CI: - 4.4, 4.3) mmHg], but it was associated with minimal diastolic BP increase [1.0 (95% CI: 0.5, 1.53) mmHg]. MRAs were not associated with systolic and diastolic BP reduction in heart failure patients. This finding suggests that MRAs should be used according to their indications in heart failure independently of initial BP levels.

Evaluation of Preoperative Predictors of 30-Day Mortality in Patients with Ruptured Abdominal Aortic Aneurysm.

PurposeRuptured abdominal aortic aneurysm (RAAA) is a rare, extremely dangerous condition. Previous studies have published preoperative, intraoperative, and postoperative data; however, there are not enough studies on the preoperative factors alone. Here we studied the preoperative predictors of 30-day mortality in patients with RAAA.Materials and MethodsWe conducted a retrospective, consecutive review of the medical records of 57 patients who received management for RAAA between February 2005 and December 2016. We analyzed the association between preoperative predictors and 30-day mortality in patients with RAAA. The initial systolic blood pressure (SBP) and hemoglobin level (HbL), which were proven as significant predictors by multivariate logistic regression analysis, were compared using receiver operating characteristic curves.ResultsOverall, early mortality was 29.8%. Results of logistic regression analysis found that 30-day mortality in patients with RAAA was associated with the initial SBP (odds ratio [OR], 0.922; 95% confidence interval [CI], 0.874–0.973; P=0.003) and initial HbL (OR, 0.513; 95% CI, 0.289–0.91; P=0.023). Area under the curves were 0.89 for the initial SBP and 0.78 for the initial HbL. The initial SBP with a cut-off value of 90 mmHg had a sensitivity of 85% and specificity of 88.2%. At a cut-off of 10.5, the sensitivity and specificity of HbL for death were 75% and 70.6%, respectively.ConclusionThe initial SBP and HbL are independent preoperative predictors of early mortality in patients with RAAA.

Effect of blood pressure control level on perinatal outcomes in women with mild-moderate gestational hypertension

Objective: To investigate the effect of blood pressure (BP) control level on perinatal outcomes in women with mild-moderate gestational hypertension (GHp). Methods: Totally, 344 women diagnosed initially as mild-moderate GHp who delivered in Peking University Third Hospital from January 2012 to December 2016 were recruited. They were divided into four groups according to the stabilized level of BP during pregnancy. (1) Group A: BP<130/80 mmHg (1 mmHg=0.133 kPa) ; (2) Group B: BP (130-139) / (80-89) mmHg; (3) Group C: BP (140-149) / (90-99) mmHg; (4) Group D: BP (150-159) / (100-109) mmHg. The clinical profile and incidence of severe GHp, pre-eclampsia with proteinuria (PE+Upro), severe pre-eclampsia (sPE), small-for-gestational age (SGA) were compared among the four groups. Student t-test was preformed to normal distributive data and Kruskal-Wallis test was used to non-normally distributed variables. Chi-square test was used in count data. Logistic regression analysis was adopted for multiple-factor analysis. Results: (1) The incidence of severe GHp in group A was lower than group B (P<0.05). The incidences of severe GHp and sPE in the group B was lower than those in group C (P<0.05). While there was no difference in the incidence of PE+Upro and SGA among the four groups (P>0.05). And the incidence of severe GHp in group D had no difference with group A, B, C (P>0.05). (2) In the 48 patients who used medications to control BP, the occurence of severe GHp in those whose initial BP was (140-149) / (90-99) mmHg was lower than those of ≥160/110 mmHg (P<0.05). But the incidence of severe GHp had no significant difference between patients whose initial BP was (140-149) / (90-99) mmHg and patients whose initial BP was (150-159) / (100-109) mmHg (P>0.05). The initial BP level had no impact on the incidence of PE+Upro, sPE and SGA (P>0.05). (3) Multivariate logistic regression analysis showed that the BP level before using medications (OR=3.566, 95%CI: 1.080-11.771, P=0.037) and the BP level maintained (OR=4.787, 95%CI: 1.115-20.551, P=0.035) were independent factor that affected the incidence of severe GHp. Edema (OR=2.651, 95% CI: 1.628-4.316 P=0.000), fetal growth restriction (FGR; OR=1.103, 95% CI: 1.427-5.914, P=0.002) and the onset gestational age of GHp (OR=0.755, 95%CI: 0.578-0.985, P=0.038) were independent factors that affected the incidence of PE+Upro. The tendency of FGR (OR=17.787, 95%CI: 1.833-40.396 P=0.000), history of PE (OR=5.294, 95%CI: 1.086-25.800, P=0.039) and the BP level during pregnancy (OR=2.109, 95%CI: 1.274-3.491, P=0.004) were independent factors affecting the incidence of sPE. FGR tendency was independent factor affecting the incidence of SGA (OR=25.622, 95%CI: 2.596-252.864, P=0.005). Conclusion: A satisfied control of BP is helpful to reduce severe GHp and sPE, but the incidence of SGA does not affected.

Trauma laparoscopy: when to start and when to convert?

The use of laparoscopy for stable patients with abdominal trauma is increasing and its accuracy is nearly 100%. However, indications for laparoscopy and for conversion differ among centers. The aim of this study was to investigate indications for trauma laparoscopy and for conversion to laparotomy. All trauma patients managed with laparoscopy over a 4-year period were retrospectively analyzed. Indications for laparoscopy, morbidity, and reasons for conversion were investigated and predictors of morbidity and conversion were sought. The management algorithm of trauma patients was reviewed and updated. Laparoscopy was used in 318 stable trauma patients. Thirty-five patients presented with blunt and 283 with penetrating abdominal injuries. The conversion rate was 11.7% for penetrating and 22.9% for blunt abdominal trauma patients. The most common reason for conversion was continuous intraabdominal bleeding that could not be controlled quickly. It was followed by multiple complex injuries, hemodynamic instability, and intraoperative visualization problems. Diagnostic laparoscopy was performed in 45%, and therapeutic laparoscopy in 55% of cases. There were no missed injuries. Complications occurred in 21.2% in the converted group and in 9.6% in the laparoscopic group. Among initial systolic blood pressure, pulse, hemoglobin, lactate, and base deficit levels, only lower pH was associated with conversion. The management of all stable trauma patients with laparoscopy appears to be a safe approach. The use of sound laparoscopic equipment by a well-coordinated trauma team with adequate expertise in laparoscopy, adherence to the algorithm, and strict compliance with predetermined procedural steps are fundamental to success. Continuous intraoperative bleeding, complexity of injuries, deterioration of the patient, poor visibility, and equipment failure are indications for conversion.

The incidence of hypertension and its risk factors in the German adult population: results from the German National Health Interview and Examination Survey 1998 and the German Health Interview and Examination Survey for Adults 2008-2011.

To analyze incident hypertension and its risk factors based on 11.9 years follow-up of a recent National Examination Survey cohort in Germany. Out of 7124 participants of the German National Health Interview and Examination Survey 1998 (GNHIES98), 640 had died at follow-up 2008-2011 and 3045 were reexamined as part of the German Health Interview and Examination Survey for Adults 2008-2011 (DEGS1). Baseline and follow-up included standardized blood pressure (BP) measurements. Hypertension was defined as BP of at least 140/90 mmHg or intake of antihypertensive medication in participants with known hypertension. Out of 2231 GNHIES98-DEGS1 participants aged 18-79 years without hypertension in 1998, 26.2% developed hypertension within a mean of 11.9 (range 10.0-14.1) years (men 29.0%, women 23.4%). In univariate analysis, hypertension incidence was positively associated with age, BMI, initial BP levels, pulse pressure, and alcohol consumption. Comorbidities such as diabetes and hyperlipidemia increased the chance to develop hypertension. In the multivariate model, initial SBP and DBP levels had the strongest influence on the development of future hypertension (7% increase in men and 5% in women per mmHg SBP). The percentage of aware, treated, and controlled hypertensive patients were 75.8, 62.1, and 50.3% in men and 83.8, 73.3, and 59.0% in women. The high 11.9-year incidence in all age groups points to the lifelong potential for prevention of hypertension.

Association between initial and final blood pressure levels in chronic kidney disease patients with intradialytic hypertension

Association between initial and final blood pressure levels in chronic kidney disease patients with intradialytic hypertension

Acute Effects of Exercise on Blood Pressure: A Meta-Analytic Investigation.

Hypertension affects 25% of the world's population and is considered a risk factor for cardiovascular disorders and other diseases. The aim of this study was to examine the evidence regarding the acute effect of exercise on blood pressure (BP) using meta-analytic measures. Sixty-five studies were compared using effect sizes (ES), and heterogeneity and Z tests to determine whether the ES were different from zero. The mean corrected global ES for exercise conditions were -0.56 (-4.80 mmHg) for systolic BP (sBP) and -0.44 (-3.19 mmHg) for diastolic BP (dBP; z ≠ 0 for all; p < 0.05). The reduction in BP was significant regardless of the participant's initial BP level, gender, physical activity level, antihypertensive drug intake, type of BP measurement, time of day in which the BP was measured, type of exercise performed, and exercise training program (p < 0.05 for all). ANOVA tests revealed that BP reductions were greater if participants were males, not receiving antihypertensive medication, physically active, and if the exercise performed was jogging. A significant inverse correlation was found between age and BP ES, body mass index (BMI) and sBP ES, duration of the exercise's session and sBP ES, and between the number of sets performed in the resistance exercise program and sBP ES (p < 0.05). Regardless of the characteristics of the participants and exercise, there was a reduction in BP in the hours following an exercise session. However, the hypotensive effect was greater when the exercise was performed as a preventive strategy in those physically active and without antihypertensive medication.

Improved Blood Pressure Control Using an Interactive Mobile Phone Support System.

This explorative, longitudinal study evaluated the effect of the daily use of a mobile phone‐based self‐management support system for hypertension in reducing blood pressure (BP) among 50 primary care patients with hypertension over 8 weeks. The self‐management system comprises modules for (1) self‐reports of BP, pulse, lifestyle, symptoms, and well‐being; (2) delivery of reminders and encouragements; and (3) graphical feedback of self‐reports. Daily use of the support system significantly reduced BP (systolic BP −7 mm Hg, diastolic BP −4.9 mm Hg) between baseline and week 8, with daily improvements leveling off as the study progressed. Three homogenous subsets of patients were identified who, despite different initial BP levels, showed similar decreases in BP during the study, indicating that patients benefited irrespective of baseline BP. In showing significant reductions in BP, our results suggest that the self‐management support system may be a useful tool in clinical practice to help patients self‐manage their hypertension.

Intravenous Access in Acute Gastrointestinal Bleeding: A Quality Improvement Project to Assess Adherence to Guidelines and Effect on Outcomes

Introduction: Gastrointestinal bleeding (GIB) carries a substantial morbidity and economic burden, and are frequently encountered in clinical practice. Aggressive initial management can improve outcomes. Textbooks and literature suggest placement of 2 large bore IV lines (2LBIV) in every patient presenting with GIB. There is paucity of literature on adherence to this guideline, and effect on outcomes in patients who get 2LBIV versus those who don't, has not been reported before. Methods: We conducted a quality improvement project to assess whether patients presenting to our hospital with GIB had 2LBIV. Our secondary outcomes included length of stay, mortality, transfer to higher level of care, and number of transfusions received. We conducted a prospective, observational study; looking at all patients who presented to our emergency department with overt GIB over a 2 month period. Forty-six consecutive patients who met the inclusion criteria were included in the study. Results: Only 9 (19.5%) of the 46 patients were found to have 2LBIV. All-cause, in-hospital mortality was 6.5% (1/9 in the 2LBIV group vs 2/37 in the group without). Length of stay was 5.7 days in the 2LBIV group and 5.6 days in those without. Zero patients in the 2LBIV group required transfer to a higher level of care, versus 22% (7/31) of those without 2LBIV. However, 44% (4/9) of patients with 2LBIV were admitted directly to the intensive care unit (ICU), versus 14% (5/36) of patients without 2LBIV. The 2LBIV group received more blood transfusions (1.89 vs 1.56 Units pRBC/patient). Drop in hemoglobin from baseline was 1.7g/dl in the 2LBIV group compared to 0.8g/dl in those without 2LBIV. Patients with 2LBIV also had a higher rate of anticoagulant/antiplatelet use (44% vs 19%), lower initial systolic blood pressure (114mmHg vs 131mmHg) and lower initial creatinine level (0.73 vs 1.44mg/dL). Conclusion: The relatively simple and cheap intervention of placing 2LBIV lines is not often executed. Our initial investigation suggests that only sicker GIB patients (higher rate of anticoagulant use, higher initial ICU disposition, lower baseline blood pressure, and lower presenting hemoglobin) receive 2LBIV. We plan to conduct an intervention consisting of a nursing and physician education, and an algorithm for protocolized care, to increase our compliance with this guideline. Data collection will be done postintervention to assess the success of this intervention, with regards to adherence and patient outcomes.

Adrenal Vein Sampling for Conn’s Syndrome: Diagnosis and Clinical Outcomes

Adrenal vein sampling (AVS) is the gold standard test to determine unilateral causes of primary aldosteronism (PA). We have retrospectively characterized our experience with AVS including concordance of AVS results and imaging, and describe the approach for the PA patient in whom bilateral AVS is unsuccessful. We reviewed the medical records of 85 patients with PA and compared patients who were treated medically and surgically on pre-procedure presentation and post-treatment outcomes, and evaluated how technically unsuccessful AVS results were used in further patient management. Out of the 92 AVS performed in 85 patients, AVS was technically successful bilaterally in 58 (63%) of cases. Either unsuccessful AVS prompted a repeat AVS, or results from the contralateral side and from CT imaging were used to guide further therapy. Patients who were managed surgically with adrenalectomy had higher initial blood pressure and lower potassium levels compared with patients who were managed medically. Adrenalectomy results in significantly decreased blood pressure and normalization of potassium levels. AVS can identify surgically curable causes of PA, but can be technically challenging. When one adrenal vein fails to be cannulated, results from the contralateral vein can be useful in conjunction with imaging and clinical findings to suggest further management.

Investigating the effect of transcendental meditation on blood pressure: a systematic review and meta-analysis.

Some evidence from previous randomized controlled trials and systematic reviews has demonstrated a positive association between hypertension and transcendental meditation (TM). However, other trials and reviews showed the effect of TM on blood pressure (BP) was unclear but did not use subgroup analysis to rigorously investigate this relationship. The American Heart Association has stated that TM is potentially beneficial but did not give a standard indication. The present study explored several subgroup analyses in systematic reviews to investigate the effect of TM on BP. Medline, Embase, Cochrane Library, Web of Science and Chinese BioMedical Literature Database were searched through August 2014. Randomized controlled trials of TM as a primary intervention for BP were included. Two reviewers independently used the Cochrane Collaboration's quality assessment tool to assess each study's quality. Twelve studies with 996 participants indicated an approximate reduction of systolic and diastolic BP of -4.26 mm Hg (95% CI=-6.06, -2.23) and -2.33 mm Hg (95% CI=-3.70, -0.97), respectively, in TM groups compared with control groups. Results from subgroup analysis suggested that TM had a greater effect on systolic BP among older participants, those with higher initial BP levels, and women, respectively. In terms of diastolic BP, it appears that TM might be more efficient in a short-term intervention and with individuals experiencing higher BP levels. However, some biases may have influenced the results, primarily a lack of information about study design and methods of BP measurement in primary studies.

Blood Pressure Management in Patients with Type 2 Diabetes.

In patients with type 2 diabetes (T2DM), the coexistence of hypertension enhances the cardiovascular risk, and the prevention of future cardiovascular disease is an important component of T2DM management. Antihypertensive therapy has been shown to be an effective method of reducing the micro- and macrovascular complications of T2DM, however, the optimal target blood pressure (BP) levels are still under debate. Most of the international guidelines have raised the target clinic BP from 130/80 to 140/90 mmHg, however, the Japanese Society of Hypertension 2014 guidelines kept the target BP level at 130/80 mmHg. However, individualized BP-lowering treatments should be considered in patients with T2DM, especially in high-risk individuals such as those with a history of stroke or retinopathy, and aggressive antihypertensive therapy below 130 mmHg should be initiated even when the initial systolic BP level is <140 mmHg. The authors performed two studies concerning the BP target levels of home BP. In the first study, the authors found that a home BP target <125/75 mmHg was effective in improving the measures of vascular stiffness and kidney damage. In the second study, when the clinic BP target was set at 130/80 mmHg, the home BP could be approximately 130/80 mmHg. More data are needed to individualize the target BP levels of T2DM patients.

Контроль артеріального тиску в гіпертензивних пацієнтів залежно від віку

Метою нашого дослідження було порівняти контроль артеріального тиску (АТ) у широкій українській популяції гіпертензивних пацієнтів віком до 65 років і старше та оцінити фактори, що асоціюються з недосягненням цільового АТ потягом тримісячного антигіпертензивного лікування, окремо в кожній віковій групі.В аналіз було включено дані 6758 пацієнтів з артеріальною гіпертензією (АГ). Усі пацієнти залежно від віку були розподілені на дві групи. У першу групу увійшло 4328 осіб віком до 65 років, у другу групу — 2430 осіб віком 65 років і старше (особи похилого віку за класифікацією ВООЗ, 2012). 531 лікар на свій розсуд призначав хворим з АГ антигіпертензивні препарати в дозах, які вважав за потрібне. Контроль ефективності лікування відбувався під час візитів (загалом 4 візити протягом 3 місяців). Пацієнтам під час візитів вимірювали офісний АТ, проводили електрокардіографію, оцінку прихильності до лікування за допомогою стандартної анкети, оцінку серцево-судинного ризику та опитування згідно з розробленою авторами дослідження анкетою. Мультифакторний регресійний аналіз застосовували для виявлення незалежних предикторів недостатньої ефективності терапії.В осіб віком 65 років і старше АГ асоціювалася з більшою частотою виявлення таких ускладнень, як серцева недостатність, інсульт, інфаркт міокарда та ураження нирок, супутніх станів (цукровий діабет, ішемічна хвороба серця) та факторів ризику (ожиріння, дисліпідемія, високий систолічний артеріальний тиск (САТ)). Більш молоді пацієнти з АГ частіше мали шкідливі звички (куріння, зловживання алкоголем та сіллю). Проте в них частіше була додаткова фізична активність та вони рідше вживали свіжі овочі та фрукти менше ніж 1 раз на день. На початку дослідження лише 27,2 % пацієнтів першої групи та 24,8 % другої (Р &lt; 0,05) мали високу прихильність до лікування. На фоні терапії спостерігалося достовірне покращення прихильності в обох групах: достовірно зменшилася частка пацієнтів із низькою прихильністю та збільшилася частка із високою та помірною. Проте в кінці дослідження більше осіб похилого віку, ніж хворих віком до 65 років, характеризувалися як пацієнти з низькою прихильністю. У кінці дослідження пацієнти віком до 65 років мали достовірно нижчі середні рівні САТ та діастолічного АТ, ніж пацієнти старшого віку. Цільовий АТ (менше від 140/90 мм рт.ст.) було досягнуто у 63,7 % пацієнтів першої групи, що було достовірно більше, ніж у пацієнтів другої групи — 54 % (Р &lt; 0,001). При цьому середня кількість препаратів, що отримували хворі похилого віку, була достовірно більшою. Фактори, що асоціювалися з високою ймовірністю недосягнення цільового АТ, були майже однаковими для пацієнтів обох вікових груп: більший початковий рівень АТ, наявність гіперхолестеринемії, низька прихильність до лікування в кінці спостереження. У пацієнтів молодшого віку додатковими факторами, за наявності яких збільшувалася ймовірність неефективного лікування, виявилися початкова низька прихильність до лікування, більший індекс маси тіла та нечасте вживання свіжих овочів і фруктів. У пацієнтів віком 65 років і старше таким додатковим фактором була наявність ознак серцевої недостатності. Отже, пацієнти більш старшої вікової групи з АГ характеризувалися гіршим контролем АТ на фоні терапії. Поряд із спільними для обох вікових груп існували й деякі відмінні фактори, що асоціювалися з відсутністю досягнення цільового АТ, які необхідно враховувати для більш ефективного ведення пацієнтів різного віку.

Blood Pressure Management in the 21st Century

The development of effective pharmacological strategies for lowering blood pressure was one of the major success stories of the 20th century in medical science. Blood pressure was proven beyond doubt to be causally and continuously related to future risk of cardiovascular events,1 and lowering blood pressure was proven to reduce that risk.2–4 Pooled data from randomized trials collectively showed that lowering systolic blood pressure by 10 mm Hg reduced coronary heart disease risk by approximately one quarter and risk of stroke by approximately one third, irrespective of previous disease history, initial blood pressure level, or the type of agent used. These studies also demonstrated that more intensive blood pressure lowering resulted in additional risk reduction, with the benefits proportional to the size of the fall in pressure.4,5 Article see p 2309 In the face of such impressive evidence, it is perhaps both surprising and disappointing that elevated blood pressure today remains the leading cause of the global disease burden6: >9 million people die each year from this cause. Although population-level blood pressure values have been declining in some high-income countries, the size of that decline is modest and highly variable by region.7 More worryingly, however, is the observation that blood pressure levels seem to be increasing in most low- and middle-income countries.7 Additionally, the clinical management of high blood pressure remains less than adequate in most countries, rich and poor. Recent global estimates suggest that less than half of those who have elevated blood pressure (defined as blood pressure >140/90 mm Hg) are aware of it, and, of those who are receiving pharmacological treatment, only one third have blood pressure levels <140/90 mm Hg.8 In view of such profound shortcomings in the control of high blood pressure and its associated cardiovascular …

Effects of long-term lifestyle and high-intensity interval training intervention on blood pressure reduction in patients with abdominal obesity

Purpose: The aims of this study were: 1) to study the impact of a combined long-term lifestyle and high-intensity interval training (HIIT) intervention on blood pressure (BP) in patients with abdominal obesity; 2) To document BP reduction responses according to the European Society of Hypertension BP classification. Methods: 105 patients with abdominal obesity (age: 53±10 yrs; 32 men; waist circumference (WC): 112±13cm; systolic/diastolic (SBP/DBP): 133±13/82±8 mmHg; 11% diabetics, 11% smokers, 68% with antihypertensive therapy) were retrospectively analyzed before and after a combined long-term lifestyle and HIIT program twice a week. Anthropometric measurements, cardiometabolic risk factors, and resting BP (5min. of supine rest, using a manual sphygmomanometer) were assessed at baseline and after 9 months of program. Results: After 9 months, we observed an improvement in weight (-4.83kg), BMI (-1.75 kg/m2), WC (-6.62 cm), an average SBP/DBP decrease of -5.59/-3.31 mmHg. These changes were not uniform, 74 patients decreased their BP (1 mmHg or more) reaching -11.69/-6.92 mmHg. The parameter which differentiated them to those who did not improve their BP was their higher initial BP level (SBP: 135±14 vs. 126±10 mmHg, P=0.001; DBP 84±7 vs. 77±3 mmHg, P<0.0001). Thus, we compared following groups in accord to their baseline ESH-BP-classification: 1/ optimal \[BP <120/80 mmHg] + [120/80 ≤ BP < 130/85 mmHg\] (n=13) vs. 2/ high normal \[130/85 ≤BP < 140/90 mmHg] + stage 1 hypertension [140/90 ≤ BP < 160/100 mmHg\] (n=92). We observed no significant difference between groups 1/ vs. 2/ in terms of gender (P=0.2), age (50±9 vs. 54±10 yrs, P=0.2), resting heart rate (72±15 vs. 75±12 bpm, P=0.3), diabetes, lipid analysis, weight loss (-3.75±4.49 vs. -4.99±5.67 kg, P=0.4), WC improvement (-5.95±3.49 vs. -6.72±11.70 cm, P=0.8). Antihypertensive therapies were at baseline less present in group 1/ than in group 2/ (38% vs. 72%, P=0.02). Furthermore, BP was not improved in group 1/ (+1.85/+4.92 mmHg) but decreased in group 2/ (-6.64/-4.48 mmHg) (P=0.04 and P=0.0003 respectively for SBP/DBP). Conclusion: A long-term lifestyle and high-intensity interval training intervention had a beneficial effect on BP levels in patients with abdominal obesity and a baseline BP ≥130/85 mmHg. This helped them to bring back to BP values.

Targeting albuminuria in arterial hypertension and diabetes

Targeting albuminuria in arterial hypertension and diabetes

Predictors of mortality of mechanically ventilated patients in internal medicine wards

PurposeBudget restrictions have led to shortage of intensive care unit (ICU) beds in several countries. Consequently, ventilated patients are often kept on the wards. This study examined survival likelihood among patients ventilated on the wards and the predictive value of commonly used severity-of-illness scores. MethodsThis study is a prospective observation and characterization of consecutive, mechanically ventilated patients in 3 internal medicine wards of a single hospital who were denied ICU admission. Outcome measures are as follows: 28-day mortality, survival to hospital discharge, and 3 months postdischarge. ResultsEighty-six patients were examined. The patients were 78.9 ± 8.9 years old; 53% were independent preadmission. Respiratory insufficiency due to infection was the main reason for mechanical ventilation (58%). Charlson and acute physiology scores (APS) averaged 4 ± 2.2 and 91.8 ± 26.7, respectively. Twenty-eight-day mortality was 71%, whereas in-hospital mortality was 74% and 3 months postdischarge mortality was 79%. Survivors were significantly younger than nonsurvivors (74.4 ± 8.5 years vs 80.4 ± 8.6 years, P < .01), were more likely to be ventilated for cardiac causes (41% vs 11%, P = .04), and had significantly higher initial mean blood pressure (79.4 mm Hg vs 58.2 mm Hg, P = .02) and blood albumin levels (29.8 g/L vs 25.7 g/L, P = .05). Death rate was 10 times more likely, with an APS greater than 90 on the day of intubation as compared with an APS less than 90. ConclusionMortality in patients ventilated on the ward was high, especially in the subgroup of patients with an APS score greater than 90. The early calculation of APS may assist in focusing therapeutic efforts on patients with better survival chances.