Maximum Systolic Blood Pressure Research Articles

Effect of a hypertensive response during exercise on growth rates of aortic diameters.

Aortic diameters are related to age, sex, and body size. There are a scarcity of data on the long-term sequelae of a hypertensive response to exercise (HRE) on aortic diameters. In this retrospective cohort study, we aimed to evaluate the relationship between the growth rates of the aorta in individuals with a HRE. Our analysis included follow-up data of 649 patients recruited between January 2009 and December 2014 with a HRE. Participants with known connective tissue disease or a history of acute aortic syndrome were excluded. Sinus of Valsalva (SoV) and ascending aorta (AscAo) diameters were measured by transthoracic echocardiography using leading edge to leading edge convention at end-diastole. At baseline, median age, maximum systolic blood pressure (BP), body mass index (BMI), diameter of the SoV, and AscAo were 62 years, 208 mmHg, 26.9kg/m2, 35mm, and 35mm respectively. 32% of patients were female and 67% had hypertension. After a median follow-up of 7.1 years, mean yearly growth rates (±SD) of the SoV and AscAo were 0.09 (0.41) mm and 0.13 (0.56) mm respectively. No significant associations were observed between growth rates of aortic diameters and maximum systolic and diastolic BP or when considering only individuals with a baseline diameter > 40mm. In this large cohort study, maximum systolic and diastolic BP during exercise showed no association with growth rates of aortic diameters. Furthermore, the mean growth rates of aortic diameters in this population were in line with growth rates in a normal population.

Triglicerydes/high-density lipoprotein ratio as a risk factor of post-Covid-19 sinus tachycardia: A retrospective study.

Inappropriate sinus tachycardia (IST) is one of the manifestations of the post-COVID-19 syndrome (PCS), which pathogenesis remains largely unknown. This study aimed to identify potential risk factors for IST in individuals with PCS. The 1349 patients with PCS were included into the study. Clinical examination, 24H Holter ECG, 24H ambulatory blood pressure monitoring and biochemical tests were performed 12-16 weeks after the COVID-19 in all participants. IST was found in 69 (3.5%) individuals. In the clinical assessment IST patients were characterized by a higher age (p < 0.001) and lower prevalence of the diagnosed hypertension (p = 0.012), compared to remaining patients. Biochemical testing showed higher serum triglycerides (1.66 vs. 1.31 pmol/L, p = 0.007) and higher prevalence of a low high-density lipoprotein (HDL) cholesterol (24.6% vs. 15.2%, p = 0.035) in the IST group. Subsequently, the triglicerydes (TG)/HDL ratio, an indicator of insulin resistance, was significantly higher in the IST individuals (3.2 vs. 2.4, p = 0.005). 24H monitoring revealed a significantly higher minimum diastolic, maximum systolic and mean arterial blood pressure values in the IST group (p < 0.001 for all), suggesting a high prevalence of undiagnosed hypertension. A multivariate analysis confirmed the predictive value TG/HDL ratio >3 (OR 2.67, p < 0.001) as predictors of IST development. A receiver operating characteristic curve analysis of the relationship between the TG/HDL ratio and the IST risk showed that the predictive cut-off point for this parameter was 2.46 (area under the ROC curve = 0.600, p = 0.004). Based on these findings, one can conclude that insulin resistance seems to be a risk factor of IST, a common component of PCS.

Exercise-induced Hypertension and Carotid Intima-media Thickness in Male Marathon Runners.

This study aimed to identify the relationship between exercise-induced hypertension and carotid artery intima-media thickness in long-distance runners. Sixty healthy male runners aged 40 to 60 years were assigned to the following three groups based on resting blood pressure and maximal systolic blood pressure during a maximal exercise test: normal blood pressure response, exercise-induced hypertension, and complex hypertension. An exaggerated systolic blood pressure response was defined as a maximal systolic blood pressure+≥+210 mmHg during the maximal exercise test, while carotid intima-media thickness was measured using B-mode ultrasonography. The carotid intima-media thickness mean values were the highest in the complex hypertension group (0.72±0.11 mm), followed by exercise-induced hypertension (0.62±0.12 mm) and normal blood pressure groups (0.55±0.13 mm), with a significant difference between the groups (p+<+0.002). In linear regression analysis, the mean intima-media thickness was independently associated with age (p=0.015) and maximal systolic blood pressure (p=0.046) but not with resting systolic blood pressure. These results suggest that exercise-induced hypertension is associated with carotid intima-media thickness, a surrogate marker of cardiovascular disease, in long-distance runners. Therefore, evaluating the blood pressure response during exercise is important for the early detection of potential cardiovascular disease risks in long-distance runners.

Comparison of the efficacy for early warning systems in predicting obstetric critical illness

ObjectiveTo validate the accuracy of four early warning scores for early identification of women at risk. MethodsThis was a retrospective study of pregnant women admitted in obstetrics Critical Care Unit (ICU). Capacity of the Modified Obstetric Early Warning Score (MOEWS), ICNARC Obstetric Early Warning Score (OEWS), Maternal Early Obstetric Warning System (MEOWS chart), and Maternal Early Warning Trigger (MEWT) were compared in predicting severe maternal morbidity. Area under receiver operator characteristic (AUROC) curve was used to evaluate the predictive performance of scoring system. ResultsA total of 352 pregnant women were enrolled and 290 were identified with severe maternal morbidity. MOEWS was more sensitive than MEOWS chart, ICNARC OEWS and MEWT (96.9 % vs. 83.4 %, 66.6 % and 44.8 %). MEWT had the highest specificity (98.4 %), followed by MOEWS (83.9 %), ICNARC OEWS (75.8 %) and MEOWS chart (48.4 %). AUROC of MOEWS, ICNARC OEWS, MEOWS chart, and MEWT for prediction of maternal mortality were 0.91 (95 % CI: 0.874–0.945), 0.765(95 % CI: 0.71–0.82), 0.657(95 % CI: 0.577–0.738), and 0.716 (95 % CI, 0.659–0.773) respectively. MOEWS had the highest AUCs in the discrimination of serious complications in hypertensive disorders, cardiovascular disease, obstetric hemorrhage and infection. For individual vital signs, maximum diastolic blood pressure (DBP), maximum systolic blood pressure (SBP), maximum respiratory rate (RR) and peripheral oxygen saturation (SPO2) demonstrated greater predictive ability. ConclusionMOEWS is more accurate than ICNARC OEWS, MEOWS chart, and MEWT in predicting the deterioration of women. The prediction ability of DBP, SBP, RR and SPO2 are more reliable.

Abstract WP175: Effect of Acute Blood Pressure Management on Outcomes in Patients With Nontraumatic Intracerebral Hemorrhage: Quality Assurance Study

Current guidelines for blood pressure (BP) management in patients with intracerebral hemorrhage (ICH) recommend acute lowering of systolic BP (SBP) to 140 mm Hg with a maintenance goal of 130 - 150 mm Hg. There remains a knowledge gap regarding frequency of BP monitoring, and level of SBP lowering in acute phase of ICH. Our study aimed to investigate effect of frequency of BP monitoring and acute SBP lowering in ICH patients within 48 hours of their admission. Methods: We conducted a retrospective review of study from our institutional SHOUT database (Stroke Health Outcomes Database) database. All ICH patients from 2018 through 2022 were included. Data involving BP measurements, maximum SBP and average BP within the first 48 hours of admission were collected. BP was categorized into 3 categories of &lt;140, 140-160 and &gt;160 mmHg. Frequency of BP measurements was obtained and was classified as &lt;25, 25-50 and &gt; 50 measurements of BP in the first 48 hours. Demographic data along with comorbidities were included in the analysis. Outcome was considered good if the patients were discharged home or had discharge mRS of 0-2. Outcome was considered poor if patient was discharged to a subacute rehabilitation facility or had mRS of 3-5. Results: 2998 patients were found to have ICH. 64.2 % of patients achieved lower mean BP &lt; 140 mm Hg and were found to have good outcome of home disposition. These results were statistically significant (P= 0.002). BP monitoring of &gt; 50 times was more likely to result in better outcomes in patients with ICH when compared to less monitoring (P&lt;0.001). Discussion: ICH patients who had higher number of BP readings during first 48 hours of their admission were more likely to have good outcome. Aggressive lowering of SBP was associated with higher likelihood of discharge to home or mrs 0-2.

Evaluation of Apatinib-Related Hypertension and Identification of Clinical Risk Factors

Purpose. Hypertension (HTN) is one of the most common adverse drug reactions to tyrosine kinase inhibitors (TKIs) targeting vascular endothelial growth factor (VEGF), but little is known about its clinical risk factors. The aim of this study was to elucidate the association between baseline clinical characteristics and the occurrence of HTN in advanced gastric cancer (GC) patients prescribed apatinib, a commonly used VEGF-TKI in China, in a real-world setting. Patients and Methods. Fifty-five GC patients treated with apatinib from December 1st, 2016, to December 1st, 2020, were retrospectively included in electronic medical records. Adverse drug reactions were defined according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Univariate and multivariable logistic regression analyses were used to investigate potential clinical risk factors for apatinib-related HTN. Results. The incidence of apatinib-related HTN of all grades was 45.45%, and grade 3 HTN occurred in 16.36% of patients. The median maximal systolic blood pressure (SBP) during apatinib treatment was 153 mm·Hg, and the median time to event was 25 days. New-onset HTN occurred in 10/33 (30.30%) patients. Preexisting HTN (odds ratio [OR]: 4.155; 95% confidence interval [CI]: 1.252, 13.787; p=0.020) was the key independent risk factor associated with apatinib-related HTN. Conclusion. The incidence of HTN was high in patients treated with apatinib, and preexisting HTN was an independent risk factor. It is important to provide thorough and close monitoring of patients during treatment with apatinib, especially for those with preexisting HTN. This trial is registered with ChiCTR1900024531.

Chronic kidney disease associated with hypertension

Background: Globally, chronic kidney disease (CKD) is acknowledged as a major public health issue. Both the incidence and prevalence of chronic kidney disease (CKD) are rising with immense pace worldwide. Hypertension and diabetes mellitus is the main risk factor of chronic kidney disease. Objective: To determine chronic Kidney disease associated with hypertension Methods: A cross-sectional study was conducted at district headquarter hospital, Mianwali, Pakistan, which was performed between June 2020 and February 2022, the total number of patients in our study were 120. The number of Male patients were 49 and female were 71. In 120 consecutive patients who underwent for blood tests and Blood pressure monitoring. We also took stages of chronic kidney disease (CKD stage 1,2,3A,3B,4 and 5). We did renal function test for all patients (serum creatinine and serum urea). Data was tabulated and analyzed by SPSS. Results: In a current study total 120 patients were enrolled. The minimum age of patients were30 and the maximum age of the patients were 84. The mean age were 50.60±10.9 years. The minimum systolic blood pressure were 130 and maximum systolic blood pressure were 200. The mean systolic blood pressure were 149.55±13.5. The minimum diastolic blood pressure were 80 and the maximum diastolic blood pressure were 100. The mean diastolic blood pressure were 89.57±3.76 The frequency of male patients were 49 and its percentage were 40.8. The frequency of female patients were 71 and its percentage were 59.2. The frequency of age group 30-50 years were 61 and its percentage were 50.8. The frequency of age group 51-70 years were 52 and its percentage were 43.3. The frequency of age group &gt;70 years were 7 and its percentage were 5.8. The mean of renal functional test Serum creatinine were 7.82 mg/dl and its SD value were 3.59 mg/dl. The mean of renal functional test Serum urea were 109.90 mg/dl and its SD value were 24.30 mg/dl. · The mean glomerular filtration rate were 20.36 ml/min and its SD value were 13.2 ml/min. · The mean weight of patients were 56.61 kg and its SD value were 10.19 kg. · The P-value of stages of Chronic kidney disease (CKD) were 0.133. The P-value of hypertension were 0.074. Conclusion: Hypertension and diabetes mellitus is the main cause of Chronic kidney disease (CKD). Stage 5 Chronic kidney disease (CKD) patients were more in our study as compare to other stages of CKD. We concluded in our study that after age of 30, patients have higher risk of Chronic kidney disease (CKD).

The influence of systolic arterial pressure in the first day after systemic thrombolysis on ischemic stroke outcomes and complication rate: a retrospective single-center study

Introduction. Reperfusion (both pharmacological and interventional) is the cornerstone of acute ischemic stroke (AIS) management. Currently, there are only limited data in the scientific literature regarding the influence of systemic hemodynamic parameters on the recanalization status and complications of AIS.The objective of our study was to assess the relationship between the systemic hemodynamic parameters in the early postreperfusion period and the outcomes of AIS.Materials and methods. For retrospective analysis, data of 292 patients who received intravenous thrombolysis (IVT) at the Arkhangelsk Regional Stroke Center between 2010 and 2021 were collected. The main endpoints were functional outcome, mortality, and symptomatic intracranial hemorrhage (sICH). The success of reperfusion was defined as the neurological improvement by 4 or more points of the NIHSS score within the first 24 hours after the start of IVT.Results. The relationship between mean systolic blood pressure (SBP) during the first 24 hours of IVT and functional recovery was obtained: B = 0.016 (β = 0.096) [95 % CI 0.000 – 0.031] (р = 0.49). The relationship between maximal SBP during the first day of IVT and functional recovery was also determined: B = 0.009 (β = 0.102) [95 % CI 0.001 – 0.018] (p = 0.037). The sICH occurred in nine cases, all of them were in the group without achieving successful reperfusion.Conclusion. The baseline levels of SBP ≥ 160 mm Hg at hospital admission in patients with AIS followed by IVT are accompanied by worse functional outcome and greater odds of death. The neurological improvement with significant decline in the NIHSS score during the first 24 hours after IVT is associated with a decreased risk of sICH.

[Metabolic Outcomes of Primary Aldosteronism Patients Receiving Adrenalectomy or Spironolactone Treatments].

To investigate the metabolic outcomes of primary aldosteronism (PA) patients receiving adrenalectomy (ADX) or spironolactone treatment and the contributing factors to the metabolic outcomes. The clinical data of 70 patients with aldosterone-producing adenoma (APA) and 86 patients with idiopathic hyperaldosteronism (IHA) were retrospectively analyzed. All subjects received confirmatory diagnosis of APA or IHA at the Department of Endocrinology and Metabolism, West China Hospital between March 2018 and October 2020. APA patients underwent ADX, while IHA patients were given spironolactone, a mineralocorticoid receptor antagonist (MRA). After ADX or spironolactone treatment, the outcomes of the metabolic indicators and the inter-group differences between the APA patients and IHA patients were studied. There was no significant difference between the baseline data of the APA group and those of the IHA group in terms of age, sex, duration of hypertension, maximum systolic blood pressure (SBP-max), maximum diastolic blood pressure (DBP-max), body mass index (BMI), fasting blood glucose (FBG), lipid parameters, and renal function. IHA patients had higher waist circumference, serum potassium, and plasma renin activity (PRA) than those of the APA patients (all P<0.05). All patients showed significant improvement in blood pressure, blood potassium, and plasma aldosterone at follow-up. However, they also showed increased triglycerides (TG) accompanied by deterioration in renal function (P≤0.001). Multiple regression showed that TG levels were associated with spironolactone treatment for IHA patients and post-treatment BMI and creatinine levels. Furthermore, APA patients showed improvement in their FBG after ADX (P=0.041), while IHA patients showed elevated levels of FBG after spironolactone treatment (P=0.037). After treatment, PA patients still may experience abnormal lipid metabolism and deteriorating renal function. Spironolactone therapy may give rise to worse glucolipid metabolism than ADX therapy does.

Reperfusion status and postoperative blood pressure in acute stroke patients after endovascular treatment.

An aggressive lowering of blood pressure (BP) could lead to neurological worsening, particularly of the area that has not been reperfused in acute stroke patients with large vessel occlusion (LVO). We sought to investigate the association of reperfusion status and BP course following mechanical thrombectomy (MT) with outcomes in LVO. Consecutive patients with LVO treated with MT between Jan 2020 to Jun 2021 were enrolled in a retrospective cohort study. Hourly systolic BP (SBP) and diastolic BP (DBP) were recorded for 72 h following MT and maximum SBP and DBP levels were identified. The Extended Thrombolysis in Cerebral Infarction (eTICI) scale was used to assess reperfusion extent. LVO patients were stratified in 2 groups based on reperfusion status: complete reperfusion (eTICI 3) and incomplete reperfusion (eTICI 2b/c). Three-month functional independence was defined as a modified Rankin Scale score of 0-2. A total of 263 acute ischemic stroke patients with LVO were retrospectively evaluated. Complete reperfusion was achieved in 210 patients (79.8%). Post-MT maximum SBP over 160 mmHg was significantly related to worse functional outcome (38.1% vs. 55.7%, p = 0.006), higher likelihood of in-hospital mortality and 3-month mortality (19.0% vs. 6.9%, p = 0.004, 27.4% vs. 14.3%, p = 0.012). No statistical correlation was found between reperfusion status and blood pressure level (p > 0.05). In patients with complete reperfusion, patients with an average BP 120-140 mmHg tends to have worse functional outcome compared with 100-120 mmHg (OR = 1.77, 95%CI: 0.97-3.23, p = 0.061). High maximum SBP levels following MT are associated with an increased likelihood of 3-month functional dependence and mortality. An average BP of 100-120 mmHg tends to have better functional independence in completely reperfused patients. The effect of intensive BP control on incomplete reperfusion still warrants further investigations.

Former SARS-CoV-2-Infection is related to decreased peak VO2 and exercise hyperten-sion in athletes

Abstract Background The COVID-19 pandemic dramatically changed lifestyle worldwide, including sport activities. Although most competitive athletes have an asymptomatic or mildly symptomatic SARS-CoV-2-infection course and are a low-risk population to develop cardiac and other complications after SARS-CoV-2-infection, a post-COVID-19 screening strategy primarily based on symptoms should detect cardiac involvement and other complications from SARS-CoV-2-infection and should enable save and early return-to-sport. However, incidence, complications and performance consequences of COVID-19-infection in athletes are not fully understood. Purpose Thus, the primary aim of the present study was to identify differences in athletes with former COVID-19-infections in comparison to those athletes without COVID-19-infection presenting for their preparticipation screening examination. Methods Competitive athletes of any age, who presented for preparticipation screening 04/2020-10/2021 were included in this study and stratified for former COVID-19-infection. Athletes with and without former COVID-19-infection were compared. Exercise hypertension was defined on the basis of the systolic blood pressure (BP)/MET slope-method: The Δ regarding systolic BP was calculated as maximum systolic BP during exercise–systolic BP at rest and was indexed by the increase in MET from rest (Δ regarding MET was calculated as peak MET – 1) to obtain the systolic BP/MET slope. In accordance with previous studies, a cut-off value &amp;gt; 6.2 mmHg/MET was used to define an exercise hypertension. Results Overall, 1200 athletes (mean age 21.9±11.6years; 34.3% females) were included in this study 04/2020-10/2021. Among these, 158 (13.1%) athletes had former COVID-19-infection. Athletes with former COVID-19-infection were older (23.4±7.1 vs. 21.7±12.1years, P&amp;lt;0.001) and more often of male sex (87.7% vs. 64.0%, P&amp;lt;0.001). While systolic/diastolic BP at rest was comparable between both groups, maximum systolic (190.0 [170.0/210.0] vs. 180.0 [160.0/205.0] mmHg, P=0.007) and diastolic BP (70.0 [65.0/75.0] vs. 70.0 [60.0/75.0] mmHg, P=0.012) during exercise-test and frequency of exercise hypertension (54.2% vs. 37.8%, P&amp;lt;0.001) were both higher in athletes with COVID-19-infection. While former COVID-19-infection was not independently associated with higher BP values at rest and maximum BP values during exercise, former COVID-19-infection was related with exercise hypertension (OR 2.13 [95%CI 1.39–3.28], P&amp;lt;0.001). VO2-peak value during exercise was lower in athletes with former COVID-19-infection compared to those without COVID-19-infection (43.4 [38.3/48.0] vs. 45.3 [39.1/50.6] ml/min/kg, P=0.010). SARS-CoV-2-Infection affected VO2 peak during exercise negatively (OR 0.94 [95%CI 0.91–0.97], P&amp;lt;0.0019) independent of age, sex and body-mass-index. Conclusions Former COVID-19-infection in athletes was accompanied by higher frequency of exercise hypertension and reduced peak VO2 during exercise testing.

Effect of hypertensive response to exercise on aortic diameters

Abstract Background The diameters of the sinus of Valsalva as well as the ascending aorta are related to age, sex, and body size. There are conflicting data regarding the effect of arterial hypertension and a scarcity of data on the effect of a hypertensive response to exercise on aortic diameters. Purpose In this prospective cohort study, we aimed to evaluate the relationship between the growth rates of the sinus of Valsalva and ascending aorta in individuals with a hypertensive response to exercise. Methods Our analysis included follow-up data of 649 patients from our cohort study. Participants with known connective tissue disease were excluded. Sinus of Valsalva and ascending aorta diameters were measured by transthoracic echocardiography using leading edge to leading edge convention at end-diastole. Maximum systolic and diastolic blood pressure response to exercise was measured during a standardized exercise test. Results At baseline, median age, max. systolic BP, BMI, diameter of the sinus of Valsalva, and diameter of the ascending aorta were 62 years, 208 mmHg, 26.9 kg/m2, 35mm, and 35mm respectively. 32% of patients were female and 67% had known arterial hypertension. After a median follow-up of 7.1 years, mean growth rate of the sinus of Valsalva and ascending aorta were 0.09 mm and 0.13 mm per year respectively. In univariate and multivariable regression models, there was a small but significant association between baseline aortic diameters and max. systolic BP, as shown in the Table 1. No significant associations were observed between growth rate of aortic diameters and max. systolic BP, as shown in the Table 2. Similar findings were obtained for max. diastolic BP and when considering only individuals with a baseline diameter ≥ 40mm. Conclusion In this large prospective cohort study, there was a small inverse relationship between max. systolic BP during exercise and baseline aortic diameters. However, max. systolic BP during exercise showed no influence on growth rates of aortic diameters. Furthermore, the mean growth rates of aortic diameters per year in this population were in line with growth rates in a normal population.Table 1.Table 2

Quantitative autonomic testing after recovery from acute COVID-19 infection: comparison with findings in controls and individuals with neurogenic autonomic dysfunction

Abstract Background/Introduction Cardiovascular autonomic dysfunction (CvAD) is believed to contribute to the persistence of troublesome symptoms following apparent recovery from an acute COVID-19 infection. Common complaints in this setting include cognitive impairment (‘brain fog’), fatigue, and both postural and exertional intolerance with a sensation of excessive rapid heart beating. However, while the occurrence of CvAD post-acute COVID-19 has been widely recognized, its quantitative assessment remains largely unexplored. Purpose The purpose of this study was to determine whether quantitative cardiovascular autonomic testing in post-acute COVID-19 patients differ from findings in Controls and are more similar to individuals with Neurogenic CvAD, such as those with Pure Autonomic Failure. Methods Quantitative autonomic testing was prospectively undertaken in two patient groups: post-acute COVID-19 and Neurogenic CvAD patients, and in control subjects. Acute COVID-19 was documented by the nasopharyngeal PCR method and all affected patients had recovered at least 1 week prior to their autonomic study. Neurogenic CvAD patients were studied as part of their diagnostic evaluation, and none had a COVID-19 infection prior to their study. Measurements included i) heart rate (HR) and blood pressure (BP) responses during active standing (AS), ii) time to BP nadir and time to BP recovery during AS, iii) Valsalva ratio (VR), and iv) respiratory sinus arrhythmia (RSA). The unpaired student t-test and Mann Whitney U test were used to analyze normally and non-normally distributed data, respectively, between post-acute COVID patients and the Control and Neurogenic CvAD patients. All variables were continuous and presented as means with corresponding standard deviations (SD) when normally distributed or interquartile ranges (IQR) when non-normally distributed. A p-value of &amp;lt;0.05 was considered statistically significant. Results Post-acute COVID-19 patients (N=55, 83.6% female) and Controls (N=82, 86.6% female) were of similar age (39 [IQR 27.3, 49.2] vs. 33 [IQR 21.4, 40.0] years, respectively, p=0.034). Neurogenic CvAD patients (N=27, 51.9% female) were older (68 [IQR 62.9, 74.3], p&amp;lt;0.00001). The main findings (Table 1, mean [SD]) indicate that post-acute COVID-19 patients exhibited HR and BP responses during AS similar to the Control group; on the other hand, average VR, maximum systolic BP drop during AS, and maximum HR increase during AS in COVID-19 patients trended towards findings in Neurogenic CvAD patients. Conclusion Recovered post-acute COVID-19 patients referred for autonomic dysfunction evaluation due to persisting symptoms exhibit autonomic testing findings similar to control subjects but trending towards observations in neurogenic CvAD.

Abstract 14807: Direct Carotid Sinus Nerve Stimulation in Anesthetized Human Subjects

Introduction: Drug resistant hypertension is a growing clinical phenomenon across the world and there is a critical need for alternative therapeutic modalities. Hypothesis: A novel multi-contact electrode designed to interface with the carotid sinus nerve in conjunction with a unique implantation technique can selectively activate the baroreflex causing reversible drops in blood pressure (BP) &amp; heart rate (HR) in anesthetized humans. Methods: Patients undergoing therapeutic operations that necessitated carotid bulb exposure were prospectively enrolled in this IRB approved trial. Using a novel surgical approach, an application specific electrode was placed around the CSN followed by contact interface mapping to identify presumed baroafferent fibers which were selectively stimulated. Outcome measures included change in systolic BP (SBP), diastolic BP (DBP), and HR during and after stimulation. Results: 14 subjects met eligibility criteria. In 13, following correct contact identification, stimulation caused a 23±20mmHg (mean±SD) maximum drop in SBP with associated drops in DPB (11±9mmHg), and HR (10±9bpm). All subjects recovered immediately following stimulation withdrawal. All drops were significant (p&lt;0.001, t-test). In subjects with baseline SBP &gt;120mmHg (n=8), maximum SBP drop was 30±23mmHg, while subjects with baseline SBP &lt;120mmHg (n=5) exhibited a maximum SBP drop of 11±3mmHg. There was evidence of a positive dose (current) response relationship. Conclusions: Using a novel surgical approach and electrode, CSN stimulation in anesthetized human subjects caused a marked drop in BP/HR followed by rapid recovery with stimulation withdrawal. There was evidence of dose dependency.

Exercise capacity and risk of incident atrial fibrillation in healthy adults

Background/Aims: Atrial fibrillation (AF) is a common arrhythmia and is associated with cardiovascular morbidity and mortality. It is important to identify and control the modifiable risk factors of AF. We aimed to examine the association of exercise capacity with the risk of incident AF within 3 years in healthy subjects.Methods: We evaluated asymptomatic adults who had undergone more than two consecutive health checkups. We included subjects who exhibited normal sinus rhythm on the first health examination and who developed AF on the second or subsequent health examinations. Subjects who underwent cardiopulmonary exercise testing within 3 years before the diagnosis of AF were examined.Results: The study population in the analyses included 428 cases (mean age 58.4 ± 7.6 yr, male 95.6%). There were significant differences in maximal systolic blood pressure (SBP; case 169.4 ± 24.2 vs. control 173.9 ± 22.3 mmHg), peak VO&lt;sub&gt;2&lt;/sub&gt; (29.5 ± 5.4 vs. 30.4 ± 4.8 mL/kg per minute), and maximal metabolic equivalents (METs; 8.5 ± 1.6 vs. 8.7 ± 1.4) between the two groups. In the multivariable logistic models, adjusted odds ratios were 0.99 for maximal SBP (95% confidence interval [CI] 0.98–0.99), 0.97 for peak VO&lt;sub&gt;2&lt;/sub&gt; (95% CI 0.95–0.99), and 0.91 for maximal METs (95% CI 0.83–0.98).Conclusions: We demonstrated that poorer exercise capacity was associated with the development of AF in a healthy population. A prospective, systematic trial is necessary to confirm that appropriate exercise training will be beneficial in preventing the development of AF in such patients.

Association between systolic blood pressure variability and severity of cerebral amyloid angiopathy in incident intracerebral hemorrhage

IntroductionThe role of systolic blood pressure (SBP) variability in the pathogenesis of cerebral amyloid angiopathy (CAA) as an underlying cause of intracerebral hemorrhage (ICH) is unknown. We studied SBP variability before ICH according to CAA severity at autopsy.MethodsWe collected office (primary care or hospital clinic) BP readings during 10 years before first-ever ICH onset in adults who died and had brain research autopsy in the Lothian IntraCerebral Hemorrhage, Pathology, Imaging, and Neurological Outcome (LINCHPIN), prospective, population-based, inception cohort study. A neuropathologist assessed CAA severity using a histopathological rating scale, masked to BP readings. Functional principal component analysis was used to model SBP levels by time before ICH, and logistic regression models assessed associations of SBP variability indices with CAA severity (moderate-severe vs. absent-mild) adjusted for age, gender, and mean SBP.ResultsAmong 72 adults (median age 81 [interquartile range 76–86], 56% female, median number of SBP readings 11 [3–19]), patients with moderate-severe CAA had similar mean SBP (143 vs. 145 mmHg, P = 0.588) but lower SBP variability (SBP standard deviation [SD] 14 vs. 17 mmHg, P = 0.033) compared with patients with absent-mild CAA, and their SBP trajectories seemed to differ over 10 years before ICH. The odds of moderate-severe CAA were higher with lower maximum SBP (adjusted OR per 10 mmHg lower: 1.53, 95% confidence interval [CI] 1.09–2.15; P = 0.015) and lower SBP range (1.29 [1.03–1.61]; P = 0.028), but not SBP SD (1.95 [0.87–4.38]; P = 0.11).DiscussionCompared with absent-mild autopsy-verified CAA, moderate-severe CAA is associated with lower maximum and range of pre-morbid SBP.

The association of out-of-hospital postpartum NSAID use and post-discharge hypertension control for people with hypertensive disorders of pregnancy.

To evaluate the relationship between amount of NSAID use postpartum and outpatient blood pressure (BP) control. This is a prospective, single-site, cohort study of postpartum people diagnosed with HDP from 2018 to 2020 using the American College of Obstetrician and Gynecologists criteria. All participants were provided an electronic BP cuff for daily evaluation after discharge. Those who provided at least 7days of data within the first 14days after discharge were included. Standard PP pain management included ibuprofen 600mg every 6h as needed. The exposure was self-reported amount of NSAIDs used within the first 14days after discharge. The primary outcome was median mean arterial pressure (MAP) over the first 14days after hospital discharge. Secondary outcomes included median and maximum systolic and diastolic BPs and need for PP readmission for HDP. Regression models were created, controlling for a propensity score for highest quartile of NSAID use. 103 participants were approached, of whom 60 met inclusion criteria. Those who had a history of a cesarean delivery were more likely to be in the highest quartile of NSAID use; no other significant differences were noted across quartiles of NSAID use. There was no association between NSAID amount used and median MAP (adjusted β coefficient 0.03, 95% CI: -0.17 to 0.22). There were no significant associations between NSAID amount used and all other secondary outcomes. Out-of-hospital NSAID use is not associated with worsened PP BP control after hospital discharge among people diagnosed with HDP.

457 Tourniquet Pressures in Orthopaedic Surgery - Is the Standard 250mmHg Safe?

Abstract Aim To determine safe levels of tourniquet inflation pressures in trauma and orthopaedic surgery. Method Data was collected on 150 patients retrospectively from the intraoperative and anaesthetic records of patients undergoing trauma and elective orthopaedic surgery at a single site. Data collected included demographic data, tourniquet inflation pressures and maximum intraoperative systolic blood pressures. British Orthopaedic Association (BOA) standards for safe intraoperative tourniquet use were used to determine safe tourniquet inflation pressures. Results The average maximum intraoperative systolic blood pressure was 125mmHg. In 134 cases (91%) the tourniquet pressure used was 250mmHg. Of the cases studied 54% of upper limb and 33% of lower limb tourniquets were overinflated when compared with BOA standards. Given the average maximum intraoperative systolic blood pressure, standard tourniquet inflation pressures of 200mmHg for upper limbs and 225mmHg for lower limbs should be used in preference to the more commonly used standard used pressure of 250mmHg. Conclusions All patients should ideally have an individual tourniquet pressure set based on their systolic blood pressure. However, if a standard pressure is to be used, values of 200mmHg for upper limbs and 225mmHg for lower limbs should be used in preference to 250mmHg as appears to commonly used currently.

OFFICE BLOOD PRESSURE VARIABILITY AND INSTABILITY IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS: ASSOCIATION WITH PRECLINICAL ORGAN DAMAGE

Objective: To evaluate the association of systolic blood pressure (SBP) variability and instability within a single office visit with preclinical target organ damage in young individuals. Design and method: Apparently healthy individuals aged 6-25 years referred for elevated blood pressure (BP) were subjected to triplicate office BP measurements in a single visit and 24h ambulatory BP monitoring. SBP variability and instability were quantified using (i) standard deviation (SD) (ii) coefficient of variation (CV) (iii) average real variability (ARV) (iv) maximum office SBP (v) maximum-minimum office SBP difference (MMD) (vi) ratio of difference between 1st-3rd measurement to the average office SBP (Relative change). Preclinical organ damage was evaluated by (i) carotid intima-media thickness (cIMT), (ii) carotid-femoral pulse wave velocity (PWV; Complior device), and (iii) echocardiographic left ventricular mass index (LVMI). Results: 301 individuals were analyzed (mean age 13.8±3.7 years, 66.8% males, BMI z-score 1.12±0.95, average office BP 122.6±16.9/72.5±10.7 mmHg, 24h ambulatory BP 119.1±11.4/67.8±6.8 mmHg). LVMI measurements were available in 258 participants, IMT in 208 and PWV in 60. LVMI, IMT and PWV were associated with office SBP (r = 0.30/0.23/0.42, respectively, p&lt; = 0.001), 24h ambulatory SBP (r = 0.35/0.33/0.48, p&lt; = 0.001) and maximum office SBP (r = 0.31/0.30/0.41, p&lt; = 0.001). LVMI and IMT were associated with SD (r = 0.14/0.15, p&lt;0.05) and MMD (r = 0.13/0.15, p&lt;0.05), while IMT and PWV with age (r = 0.31/0.38, p&lt;0.001). Other indices of variability were not associated with indices of organ damage. In stepwise multivariable linear regression models (independent variables: age, sex, BMI z-score, office SBP, 24h ambulatory SBP, maximum office SBP, SD, MMD), LVMI was determined by BMI z-score and 24h ambulatory SBP, IMT by age, male sex and 24h ambulatory SBP, and PWV by 24h ambulatory SBP. Conclusions: These results suggest that in young individuals the variability and instability of office SBP within a single visit are not associated with preclinical organ damage.

Respiratory muscle training for obstructive sleep apnea: Systematic review and meta-analysis.

Obstructive sleep apnea is the most common sleep disorder. This review aims to evaluate the effectiveness and safety of respiratory muscle training in the treatment of patients with obstructive sleep apnea. The study protocol was registered in Prospero Platform (CRD42018096980). We performed searches in the main databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) via Pubmed; Excerpta Medica dataBASE (Embase) via Elsevier; Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library; Latin American and Caribbean Literature on Health Sciences (LILACS) through the Portal of the Virtual Health Library and Physiotherapy Evidence Database (PEDro) for all randomised-controlled trials published before July 2022. The randomised-controlled trials were assessed for risk of bias and certainty of evidence. Thirteen randomised-controlled trials were included. All studies had an overall high risk of bias. Inspiratory muscle training probably improves systolic blood pressure and sleepiness when compared with sham. However, inspiratory muscle training probably does not improve diastolic blood pressure and maximum expiratory pressure, and may not be superior to sham for apnea-hypopnea index, forced expiratory volume in 1 s, forced vital capacity, sleep quality and quality of life. In addition, it is uncertain whether there is any effect of inspiratory muscle training on maximum inspiratory pressure and physical capacity. Inspiratory muscle training may also improve maximum inspiratory pressure and maximum expiratory pressure compared with oropharyngeal exercises. However, it may not be superior for apnea-hypopnea index, sleep quality, sleepiness, quality of life and functional capacity. When associated with physical exercise, inspiratory muscle training may not be superior to physical exercise alone for maximum inspiratory pressure, maximum expiratory pressure, systolic and diastolic blood pressure, and functional capacity. At the same time, when associated with cardiac rehabilitation exercises, inspiratory muscle training may reduce apnea-hypopnea index, improve inspiratory muscle strength, sleepiness and sleep quality compared with cardiac rehabilitation alone. However, it may not be superior for improving quality of life. Regarding expiratory muscle training, it may improve expiratory muscle strength and sleep quality, but not sleepiness when compared with sham. The evidence on the effects of expiratory muscle training in apnea-hypopnea index is very uncertain.