BP Levels Research Articles

A prospective study on efficacy of nicorandil and isosorbide mononitrate in coronary artery disease

Background: The aim of this prospective study was to assess the efficacy of Nicorandil (NR) and Isosorbide Mononitrate (ISMN) in coronary artery disease (CAD). Nicorandil strengthens CAD treatment by inhibiting cardiac fatty acid oxidation, easing aggravation and improving heart function, which is critical for preventing heart failure and other significant consequences. Methods: 110 patients with CAD were selected as research subjects and randomly assigned to two groups: observational (Group O) and control (Group C), with 55 patients in each. The control group was given traditional CAD treatment, whereas the observational group received NR and ISMN in addition to conventional treatment. The blood pressure, CRP, left ventricular ejection fraction (LVEF), troponin T, and ST-segment levels of two groups were assessed and compared at baseline, as well as after the second and fourth months, respectively. Results: This study found significant differences (P<0.05) between the observational and control groups in terms of BP, CRP, troponin T, and ST segment levels after the second and fourth months, whereas LVEF rose significantly (P<0.05) using one-way ANOVA. Similarly, an independent t-test was used to assess significant improvements in each group. Conclusions: The addition of Nicorandil and Isosorbide Mononitrate to a standard CAD regimen was found to have an important association with LVEF and inflammatory mediators, which can significantly improve cardiac functions while also preventing other cardiovascular complications in patients with coronary artery disease.

Inclusion of a Bacillus-based probiotic in non-starch polysaccharides-rich broiler diets

ABSTRACT This study examined the effects of a 3-strain Bacillus-based probiotic (BP; Bacillus amyloliquefaciens and two Bacillus subtilis) in broiler diets with different rye levels on performance, mucus, viscosity, and nutrient digestibility. We distributed 720 one-d-old female broilers into 72 pens and designed nine diets using a 3 × 3 factorial approach, varying BP levels (0, 1.2 × 106, and 1.2 × 107 CFU/g) and rye concentrations (0, 200, 400 g/kg). On d 35, diets with 200 or 400 g/kg rye reduced broiler weight gain (BWG). Diets with 400 g/kg rye had the highest FCR, while rye-free diets had the lowest (p ≤0.05). Adding BP increased feed intake and BWG in weeks two and three (p ≤0.05). It should be noted that the overall performance fell below the goals of the breed. Including rye in diets reduced the coefficient of apparent ileal digestibility (CAID) for protein, ether extract (EE), calcium, phosphorus, and all amino acids (p ≤0.05). Rye-free diets exhibited the highest CAID for all nutrients, except for methionine, EE, and calcium, while diets with 400 g/kg of rye demonstrated the lowest CAID (p ≤0.05). BP in diets decreased phosphorus CAID (p ≤0.05). Diets containing 1.2 × 107 CFU/g (10X) of BP exhibited higher CAID of methionine than the other two diets (p ≤0.05). Diets containing 10X of BP showed higher CAID of cysteine than diets with no BP (p ≤0.05). Ileal viscosity increased as the inclusion level of rye in the diets increased (p ≤0.05). The ileal concentration of glucosamine in chickens fed diets with 400 g/kg of rye was higher than in those fed diets with no rye (p ≤0.05). Furthermore, ileal galactosamine concentrations were elevated in diets with 200 and 400 g/kg of rye when compared to rye-free diets (p ≤0.05). However, BP in diets had no impact on ileal viscosity, galactosamine, or glucosamine (p > 0.05). In conclusion, the applied Bacillus strains appeared to have a limited capacity to produce arabinoxylan-degrading enzymes and were only partially effective in mitigating the negative impacts of rye arabinoxylans on broilers.

Clinical Characteristics, Metabolic Parameters, and Risk Factors for Suicide Attempts Vary with Untreated Major Depressive Disorder Duration

Suicidal attempts (SAs) are common in major depressive disorder (MDD). However, only few studies have so far assessed how risk factors for SAs in patients with MDD might be related to the duration of untreated illness (DUI). We interviewed 1,718 drug-naive outpatients with MDD with first-episode SAs and divided them into groups that had and had not attempted suicide. DUI was used as an additional grouping criterion. The patients (20.14%; 346/1718) who had a history of SAs were older and had a longer DUI; lower educational level (middle school-educated only); more psychotic symptoms; higher scores on depression and anxiety scales; and higher BP, plasma BG, TC, and LDL-C levels, but lower HDL-C concentrations. Anxiety symptoms, high education level, and being unmarried were risk factors for SA in patients with MDD with DUIs of <3 months; anxiety symptoms, low BMI, high plasma TC, and low plasma HDL-C were risk factors for SA in the group with DUIs between 3 and 8 months; age, anxiety symptoms, and higher systolic blood pressure were risk factors for those with DUIs>8 months. This study was a single-center cross-sectional survey, and its limitations include a lack of outside validation. Patients with MDD with and without a SA history have different clinical characteristics and metabolic parameters, and risk factors for suicide vary across DUI stages. Anxiety was a general risk factor, suggesting that clinicians should strengthen their assessment of SA risk in patients with MDD during diagnosis and treatment.

Effects of dietary baobab, Adansonia digitata on growth, haemato-immunological status, antioxidant biomarkers, intestinal histomorphometry, gene expression responses, and disease resistance in Nile tilapia, Oreochromis niloticus

This study explored the influences of baobab fruit extract powder (BP) on growth, oxidant-antioxidant balance, immunity, intestinal histology, expression of growth and immune genes, and disease resistance in Nile tilapia. Fish were fed on five test diets supplied with different BP levels as BP0 (control; 0 g kg−1), BP1 (1 g kg−1), BP2 (2 g kg−1), BP3 (3 g kg−1), and BP4 (4 g kg−1) for two months. Results revealed that dietary BP improved the growth in all BP groups compared with the BP0 group, with the best values apparent in the BP4 group. However, dietary BP did not affect the whole-body chemical composition and survival rates in all groups. Serum immunity biomarkers (lysozyme, myeloperoxidase, and bactericidal activities) were enhanced in all BP groups compared to the BP0 group. Hepatic antioxidant status significantly improved, as manifested by increases in the hepatic CAT, SOD, and T-AOC and decreases in MDA concentrations in BP groups compared to the controls. Of interest, dietary BP supplementation significantly increased the expression of growth-related genes (ghr1, ghr2, igf-1, and igf-2) in the liver and immunity-associated genes (inf-γ1, lyz, il-1β, il-10, and hepcidin) in the spleen of BP-treated fish in comparison with the controls. The intestinal histological sections revealed no significant variations among all groups with normal histoarchitecture and goblet cells. After experimental infection with Aeromonas hydrophila, the survival rates (%) in the BP0, BP1, BP2, BP3, and BP4 groups were 23.33, 43.33, 56.67, 63.33, and 70.00, respectively, suggesting the positive roles of BP in increasing the fish disease resistance. To conclude, dietary BP could improve growth (particularly in the BP4), serum immunity, antioxidant capacity, and transcription of growth and immune genes in O. niloticus. In addition, the highest disease resistance was also found in the BP4 group. All in all, BP at a dose rate (4 g kg−1 diet) could be regarded as a functional feed supplement for tilapia farming.

Features of the arterial hypertension course and arterial stiffness in patients with ankylosing spondylitis who get infected COVID-19

Objective: to evaluate the features of development and course of arterial hypertension (AH) and changes in vascular stiffness in patients with ankylosing spondylitis (AS) who underwent COVID-19. Materials and methods: 60 patients with a reliable diagnosis of AS were included in the study. Patients were divided into 2 groups depending on the presence of COVID - 19 in anamnesis. The main group consisted of 30 patients with AS who had suffered COVID-19 of varying severity during the previous 12 months. The comparison group consisted of 30 patients with AS who had no laboratory and clinically confirmed COVID-19 infection within the last year. Patients were interviewed regarding the severity of their previous coronavirus infection and persisting symptoms in the post-COVID-19 period. AS activity was evaluated by ASDAS (CRB, BASDAI-index). BP measurement and study of arterial stiffness parameters by oscillographic method, evaluation of the results of ambulatory BP measurement were performed. Results: 6 (20%) patients had BP destabilization at the outpatient stage during home BP measurement early after COVID-19. After 12 months, BP elevation persisted in only 2 (7%) patients, the rest had BP stabilization with withdrawal of antihypertensive drugs. No correlation between BP level, arterial stiffness and AS activity was found. There was a weak inverse correlation between the severity of coronavirus infection and the level of systolic blood pressure, between age and pulse wave velocity. No significant differences in systolic, diastolic blood pressure, pulse wave velocity, aortic augmentation index were found in patients with AS with and without coronavirus infection. In the main group, 1 fatal outcome due to the development of acute ST-elevation myocardial infarction 6 months after COVID-19 was recorded, and no adverse cardiovascular events were registered among patients in the comparison group. Conclusion: it was hypothesized that patients with AS who underwent COVID-19 would be more likely to show BP elevation than those who did not undergo COVID-19. It was found that early after COVID-19 (first three months) a reversible increase in BP without significant changes in arterial stiffness is possible. However, no significant differences in the frequency of BP elevation, BP level, and arterial stiffness were found in patients with AS and COVID-19 or without COVID-19 in anamnesis.

Novel Pulse Waveform Index by Ambulatory Blood Pressure Monitoring and Cardiac Function: A Pilot Study

BackgroundA simple ambulatory measure of cardiac function could be helpful for monitoring heart failure patients. ObjectivesThe purpose of this paper was to determine whether a novel pulse waveform analysis using data obtained by our developed multisensor-ambulatory blood pressure monitoring (ABPM) device, the 'Sf/Am' ratio, is associated with echocardiographic left ventricular ejection fraction (LVEF). MethodsMultisensor-ABPM was conducted twice at baseline in 20 heart failure (HF) patients with HF-reduced LVEF or HF-preserved LVEF (median age 66 years, male 65%) and over a 6- to 12-month follow-up after patient-tailored treatment. We assessed the changes in the pulse waveform index Sf/Am and LVEF that occurred between the baseline and follow-up. The Sf/Am consists of the area of the ejection part in the square forward wave (Sf) and the amplitude of the measured wave (Am). We divided the patients into the recovered (n = 11) and not-recovered (n = 9) groups defined by a ≥10% increase in LVEF. ResultsAlthough the ambulatory BP levels and variabilities did not change in either group, the Sf/Am increased significantly in the recovered group (baseline 21.4 ± 4.5; follow-up, 25.6 ± 3.7, P = 0.004). The not-recovered group showed no difference between the baseline and follow-up. The follow-up/baseline Sf/Am ratio was significantly associated with the LVEF ratio (r = 0.469, P = 0.037). The Sf/Am was significantly correlated with the LVEF in overall measurements (n = 40, r = 0.491, P = 0.001). ConclusionsThese results demonstrated that a novel noninvasive pulse waveform index, the Sf/Am measured by multisensor-ABPM is associated with LVEF. The Sf/Am may be useful for estimating cardiac function.

Prognostic Significance of Blood Pressure at Rest and After Performing the Six-Minute Walk Test in Patients With Acute Heart Failure.

It remains unclear whether systolic (SBP) and diastolic (DBP) pressure and BP response after six-minute walk test (6MWT) are associated with adverse outcomes in patients with acute heart failure (AHF). We investigated these associations in 98 AHF patients (24.5% women; mean age, 70.5 years) enrolled in the ROSE trial (The Low-dose Dopamine or Low-dose Nesiritide in Acute Heart Failure with Renal Dysfunction). The primary endpoint consisted of any death or rehospitalization within 6 months after randomization. We computed hazard ratios (HRs) of the risks associated with 1-SD increase in post-exercise BP levels and BP ratios, calculated as BP immediately after 6MWT divided by BP before 6MWT. The BP before and after 6MWT averaged 110.6/117.5 mm Hg for SBP and 61.9/64.7 mm Hg for DBP. In multivariable-adjusted analyses including clinic BP measured at the same day of 6MWT, higher DBP after 6MWT was associated with lower risk of the primary endpoint (HR, 0.49; 95% confidence interval [CI], 0.26-0.95; P = 0.034). Both higher SBP and DBP immediately after 6MWT were associated with lower risk of 6-month mortality (HRs, 0.39/0.16; 95% CI, 0.17-0.90/0.065-0.40; P ≤ 0.026). The post-exercise SBP ratio was associated with the risk of 6-month mortality in multivariable-adjusted analyses (HR, 0.44; P = 0.023). Higher BP levels and BP ratios immediately after 6MWT conferred lower risk of adverse health outcomes. Our observations highlight that 6MWT-related BP level and response may refine risk estimates in patients hospitalized AHF and may help further investigation for the development of HF preventive strategies.

Transcranial Electrostimulation as a Non-pharmacological Method of Treating Arterial Hypertension I Degree in young patients

Purpose: The authors determined the efficacy of transcranial electrostimulation (TES) in treating arterial hypertension I degree in young patients and compared it with electrically induced sleep therapy. Materials and Methods: The performed study is a prospective randomized controlled trial that enrolled 212 patients aged 18-20years with arterial hypertension I degree. Patients were divided into two groups. Group 1 consisted of 110 patients who underwent transcranial electrostimulationusing a method developed at the Institute of Physiology named after I. P. Pavlov, Russian Academy of Sciences in Saint Petersburg. Group 2 included 112 patients who underwent electrically induced sleep therapy procedures with the orbital-retro mastoidal technique of electrode application in a "sedative" mode. The control group included 45 patients with normal blood pressure. All patients underwent 24-hour ambulatory blood pressure monitoring, determination of central hemodynamic parameters, diurnal heart rate variability, and endothelial function parameters. Results: As a result of TES therapy in patients significantly decreased the average diurnal SBP and DBP values, pressure load, normalized the diurnal BP profile, AT, and EF values. As a result of electrosleep therapy, average diurnal SBP, and DBP values decreased unreliably, decreased pressure load, and signs of sympathicotonia, but AT and EF values did not change significantly. TES therapy's effectiveness for treating stage 1 hypertension in young patients is significantly higher by 1.9 times in comparison with electrosontherapy. Conclusion: This study has shown that the TES treatment is more effective than traditional non-pharmacological electrosleep therapyin a "sedative" mode. TES normalizes hemodynamics, BP levels, and EF indicators and can be recommended as one of the methods of antihypertensive therapy in young patients.

A meta-analysis of the impact of pharmacist interventions on clinical outcomes in patients with type-2 diabetes

ObjectiveTo evaluate the effects of pharmacist interventions in type-2 diabetes patients by collecting and evaluating literature. MethodsA systematic search was conducted across six databases, including CNKI, Wanfang Data, VIP, PubMed, Web of Science, and Cochrane Library, from January 2001 to January 2023. Randomized controlled trials evaluating the clinical outcomes of pharmacist interventions on type-2 diabetes patients were searched, and data were extracted and analysed by RevMan version 5.4 software. ResultsA total of 35 studies involving 4827 patients were included. Meta-analysis demonstrated that pharmacist interventions had an influence on improving patients’ HbA1c (MD=−0.70), LDL-C (MD=−5.51), SBP (MD=−4.58), DBP (MD=−1.90], BMI (MD=−0.47) and FBG (MD=−19.82), but there was no evidence from the study that pharmacist interventions could significantly improve HDL-C (MD=−0.61), TC (MD=−5.12) or TG (MD=−3.14). In addition, medication adherence was significantly improved. ConclusionPharmacist interventions significantly improved HbA1c, BP, and LDL-C control levels, BMI, and medication adherence in type-2 diabetes patients, but there was no evidence from this study that pharmacist interventions significantly improved HDL-C, TC, or TG. Practice implicationsEffective pharmacist interventions are important to improve type-2 diabetes patients’ clinical outcomes.

Different systolic blood pressure targets and outcomes: a systematic review and meta-analysis of randomized trials

Abstract Background Blood pressure (BP)-lowering is accompanied by a reduction of fatal or nonfatal outcomes in hypertensive patients. However, the achieved systolic BP target associated with higher outcome benefits remains unsettled. Purpose The aim was to determine the effects of BP-lowering treatment on outcome incidence at different achieved systolic BP strata. Methods A systematic review was conducted to identify randomized trials in electronic databases (Pubmed and CENTRAL, search between 1966 and 11/2022) for the effect of BP-lowering treatment against placebo or less aggressive treatment on the composite outcome of major cardiovascular (CV) events (i.e., myocardial infarction, stroke, and heart failure). Selected studies reported outcomes in patients with or without a history of previous CV disease. Studies were categorized according to the achieved level of systolic BP in the active or more actively treated group. Risk ratios (RR) were calculated with their 95% confidence interval (CI) under the random-effects model. Results We included 51 primary prevention studies (i.e., 16 trials in which systolic BP was lowered to values no less than 140 mmHg, n=36,189 patients; 22 trials with achieved systolic BP between 130 and 140 mmHg, n=84,952; and 13 trials with achieved systolic BP less than 130 mmHg, n=41,660) and 44 secondary prevention studies (i.e., 11 trials in which systolic BP was lowered to values no less than 140 mmHg, n=12,518 patients; 19 trials with achieved systolic BP between 130 and 140 mmHg, n=71,449; and 14 trials with achieved systolic BP less than 130 mmHg, n=39,085). For a standard systolic/diastolic BP reduction of 10/5 mmHg, the relative risk of the composite outcome was reduced in all achieved systolic BP strata, without a significant trend from higher to lower systolic BP targets, in both prevention groups. In addition, there was no difference in the absolute risk reduction of the combined outcome, as calculated by the number of events prevented in every 1000 patients treated for 5 years, between the systolic BP targets in each prevention group. However, only in primary prevention did a significant negative incremental trend from higher to lower systolic BP targets for the residual risk of the combined outcome become apparent. Conclusions Although antihypertensive treatment provides CV protection to all hypertensive patients, the lower systolic BP target is associated not only with outcome benefits but also with a lower rate of residual risk in primary prevention only.

Abstract 15200: Impact of Nocturnal Blood Pressure Fall on Long-Term Outcome for Recurrence of Atrial Fibrillation After Catheter Ablation

Introduction: Hypertension is known as a risk factor to progress the etiology of atrial fibrillation (AF). However, influence of non-dipper on AF recurrence after pulmonary vein isolation (PVI) remains unknown. Methods: We investigated the clinical impact of non-dipper evaluated by 24-hour ambulatory BP monitoring on the long-term outcome for AF recurrence in 76 AF patients underwent the PVI. Results: All of 76 patients (mean age:66±9 years, hypertension:78%, non-paroxysmal AF:24%) had procedural success of PVI. Twenty patients had AF recurrence during follow-up of median of 1158 days post-PVI. There was no difference in BP level between the AF recurrence and non-recurrence groups (average 24h-systolic BP:126±17 vs. 125±14mmHg, P=0.84). On the other hand, the patients with non-dipper had a higher AF recurrence than those with dipper (38.9% vs. 15.0%, P=0.018). In Cox hazard analysis adjusted by age, non-paroxysmal AF, and average 24h-systolic BP level, the non-dipper was an independent predictor of AF recurrence (HR 2.78 [95%CI: 1.05-7.34], P=0.039). The patients with non-dipper had a larger left atrial (LA) volume index than those with dipper (45.9±17.3 vs. 38.3±10.2ml, P=0.037). In 58 patients underwent the high-density voltage mapping in LA, 11 patients had low voltage area (LVA) defined as an area with a bipolar voltage < 0.5mV. There was no difference in existence of LVA between patients with non-dipper and those with dipper (22.2% vs. 16.1%, P=0.555). Conclusions: Non-dipper is an independent predictor of AF recurrence after PVI. Management for abnormal diurnal BP variation may be important in patients after PVI.

Abstract 16795: Blood Pressure Lowering Therapeutical Strategies Have Different Impact on Brain Functional Connectivity

Hypertension is a major risk factor for cognitive impairment and dementia. Using functional MRI, researchers have been able to study the brain’s functional connectivity in hypertensive patients. This has revealed that even before showing signs of vascular dementia, hypertensive patients have altered brain connections compared to normotensive patients. Our aim is now to characterize whether different classes of antihypertensive drugs, which vary in their mechanism of action and ability to cross the blood-brain barrier, have different effects on the brain’s functional organization. In this study, 42 hypertensive patients with controlled blood pressure underwent resting-state functional MRI. The data was analyzed using CONN to build functional connectivity network matrices and analyze the amplitude of spontaneous brain activity fluctuations (fALFF). These results were then evaluated using general linear models to identify connections that were modulated by specific classes of antihypertensive drugs. We applied regression models taking into account age, sex, BMI, alcohol, smoke and BP levels as covariates. Our results show that treatment with diuretics was associated with a large connectivity network among several brain networks (A). Treatment with ACE inhibitors (B), ARBs (C), and beta-blockers (D) was also associated with significant modulation of specific connections (all highlighted connections p<0.05, statistics in figure). Overall, diuretics had the greatest impact on brain function, possibly due to their effect on blood volume and cerebral circulation, with the effect further confirmed by fALFF analyses, showing a widespread reduction of the BOLD-signal intensity of spontaneous cerebral activity (all highlighted clusters p<0.05, statistics in figure E). These findings may help inform the choice of antihypertensive treatment for individual patients, taking into account the potential cognitive and functional impact of different drugs.

Abstract 13569: Impact of Intense Smartphone Application Based versus Routine Outpatient Follow-Up on Short Term Clinical Outcomes in Acute Decompensated Heart Failure (ADHF)

Introduction: Heart failure (HF) poses a global health burden, with about 26 million people affected and an estimated health expenditure of US$31 billion worldwide . The outcome of HF patients with reduced ejection fraction (HFrEF) has improved significantly due to the availability of evidence-based therapies. Still, the readmission rates, and subsequent mortality, have remained unchanged in the last two decades. Despite immense positive evidence, < 25% of patients with HFrEF are on the appropriate target doses of medical therapy. Objectives: Impact of intense versus routine outpatient follow-up on clinical outcomes and patient satisfaction in Acute decompensated heart failure (ADHF) patients over a 3-month follow-up.METHODS: This is a prospective open-label randomized study analyzing readmission rates and achieving target doses of GDMT. Results: A total of 226 subjects (Intense smartphone application-based follow-up -112) (routine outpatient follow-up -114) were enrolled in the study. The mean age was 53 and 54 years in intense follow-up and routine follow up, respectively. Both study arms were well-matched and randomized. There was a significant reduction in rehospitalization rate in the intense follow-up arm (28 vs. 57) p - 0.005. Subjects on smartphone application-based follow-up had better drug compliance and a rapid escalation of GDMT to reach target doses. Number of patients on target dose of GDMT at three months Conclusion: Intense smartphone application based follow-up was feasible and safe for ADHF patients. The incidence of 30-day and three months readmissions improved. They also showed improved BP, HR, and NT Pro-BNP levels. Drug dosages were up-titrated periodically in these subsets of patients based on their cardiac function and laboratory parameters. Newer apps should be designed to incorporate artificial intelligence (AI) with features more likely to improve key patient-reported and clinical outcomes.

Abstract 18321: Identifying Predictors of Non-Home Discharge Dispositions Using Machine Learning Among Critically Ill Patients Undergoing Coronary Artery Bypass Grafting

Introduction: Managing patients undergoing coronary artery bypass graft (CABG) procedures can be challenging. Research shows hospital discharges to locations other than home following CABG are associated with an increased risk of late mortality. We aimed to develop machine learning (ML) models to predict the risk of postoperative discharge dispositions other than home among these patients and assess their long-term postoperative prognosis. Methods: The Medical Information Mart for Intensive Care IV database was utilized to identify patients who underwent CABG procedures. The cases were divided into training (75%) and test (25%) sets. The AUROC, accuracy, and F1 scores were used to compare the performance of models. Several methods, such as penalized logistic regression, random forest, SVM, XGBoost, gradient boosting classifier, and lightGBM, were utilized, accounting for variables from demographics, labs, charting events, and comorbidity domains. Results: The study included 2228 eligible patients who underwent CABG procedures. The sample consisted of 23% females, 72% whites, and 43% were insured by Medicare. The median age of the sample was 69 years. Among these, 781 (35.05%) patients were discharged to locations other than home. Results show that the gradient boosting method had the highest accuracy (76.8%) with an AUROC of 80.8%. Age, BUN, male sex, PO2, hemoglobin, heart rate, mean arterial BP, chloride, platelet count, and creatinine levels were the top predictors for predicting non-home discharges. Results from the other models represented similar attributes as the top significant predictors. Conclusion: Predictors of discharge to locations other than home were identified with high accuracy, and this may aid in selective intervention to reduce the risk of death in this vulnerable patient population. ML can be used to investigate these patterns and possibly highlight particular patient subsets to enhance risk stratification and management.

Association between blood pressure variability and outcomes after endovascular thrombectomy for acute ischemic stroke: An individual patient data meta-analysis.

Data on the association between blood pressure variability (BPV) after endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) and outcomes are limited. We sought to identify whether BPV within the first 24 hours post EVT was associated with key stroke outcomes. We combined individual patient-data from five studies among AIS-patients who underwent EVT, that provided individual BP measurements after the end of the procedure. BPV was estimated as either systolic-BP (SBP) standard deviation (SD) or coefficient of variation (CV) over 24 h post-EVT. We used a logistic mixed-effects model to estimate the association [expressed as adjusted odds ratios (aOR)] between tertiles of BPV and outcomes of 90-day mortality, 90-day death or disability [modified Rankin Scale-score (mRS) > 2], 90-day functional impairment (⩾1-point increase across all mRS-scores), and symptomatic intracranial hemorrhage (sICH), adjusting for age, sex, stroke severity, co-morbidities, pretreatment with intravenous thrombolysis, successful recanalization, and mean SBP and diastolic-BP levels within the first 24 hours post EVT. There were 2640 AIS-patients included in the analysis. The highest tertile of SBP-SD was associated with higher 90-day mortality (aOR:1.44;95% CI:1.08-1.92), 90-day death or disability (aOR:1.49;95% CI:1.18-1.89), and 90-day functional impairment (adjusted common OR:1.42;95% CI:1.18-1.72), but not with sICH (aOR:1.22;95% CI:0.76-1.98). Similarly, the highest tertile of SBP-CV was associated with higher 90-day mortality (aOR:1.33;95% CI:1.01-1.74), 90-day death or disability (aOR:1.50;95% CI:1.19-1.89), and 90-day functional impairment (adjusted common OR:1.38;95% CI:1.15-1.65), but not with sICH (aOR:1.33;95% CI:0.83-2.14). BPV after EVT appears to be associated with higher mortality and disability, independently of mean BP levels within the first 24 h post EVT. BPV in the first 24 h may be a novel target to improve outcomes after EVT for AIS.

Relationship between hypertension/blood pressure and hearing sensitivity among drivers: A correlation analysis.

One of the most common chronic diseases is hypertension. The majority of research has linked hearing loss to hypertension. However, the relationship between hypertension and hearing is still unknown. The primary goal of the study is to investigate the effect of hypertension on hearing and to find out the association between blood pressure levels and auditory health in auto-rickshaw drivers. The study utilized 121 healthy professional auto-drivers between the age range of 25 and 55 years. Pure-tone audiometry (PTA) and extended high-frequency audiometry (EHFA) were used to determine the participants' hearing thresholds from 0.25 to 16 kHz. The cochlear hair cell functioning was evaluated using distortion-product otoacoustic emission (DPOAE) testing. Blood pressure (mmHg) measurements were categorized under hypertension stage (normal (120; <80); elevated (120-129; <80); hypertension - stage 1 (130-139; 80-89); hypertension - stage 2 (≥140; ≥90)). The mean age of the study participants was 42.17 ± 9.03 years. The mean systolic and diastolic BP of all the study participants were 138.24 ± 19.73 (105-216) mmHg and 87.69 ± 12.14 (60-134) mmHg, respectively. BP levels were normal for 17.4% (N = 21) of the study participants, 21.5% (N = 26) had elevated blood pressure, 21.5% (N = 26) of the population falls under stage 1 hypertension, and 39.7% (N = 48) had stage 2 hypertension. Our study discovered a significant difference between main group effects and no significant difference between group interaction effects. Hearing thresholds were significantly higher in hypertensive participants compared to non-hypertensive participants. However, there was no statistically significant relationship between the two variables hypertension and hearing loss. Implementing health promotion initiatives and raising awareness about hearing health could improve the quality of life for a high-risk occupational group of drivers.

Reliability of systolic blood pressure measured by parents in young children at home using a hand held doppler device and aneroid sphygmomanometer.

We report data regarding systolic BP monitoring in children aged <5 years performed over a 2-week period by parents at home using a hand-held doppler device and aneroid sphygmomanometer for SBP measurements (HDBPM). Our objectives were to compare health professional measured office systolic BP by doppler device (Office-SBP Doppler ) with parent measured home systolic BP using the same doppler device (Home-SBP Doppler ). We also report data evaluating reliability and optimal number of days of measurement required. We taught parents to measure systolic BP and assessed their technique using a hand-held doppler device and aneroid sphygmomanometer. We requested parents to perform three consecutive BP measurements twice daily (ideally morning and evening around similar times) when the child was awake, settled and cooperative. Over a 3-year period, data from 48 of 62 children who underwent HDBPM measurements were evaluated with median (IQR) age of 1.9 (0.9, 3.6) years, 27 (56%) boys and 14 (29%) on antihypertensive medication. Office-SBP Doppler was 2.9 ± 8.9 mmHg [95% confidence interval (CI), -14.4 to 20.4, P = 0.026] higher than Home-SBP Doppler . Mean Home-SBP Doppler between Week-1 and Week-2 monitoring was similar -0.45 ± 3.5 mmHg (95% CI, -7.35 to 6.45, P = 0.41). Morning HDBPM measurements were lower than evening with a mean difference of -2.77 ± 3.92 mmHg, P < 0.001). Over Week-1, mean Home-SBP Doppler was closer to mean Office-SBP Doppler with increasing cumulative days of monitoring and with smaller standard deviations suggesting that readings become more reliable from day 4 onwards. HDBPM is a reliable method for measuring systolic BP in young children with BP levels measured by parents comparable to those performed by health professional in clinic. HDBPM technique described here and performed by parents over a 7-day period with a minimum of 4-days, offers a reliable and reproducible technique to measure blood pressure at home.

Blood pressure measurement device change in the Healthy Finland health examination survey

Abstract Background Blood pressure (BP) measurements in health examination surveys (HESs) are needed for public health monitoring. In Finland, population-based HESs with BP measurements have been performed with mercury sphygmomanometers since the 1960's. The use of oscillometric devices has rendered sphygmomanometers impractical for health surveys. This study describes the change in BP measurement method and mean BP values in Finnish HESs. Methods 66 000 randomly selected adults living in Finland were invited to the Healthy Finland questionnaire-based health survey in 2022-2023. Of those, 10 000 were asked to participate in a HES including BP, anthropometric, and functional capacity measurements as well as collection of biological samples. Prior to the selection of the new oscillometric BP device, validation studies for devices were evaluated, and the availability was checked. BP measurements were performed using WatchBP Office Vascular (TWIN200 VSR) device. Results Two consecutive BP measurements were obtained from 3424 participants aged 30 years or older (ongoing until 6/2023). The mean (95% CI) systolic blood pressures (SBP) for men and women were 137.1 (136.2-140.0) and 134.7 mmHg (133.7-135.6), respectively. The corresponding values for diastolic blood pressure (DBP) were 82.3 (81.8-82.8) and 79.3 mmHg (78.9-79.8). The mean difference (95% CI) between the 1st and the 2nd SBP measurements were -2.4 (-2.7- -2.0) and -1.8 (-2.1- -1.4) in men and women, while the corresponding values for DBP were -1.1 (-1.4- -0.9) and -1.2 (-1.5- -1.0). Distribution of measurements was Gaussian apat from some values, that were unlikely to be obtained (SBP: 155, 156, 157; DBP: 96, 99). Conclusions Oscillometric BP provide reliable data in HESs. Finnish BP levels may be on the rise. Further reseach is needed to estimate the effects of gaps in the measurement algorithm of TWIN200 VSR and the differences in consecutive measurements. Key messages • In a health examination survey, oscillometric blood pressure measurements led to similar results as with a sphygmomanometer. • Algorithm gaps and smaller difference on successive measurements were seen.

Connections between serum Trimethylamine N-Oxide (TMAO), a gut-derived metabolite, and vascular biomarkers evaluating arterial stiffness and subclinical atherosclerosis in children with obesity.

Childhood obesity leads to early subclinical atherosclerosis and arterial stiffness. Studying biomarkers like trimethylamine N-oxide (TMAO), linked to cardio-metabolic disorders in adults, is crucial to prevent long-term cardiovascular issues. The study involved 70 children aged 4 to 18 (50 obese, 20 normal-weight). Clinical examination included BMI, waist measurements, puberty stage, the presence of acanthosis nigricans, and irregular menstrual cycles. Subclinical atherosclerosis was assessed by measuring the carotid intima-media thickness (CIMT), and the arterial stiffness was evaluated through surrogate markers like the pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures. The blood biomarkers included determining the values of TMAO, HOMA-IR, and other usual biomarkers investigating metabolism. The study detected significantly elevated levels of TMAO in obese children compared to controls. TMAO presented positive correlations to BMI, waist circumference and waist-to-height ratio and was also observed as an independent predictor of all three parameters. Significant correlations were observed between TMAO and vascular markers such as CIMT, PWV, and peripheral BP levels. TMAO independently predicts CIMT, PWV, peripheral BP, and central SBP levels, even after adding BMI, waist circumference, waist-to-height ratio, puberty development and age in the regression model. Obese children with high HOMA-IR presented a greater weight excess and significantly higher vascular markers, but TMAO levels did not differ significantly from the obese with HOMA-IR<cut-offs. TMAO did not correlate to HOMA-IR and insulin levels but presented a negative correlation to fasting glucose levels. An increase in TMAO was shown to be associated with an increase in the probability of the presence of acanthosis nigricans. TMAO levels are not influenced by other blood biomarkers. Our study provides compelling evidence supporting the link between serum TMAO, obesity, and vascular damage in children. These findings highlight the importance of further research to unravel the underlying mechanisms of this connection.

Uncontrolled and masked uncontrolled blood pressure in treated pregnant women with chronic hypertension and risk for preeclampsia/eclampsia.

To analyze the relationship between the level of BP achieved with treatment and the risk for development of preeclampsia/eclampsia (PE), we conducted a historical cohort study on 149 consecutive pregnant women with treated chronic hypertension, evaluated between January 1, 2016, and November 31, 2022. According to office BP readings and ambulatory blood pressure monitoring (ABPM) performed after 20 weeks of gestation, the cohort was classified in controlled hypertension, white-coat uncontrolled hypertension, masked uncontrolled hypertension and sustained hypertension. Risks for the development of PE were estimated using logistic regression. One hundred and twenty-four pregnant women with a control BP evaluation were included in this analysis. The rates of PE were 19.4%, 27.3%, 44.8% and 47.1% for controlled, white-coat uncontrolled, masked uncontrolled and sustained uncontrolled hypertension, respectively. Compared with women with controlled hypertension, the relative risk for PE increased markedly in women with sustained uncontrolled (OR 3.69, 95% CI, 1.19-11.45) and masked uncontrolled (OR 3.38, 95% CI, 1.30-11.45) hypertension, but not in those with white-coat uncontrolled (OR 1.56 95% CI, 0.36-6.70); adjustment for covariates did not modify the results. Each mmHg higher of systolic and diastolic daytime ABPM increased the relative risk for PE ~4% and ~5%, respectively. Each mmHg higher of systolic and diastolic nocturnal BP increased the risk ~5% and ~6%, respectively. When these risks were adjusted for ABPM values in opposite periods of the day, only nocturnal ABPM remained as a significant predictor. In conclusion, masked uncontrolled hypertension implies a substantial risk for the development of PE, comparable to those of sustained uncontrolled. The presence of nocturnal hypertension seems important.