Lower Diastolic Pressure Research Articles

Evaluation of perfusion index to predict hypotension in lower segment caesarean section under spinal anaesthesia

Background: Spinal Anaesthesia is the most popular choice for elective caesarean section. Both general anaesthesia and regional anaesthesia are acceptable techniques for anaesthesia for elective and emergency caesarean sections. Objectives: The study aimed to investigate the role of the perfusion index in predicting the incidence of hypotension following spinal anaesthesia in parturients undergoing elective lower segment caesarean sections. Methods: A prospective, observational study was carried out among sixty parturients posted for elective caesarean section. The study was conducted in the operation theatres of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. About 60 participants were interviewed for the study. Data were entered and analysed with the help of the Statistical Package for Social Science (SPSS) version.16. Results: Sixty eligible ASAI (American society of anaesthesiologist’s physical status classification) parturients scheduled for elective caesarean section were divided into two groups pre-operatively after determining their baseline Perfusion Index (PI) as those with PI ≤ 3.5 and those with PI > 3.5 using a Masimo® pulse oximeter probe. When comparing the heart rate at time intervals among the two groups, it became increasingly clear that those with baseline PI > 3.5 had generally higher heart rate especially immediately after the block and at 2nd, 4th, 6th,8th, 10th, 12th, 14th and 20th minutes. Conclusion: The study concludes that a Perfusion Index > 3.5 is associated with a higher incidence of hypotension in lower segment caesarean section under spinal anaesthesia. The hemodynamic parameters such as increased heart rate and significantly lower systolic, diastolic and mean arterial pressures in parturients with baseline PI > 3.5 suggest that these patients have lower baseline SVR and depleted autonomic resilience to hypotension compared to those with baseline PI ≤ 3.5. High BMI seems to be significantly associated with high baseline PI.

Risk factors for cognitive decline in non-demented elders with amyloid-beta positivity

BackgroundAs a currently incurable but preventable disease, the prevention and early diagnosis of Alzheimer’s disease (AD) has long been a research hotspot. Amyloid deposition has been shown to be a major pathological feature of AD. Notably, not all the people with amyloid-beta (Aβ) pathology will have significant cognitive declines and eventually develop AD. Therefore, the aim of this study was to explore the risk factors for cognitive decline in Aβ-positive participants.MethodsWe included 650 non-demented participants who were Aβ-positive at baseline from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. Mixed effects and COX regression models were applied to assess 37 potential risk factors. Mixed effects models were employed to assess the temporal associations between potential risk factors and four cognitive assessment scales. COX regression models were used to assess the impact of potential risk factors on cognitive diagnosis conversion. Univariate and multivariate analyses were applied to the above models. Additionally, we used the Cochran-Armitage trend test to examine whether the incidence of cognitive decline increased with the number concurrent of risk factors.ResultsSix factors (low diastolic pressure, low body mass index, retired status, a history of drug abuse, Parkinsonism, and depression) were the identified risk factors and four factors (a history of urinary disease, musculoskeletal diseases, no major surgical history, and no prior dermatologic-connective tissue diseases) were found to be suggestive risk factors. The incidence of cognitive decline in the Aβ-positive participants gradually increased as the number of concurrent risk factors increased (p for trend = 0.0005).ConclusionsOur study may facilitate the understanding of the potential pathological processes in AD and provide novel targets for the prevention of cognitive decline among participants with Aβ positivity.

Atrial fibrillation ablation performed under general anesthesia is associated with significantly low arterial blood pressure and higher incidence of hypotensive events

Abstract Introduction Catheter ablation is a pivotal treatment for atrial fibrillation (AF). When performed under general anesthesia (GA), it may be associated to hypotensive events, with unclear prevalence and prognostic impact. Continuous non-invasive blood pressure (CNBP) measurement is a validated and reliable tool for intraprocedural beat-to-beat advanced hemodynamic monitoring. Purpose To assess and compare the hemodynamic impact of GA during AF ablation using a CNBP (ClearSight) system. Methods In an observational single large volume center study we prospectively enrolled all patients undergoing AF ablation at our institution with CNBP monitoring, as per local practice. Patients were assigned to deep sedation (DS) or general anesthesia (GA) group according to the chosen sedation regimen. The following parameters were compared between the two strategies: systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume index (SVI). Hypotension events (HE) (MAP < 65 mmHg) were counted and compared between groups. Results Two hundred patients were enrolled from September 2022 to August 2023. 170 patients underwent AF ablation under DS (76,7% male, mean age 56,77±15,76), while 30 patients were treated under GA (70% male, mean age 60,72±13,79). A total of 117709 measurements were analyzed and compared, for an overall monitoring time of 39293,66 minutes. Patients treated under GA had significantly lower average SBP (104,83±21,48 mmHg vs 138,05±22,09 mmHg, p<0,001), DBP (59,59±11,89 mmHg vs 76,12±12,75 mmHg, p<0,001), MAP (74,96±15,02 mmHg vs 97,12±15,38 mmHg, p<0,001). We also observed significantly lower CO (4,40±1,47 L/min vs 5,16±1,62 L/min, p<0,001), CI (2,22±0,71 L/min/m2 vs 2,61±0,78 L/min/m2, p<0,001) SV (62,37±18,04 mL/beat vs 70,65±24,95 mL/beat, p<0,001) and SVI (31,40±8,54 mL/beat/m2 vs 35,80±12,07 mL/beat/m2, p<0,001). Patients treated under GA witnessed a higher number of per-patient HE (10,53±9,16 vs 0,61±2,07, p<0,001), and higher HE duration (4,8±6,62 min vs 2,82±3,66, p<0,001). Conclusion AF ablation performed under general anesthesia is associated with significantly lower systolic, diastolic, and mean arterial pressure, reduced cardiac output, stroke volume and stroke volume index when compared to deep sedation. Patients undergoing AF ablation under GA witness higher incidence and duration of hypotensive events. CNBP is a valid tool for beat-to-beat procedural hemodynamic assessment and can help identifying and treat hypotensive events. Further studies are needed to assess the potential prognostic impact of intraprocedural hypotension during AF ablation.

Diastolic blood pressure in hemorrhagic shock, the disregarded parameter

The management of trauma and hemorrhagic shock (T/HS) is a critical aspect of emergency medicine and trauma care. The use of whole blood for fluid resuscitation is considered the gold standard when available because it provides a balanced combination of red blood cells, plasma, and clotting factors. However, whole blood is not always readily available, and alternative options must be considered. In such cases, various fluid replacements and vasoactive drugs can be used to help stabilize patients with T/HS. The goal of our study was to compare several fluid therapies and vasoactive drugs for blood pressure stabilization after T/HS. Male Wistar rats (±400g) were subjected to laparotomy and hypotension (a mean arterial blood pressure (MAP) of 35-40mmHg) was induced by blood withdrawal for 90 min. Following the hypotensive period, animals were resuscitated with candidate solutions and/or vasoactive drugs in an effort to increase MAP to at least 60mmHg for 120min. Lactated Ringers (LR) with 5% dextrose was used as control fluid and in combination with vasopressors; whole blood resuscitation was considered the positive control. Among the studied medications, only vasopressin (60.0mmHg*) and resveratrol (60.2mmHg*) were able to achieve the target MAP. (Packed) red blood cells (70.4mmHg***), polymerized hemoglobin (74.4mmHg***), and whole blood (84.4mmHg****) increased MAP closer to baseline levels. While all of the groups studied were capable of restoring systolic pressure not significantly different from to baseline (SHAM =108.5mmHg), the inability to recover MAP was almost exclusively due to low diastolic arterial pressure (DAP). Using the SHAM DAP as reference (65.2mmHg) and the LR-reperfusion group as control (31.7mmHg), there was no increase in effcacy upon addition of angiotensin II (25.4mmHg), phenylephrine (27.9mmHg), vasopressin (37.8mmHg), L-NAME (35.7mmHg), resveratrol (41.1mmHg), sphingosine-1-phosphate (33.0mmHg), or naloxone (31.8mmHg). There was a similar lack of effcacy found using different fluid therapies: Hetastarch increased DAP to only 33.9mmHg, and 10% Albumin (41.0mmHg), and plasma (38.6mmHg) were only slightly superior to control. Only oxygen-carrying solutions were able to increase DAP: polymerized hemoglobin (55.7mmHg***), red blood cells (55.5mmHg***), and whole blood (67.8mmHg***). These findings underscore the complexity of T/HS management and the challenges in restoring and maintaining perfusing blood pressure, e.g. MAP, in these situations. This study provides valuable insights into the comparative effectiveness of various resuscitative approaches, shedding light on potential strategies to enhance outcomes after T/HS. Many shock studies often concentrate only on mean arterial pressure, potentially overlooking a crucial aspect of hemorrhage resuscitation—low diastolic pressure. Our study emphasizes that low diastolic pressure constitutes the primary component contributing to low MAP after reperfusion in T/HS. This result is likely associated with inadequate oxygen availability to the tissues, as only oxygen carriers, such as polymerized hemoglobin, red blood cells, and whole blood were capable of improving DAP. Future therapies should be directed towards preferentially improving DBP as an approach to achieving optimal hemodynamics after T/HS.(*p<0.05, **p<0.01, ***p<0.001, ****p<0.0001 compared to LR control). Department of Defense Award W81XWH-17-2-0047. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Central α2-adrenergic mechanisms differentially affect baroreflex control of sympathetic and cardiovagal outflow

This study aimed to investigate the impact of central α2-adrenergic mechanisms on arterial baroreflex control of sympathetic and cardiovagal outflow in healthy humans. R-R interval (ECG), blood pressure (brachial arterial catheter), and muscle sympathetic nerve activity (MSNA; peroneal microneurography) were measured in eight healthy participants (5 females; 28±7 years). Sympathetic action potentials (AP) were extracted from the filtered MSNA neurogram (continuous wavelet transform) during a 5-minute baseline (BSL) and an intravenous dexmedetomidine infusion consisting of a loading dose (LD; 10 minutes at 0.225 μg/kg/hr) and a maintenance dose (MD; ~0.15 μg/kg/hr). Sympathetic AP baroreflex threshold gain was measured as the slope of the linear relationship between AP discharge probability and diastolic blood pressure. The linear relationship between R-R interval and systolic blood pressure (sequence technique) quantified cardiovagal baroreflex gain. Mixed-effects analyses and post-hoc t-tests were performed. Data are reported as mean ± SD. Dexmedetomidine reset the baroreflex threshold operating points for all sympathetic AP clusters downwards to lower firing probabilities (cluster 4; BSL: 20±6, LD: 13±8, MD: 6±5%, both p<0.01 vs. BSL) and leftwards to lower diastolic pressures (BSL: 72±9, LD: 69±8, MD: 65±10 mmHg, both p<0.01 vs. BSL). Dexmedetomidine reduced baroreflex threshold gain for the subpopulation of medium-sized sympathetic APs (cluster 4; BSL: -6.5±2.0, LD: -2.6±1.6, MD: -2.0±0.7 %/mmHg, both p<0.01 vs. BSL). Dexmedetomidine did not affect baroreflex threshold gain of small (cluster 1; BSL: -1.9±1.1, LD: -1.3±1.6, MD: -1.1±0.8 %/mmHg, both P>0.88 vs. BSL) or large AP clusters (cluster 9; BSL: -0.8±0.4, LD: -0.8±1.0, MD: -0.2±0.7 %/mmHg, both P>0.98 vs. BSL). Dexmedetomidine reset the cardiovagal baroreflex to lower systolic pressures but did not affect R-R interval (BSL: 1035±261, LD: 1025±308, MD: 1005±292ms, Main effect P=0.45) or gain (BSL: 24±11, LD: 30±20, MD: 26±25 ms/mmHg, Main effect P=0.63). These findings suggest that central α2-adrenergic mechanisms differentially affect arterial baroreflex control of sympathetic and cardiovagal outflow in humans by minimally affecting cardiovagal baroreflex gain but strongly affecting the baroreflex gain for the subpopulation of medium-sized sympathetic APs. This work was supported by the Natural Sciences and Engineering Research Council of Canada (NSERC) and the National Institutes of Health (NIH). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Association of Christian Orthodox Fasting with Sociodemographic, Anthropometric and Lifestyle Factors and Serum Biochemical Indices: A Cross-Sectional Study on Patients with Metabolic Diseases.

Christian Orthodox fasting, a type of time-restricted diet, which presents some similarities to the Mediterranean Diet, also including certain similarities with periodic vegetarianism or other time-restricted diets (e.g., intermittent diet and Ramadan fasting), may cumulatively be related to the same or even better beneficial healthy effects as these well-recognized dietary patterns. The present study aimed to explore the potential beneficial impact of Christian Orthodox fasting in patients with metabolic disorders, such as diabetes mellitus type 2, excessive obesity, hypothyroidism and osteoporosis. This was a cross-sectional study, including 135 patients with metabolic disorders (67 fasters and 68 non-fasters). The enrolled fasters had adapted Christian Orthodox fasting recommendations for at least twelve consecutive years or even from childhood. Relevant questionnaires were used to record sociodemographic, anthropometric and lifestyle data of the study population through face-to-face interviews between the enrolled individuals and qualified personnel during a non-fasting period. Christian Orthodox fasting patients showed a significantly and independently lower prevalence of overweight/obesity and abdominal obesity, which is highly associated with cardiometabolic disease risks, as well as a significantly and independently lower incidence of hypertension, including separately lower systolic and diastolic pressure, than non-fasting patients. Fasters also had a significantly and independently increased prevalence of an advanced educational level and no smoking history, as well as a lower incidence of sedentary behavior, and a trend of a correlation with reduced c-reactive protein (CRP), an indicator of inflammation, compared to non-fasters. Fasters also exhibited higher serum albumin and high-density lipoprotein (HDL) levels, as well as lower glucose levels, than non-fasters. This is one of the few cross-sectional studies demonstrating that Christian Orthodox fasting may promote metabolic health by improving several aspects of metabolic disorders, being associated with specific sociodemographic, anthropometric and lifestyle factors. Further studies conducted on larger sample sizes from different countries and different ethnicities that include Christian Orthodox fasters are recommended to evaluate the impact of long-term religious fasting effects on human health, either as a preventative factor reducing the risk of chronic diseases and especially cardiometabolic disorders or as a nutritional intervention to ameliorate symptom severity.

Relationship between Noise Exposure and Prognosis of Patients with Heart Failure: A Retrospective Analysis.

Environmental noise damages the cardiovascular system and endangers human health. This study was conducted to analyze the relationship between noise exposure and prognosis of patients with heart failure and to provide a good strategy for disease treatment. This study was a retrospective analysis. A total of 487 patients with heart failure admitted to Ganzhou People's Hospital from September 2021 to September 2023 were selected as research subjects, and they were divided into the low noise exposure group (<55 dB; group A) and the high noise exposure group (≥55 dB; group B) according to the noise exposure conditions. The baseline data and physiological indicators of the two groups were analyzed. In this study, 84 patients were included in group B, and the remaining 403 patients were included in group A. Group A had lower systolic pressure, diastolic pressure, heart rate, and respiratory rate compared to group B (P < 0.05). The serum B-type natriuretic peptide (BNP) level in group A was lower than that in group B (P < 0.001). Group B had significantly higher scores on the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) compared to group A (P < 0.001). The noise level was correlated with SAS score, SDS score, and serum BNP level (all P < 0.001). The noise exposure is correlated with the prognosis of patients with heart failure, suggesting that active strategies should be adopted to reduce the impact of noise on their disease.

Comparison of the Efficacy of Midazolam and Dexmedetomidine As Sedative Agents in Third Molar Surgery.

Introduction Minor dental and oral surgical procedures have been made comfortable with the rise in the use of daycare sedatives. Of these sedatives, midazolam is deemed a common sedative used for minor oral surgical procedures. Newer and safer sedatives such as dexmedetomidine have certain properties that may prove more efficient in oral surgical procedures. Third molar surgery is one of the most common minor oral surgical procedures performed in dentistry. Thus, this study aims to compare the efficacy of midazolam and dexmedetomidine as sedative agents in third molar surgery. Materials and methods Sixty young adult patients free from other comorbidities were included in the study with ages ranging between 18 and 50 years. The samples were matched for the difficulty of impacted teeth and randomly distributed among the groups. Groups were administered the respective sedative drugs midazolam and dexmedetomidine and their effects were observed through the Observer's Assessment of Alertness/Sedation scale. The intraoperative vitals and sedation effects were checked every 15 minutes. Statistical analysis was done using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). Independent samples t-test and analysis of variance were the statistical tests employed to analyze the obtained data with p<0.05 considered as statistically significant. Results The depth of sedation has been both subjectively and objectively assessed and had no significant difference among the groups. The intra-operative heart rate assessment proved a more efficient reduction of pulse rate in the dexmedetomidine group as compared with the midazolam group. However, it was not statistically significant (p=0.121). The mean diastolic blood pressure showed a statistically significant difference between the groups with dexmedetomidine having lower blood diastolic pressure compared to midazolam (p=0.004). Quick arousal was witnessed in the dexmedetomidine group. Conclusion It can be concluded from the study that both dexmedetomidine and midazolam were equally effective as sedative agents for third molar surgery. However, the nature of cardio-protection, anti-sialagogue, and analgesic properties of dexmedetomidine can prove helpful, especially in minor oral surgical procedures like third molar surgery and it is recommended.

NSTEMI MINOCA: clinical-instrumental characterization of a heterogeneous clinical enigma

Abstract Background The nosology of angiographically non-critical coronary myocardial infarction (MINOCA) with the presentation of NSTEMI represents a challenge for the clinician due to the lack of a clear definition of this entity, which is often interpreted as a transitional diagnosis awaiting a more precise investigation. Purpose The aim of the study was to investigate the epidemiological, clinical and prognostic characteristics of MINOCA with NSTEMI presentation, comparing it with a population of type 2 (T2) NSTEMI to identify significant clinical-instrumental and outcome predictors. Methods In this single-centre retrospective observational study, 18223 undergoing invasive coronary angiography were screened from 2005 to 2022. After a review of angiographic data and clinical presentation, 538 patients were included, of which 301 were classified as MINOCA and 237 as T2 NSTEMI following guidelines. The primary outcome was defined as a composite of death, non-fatal AMI, non-fatal transitory ischemic attack or stroke, and hospitalization for heart failure. Results After stratification by diagnosis, patients with MINOCA were younger than those with T2 NSTEMI (66.33 ± 11.67 vs 70.55 ± 10.94 years, respectively, p&amp;lt;0.0001), tended to be less hypertensive (SBP 137.34 ± 18.98 vs 144.68 ± 30.32, respectively, p=0.001), with lower diastolic pressure (81.1 ± 16.95 vs 78.28 ± 10.35, respectively, p=0.018). The MINOCA group had a lower incidence of typical risk factors such as diabetes (p=0.001), hypertension (p=0.002), atherosclerotic disease (p&amp;lt;0.0001) and sedentary lifestyle (p=0.002) but was more frequently smokers (p&amp;lt;0.0001). Atypical cardiovascular risk factors such as adverse events during pregnancy (p=0.013) were more frequent in the MNOCA group. At logistic regression analysis, typical chest pain (p&amp;lt;0.0001), the absence of palpitations (p&amp;lt;0.0001), lower heart rate (p=0.012), sinus rhythm (p=0.001), advanced age (p=0.015), absence of ST-segment changes (p=0.002), absence of diastolic dysfunction (p=0.001) and hypo/akinesia with non-coronary distribution at echocardiography (p&amp;lt;0.0001), and postmenopausal status (p=0.009) were independent predictors of MINOCA. During a median follow-up time of 61.1 [34.2 – 100.34] months, 135 patients met the primary endpoint. The Kaplan-Meier analysis indicated that patients with MINOCA were less likely to experience the composite endpoint than NSTEMI T2 (p&amp;lt;0.0001). Conclusions The MINOCA group was associated with a more subtle clinical-instrumental presentation and unconventional risk factors that account for the greater diagnostic difficulty. Moreover, in the MINOCA group, the absence of elements that classically characterize the AMI-CAD predicts the occurrence of the event with high accuracy. Finally, the MINOCA subgroup had a better prognosis for the major cardiac adverse events than T2 NSTEMI, the latter is therefore comparable to the classic MI-CAD.Nomogram for MINOCA predictors

Abstract 15170: Prognostic Implication of Left Atrial Reservoir Strain in Severe Mitral Stenosis With Low Transmitral Diastolic Pressure Gradient: Result From Long-Term Follow-Up Registry

Background: Prognosis of severe mitral stenosis (MS) with low transmitral mean diastolic pressure gradient (MDPG) has not been fully understood with lack of long-term follow-up study. Aims: We investigated the prognostic implication in severe MS with low MDPG. Methods: We included patients with severe rheumatic MS (mitral valve area [MVA] &lt; 1.5 cm 2 ) from the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry. Patients with severe MS were categorized into high (≥ 5 mmHg) or low (&lt; 5 mmHg) MDPG groups. The primary outcome was a composite of all-cause mortality and stroke. Among 1,248 patients with severe MS, 322 (25.8%) had low and 926 (74.2%) had high MDPG. Results: Their mean age was 59±13 years, 25% were men, and 74% had atrial fibrillation. Patients with low MDPG were older and had a higher prevalence of atrial fibrillation. During a mean follow-up of 6.8±5.9 years, 194 patients (15.5%) experienced composite events. Patients with severe MS and low MDPG had a higher risk of experiencing composite events compared to those with high MDPG (hazard ratio [HR]: 1.56, 95% CI: 1.15-2.12; p=0.004). Subgroup analysis with low MDPG revealed that decreased left atrial reservoir strain (LARs) was independently associated with poorer outcome (HR, 2.58, 95% CI: 1.08-6.20; p=0.034). Conclusion: Severe MS patients with low MDPG are at higher risk of adverse events compared to those with high MDPG. The assessment of LARs can be useful in identifying subgroups of low MDPG severe MS patients with poor prognosis.

Female is Associated with Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes.

Diabetic cardiomyopathy is a subset of heart disease that is directly associated with diabetes, and left ventricular diastolic dysfunction is the earliest sign. We aimed to investigate the association between sex differences and left ventricular diastolic function in patients with type 2 diabetes. This was a cross-sectional study included patients with type 2 diabetes who visit the National Metabolic Management Center (MMC) at the First People's Hospital of Yunnan from 2018 to 2021. Patients with hypertension, history of heart disease or ejection fraction <50% were excluded from the study. Logistic regression was used to analyze their associations. A total of 1778 patients were included in the study. The study included 1205 (70%) males and 573 (30%) females. Compared with males, females had higher total cholesterol and LDL cholesterol levels but lower diastolic pressure, body mass index (BMI), visceral fat area, HbA1c, blood urea nitrogen (BUN), serum creatinine and triglyceride. Females had a relatively higher ejection fraction than males (68.17 ± 6.055 vs 67.5 ± 6.096, P < 0.05). More female patients than male patients in the age group of 45-60 years old had left ventricular diastolic dysfunction (female vs male, 54.5% vs 46.9%, P < 0.05). We also found that females were independently associated with left ventricular diastolic dysfunction, after adjusting for important clinical factors. Left ventricular diastolic function might be worse in female patients with type 2 diabetes. Further study is needed to verify the underlying mechanism.

Combined Exercise Training Promotes More Benefits on Cardiovascular Autonomic Modulation in Ovariectomized Rats Than Isolated Aerobic or Resistance Training.

Cardiovascular risk increase after ovarian deprivation has been extensively demonstrated by our research group through cardiovascular autonomic analysis. Interventions involving different types of exercises, such as resistance exercises or combined exercises (aerobic and resistance) have been widely recommended to prevent or minimize neuromuscular decline in postmenopausal women, which is aggravated by a sedentary lifestyle. Experimentally, the cardiovascular effects of resistance or combined training, as well as comparison between aerobic, resistance, and combined training, in ovariectomized animals are scarce. In this study, we hypothesized that the combination of aerobic and resistance training may be more effective in preventing muscle mass loss, as well as improving cardiovascular autonomic modulation and baroreflex sensitivity, than aerobic or resistance training individually in ovariectomized rats. Female rats were divided into 5 groups: sedentary (C); ovariectomized (Ovx); trained ovariectomized submitted to aerobic training (OvxAT); resistance training (OvxRT); combined training (OvxCT). Exercise training lasted 8 weeks, with the combined group alternating between aerobic training and resistance training every other day. At the end of the study, glycemia and insulin tolerance were evaluated. Arterial pressure (AP) was directly recorded. Baroreflex sensitivity was assessed by heart rate response to changes in arterial pressure. Cardiovascular autonomic modulation was evaluated by spectral analysis. Combined training was the only training regime that increased baroreflex sensitivity for tachycardic response and reduced all systolic blood pressure variability parameters. Furthermore, all animals submitted to exercise training on a treadmill (OvxAT and OvxCT) presented lower systolic, diastolic, and mean pressure, as well as improvements in the autonomic modulation for the heart. Combined training showed to be more effective than isolated aerobic and resistance training, mixing the isolated benefits of each modality. It was the only modality able to increase baroreflex sensitivity to tachycardic responses, reduce arterial pressure and all parameters of vascular sympathetic modulation.

S-52-1: CARDIOVASCULAR OUTCOMES IN HYPERTENSIVE PATIENTS WHO DISCONTINUE STUDY MEDICATION IN A LARGE OUTCOME TRIAL. THE LIFE STUDY.

Objective: Patient discontinuation of study medication during an outcome trial has significant implications for study power. However, patients who discontinue cardiovascular outcome trials are not well described. We aimed to assess readily available patient characteristics and outcomes in patients with hypertension and left ventricular hypertrophy (LVH) who discontinued the study drug but otherwise remained in the study until the end of follow-up. Methods: In patients who discontinued vs. those continuing, Cox proportional hazards models identified baseline variables that had a significant impact on the occurrence of the primary composite endpoint (cardiovascular death, stroke, and myocardial infarction) in 9,193 hypertensive patients and LVH in the LIFE study. Results: During a mean follow-up of 4.8 years, 3,281 patients (35.7%) discontinued one or more days during the trial, not counting death as a reason for discontinuation. The distribution of days to discontinuation was highly skewed towards the first part of the study; the 25th percentile was at day 161, and the median was at day 669. Reasons for discontinuation were a clinical adverse event (50%), a secondary study endpoint (19%), required study therapy (11%), withdrawal (2%), administrative (18%), and lost to follow-up (0.2%). Those who discontinued were older, more often male, had slightly lower body mass index, higher systolic and lower diastolic pressure, higher Framingham Risk Score (FRS), and more ECG LVH determined by either Cornell voltage-duration product or Sokolow-Lyon criteria compared to those who continued in the study. Of particular note, the discontinuation rate between the two study drugs was not equal. Patients randomized to losartan discontinued less than those randomized to atenolol. Multivariate analyses showed that older age, male gender, FRS, Sokolow-Lyon criteria, atenolol treatment as well as a history of pre-study myocardial infarction, cerebral vascular disease, peripheral vascular disease, and atrial fibrillation as well as lower levels of hemoglobin, higher serum creatinine and lower cholesterol all independently predicted discontinuation from the study drug. Conclusions: Patients discontinued during the first part of the study mainly due to experience of a clinical adverse event. Patients who discontinued the study drug had, on average, more previous and concurrent cardiovascular disease than those who continued until the study ended. There is no risk reduction and futility if an outcome study recruits patients with too little risk. However, too high risk implies early drug discontinuation and thus reduction in the study power.

QUALITY ASPECTS TO CONSIDER IN FLAXSEED AS A VALID OMEGA-3 DIETARY SUPPLEMENT: A RANDOMIZED CONTROLLED TRIAL

Dietary supplements, based on essential polyunsaturated fatty acids, help in normalizing the circulating lipids in overweight people. These fatty acids are abundant in fish oils and certain vegetable seed oils. In this context, the fatty acid profile of 9 commercial flaxseed trademarks was analyzed. Regarding fatty acid composition, α-linolenic acid represented more than 60% of the total fatty acids. In addition, sample 3 displayed the highest oxidative stability; thus, it was selected to be used in a pilot nutritional intervention study. The objective was to assess the hypolipidemic effects of flaxseed together with an isocaloric fish-rich diet. Two groups of women aged 25-70 years presenting high levels of circulating cholesterol (&gt; 200 mg dL-1) and triglycerides (&gt;150 mg dL-1) participated. Group F consumed flaxseed, while group D did not. At the end of intervention, participants from group F presented significantly reduced total cholesterol and lower systolic and diastolic pressure as compared to group D. Triacylglycerols decreased in both groups with respect to initial values, suggesting a role of diet. The flaxseed trademark is an influencing variable in its fatty acid composition and flaxseed supplementation combined with a fish-rich diet can help to reduce blood lipid parameters.

The association of egg consumption with blood pressure levels and glycated hemoglobin in Spanish adults according to body mass index

The objective of this study was to evaluate the association of egg consumption with blood pressure (BP) and glycated hemoglobin (HbA1c). In addition, it was assessed whether this association changes according to body weight status. This cross-sectional study is based on multicenter data from Spanish adult participants in the EVIDENT II trial. Egg consumption was assessed with a Food Frequency Questionnaire, and data on BP and HbA1c were collected using standardized procedures. Linear regression and ANCOVA models adjusted for the main confounders were performed. The analyses were stratified by body weight status. A total of 668 participants were analyzed (mean age 52.4 ± 11.8 years, 62.3% women). Compared with lower consumption, higher egg consumption was associated with lower systolic (ß = − 6.15 ± 1.74; p-for-trend = 0.017), diastolic (ß = − 4.41 ± 1.03; p-for-trend = 0.002), and mean arterial pressure (ß = − 4.99 ± 1.17; p-for-trend = 0.003) and with lower HbA1c (ß = − 0.19 ± 0.06; p-for-trend = 0.019) levels. These associations lost statistical significance in the adjusted analyses. The results did not vary by body weight status. In conclusion, consumption of up to 1 egg per day is not associated with BP or HbA1c, even in overweight or obese individuals. Our findings suggested that this frequency of egg consumption is safe as part of a healthy diet and lifestyle for cardiometabolic risk.

Abstract P221: Cardiovascular Outcomes In Hypertensive Patients Who Discontinue Study Medication In A Large Outcome Trial. The Life Study.

Objective: Patient discontinuation of study medication during a hypertension outcome trial has implications for study power. We aimed to assess patient characteristics and outcomes in patients with hypertension and left ventricular hypertrophy (LVH) who discontinued the study drug but otherwise remained in the study until the end of follow-up. Methods: In patients who discontinued vs. those continuing, Cox proportional hazards models identified baseline variables that had a significant impact on the occurrence of the primary composite endpoint (cardiovascular death, stroke, and myocardial infarction) in 9,193 hypertensive patients and LVH in the LIFE study. Results: During a mean follow-up of 4.8 years, 3,281 patients (35.7%) discontinued one or more days, not counting death as a reason for discontinuation. The distribution of days to discontinuation was highly skewed towards the first part of the study; the 25 th percentile was at day 161, and the median was at day 669. Reasons for discontinuation were a clinical adverse event (50%), a secondary study endpoint (19%), required study therapy (11%), withdrawal (2%), administrative (18%), and lost to follow-up (0.2%). Those who discontinued were older, more often male, had slightly lower body mass index, higher systolic and lower diastolic pressure, higher Framingham Risk Score (FRS), and more ECG LVH determined by either Cornell product or Sokolow-Lyon criteria. Patients randomized to losartan discontinued less than those randomized to atenolol. Multivariate analyses showed that older age, male gender, FRS, Sokolow-Lyon criteria, atenolol treatment as well as a history of pre-study myocardial infarction, cerebral vascular disease, peripheral vascular disease, and atrial fibrillation as well as lower levels of hemoglobin, higher serum creatinine and lower cholesterol independently predicted discontinuation. Conclusions: Patients discontinued during the first part of the study mainly due to a clinical adverse event. Patients who discontinued the study drug had, on average, more previous and concurrent cardiovascular disease than those who continued until the study ended. Thus, too high risk in an outcome study implies early drug discontinuation and thus reduction in the study power.

Low Heart Rate Is Associated with Cerebral Pulsatility after TIA or Minor Stroke.

Beta-blockers are beneficial in coronary artery disease but less so in stroke prevention and dementia, potentially due to reduced heart rate (HR). Cerebral pulsatility is strongly associated with cerebral small vessel disease (SVD) and may be increased by lower diastolic pressures resulting from longer cardiac cycles. Patients 4-6 weeks after TIA or non-disabling stroke (Oxford Vascular Study) underwent 5 minutes continuous monitoring of blood pressure (BP), electrocardiogram (ECG), and middle cerebral artery flow velocity (transcranial ultrasound). Beat-to-beat relationships between HR, blood pressure and Gosling's pulsatility index (MCA-PI) are reported as beta-coefficients from general linear models for each individual. Across 759 patients, average MCA-PI during monitoring was associated with lower HR and diastolic BP (DBP) and greater systolic BP (SBP) (∆MCA-PI per 10 bpm/mmHg: -0.02, -0.04, 0.03, all p < 0.001), with HR particularly associated with low end-diastolic cerebral velocity (0.86, p=0.014). Beat-to-beat HR was strongly associated with concurrent low DBP and high SBP, potentially mediating the association with greater beat-to-beat cerebral pulsatility (average ∆MCA-PI vs HR/DBP/SBP unadjusted: -0.062, -0.052, 0.0092; adjusted for concurrent BP: -0.039, -0.11, 0.041). The beat-to-beat association between HR and MCA-PI increased with age, beta-blockers, arterial stiffness, low HR (age > 70 + HR < 65 vs age < 70 + HR > 65: -0.081 vs -0.024, interaction p < 0.001), and severe SVD on MRI (age > 70 + severe vs age < 70 + none: -0.087 vs -0.047, interaction p=0.03), with interactions between age, severe SVD, and low HR synergistically increasing MCA-PI. Low HR is associated with greater cerebral pulsatility in patients with SVD, potentially mediated by lower diastolic blood flow and representing a novel potential treatment target. ANN NEUROL 2022;92:909-920.

RELIGIOSITY, BIOLOGICAL MARKERS AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH HYPERTENSION

Motivation/Background: the adoption of a healthy lifestyle has a positive influence on the control of hypertension. Objective: The objective of this study was to analyze the effect of Spirituality and Health Workshops on biological markers and Health-Related Quality of Life of hypertensive patients. Method: This is a randomized controlled trial study in which an educational intervention was carried out and the religiosity and Quality of Life indices as well as the blood pressure and, Cortisol, C-Reactive Protein (CRP) and cholesterol were evaluated. Results: The intervention group experienced a lower diastolic pressure (p &lt;0.05). There were no differences between intervention and control groups on systolic blood pressure, quality of life, somatic manifestations, mental state, CRP, and cholesterol levels. Conclusions: It was concluded that the intervention positively influenced the results, at least in one of the biological markers and the quality of life of this group.

If We Cannot Use Nitric Oxide for Newborn Persistent Pulmonary Hypertension, is Oral Sildenafil Therapeutic? A Single-center Experience

Background: Persistent pulmonary hypertension is still an issue in newborn period with different treatment strategies. In this study, we aimed to evaluate the three-year experience of a neonatal intensive care unit on use of sildenafil citrate for treating newborns with persistent pulmonary hypertension. Methods: Twenty-nine newborn patients with the diagnosis of persistent pulmonary hypertension solely treated by sildenafil citrate (2 mg/kg per dose, orally, three times a day) in intensive care unit of a private hospital between 2018 and 2021 were retrospectively analyzed. Results: The newborns that underwent sildenafil treatment and the newborns that received no treatment had statistically similar length of hospital stay (p = 0.188). The premature newborns had significantly lower systolic and diastolic blood pressure than the term newborns on their first day of sildenafil treatment (p = 0.001 for both). The premature newborns had significantly lower systolic, diastolic, and right ventricular systolic pressure than the term newborns on their day of hospital discharge (p = 0.003, p = 0.013 and p = 0.001 respectively). The premature newborns had significantly lower systolic, diastolic, and right ventricular systolic pressure on their day of hospital discharge than their first day of sildenafil treatment (p = 0.039, p = 0.041 and p = 0.043 respectively). The term newborns had also significantly lower systolic, diastolic, and right ventricular systolic pressure on their day of hospital discharge than their first day of sildenafil treatment (p = 0.001 for each). Conclusions: Sildenafil citrate can be considered as an efficient and safe alternative for the treatment of persistent pulmonary hypertension in newborn at the in tertiary neonatal intensive care units without nitric oxide and devices.

Lung Transplant Outcomes in Patients with Pulmonary Veno-Occlusive Disease

<h3>Purpose</h3> Pulmonary veno-occlusive disease (PVOD) is a rare cause of pulmonary hypertension. Prognosis of PVOD is worse than PAH. Most patients need lung transplantation. Previous study showed that PVOD patients had higher waitlist mortality compared to PAH patients. To date, there are no study report outcomes of lung transplant in this population. We would like to study the outcome and compare with IPAH patients. <h3>Methods</h3> This is a retrospective observational study. Patients with a diagnosis of PVOD and PAH underwent lung transplant between 2005 and 2018 were identified from SRTR database. Numerical data were reported in mean and standard deviation. Categorical data were reported in count and percent. T-test and Chi-square test were performed to compare variables between 2 groups. Survival was compared using Kaplan-Meier (K-M) method. <h3>Results</h3> 61 PVOD patients and 970 PAH patients underwent lung transplant were identified. There was no significant difference in age and BMI. Patients with PVOD had significant lower post-transplant systolic, diastolic and mean PA pressure and higher cardiac output. LAS at matching were not significantly different. PVOD patients had shorter time on waiting list (152.7±263.34 vs 337.56±511.14, p<0.01). Proportion of patients requiring ECMO post lung transplant were higher in PVOD group (13.11% vs 4.23%, p<0.01). Proportion of patients developing primary graft dysfunction (PGD) were lower in PVOD group (37.5% vs 61.93%, p=0.056). There was no difference of length of stay, FEV1, FVC, PCO2 post lung transplant and acute rejection between 2 groups. Survivals were not different between 2 groups using K-M method (p=0.33). <h3>Conclusion</h3> We found that PVOD patients who underwent lung transplant had shorter waiting time compared to PAH patients which suggest that disease severity of PVOD is higher than PAH. Despite that more PVOD patients required ECMO support post-operative, patient survival and other long-term outcomes such as lung function or rejection were not different between from PAH patients.