Lower Diastolic Pressure Research Articles

Effects of potentially modifiable risk factors on the health of adults in the Eastern Province of KSA.

ObjectivesThe purpose of this study was to investigate the association between selected major modifiable risk factors including life style habits, household income and smoking on health.MethodsThis cross-sectional study was conducted during 2015–2016 among 104 healthy men aged 38 ± 8 years. The data were collected using a self-administered questionnaire that enquired about clinical information about blood pressure and body mass index. Venous blood samples were taken to assess the fasting blood glucose (FBG), lipid profile, high density lipoprotein and triglyceride.ResultsCurrent smoking status and consumed energy drinks were significantly positive risk factors for increased systolic blood pressure and FBG, respectively. Participants with monthly income of more than 10,000 Saudi Riyals showed significantly lower diastolic pressure than those with lower income. However, there was a significant decrease in body weight among those who consumed vegetables.ConclusionThis study highlights the effect of major modifiable risk factors on health. There is a great need for improving and enhancing a healthy lifestyle behaviour.

Hollow viscus injuries: predictors of outcome and role of diagnostic delay.

IntroductionHollow viscus injuries (HVIs) are uncommon but potentially catastrophic conditions with high mortality and morbidity rates. The aim of this study was to analyze our 16-year experience with patients undergoing surgery for blunt or penetrating bowel trauma to identify prognostic factors with particular attention to the influence of diagnostic delay on outcome.MethodsFrom our multicenter trauma registry, we selected 169 consecutive patients with an HVI, enrolled from 2000 to 2016. Preoperative, intraoperative, and postoperative data were analyzed to assess determinants of mortality, morbidity, and length of stay by univariate and multivariate analysis models.ResultsOverall mortality and morbidity rates were 15.9% and 36.1%, respectively. The mean length of hospital stay was 23±7 days. Morbidity was independently related to an increase of white blood cells (P=0.01), and to delay of treatment >6 hours (P=0.033), while Injury Severity Score (ISS) (P=0.01), presence of shock (P=0.01), and a low diastolic arterial pressure registered at emergency room admission (P=0.02) significantly affected postoperative mortality.ConclusionThere is evidence that patients with clinical signs of shock, low diastolic pressure at admission, and high ISS are at increased risk of postoperative mortality. Leukocytosis and delayed treatment (>6 hours) were independent predictors of postoperative morbidity. More effort should be made to increase the preoperative detection rate of HVI and reduce the delay of treatment.

Upper Extremity Pulse Pressure Predicts Amputation-Free Survival after Lower Extremity Bypass

Increased pulse pressure reflects pathologic arterial stiffening and predicts cardiovascular events and mortality. The effect of pulse pressure on outcomes in lower extremity bypass patients remains unknown. We thus investigated whether preoperative pulse pressure could predict amputation-free survival in patients undergoing lower extremity bypass for atherosclerotic occlusive disease. An institutional database identified 240 included patients undergoing lower extremity bypass from 2005 to 2014. Preoperative demographics, cardiovascular risk factors, operative factors, and systolic and diastolic blood pressures were recorded, and compared between patients with pulse pressures above and below 80 mm Hg. Factors were analyzed in bi- and multivariable models to assess independent predictors of amputation-free survival. Kaplan-Meier analysis was performed to evaluate the temporal effect of pulse pressure ≥80 mm Hg on amputation-free survival. Patients with a pulse pressure ≥80 mm Hg were older, male, and had higher systolic and lower diastolic pressures. Patients with pulse pressure <80 mm Hg demonstrated a survival advantage on Kaplan-Meier analysis at six months (log-rank P = 0.003) and one year (P = 0.005) postoperatively. In multivariable analysis, independent risk factors for decreased amputation-free survival at six months included nonwhite race, tissue loss, infrapopliteal target, and preoperative pulse pressure ≥80 mm Hg (hazard ratio 2.60; P = 0.02), while only tissue loss and pulse pressure ≥80 mm Hg (hazard ratio 2.30, P = 0.02) remained predictive at one year. Increased pulse pressure is independently associated with decreased amputation-free survival in patients undergoing lower extremity bypass. Further efforts to understand the relationship between increased arterial stiffness and poor outcomes in these patients are needed.

SIMULTANEOUS CHANGES IN BLOOD PRESSURE, COGNITION AND BRAIN VOLUME IN AGEING, MILD COGNITIVE IMPAIRMENT AND ALZHEIMER’S DISEASE

Hypertension is associated with reduced brain volume, higher future dementia risk, and greater Alzheimer's disease (AD) pathology. However, average blood pressure (BP) is lower in people with AD than in controls. Understanding whether changes in BP, cognition and brain volume occur simultaneously could inform strategies for AD prevention and management. Using data from two cohorts, we investigated whether baseline BP predicted baseline and changes in cognition, and the correlation between changes in cognition, BP and brain volume change (atrophy). Alzheimer's Disease Neuroimaging Initiative 1 participants were investigated: 198 controls, 345 MCI and 154 ADs. National Alzheimer Co-ordinating Center participants were separately investigated; 1,098 controls, 1,126 mild cognitive impairment (MCI) and 5,100 AD subjects. Multivariate mixed linear regression models were fitted with outcomes of BP (systolic, diastolic and pulse pressure), MMSE and atrophy (whole brain, hippocampus). Analyses were adjusted for age, gender, APOE genotype, head-size (for atrophy) and antihypertensive use (NACC only). A random intercept (BP, MMSE) and random slope (all outcomes) were included for participant level with unstructured covariance to allow for correlations between all random effects. Likelihood ratio tests were used to examine the evidence for the correlation between baseline values of outcomes and the evidence for correlation between change in (Δ) outcomes. In ADNI, higher hippocampal atrophy was associated with greater baseline systolic ((r, p value); 0.2, p=0.004) and pulse pressure (0.2, p=0.007) in MCIs; no associations were found in controls. In NACC, higher baseline systolic BP was associated with lower baseline MMSE in MCIs (-0.23, <0.001); falling MMSE was predicted by falling systolic (0.35, p<0.001) and pulse pressure (0.34, p=0.001). Conversely, in AD patients, lower MMSEs were associated with lower systolic (0.10, p<0.001), diastolic (0.06, p=0.05), and pulse pressure (0.08, p=0.01). These results suggest whilst high BP may be associated with AD development, falling BP may be important in the mid-late AD stages; MCIs with falling BP were more likely to worsen on MMSE, and AD subjects with low systolic BP more likely to have lower baseline MMSEs. Further work is required to understand whether this could inform AD management and prevention strategies.

Autonomic Function Impairment and Brain Perfusion Deficit in Parkinson's Disease.

Autonomic disorders have been recognized as important Parkinson's disease (PD) components. Some vulnerable structures are related to the central autonomic network and have also been linked to autonomic function alterations. The aims of the study are to evaluate the severity of the autonomic dysfunction and the cortical hypoperfusion using arterial spin labeling (ASL) MRI. And then, possible relationships of significant between-group differences in perfusion pattern to clinical variables and autonomic functions were examined to determine the pharmaceutical effects of dopaminergic treatment on cerebral blood flow (CBF) in patients with PD. Brain ASL MRI was carried out in 20 patients with PD (6 men and 14 women, mean age: 63.3 ± 6.4 years) and 22 sex- and age-matched healthy volunteers to assess whole-brain CBF and the effects of dopaminergic therapy on perfusion. All subjects underwent a standardized evaluation of cardiovagal and adrenergic function including a deep breathing, Valsalva maneuver, and 5-min head-up tilt test. Perfusion MRI data were acquired on a 3.0 T scanner with a pulsed continuous ASL technique. The CBF, autonomic parameters, and clinical data were analyzed after adjusting for age and sex. Patients exhibited a decline in autonomic function (rapid heart rate in response to deep breathing, low baroreflex sensitivity, high systolic and diastolic pressure, and altered tilting test response), widespread low CBF, and robust response to dopaminergic therapy. Lower perfusion in the middle frontal gyrus was associated with increased clinical disease severity (Unified Parkinson's Disease Rating Scale I score, P < 0.001). Lower perfusion in autonomic control areas, such as the frontal lobe and insula, were significantly associated with autonomic impairment (P < 0.001). Our study indicates that PD is a progressive neurodegenerative disorder that changes the perfusion of central nervous system and is associated with variable autonomic dysfunctions. Neuronal loss and sympathetic activation may explain the interaction between cortical autonomic region perfusion and cardiovascular autonomic function.

Clinical course and prognostic factors of patients in severe accidental hypothermia with circulatory instability rewarmed with veno-arterial ECMO - an observational case series study

BackgroundRecently, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has become the rewarming treatment of choice in hypothermic cardiac arrest. The detailed indications for extracorporeal rewarming in non-arrested, severely hypothermic patients with circulatory instability have not been established yet. The primary purpose of the study was a preliminary analysis of all aspects of the treatment process, as well as initial identification of mortality risk factors within the group of severely hypothermic patients, treated with arteriovenous extracorporeal membrane oxygenation (VA-ECMO). The secondary aim of the study was to evaluate efficacy of VA-ECMO in initial 6-h period of treatmentMethodsFrom July 2013 to June 2016, thirty one hypothermic patients were accepted for extracorporeal rewarming at Severe Accidental Hypothermia Center, Cracow. Thirteen patients were identified with circulatory instability and were enrolled in the study. The evaluation took into account patients’ condition on admission, the course of therapy, and changes in laboratory and hemodynamic parameters.ResultsNine out of 13 analyzed patients survived (69%). Patients who died were older, had lower both systolic and diastolic pressure, and had increased creatinine an potassium levels on admission. In surviving patients, arterial blood gases parameters (pH, BE, HCO3) and lactates would normalize more quickly. Their potassium level was lower on admission as well. The values of the core temperature on admission were comparable. Although normothermia was achieved in 92% of patients, none of them had been weaned-off VA-ECMO in the first 6 h of treatment.Discussion and ConclusionsIn our preliminary study more pronounced markers of cardiocirculatory instability and organ hypoperfusion were observed in non-survivors. Future studies on indications to extracorporeal rewarming in severely hypothermic, non-arrested patients should focus on the extent of hemodynamic disturbances. Short term (<6 h) treatment in severe hypothermic, non-arrested patients seems to be not clinically appropriate.

Study on variation of blood-pressure in relation to posture among children aged 4-14 years

Background: The response of blood pressure to change in body position has been used in epidemiological studies as a measure of cardiovascular reactivity. Studies had shown that the difference between the supine and seated blood pressures is positively associated with subsequent development of systemic hypertension independent of supine blood pressure. Objective of present study is to study the variation in blood pressure among children in the age group of 4-14 years in relation to the change in their posture.Methods: cross-sectional study was conducted in a rural area near our medical college hospital. A primary and middle school in that area was selected for our study. A total of 500 children in the age group of 4 -14 years were included in our study. Demographic profile was recorded for all children. Height, weight and BMI were measured. Blood pressure measurement was done by using the auscultation method and with appropriate sized blood pressure cuff.Results: The blood pressure shows a gradual increase as the age of the study subjects increases and there was no statistically significant difference in the blood pressure between males and females (p&gt;0.05). Supine posture shows a comparatively higher systolic pressure and a lower diastolic pressure reading than the sitting and standing posture. The mean difference in systolic blood pressure between sitting and supine posture was less than the mean difference between sitting and standing and the mean difference between supine and standing, which was found to be very high and a similar type of result was also shown in the diastolic blood pressure and this mean difference between the postures was found to be statistically significant (p&lt;0.05).Conclusions: Postural changes in systolic and diastolic deserve further study as a potential risk factor for the development of hypertension as this could be easily measured in clinical practice and in epidemiological studies.

Acute Effect of Slow Deep Breathing Maneuver on Patient with Essential Hypertension Stage 1 and 2

Background: Hypertension remains one of the most common health issues in Indonesia. Slow deep breathing maneuver is a non-pharmacological therapy that achieves systolic and diastolic blood pressure lowering effect through sympathetic and parasymphathetic firing rate.Methods: This study was done using cross-sectional design, with consecutive sampling. Sample population was patients with hypertension stage 1 and 2, age range 40-55 years old, who came to Puskesmas Balaraja.Results: Systolic blood pressure lowered from 148.04+5.82 mmHg to 138.15+5.9 mmHg (p&lt;0.05) and diastolic pressure lowered from 85+5.05 mmHg to 78.47+5.46 mmHg (p&lt;0.05). This study showed that there is a relation between the manuever and lowering the systolic and diastolic blood pressure (p=0.000, on T-Test analytical study).Conclusion: Based on the data, the slow deep maneuver can be used as a non-pharmacological therapy for patients with hypertension. Because the effect is acute, it can be considered for hypertension crisis, but further studies are still needed.

The association between high blood pressure, physical fitness and fatness in adolescents.

Hypertension is a health problem that is of national importance. It is a major risk factor for the occurrence of atherosclerosis and cardiovascular, cerebrovascular and renal diseases that are leading or among the leading causes of mortality and morbidity as in ours, as in the most developed and less developed countries. The purpose of this study is to analyze the relation of cardiorespiratory fitness and obesity, blood pressure and hypertension for adolescents. The research was realized on a sample of 4,051 boys and girls at the age of 11 to 14 years. Cardiorespiratory fitness was assessed by using a three minute step test, while the percentage of body fat was determined by bioelectrical impedance method. Blood pressure was measured three times at intervals of 60 seconds, and the result was the median value of the three measurements. The measurements were performed in a separate room with optimum ambient conditions. The relation between hypertension, cardiorespiratory fitness and fat was determined by correlation and multi-nominal logistic regressive analysis. Boys had higher systolic pressure and lower diastolic pressure compared to girls. The low level of cardiorespiratory fitness and high percentage of body fat were independently associated with an increased risk of blood pressure and hypertension for both boys and girls. The interaction was established between the percentage of body fat and fitness. The results should be taken into account for building strategies and recommendations for improvement of lifestyle and health for adolescents.

Acute Effects of Inspiratory Muscle Training on Pulmonary Arterial Pressure,Cardiac Output and Pulmonary Arterial Saturation Derived Oxygen Cost of Breathing

Respiration and respiratory maneuvers affect cardiac output. Inspiratory muscle training (IMT) increases the negative thoracic pressure, which could have an impact on intra-thoracic hemodynamics and thereby influence the cardiac output (CO). The objective of our study was to determine changes in pulmonary arterial (PA) hemodynamics and the CO during IMT in patients with suspected pulmonary hypertension. A new method for measuring the oxygen cost of breathing during IMT was also developed. 22 patients were included in this prospective study. They performed IMT during right heart catheterization. Mixed-venous blood gas analysis was performed before and at the end of IMT to calculate the oxygen cost of breathing. The baseline PA pressure was systolic/diastolic/mean (s/d/m) 41 ± 20/13 ± 20/25 ± 11 mmHg. The CO was 5.3 ± 1.5 l/min. The IMT was set to 2.3 ± 0.6 kPa (23.7 ± 5.7 cmH2O). The PA pressure at the end of IMT was s/d/m 44/10/22 mmHg s/d/m. Though there was a trend towards a lower diastolic pressure, this change was not statistically significant (p=0.06). CO (6.2 ± 1.1 l/min) did not change due to IMT. The mixed-venous hemoglobin oxygen saturation was 71.8 ± 2.3% before IMT, with a significant reduction to 65.8 ± 5.9% (p=0.027) at the end of IMT. IMT as performed in our study neither changed the mean PA pressure nor the CO. Measuring the oxygen cost of breathing is feasible by the method described in our paper.

Prognostic Analysis for Cardiogenic Shock in Patients with Acute Myocardial Infarction Receiving Percutaneous Coronary Intervention.

Cardiogenic shock (CS) is uncommon in patients suffering from acute myocardial infarction (AMI). Long-term outcome and adverse predictors for outcomes in AMI patients with CS receiving percutaneous coronary interventions (PCI) are unclear. A total of 482 AMI patients who received PCI were collected, including 53 CS and 429 non-CS. Predictors for AMI patients with CS including recurrent MI, cardiovascular (CV) mortality, all-cause mortality, and repeated-PCI were analyzed. The CS group had a lower central systolic pressure and central diastolic pressure (both P < 0.001). AMI patients with hypertension history were less prone to develop CS (P < 0.001). Calcium channel blockers and statins were less frequently used by the CS group than the non-CS group (both P < 0.05) after discharge. Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, CV mortality, and all-cause mortality were higher in the CS group than the non-CS group (all P < 0.005). For patients with CS, stroke history was a predictor of recurrent MI (P = 0.036). CS, age, SYNTAX score, and diabetes were predictors of CV mortality (all P < 0.05). CS, age, SYNTAX score, and stroke history were predictors for all-cause mortality (all P < 0.05). CS, age, and current smoking were predictors for repeated-PCI (all P < 0.05).

CARDIOPROTECTIVE EFFECTS OF NECROSTATIN‑1S AND NECROSULFONAMIDE IN THE MODEL OF PROLONGED STATIC COLD STORAGE OF THE DONOR RAT HEART

Objective . To investigate the effects of necroptosis inhibitors — necrosulfonamide and necrostatin‑1s — on morphofunctional characteristics of the myocardium in the model of prolonged cold preservation of the donor rat heart. Design and methods . The study was performed on 27 Wistar rats. The animals were divided into the following groups: 1) control (n = 7), 2) dimethylsulfoxide (DMSO, n = 6), 3) necrostatin‑1s (n = 8), 4) necrosulfonamide (n = 6). All test compounds were administered intraperitoneally 1 hour before the start of the experiment. Histidine-tryptophan-ketoglutarate (HTK) solution cooled to 4 °C was used as a preservative agent. DMSO was used as a solvent for necrostatin‑1s and necrosulfonamide. During the experiment, left ventricular pressure, heart rate and coronary flow were recorded. At the end of 8‑hour of ischemia and 2‑hour of reperfusion, myocardial infarct size was planimetrically evaluated. Results . Necrostatin-1s and necrosulfonamide show cardioprotective effects, as evidenced by the significantly lower levels of myocardial necrosis in these groups, as well as the best indices of intracardiac hemodynamics during reperfusion. In the groups of necrosulfonamide and necrostatin‑1s, myocardial infarct size was 32,2 ± 9,6 and 29,0 ± 9,2 %, respectively, which is significantly lower than in control groups and DMSO (54,4 ± 6,6 and 59,2 ± 5,6 %, respectively, p < 0,05). During reperfusion in necrosulfonamide and necrostatin‑1s groups, higher values of pulse intraventricular pressure and coronary flow rates were recorded, as well as lower diastolic intraventricular pressure, compared to control group and DMSO (p < 0,05). Conclusions . Necroptosis inhibitors necrostatin‑1s and necrosulfonamide improve morphofunctional characteristics of the myocardium state during prolonged cold preservation of the donor heart.

Patient characteristics and risk factors of early and late death in incident peritoneal dialysis patients.

This study was conducted to identify key patient characteristics and risk factors for peritoneal dialysis (PD) mortality in terms of different time-point of death occurrence. The incident PD patients from January 1, 2006 to December 31, 2013 in our PD center were recruited and followed up until December 31, 2015. Patients who died in the early period (the first 3 months) were older, had higher neutrophil to lymphocyte ratio (N/L), serum phosphorus, and uric acid level, and had lower diastolic pressure, hemoglobin, serum albumin, and calcium levels. After adjustment of gender, age, and PD inception, higher N/L level [hazard ratio (HR) 1.115, P = 0.006], higher phosphorus lever (HR 1.391, P < 0.001), lower hemoglobin level (HR 0.596, P < 0.001), and lower serum albumin level (HR 0.382, P = 0.017) were risk factors for early mortality. While, presence of diabetes (HR 1.627, P = 0.001), presence of cardiovascular disease (HR 1.847, P < 0.001) and lower serum albumin level (HR 0.720, P = 0.023) were risk factors for late mortality (over 24 months). In conclusion, patient characteristics and risk factors associated with early and late mortality in incident PD patients were different, which indicated specific management according to patient characteristics at the initiation of PD should be established to improve PD patient survival.

Hypertension and coronary artery disease: epidemiology, physiology, effects of treatment, and recommendations : A joint scientific statement from the Austrian Society of Cardiology and the Austrian Society of Hypertension.

High blood pressure is amajor modifiable risk factor for all clinical manifestations of coronary artery disease (CAD). In people without known cardiovascular disease, the lowest systolic (down to 90-114mmHg) and the lowest diastolic (down to 60-74mmHg) pressures are associated with the lowest risk for developing CAD. Although diastolic blood pressure is the strongest predictor of CAD in younger and middle-aged people, this relationship becomes inverted and pulse pressure shows the strongest direct relationship with CAD in people above 60years of age.Pathophysiological mechanisms of blood pressure as arisk factor for CAD are complex and include the influence of blood pressure as aphysical force on the development of the atherosclerotic plaque, and the relationship between pulsatile hemodynamics/arterial stiffness and coronary perfusion. Treatment of arterial hypertension has been proven to prevent coronary events in patients without clinical CAD. In patients with established CAD, the effect of blood pressure lowering per se is beneficial, probably more than specific drugs or drug classes. The important exceptions are beta blockers (BBs), which are superior to all other drug classes for use after arecent myocardial infarction. Blood pressure targets in patients with established CAD have created controversy in the light of the so-called J-curve phenomenon, which describes an increase in coronary events at lower diastolic blood pressures. One explanation for this observation is that perfusion of the left ventricle occurs predominantly during diastole, and that coronary autoregulation may be exhausted with low diastolic blood pressure in the setting of left ventricular hypertrophy and atherosclerotic narrowing of the epicardial coronaries. The worst situation is ahigh systolic blood pressure in the presence of alow diastolic blood pressure, both ahallmark of increased aortic stiffness. However, the lowering of systolic blood pressure is clearly beneficial in this setting, even at the price of further lowering diastolic pressure. Primary blood pressure goal in patients with established CAD is below 140/90mmHg. Recent studies suggest that alower systolic blood pressure may be appropriate, whereas caution is advised with diastolic blood pressure below 60mmHg.

EFEKTIVITAS COOKIES KACANG KEDELAI TERHADAP PENURUNAN TEKANAN DARAH PADA SISWA MENENGAH ATAS

Background : Essential hypertension is the hypertension that is often experienced by adolescents (aged 13-18 years). Food sources of potassium has excellent potential to lower systolic and diastolic blood pressure. One of them is a soybean that has a potassium content of 1797 mg / 100 g which can be processed into cookies . Objectives : To determine the effectiveness of soy bean cookies to blood pressure in senior high school students of class X State 10 Semarang Method : The types of research is a true experimental Pre and Post Test Control Group Design. Number of subjects in the study of 20 persons. 10 persons the treatment group and 10 persons control group with a blood pressure of students who otherwise hypertension if ≥90 percentile according to age. This type of treatment given is the provision of a cookie soybean 100g a day , for 7 days. Statistical analysis used is anova repeated measure test. Result : In the treatment group there is a decrease in systolic and diastolic blood pressure before and after treatment has been controlled with potassium intake (p=0.000). A decrease in blood pressure after the administration of cookies soybeans is systolic blood pressure of 6.7 mmHg from 135.7 ± 5.16 mmHg to be 129± 4.94 mmHg and diastolic blood pressure 5 mmHg mmHg of 79.00±8.472 to be 75.00 ± 79.475 mmHg in the treatment group. Conclusion : There is a decrease in the effectiveness of blood pressure with soybean cookies s were statistically significant in Senior High School State 10 Semarang students hypertension. As an alternative choice of functional foods and effective in lowering blood pressure.

MP73-10 MODIFIABLE RISK FACTORS TO REDUCE RENAL CELL CARCINOMA CANCER INCIDENCE IN THE PLCO TRIAL

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging I1 Apr 2016MP73-10 MODIFIABLE RISK FACTORS TO REDUCE RENAL CELL CARCINOMA CANCER INCIDENCE IN THE PLCO TRIAL Aashish Kabra, Jonathan Gelfond, Steven Madson, Robert Svatek, Dharam Kaushik, and Michael Liss Aashish KabraAashish Kabra More articles by this author , Jonathan GelfondJonathan Gelfond More articles by this author , Steven MadsonSteven Madson More articles by this author , Robert SvatekRobert Svatek More articles by this author , Dharam KaushikDharam Kaushik More articles by this author , and Michael LissMichael Liss More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1665AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is good evidence that overweight and obesity cause increased incidence of renal cell carcinoma (RCC) Identifying modifiable factors might play a role in disease prevention and reducing healthcare costs. We investigated the PLCO trial to identify modifiable risk factors for RCC. METHODS The PLCO database was queried for the primary outcome of kidney cancer. Demographics were investigated, specifically focusing on modifiable risk factors, such as smoking, obesity, and hypertension. Statistical analysis includes the Student T test for continuous variables, chi-squared or Fisher’s Exact tests for dichotomous variables for univariable analysis. Multivariable analysis included cox proportional hazard models. Time to event analysis included log rank test and displayed as Kaplan-Meier graphs. RESULTS After IRB approval and request to the PLCO for data with data use agreement, we investigate existing data relating specifically to renal cancer. After missing data was excluded, we analyzed 149,683 subjects enrolled in the PLCO trial and noted 0.5% (n=748) subjects developed renal cancer. Age, male gender, body mass index (BMI), diabetes, and hypertension were all significant associations with renal cancer in univariate analysis (all <0.05). Men have a significant increased risk of kidney cancer over women (HR 1.85, 95% CI: 1.58, 2.16, p<0.0001). Non-modifiable risk factors that are associated with kidney cancer include age (HR 1.05, 95% CI: 1.01, 1.05, p=0.001). Modifiable risk factors include obesity measured by body mass index; (HR 1.05 95% CI: 1.02, 1.07, p<0.0001), hypertension (HR 1.32 95% CI: 1.13, 1.54, p=0.0004), and smoking in pack years (HR 1.04 95% CI: 1.02, 1.07, p=0.0002). CONCLUSIONS Reducing obesity, hypertension, and smoking are the three modifiable risk factors that could aggressively be targeted to reduce RCC. In particular, future investigation regarding aggressive management of hypertension with lower systolic and diastolic pressures than 140/90 set by the Joint National Committee and weight loss interventions, especially in at risk men, could prove to be the most beneficial prevention strategy. Further research is needed to elucidate mechanism of increased incidence of RCC in these patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e964 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Aashish Kabra More articles by this author Jonathan Gelfond More articles by this author Steven Madson More articles by this author Robert Svatek More articles by this author Dharam Kaushik More articles by this author Michael Liss More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Analysis of the characteristics of atherosclerosis in elderly hypertensive patients with low diastolic blood pressure and factors associated low diastolic blood pressure

Objective To analyze the characteristics of atherosclerosis in elderly patients with isolated systolic hypertension (ISH) combined with low diastolic blood pressure and risk factors related to low diastolic blood pressure (DBP). Methods A total of 447 elderly patients with untreated ISH were divided into the low DBP (DBP 70 mmHg) group (n=241) according the DBP level. Clinical data including brachial-ankle pulse wave velocity (baPWV), carotid artery ultrasonography, blood lipids, blood glucose, plasma homocysteine were collected and determined. baPWV, carotid intimal-medial thickness (IMT) and the incidence of carotid plaques were compared between the two groups. Risk factors for low DBP were analyzed. Results There were no significant difference in systolic pressure levels between the low DBP group and the non-low DBP group 〔(160.8±10.1) mmHg vs. (161.1±10.9) mmHg, P>0.05〕. Pulse pressure, baPWV levels, IMT and the incidence of carotid artery plaque were higher in the low DBP group than in the non-low DBP group 〔(98.4±11.7)vs. (77.4±12.0) mmHg, (1 785.3±175.0) vs. (1 436.5±114.4), (1.2±0.2) mm vs. (1.1±0.3) mm and 78.2% (161/206) vs. 67.2% (162/241), each P<0.05〕. Stepwise logistic analysis showed that age, gender (female) and diabetes were independent risk factors for low DBP (OR=1.62, 2.07, 1.38, all P<0.05). Conclusions Atherosclerosis is more serious in elderly patents with ISH combined with low diastolic blood pressure than those without low DBP. Age, gender (female) and diabetes are independent risk factors for low DBP. Key words: Hypertension; Atherosclerosis; Risk factors

Characteristic of blood pressure profile in elderly hypertensive patients with chronic kidney disease: a tertiary hospital-based study

To identify the characteristics of blood pressure (BP) in the elderly hypertensive patients with chronic kidney disease (CKD). We retrospectively recruited 337 CKD patients who had been admitted into our renal unit during January 2010 to December 2012 and undergone clinical blood pressure (CBP) and ambulatory blood pressure (ABP) measurement with detailed clinical data. Those with age ≥ 60 years old (n = 94) were designated as elderly patients and their BP data were compared with those of young- and middle-aged patients (< 60 years old, n = 243). Logistic regression was adopted to analyze the independent risk factor for white-coat hypertension and reverse-dipper rhythm. Compared to those < 60 y, the elder CKD patients had the following characteristics: (1) Higher prevalence of white-coat hypertension (24.5% vs 12.3%, P = 0.008). (2) Significantly lower diastolic blood pressure of average 24 h, daytime and nighttime by ambulatory monitoring of blood pressure (ABPM) (all P < 0.001). (3) Higher BP variability with significant difference (all P < 0.05) and more patients with morning surge (11.7% vs 3.7%, P = 0.009). (4) Higher prevalence of reverse-dipper circadian BP rhythm (41.5% vs 25.1%, P = 0.004). (5) Age was an independent predictor for white-coat hypertension (OR = 1.024, 95% CI: 1.004-1.044) and reverse-dipper circadian BP rhythm (OR = 1.016, 95% CI: 1.001-1.032). The BP profile of elderly hypertensive CKD patients is different from that of young- and middle-aged patients. ABPM should be more commonly performed to improve BP treatment of elderly CKD patients.

Analysis of clinical characteristics and risk factors for chronic heart failure in the elderly

Objective To investigate the clinical features and risk factors for chronic heart failure in elderly patients. Methods The 2, 407 chronic heart failure patients were enrolled, including 1, 513 elderly patients (62.9%) (aged≥65 years). Risk factors for chronic heart failure, clinical features, biochemical and physical examination were retrospectively analyzed. The effects of different factors on patients with different age were analyzed by Logistic regression analysis. Results Compared with the young and middle-aged patients, the higher prevalences of New York Heart Association functional classification (NAFC), diabetes, ischemic heart disease, hypertension, anemia, renal insufficiency and hyperuricemia were found, but the percentages of males, smoker, patients with dilated cardiomyopathy, valvular heart disease and hyperlipidemia were reduced in elderly patients. The levels of blood creatinine, high density lipoprotein (HDL), serum potassium, hemoglobin, albumin, pre-albumin, total cholesterol (TC), lower density lipoprotein (LDL), triglyceride (TG) and diastolic blood pressure were lower, but left ventricular ejection fraction (LVEF) and systolic blood pressure were higher, in the elderly patients than in young and middle-aged patients. Elderly patients had higher usage rates of stain and angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB), but lower usage rate of β–blocker as compared with young and middle-aged patients. In elderly patients, logistic regression analysis revealed that gender (OR=1.89, 95%CI: 1.566-2.285), a history of ischemic heart disease (OR=1.81, 95%CI: 1.457-2.243), hypertension (OR=1.87, 95%CI: 1.462-2.389), anemia (OR=2.66, 95%CI: 2.197-3.211), hyperuricemia (OR=1.41, 95%CI: 1.186-1.678) were significantly related with chronic heart failure, whilein young and middle-aged patients, dilated cardiomyopathy (OR=0.49, 95%CI 0.351-0.689), hyperlipidemia (OR=0.53, 95%CI: 0.433-0.641), smoking (OR=0.79, 95%CI: 0.652-0.966) were significantly related with chronic heart failure. Conclusions Gender, ischemic heart? disease, hypertension, anemia, hyperuricemia are the independent risk factors for chronic heart failure in elderly patients. Key words: Ventricular dycfunction; Risk factors

COMPARISON OF HIGH-DEFINITION OSCILLOMETRIC AND DIRECT ARTERIAL BLOOD PRESSURE MEASUREMENT IN ANESTHETIZED CHEETAHS (ACINONYX JUBATUS).

Blood pressure measurement reveals important insights into the health of conscious and anesthetized individuals. This is of particular interest in cheetahs (Acinonyx jubatus), which in captivity are known to suffer from chronic diseases that may be associated with hypertension and which often require immobilization for transport or veterinary treatment. Invasive testing methods are considered the gold standard but are not practical in many settings. Consequently, it is important to evaluate the use of noninvasive methods in this species. Measurements for systolic, diastolic, and mean arterial pressure obtained using high-definition oscillometry (HDO) at the coccygeal artery were compared to simultaneous direct measurements obtained via catheterization of the femoral or dorsal pedal artery in eight anesthetized captive cheetahs during nine anesthetic events. Overall, HDO and direct measurements agreed most closely for mean arterial pressure, and the poorest agreement was observed for systolic pressure. There was a tendency for low diastolic pressures to be underestimated and for high diastolic pressures to be overestimated. Across all three parameters, HDO measurements from the tail overestimated directly measured pressures in the femoral artery and underestimated those in the dorsal pedal artery. HDO agreed most closely with directly measured dorsal pedal pressures. Mean arterial pressure showed the greatest precision (standard deviation of 10.2 mm Hg) and lowest bias (-1.2 mm Hg), with 75.9% of readings within 10 mm Hg of the direct dorsal pedal pressure. Agreement with systolic pressure was hindered by a high bias (-10.4 mm Hg), but if a correction factor of +10 mm Hg was applied to all systolic measurements, agreement was improved and 65.7% of readings were within 10 mm Hg of the direct pressure. When compared to criteria defined by the American College of Veterinary Internal Medicine for validation of blood pressure devices, results were favorable, but a limited sample size prevented formal validation.