Lower Systolic Blood Pressure Research Articles

The impact of atrial fibrillation on oxygen uptake and hemodynamics in patients with heart failure: A systematic review and meta-analysis

Abstract Background Atrial fibrillation (AF) may exacerbate exercise intolerance and hemodynamic limitations in individuals with heart failure (HF). Therefore, we performed a systematic search and meta-analysis to quantify the impact of AF on exercise tolerance (peak oxygen uptake, VO2peak; primary outcome) and exercise hemodynamics (secondary outcomes) in patients with HF. Methods PubMed, Scopus, and Web of Science databases were systematically searched for articles from inception to June 2024. Studies were included if they: 1) examined participants with HF; 2) compared participants with AF to those not in AF (i.e. sinus rhythm); 3) measured VO2peak from expired gas analysis. A fixed-effects meta-analysis was performed, with groups compared using the weighted average effect size, represented as the weighted mean difference (WMD) with 95%-confidence intervals (95%-CI). Results Of 573 identified studies, 16 met the full inclusion comparing VO2peak in HF-patients in AF (HF-AF; n=1,271, 68% male, 67yrs, left-ventricular ejection fraction (LVEF): 41%) and HF in sinus rhythm (HF-SR; n=4,910; 62% male, 62yrs, LVEF: 41%). VO2peak was significantly lower in HF-AF (WMD: -1.55mL/kg/min, 95%-CI: -1.81 to -1.28, n=6,471). This coincided with a slightly lower peak heart rate (WMD: -2.94 b/min, 95%-CI: -4.76 to -1.13 b/min, n=5,115), decreased O2pulse (WMD: -1.58mL/beat, 95%-CI: -1.90 to -1.26, n=3,049) and lower systolic blood pressure (WMD: -11.11mmHg, 95%-CI: -14.01 to -8.21, n=2,409). Conclusions In patients with HF, AF is associated with greater VO2peak impairment, potentially due to reduced stroke volume and/or arterio-venous oxygen difference. This highlights the importance of combined strategies to identify and manage AF in individuals with HF.

Effects of high-intensity interval training on physical performance, systolic blood pressure, oxidative stress and inflammatory markers in skeletal muscle of spontaneously hypertensive rats.

To investigate whether high-intensity interval training (HIIT) improves physical performance, systolic blood pressure, and markers of oxidative stress and inflammation in skeletal muscle of spontaneously hypertensive rats (SHR). Nineteen male SHR rats were randomly assigned to two groups: sedentary (SHRC) and trained (SHR+T). The SHR+T group trained five times a week for eight weeks on a treadmill, while the SHR group remained without any exercise stimulus throughout the experimental period. Maximum physical performance and systolic blood pressure (SBP) were assessed before and after the training period. The following variables were measured in the tibialis anterior (TA) muscle: gene expression of the NADPH oxidase complex (NOX2, NOX4, p22phox, p47phox) and the NF-kB pathway (NF-kB and Ik-B), lipid peroxidation (malonaldehyde; MDA), protein carbonylation, hydrophilic antioxidant capacity (HAC) and pro-inflammatory cytokines (IL-6 and TNF-α). SHR+T rats showed higher physical performance and levels of IL-6, and lower SBP and protein carbonylation (p<0.05), compared with SHRC rats. No significant differences (p>0.05) were observed in the other variables. Our results indicate that HIIT is an effective non-pharmacologic strategy to improve physical performance, reduce SBP, and modulate the skeletal muscle oxidative damage and inflammation in hypertensive rats.

Prevalence and clinical correlates of chronic obstructive pulmonary disease in heart failure patients: a cross-sectional study in China

BackgroundDespite chronic obstructive pulmonary disease’s (COPD)'s prevalence in the general populace, its incidence in heart failure (HF) patients is understudied. This study aimed to assess COPD prevalence and clinical associations in Chinese HF patients.MethodsFrom the Chinese Heart Failure Study, demographic and clinical details of 2008 HF patients were analyzed. Divided into 233 COPD cases and 1775 non-COPD controls, a multivariable logistic regression identified factors linked to COPD onset in HF, with thorough examination of intergroup clinical differences.ResultsThe incidence of COPD in HF individuals was 11.60% (233/2008). The COPD subgroup featured a higher ratio of individuals over 60 and males, alongside lower systolic blood pressure (SBP), body mass index (BMI), higher Charlson Comorbidity Index (CCI) scores, and increased PaCO₂ levels (p &amp;lt; 0.05). Type II respiratory failure and right ventricular dysfunction (RVD) were more prevalent in the COPD subgroup (p &amp;lt; 0.001). Binary logistic regression, after adjustments, indicated positive associations between COPD and age over 60 (OR = 3.831, 95%CI: 1.085–13.526, p = 0.037), male sex (OR = 1.587, 95%CI: 1.032–2.441, p = 0.036), higher CCI (OR = 2.214, 95%CI: 1.796–2.729, p &amp;lt; 0.001), elevated PaCO2 (OR = 1.035, 95%CI: 1.015–1.055, p &amp;lt; 0.001), and RVD (OR = 0.605, 95%CI: 0.119–3.063, p = 0.544). Inversely, higher SBP (OR = 0.990, 95%CI: 0.982–0.998, p = 0.020) and log (triglycerides) (OR = 0.183, 95%CI: 0.064–0.552, p = 0.002) were negatively correlated with COPD in HF patients.ConclusionIn a large cohort of Chinese Heart Failure (HF) patients, our study revealed a notable COPD prevalence. Key risk factors included age, sex, elevated PaCO2, CCI score, and right heart failure, while higher SBP and triglyceride levels offered protection. These insights lay groundwork for probing disease mechanisms and therapeutic approaches.

Factors Determining the Need for Ultrafiltration in Cardiorenal Syndrome

This study investigates the factors determining the need for ultrafiltration (UF) in patients with cardiorenal syndrome presenting with hypervolemia-related symptoms and signs. A total of 88 patients hospitalized for hypervolemia were treated according to current guidelines, with UF employed as a rescue therapy when diuretic treatment failed to achieve adequate decongestion. Data collected included medical history, laboratory findings, blood pressures, diuretic doses, spot urine sodium (measured 6 hours after diuretic therapy), response to diuretics, postdischarge creatinine levels, rehospitalization rates, and mortality rates. UF was required in 23.90% of patients due to insufficient response to diuretics, with a higher rate observed in men (34.10%) compared with women (13.64%). Patients needing UF had lower systolic blood pressure, higher initial serum creatinine levels, and elevated pro-B-type natriuretic peptide levels. Statistical analysis showed that an increase in initial creatinine levels raised the risk of requiring UF by 6.443 times, while a one-unit decrease in urine sodium increased the risk by 1.037 times. These findings suggest that male gender, high pro-B-type natriuretic peptide levels, low spot urine sodium, low systolic blood pressure, and high initial creatinine levels may predict the need for UF. Further research involving larger patient cohorts is necessary to refine these criteria and develop a risk score.

The influence of exercise modality and intensity on ventricular arrhythmia burden and perception of effort in patients with Arrhythmogenic Right Ventricular Cardiomyopathy with plakophilin-2 variants

Introduction Intense endurance exercise is discouraged for patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), as it can increase the risk for adverse cardiac events as well as accelerate disease progression. While a sedentary lifestyle is also not advisable, there is currently no prospective data on the safety of physical activity for ARVC patients. To describe ARVC patients' average and peak ventricular arrhythmia burden – estimated from the prevalence of premature ventricular contractions (PVC) – measured during and after different exercise modalities and intensities, in context with cardiac and physiological load. Methods Twenty ARVC patients (8 f/12 m, age 48 ± 15 years, BMI 24 ± 3 kg/m2, resting PVC burden 4 ± 4%) with a heterozygous pathogenic/likely pathogenic plakophilin-2 (PKP-2) variant prospectively performed different exercises while monitored via 12-lead ECG. The order of modalities was randomized and participants were instructed to stop when surpassing perceived exertion of 15 (6-20 Borg scale). Resistance exercises included 2-min two-legged squats and single arm biceps curls (20 repetitions each) while endurance exercise included 5-min treadmill walking at comfortable speed and 3-min cycling bouts at a heart rate (HR) of 80, 100 and 120 bpm. Each activity was followed by a 10-min recovery period. Blood lactate concentration [La-] was assessed at the end of each cycling bout, with 4 mmol/L defined as a threshold to describe high-intensity exercise. Results No adverse events (including sustained ventricular tachyarrhythmia) nor premature terminations occurred. Average PVC burden during activities (including 5 min recovery) was lower for biceps curls compared with all other activities (p &lt; 0.046), despite having the second highest level of perceived effort (13.8 ± 1.7 units). Biceps curls elicited ~20 mmHg (p &lt; 0.001) lower peak systolic blood pressure and ~40 bpm peak lower HR (p &lt; 0.001) compared with cycling at 120 bpm, despite similar perception of effort (12.9 ± 1.7, p = 0.818). Peak PVC burden during the different activities (highest PVC count in 1 min) ranged between 0–57% among participants and it was lower during the activities (5 ± 8%) than the subsequent 5-min recovery (8 ± 8%, p = 0.006). but no differences were detected between activities. Five patients (25%) presented [La-] that exceeded 4.0 mmol/L when cycling at 120 bpm. Discussion/Conclusion PVC burden, a marker for arrhythmogenicity, was generally higher during recovery than during exercise, with the smallest burden found during the exercise with a small muscle mass, despite high perceived exertion. Thus, such exercises might be better suited for training in ARVC patients. Generalized recommendations for a maximum HR of 120 bpm during exercise likely predispose a high number of ARVC patients to inadvertently perform high-intensity exercise, risking accelerating disease progression. Therefore, individualized exercise prescription should be recommended.

Persistent effect of salt reduction in schoolchildren and their families: 1-year follow-up after an application-based cluster randomized controlled trial

BackgroundA 12-month cluster randomized controlled trial (RCT) demonstrated the effectiveness of an application-based education program in reducing the salt intake and systolic blood pressure (SBP) of schoolchildren’s adult family members. This study aimed to assess whether the effect at 12 months persisted at 24 months.MethodsFifty-four schools were randomly assigned to either the intervention or control group. All participants (594 children in grade 3 and 1188 of their adult family members) who completed the baseline survey were contacted again 12 months after the trial. The primary outcome was the difference in salt intake change between the intervention and control groups at 24 months versus baseline and 12 months, measured by the mean two consecutive 24-h urinary sodium excretions. The secondary outcome was the difference in the change of blood pressure and salt-related Knowledge, Attitude, Practice (KAP) score.ResultsThe difference in salt intake change in adults between the intervention and control groups after adjusting for confounding factors was − 0.38 g/day at 24 months versus baseline (95% CI − 0.81 to 0.05, p = 0.09), following the − 0.83 g/day (95% CI − 1.25 to − 0.41, p < 0.001) at 12 months. The adjusted difference in SBP change was − 2.19 mm Hg (95% CI − 3.63 to − 0.76, p = 0.003) at 24 months versus baseline, following the − 1.80 mm Hg (95% CI − 3.19 to − 0.40, p = 0.01) at 12 months. The intervention group had a higher KAP score than the control group both at 12 months and at 24 months versus baseline. No significant changes were found in children.ConclusionsThe effect of the education program on adults’ salt intake faded, but the SBP lowering effect and the improvement of KAP score remained 12 months after the completion of the RCT. Continuous efforts are needed to maintain the salt reduction effects in real-world settings.Trial registrationChiCTR1800017553. Registered on August 3, 2018.

Interactions between DASH-style diet and ADIPOQ and ARL15 genes polymorphisms on blood pressure and central obesity in Iranian adults

This study aimed to investigate the interactions between the Dietary approaches to stop hypertension (DASH) and the rs1501299 and rs6450176 SNPs in terms of cardiometabolic risk factors. This cross-sectional study was conducted on 387 adults (20–70 years old) residing in Yazd, Iran. The participants were selected from participants in the recruitment phase of the Yazd Health Study (YaHS) which is a population-based cohort of 9,962 adults. The genotypes of rs1501299 and rs6450176 SNPs were determined using the restriction fragment length polymorphism (RFLP) method. Unlike for the G allele carriers of rs1501299, high adherence to the DASH dietary pattern was related to the lower diastolic blood pressure (DBP; P-interaction = 0.014) and systolic blood pressure (SBP; P-interaction = 0.051) in the participants with TT genotype. Moreover, in individuals with the AA genotype of rs6450176 SNP, adherence to this diet was associated with lower SBP (P-interaction = 0.012), waist-to-hip ratio (WHR; P-interaction = 0.026) and waist-to-height ratio (WHtR; P-interaction = 0.040), while in G allele carriers, the mean of these items was greater in individuals with high adherence to the DASH diet. The results suggest that following the DASH diet may be related to lower blood pressure and central obesity indices only in individuals with TT genotype of rs1501299 and AA genotype of rs6450176, respectively, whereas it can be associated with higher WHR and WHtR in G allele carriers of rs6450176.

Frailty determinants in heart failure: Inflammatory markers, cognitive impairment and psychosocial interaction.

This study aimed to identify factors associated with frailty in heart failure (HF) patients, focusing on demographic, biochemical and health-related variables. It also explored the correlation between frailty and comorbidities such as malnutrition, cognitive impairment and depression, assessing how these factors interact to influence frailty risk. A total of 250 HF patients (mean age 73.5±7.2years; 45.6% female) hospitalized for acute decompensated HF were included. Frailty was assessed using Fried phenotype criteria. Cognitive function, depression and nutritional status were evaluated using validated instruments [Mini-Mental State Examination (MMSE), Patient Health Questionnaire-9 (PHQ-9) and Mini Nutritional Assessment (MNA)]. Biochemical markers included C-reactive protein (CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), haemoglobin, estimated glomerular filtration rate (eGFR) and systolic blood pressure (SBP). Statistical analyses, including logistic regression, were performed to assess associations and odds ratios (ORs) for frailty, adjusted for inflammation and HF type. Frailty was present in 60.4% of patients. Frail individuals exhibited significantly higher CRP (median 4.60 vs. 2.54mg/L, P<0.001) and NT-proBNP (median 2558.8 vs. 1102.6pg/mL, P=0.001) and lower haemoglobin (13.7 vs. 14.3g/dL, P=0.012), eGFR (62 vs. 71mL/min/1.73m2, P=0.025) and SBP (130 vs. 134mmHg, P=0.026). Each 10% increase in CRP was associated with a 5.5% increase in frailty odds (P<0.001). Frailty was linked to cognitive impairment (OR 2.1, P=0.018), malnutrition (OR 3.0, P<0.001) and depression (OR 3.1, P<0.001), while high adherence to treatment reduced frailty risk by 78.9% (P=0.027). Interactions were observed between cognitive impairment and body mass index (BMI) (P=0.020), where higher BMI mitigated the frailty odds difference between cognitively impaired and unimpaired patients. Depression's association with frailty odds varied by adherence levels (P=0.034) and central obesity (P=0.047), with the absence of depression offering protection against frailty in patients with central obesity. These interactions remained significant after adjustment for HF type and left ventricular ejection fraction (LVEF) and were consistent across stratifications by these factors. Frailty in HF is influenced by inflammatory markers, cognitive impairment and psychosocial factors. Elevated CRP and NT-proBNP were strong predictors of frailty. Cognitive impairment and depression were key modifiable factors, interacting with BMI, adherence and obesity. Targeting these factors with early interventions could mitigate frailty risk, improving outcomes and quality of life in HF patients.

Loneliness mediates the association between trait social anxiety and cardiovascular reactivity to acute psychological stress.

The primary aims of the current study are (1) to examine the association between trait social anxiety and cardiovascular reactivity to acute psychological stress, and (2) to identify if loneliness significantly mediates the association between trait social anxiety and cardiovascular reactivity. A sample of 658 participants completed a cardiovascular reactivity protocol consisting of a resting baseline and stressor phase (mental arithmetic and Stroop), with systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) monitored throughout. Participants also completed self-reported measures assessing social anxiety and loneliness. Social anxiety was associated with increased self-reported stress. However, no significant associations between social anxiety and measures of cardiovascular reactivity were observed in regression analyses. Loneliness was significantly associated with lower SBP and DBP reactivity. Additionally, loneliness significantly mediated the association between trait social anxiety and both SBP reactivity and DBP reactivity. Here, trait social anxiety predicted greater levels of loneliness, which in turn was associated with diminished cardiovascular reactivity. No significant associations emerged for HR reactivity. These blunted blood pressure responses to acute stress may indicate a potential mechanism leading to adverse prospective health outcomes.

Fluid Resuscitation and Initial Management in Patients Presenting with Sepsis in the General Ward.

The optimal management of hospital-presenting sepsis remains poorly understood. We investigated the initial management in patients presenting with sepsis in the general ward, the association between fluid resuscitation and clinical outcomes, and the factors affecting fluid resuscitation. A retrospective study was conducted on patients who presented with sepsis-induced hypotension in the general ward. Patients were divided into Less 30 (fluid resuscitation less than 30 mL/kg) and More 30 (fluid resuscitation 30 mL/kg or more) groups. Multivariable logistic regression analysis was performed. The median resuscitation fluid volume was 500 mL (9.2 mL/kg) and 2000 mL (35.9 mL/kg) in the Less 30 (n = 79) and More 30 (n = 11) groups, respectively. The intensive care unit (ICU) mortality was similar between the two groups (43.0% vs. 45.5%). Twenty-two patients received continuous renal replacement therapy (CRRT) in the Less 30 group, whereas none received it in the More 30 group (27.8% vs. 0%). Fluid resuscitation ≥30 mL/kg was not associated with ICU mortality. Low body weight and systolic blood pressure were associated with fluid resuscitation ≥30 mL/kg. Most hospital-presenting sepsis patients received less than 30 mL/kg of fluid, and fluid resuscitation was not associated with ICU mortality.

Household Air Pollution Exposures Over Pregnancy and Maternal Blood Pressure Trajectories through 8 Years Postpartum: Evidence from the Ghana Randomized Air Pollution and Health Study (GRAPHS).

Household air pollution is a major contributor to cardiovascular disease burden in women in Sub-Saharan Africa. However, little is known about exposures during pregnancy or the effect of clean cooking interventions on postpartum blood pressure trajectories. The Ghana Randomized Air Pollution and Health Study (GRAPHS) randomized 1414 non-smoking women in the first and second trimesters to liquefied petroleum gas (LPG) or improved biomass stoves - vs control (traditional three-stone open fire). Personal exposure to carbon monoxide was measured at four prenatal timepoints and three times over the first postpartum year. Participants were prospectively followed with annual resting BP measurements at 2, 4, 5, 6, 7, and 8 years postpartum. We employed linear mixed effects models to determine effect of GRAPHS interventions on postpartum BP, and to examine associations between prenatal and postnatal CO and postpartum BP. LPG intervention was associated with 3.54mmHg (95% CI-5.55,-1.53) lower change in systolic BP from enrolment through 8 years postpartum, and 2.27mmHg (95% CI-3.61,-0.93) lower change in diastolic BP from enrolment through 8 years postpartum, as compared to control. In exposure-response analysis, average prenatal CO was positively associated with change in systolic BP from enrolment (β=0.71mmHg, 95% CI 0.08, 1.30, per doubling of CO). LPG cookstove intervention initiated in early pregnancy and maintained through the first postpartum year was associated with lower systolic and diastolic BP trajectories through 8 years postpartum. These findings support the need to integrate clean cooking solutions into existing antenatal care packages.

Contribution of nebulized budesonide before bronchoscopy, a prospective clinical study.

This study evaluated the efficacy of adding budesonide to nebulized lidocaine in patients undergoing flexible bronchoscopy (FB) under topical anaesthesia. Patients aged ≥18years, scheduled for FB under topical anaesthesia were randomized into two groups: the combination group received a pre-treatment of 2ml 1mg budesonide with 5ml 2% lidocaine, whilst the lidocaine group received 5ml 2% lidocaine with 2ml saline solution, both administered via nebulization. Blood pressure (BP), heart rate, and percutaneous oxygen saturation were recorded before, during, and 10min after FB. The Visual Analogue Scale (VAS) and Wong-Baker FACES Pain Rating Scale (FPS-R) were used to evaluate cough severity, discomfort, willingness to accept reoperation, and the operator's satisfaction with patient cooperation. In addition, the duration of the procedure, total lidocaine dosage instilled through the bronchoscope during the procedure, and types of procedures performed were documented. Compared to the lidocaine group, the combination group showed lower maximum systolic and diastolic BP, higher minimum percutaneous oxygen saturation, and lower cough and discomfort severity scores. Operator's satisfaction, as measured via the VAS or FPS-R, was greater in the combination group, which also exhibited shorter procedure times and required lower lidocaine dosages. There were no significant differences between the groups in terms of willingness to accept reoperation or types of procedures performed. In patients undergoing FB with topical anaesthesia, pre-treatment with a combination of nebulized lidocaine and budesonide is more effective than nebulized lidocaine alone. Key message What is already known on this topic? Flexible bronchoscopy (FB) with topical anaesthesia remains a common practice in many settings, although it can cause significant discomfort for patients. What this study adds? Pre-treatment with a combination of nebulized budesonide and lidocaine was more effective and safer than nebulized lidocaine alone for improving patient tolerance during FB. How this study might affect research, practice, or policy? In settings where conscious sedation is not feasible, the combined nebulization of lidocaine and budesonide may offer an optimized approach for FB, enhancing patient comfort and procedural efficiency.

Associations between skeletal muscle mass and elevated blood pressure are independent of body fat: a cross-sectional study in young adult women of African ancestry.

Although research on the relationship between lean body mass and blood pressure (BP) has been inconsistent, most studies reported that measures of lean body mass are associated with a higher risk of hypertension. We explored relationships between body composition (fat and skeletal muscle mass) and BP in 1162 young adult African women. DXA-derived measures of whole body, central and arm fat mass were associated with higher systolic and diastolic BP, while leg fat percentage was associated with lower systolic and diastolic BP. However, only the associations with diastolic BP remained after adjusting for appendicular skeletal muscle mass (ASM). ASM was associated with higher systolic and diastolic BP, before and after adjusting for whole-body fat percentage and VAT.While there was no overlap in targeted proteomics of BP and body composition, REN was lower in the elevated BP than the normal BP group and was inversely associated with diastolic BP (false-rate discovery adjusted p<0.050). Several proteins were positively associated with both VAT and ASM (LEP, FABP4, IL6, and GGH) and negatively associated with both VAT and ASM (ACAN, CELA3A, PLA2G1B, and NCAM1). NOTCH3, ART3, COL1A1, DKK3, ENG, NPTXR, AMY2B, and CNTN1 were associated with lower VAT only, and IGFBP1 was associated with lower ASM only.While the associations between body fat and BP were not independent of skeletal muscle mass, the associations between muscle mass and BP were independent of overall and central adiposity in young adult African women. Future interventions targeting muscle mass should also monitor BP in this population.

Cardiac Computed Tomography Measurements in Pulmonary Embolism Associated with Clinical Deterioration

Introduction: Most pulmonary embolism response teams (PERT) use a radiologist-determined right ventricle to left ventricle ratio (RV:LV) cut-off of 1.0 to risk-stratify pulmonary embolism (PE) patients. Continuous measurements from computed tomography pulmonary angiograms (CTPAs) may improve risk stratification. We assessed associations of CTPA cardiac measurements with acute clinical deterioration and use of advanced PE interventions. Methods: This was a retrospective study of a PE registry used by eight affiliated emergency departments. We used an artificial intelligence (AI) algorithm to measure RV:LV on anonymized CTPAs from registry patients for whom the PERT was activated (2018–2023) by institutional guidelines. Primary outcome was in-hospital PE-related clinical deterioration defined as cardiac arrest, vasoactive medication use for hypotension, or rescue respiratory interventions. Secondary outcome was advanced intervention use. We used bivariable and multivariable analyses. For the latter, we used least absolute shrinkage and selection operator (LASSO) and random forest (RF) to determine associations of all candidate variables with the primary outcome (clinical deterioration), and the Youden index to determine RV:LV optimal cut-offs for primary outcome. Results: Artificial intelligence analyzed 1,467 CTPAs, with 88% agreement on RV:LV categorization with radiologist reports (kappa 0.36, 95% confidence interval [CI] 0.28–0.43). Of 1,639 patients, 190 (11.6%) had PE-related clinical deterioration, and 314 (19.2%) had advanced interventions. Mean RV:LV were 1.50 (0.39) vs 1.30 (0.32) for those with and without clinical deterioration and 1.62 (0.33) vs 1.35 (0.32) for those with and without advanced intervention use. The RV:LV cut-off of 1.0 by AI and radiologists had 0.02 and 0.53 P-values for clinical deterioration, respectively. With adjusted LASSO, top clinical deterioration predictors were cardiac arrest at presentation, lowest systolic blood pressure, and intensive care unit admission. The RV:LV measurement was a top 10 predictor of clinical deterioration by RF. Optimal cut-off for RV:LV was 1.54 with odds ratio of 2.50 (1.85, 3.45) and area under the curve 0.6 (0.66, 0.70). Conclusion: Artifical intelligence-derived RV:LV measurements ≥1.5 on initial CTPA had strong associations with in-hospital clinical deterioration and advanced interventions in a large PERT database. This study points to the potential of capitalizing on immediately available CTPA RV:LV measurements for gauging PE severity and risk stratification.

COMPARISON OF TWO DIFFERENT DOSES OF TABLET CLONIDINE (100MCG AND 150MCG) GIVEN 90 MIN PRIOR TO SURGERY TO ATTENUATE HAEMODYNAMIC CHANGES DURING ENDOTRACHEAL INTUBATION

Objective: Endotracheal intubation can elicit significant haemodynamic responses, posing risks for patients with cardiovascular conditions. Clonidine, an alpha-2 adrenergic agonist, is used to mitigate these responses, but the optimal dosing is uncertain. This study compares the efficacy and safety of two doses of oral clonidine, 100 μg and 150 μg, administered 90 min before surgery. Methods: Sixty patients aged 18–55 y, classified as ASA physical status I or II and scheduled for elective lower abdominal surgeries, were randomly assigned to two groups. Group A received 100 μg of oral clonidine, and Group B received 150 μg. Haemodynamic parameters-heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)-were recorded at baseline, during induction, immediately after intubation, and at intervals up to 15 min post-intubation. Side effects and the need for rescue analgesia were also assessed. Results: Group A demonstrated significantly lower SBP and HR at induction and during the immediate post-intubation period compared to Group B (p &lt; 0.05). No significant differences were observed in DBP and MAP at most time points. The incidence of hypotension was higher in Group B but not statistically significant. Group B required significantly less rescue analgesia postoperatively (p &lt; 0.001). Conclusion: A 100 μg dose of oral clonidine is more effective in attenuating haemodynamic responses during endotracheal intubation compared to a 150 μg dose. While the higher dose offers improved postoperative analgesia, it does not enhance haemodynamic stability and may increase the risk of hypotension.

Effects of Scalp Nerve Block on Symptomatic Cerebral Hyperperfusion Syndrome After Combined Revascularization Surgery for Moyamoya Disease.

Strict blood pressure control can be used to prevent or treat cerebral hyperperfusion syndrome. This study investigated whether scalp nerve block (SNB) is associated with a reduced risk of postoperative symptomatic cerebral hyperperfusion syndrome (SCHS) by reducing postoperative blood pressure in adult patients who underwent combined revascularization surgery for moyamoya disease. Patients were retrospectively divided into the SNB (n=167) and control (n=221) groups depending on whether SNB was performed immediately before placement of wound dressings at the end of surgery. Postoperative SCHS was defined as new-onset postoperative neurological deficits with a focal increase in cerebral blood flow at the perianastomosis site in the absence of infarction or hemorrhage on postoperative brain imaging. Inverse probability of treatment weighting was used to balance preoperative variables between the 2 groups. The incidence of postoperative SCHS did not differ between the SNB and control groups (61 [36.5%] vs. 102 [46.2%], P=0.072), but its duration was shorter in the SNB group (4 [2-6] vs. 5 [3-7] days, P=0.021). Although of limited clinical relevance, the SNB group had lower postoperative pain scores and systolic blood pressures at postoperative days 0 to 1 and a shorter intensive care unit stay. Despite some potential benefits, SNB was not associated with a reduced incidence of postoperative SCHS in adult patients who underwent combined revascularization surgery for moyamoya disease.

Association of antihypertensive drug target genes with alzheimer’s disease: a mendelian randomization study

BackgroundEpidemiological and genetic studies have elucidated associations between antihypertensive medication and Alzheimer’s disease (AD), with the directionality of these associations varying upon the specific class of antihypertensive agents.MethodsGenetic instruments for the expression of antihypertensive drug target genes were identified using expression quantitative trait loci (eQTL) in blood, which are associated with systolic blood pressure (SBP). Exposure was derived from existing eQTL data in blood from the eQTLGen consortium and in the brain from the PsychENCODE and subsequently replicated in GTEx V8 and BrainMeta V2. We performed two-sample Mendelian randomization (MR) to estimate the potential effect of different antihypertensive drug classes on AD using summary statistics from a meta-analysis (111,326 cases and 677,663 controls) and further replicated in FinnGen cohorts (9301 cases and 367,976 controls). The reverse causality detection, assessing horizontal pleiotropy, Bayesian co-localization, phenotype scanning, and protein quantitative trait loci (pQTL) analysis were implemented to consolidate the MR findings further.ResultsA 1-standard deviation (SD) lower expression of the angiotensin-converting enzyme (ACE) gene in blood was associated with a lower SBP of 3.92 (95% confidence interval (CI), 2.69–5.15) mmHg but an increased risk of AD (odds ratio (OR), 2.46; 95% CI, 1.82–3.33). A similar direction of association was also observed between ACE expression in prefrontal cortex (OR, 1.19; 95% CI, 1.10–1.28), frontal cortex (OR, 1.19; 95% CI, 1.11–1.27), cerebellum (OR, 1.13; 95% CI, 1.09–1.17), cortex (OR, 1.59; 95% CI, 1.33–1.28) and ACE protein levels in plasma (OR, 1.13; 95% CI, 1.09–1.17) and AD risk. Colocalization supports these results. Similar results were found in external validation. We found no evidence for an association between genetically estimated blood pressure (BP) and AD risk.ConclusionsThere findings suggest an adverse association of lower ACE messenger RNA and protein levels with an elevated risk of AD, irrespective of its BP-lowering effects. These findings warrant greater pharmacovigilance and further investigation into the effect of ACE inhibitors, particularly those that are centrally acting, on neurodegenerative symptoms in patients with AD.

Camk2n1 deficiency reduces the NaCl cotransporter activity through the CUL3/KLHL3/WNK4 complex in the kidney.

Calcium/calmodulin dependent protein kinase II inhibitor 1 (Camk2n1) is closely associated with a peak logarithm of odds score in quantitative trait loci for systolic blood pressure. Increased Camk2n1 mRNA expression has been specifically observed in the kidneys of hypertension mouse models. However, the precise role of Camk2n1 in the kidney remains unclear. We generated Camk2n1-/- mice using the CRISPR/Cas9 system. Compared to controls, Camk2n1-/- mice exhibited consistently lower systolic blood pressure across all measured time points. Deletion of Camk2n1 resulted in decreased apical labeling of phosphorylated and total thiazide-sensitive NaCl cotransporter (NCC) in the distal convoluted tubule. NCC phosphorylation is regulated by activated SPAK/OSR1 kinases, which act downstream of With-No-lysine (K) kinase (WNK). In Camk2n1-/- mice, the elevated abundances of key components of the Cullin 3 (CUL3) RING ubiquitin ligase, including neddylated CUL3 and the adaptor Kelch-like protein 3, promoted proteasomal degradation of WNK4. In renal tissues, Camk2n1 deletion led to increased mRNA and protein levels of ubiquitin-like modifier-activating enzyme 3 (UBA3) and ubiquitin-conjugating enzyme E2 (UBE2M). Conversely, Camk2n1 overexpression in HEK293 cells resulted in decreased levels of UBA3 and UBE2M, along with reduced CUL3 neddylation. Treatment with MLN4924 effectively suppressed CUL3 hyperneddylation and restored WNK4 levels in the kidneys of Camk2n1-/- mice. In summary, Camk2n1 deletion lowers blood pressure, likely by promoting WNK4 degradation through dysregulated CUL3 RING ubiquitin ligase activity, which leads to decreased NCC activity.

Effects of Immediate Postpartum Diuretic Treatment on Postpartum Blood Pressure among Individuals with Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis.

Hypertensive disorders of pregnancy (HDP) are associated with ongoing postpartum hypertension (HTN) and increased morbidity. Extravascular water and sodium mobilization is implicated in postpartum blood pressure (BP) elevation, however trials of postpartum diuretics in HDP have had mixed results. Our meta-analysis aimed to analyze the impact of postpartum diuretics on postpartum hypertension following HDP. Systematic review identified randomized controlled trials (RCTs) studying the efficacy of diuretics in the treatment of postpartum BP. Meta-analysis outcomes included persistent HTN up to 10 days postpartum, mean postpartum systolic and diastolic BPs, and use of additional antihypertensive medications. From 9 RCTs, 1273 subjects were included in the meta-analysis. Postpartum diuretic use was associated with lower systolic BP (SMD standard mean difference]: -0.36; 95% confidence interval [CI]: -0.72; -0.01) without a difference in diastolic BP (SMD: 0.01; 95% CI: -0.22; 0.23) compared with controls. There was no difference in rates of persistent HTN between the postpartum diuretics group versus controls (OR: 0.70; 95% CI: 0.4; 1.05) or in antihypertensive medication use (OR: 0.66; 95% CI: 0.42; 1.05). Postpartum diuretic use was associated with lower systolic BP compared with controls and non-significant trends of lower rates of persistent HTN and postpartum antihypertensive medication use. Due to the low certainty of evidence, uniform postpartum diuretic use with HDP cannot be recommended. Future studies are needed to evaluate specific HDP subgroups who may benefit from diuretic use.

Functional Outcomes Following Injury in Pediatric Patients without Traumatic Brain Injury

BackgroundPediatric trauma patients often have disability after successful resuscitation for hemorrhage. Clinical characteristics related to dependency on living following injury were elucidated among pediatric patients without traumatic brain injury. MethodsThis retrospective cohort study used the 2019–2021 Japan Trauma Data Bank and included pediatric patients aged ≤16 years without head injury (Abbreviated Injury Scale [AIS] ≥ 2). The unfavorable function was defined as dependency in daily life at discharge (Glasgow Outcome Scale ≤ 3), and predictors for unfavorable functional outcomes were examined using a generalized estimating equations (GEE) model, including age, sex, physical disability before injury, injury mechanism, transportation time, prehospital procedures, vital signs on arrival, surgery in each body region, transfusion, AIS in each region, and institutions. Furthermore, these factors were analyzed separately in toddler/preschool (≤5 years), school age (6–11 years), and adolescence (12–16 years). ResultsAmong 1,412 patients eligible for the study, 137 had an unfavorable physical function at discharge. The GEE model revealed that female sex, physical disability before injury, prehospital transfusion, lower Glasgow Coma Score (GCS) score on arrival, neck surgery, and higher AIS in the neck and extremity/pelvis were independently associated with unfavorable function at discharge. In age-specific analyses, physical disability before injury strongly predicted worse functional outcomes in toddlers/preschoolers, whereas higher AIS in the chest and lower systolic blood pressure on arrival were additional predictors of dependent living among adolescents. ConclusionsSevere neck/extremity/pelvis injury and lower GCS on arrival are associated with unfavorable functional outcomes in patients with pediatric trauma.