Maximum Systolic Blood Pressure Research Articles

Cardiovascular and metabolic effects of intensive Hatha Yoga training in middle-aged and older women from northern Mexico

Background:Hatha Yoga (HY) can be an alternative to improve physical activity in middle-aged and older women. However, conventional HY (CHY) exercising may not result in enough training stimulus to improve cardiovascular fitness. The purpose of this study was to evaluate the effect of an intensive HY intervention (IHY) on cardiovascular risk factors in middle-aged and older women from Northern Mexico.Materials and Methods:In this prospective quasiexperimental design, four middle-aged and nine older CHY practicing females (yoginis) were enrolled into an 11-week IHY program consisting of 5 sessions/week for 90 min (55 sessions). The program adherence, asana performance, and work intensity were assessed along the intervention. Anthropometric [body mass index (BMI), % body fat and Σ skin folds], cardiovascular fitness [maximal expired air volume (VEmax), maximal O2 consumption (VO2max), maximal heart rate (HRmax), systolic (BPs) and diastolic blood pressure (BPd)], biochemical [glucose, triacylglycerols (TAG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)], and dietary parameters were evaluated before and after IHY.Results:Daily caloric intake (~1,916 kcal/day), program adherence (~85%), and exercising skills (asana performance) were similar in both middle-aged and older women. The IHY program did not modify any anthropometric measurements. However, it increased VO2max and VEmax and HDL-C while TAG and LDL-C remained stable in both middle-aged and older groups (P < 0.01).Conclusions:The proposed IHY program improves different cardiovascular risk factors (namely VO2max and HDL-C) in middle-aged and older women.

Successful Cardiac Resynchronization Therapy in a 3-Year-Old Girl With Isolated Left Ventricular Non-Compaction and Narrow QRS Complex

Cardiac resynchronization therapy (CRT) is a new method of treatment for refractory heart failure. However, for children, its indication, efficacy, and long-term prognosis remain unclear. This study describes the use of CRT for a 3-year-old girl with intractable heart failure caused by isolated left ventricular non-compaction (LVNC) with narrow QRS complex. Echocardiography showed diffuse hypokinetic left ventricular (LV) wall motion (ejection fraction =29.3%) with dyssynchrony between the apex, posterior and lateral walls, where numerous prominent trabeculations existed, and severe mitral regurgitation. Biventricular resynchronization using epicardial pacing leads was performed under general anesthesia. Pacing sites for optimal synchronization in the ventricular walls where chosen using tissue Doppler imaging, and AV delay was adjusted to achieve maximal systolic blood pressure and maximal cardiac output. Over a follow-up period of 2 years, she exhibited significant and sustained improvement in LV function and clinical symptoms. BNP levels decreased from 1,960 to 82 pg/ml. QRS duration (103 ms) on ECG did not change after CRT. We conclude that pediatric CRT provides a highly useful adjunct for the treatment of heart failure, even in patients with a narrow QRS duration, and might improve the prognosis of patients with LVNC.

Effect of successful parathyroidectomy on 24-hour ambulatory blood pressure in patients with primary hyperparathyroidism

Objective The pathogenesis of hypertension in patients with primary hyperparathyroidism (PHPT) is unclear, and the prevailing opinion is that parathyroidectomy does not affect the blood pressure (BP). Most previous studies have been based on BP measurements at rest in a clinical setting. The aim of this study was to get additional information by 24-hour ambulatory measurements. Design and patients Forty-nine consecutive patients with PHPT (age 63 ± 12 years, 44 women) were examined before and 6 months after curative parathyroid surgery. Measurements Serum concentrations of calcium and PTH, and 24-hour ambulatory mean, minimum, and maximum systolic (S) and diastolic BP, and mean arterial BP. Results On average, the patients showed no BP change after parathyroidectomy. However, those with a history of hypertension ( n = 20) showed generally increased BP values after parathyroidectomy, with significantly increased minimum and average SBP ( P = 0.02 and P = 0.04, respectively), whereas patients without a history of hypertension ( n = 29) showed unchanged or slightly reduced BP values after parathyroidectomy, with significantly decreased maximum SBP ( P = 0.04). Serum concentrations of PTH and calcium were not significantly related to any of the BP variables measured. Conclusions The novel finding that patients with both PHPT and hypertension may show increased BP after parathyroidectomy warrants intensified BP control postoperatively in these patients, and motivates early treatment of PHPT in order to prevent the development of complicating hypertension.

Abstract 4835: Angiotensin-Converting-Enzyme 2 (rhACE2) Potently Attenuates the Negative Hemodynamic Effects of Angiotensin II (ATII) and Improves Post-Myocardial Infarction (MI) Remodeling

ATII is a potent vasoconstrictor involved in the pathophysiology of several diseases. Antagonizing the Renin-Angiotensin-Aldosterone-System (RAAS) is one of the key principles in the treatment of heart failure. ACE2, a recently discovered homologue of the Angiotensin-Converting-Enzyme (ACE), catalyzes the cleavage of ATII to Angiotensin (1–7) as well as other reactions. rhACE2 has proven to be therapeutic in a model of the Adult Respiratory Distress Syndrome (ARDS). This study has been planned to study the in-vivo hemodynamic effects of rhACE2 as well as its effects on post-MI remodeling. rhACE2 was produced in a mammalian expression system. Pressure-volume catheter measurements were carried out in male C57/Bl6N mice. Post-MI remodeling was studied by echocardiography in female C57/Bl6N mice after LAD-ligation. Bolus infusion of 2mg/kg rhACE2 (n=7) lead to a significant reduction of arterial elastance by 13.2±1.1% (p&lt;0.01) paralleled by a modest drop in maximal systolic blood pressure from 93.4±4.2mmHg to 86.3±5.1mmHg (p&lt;0.01). Stroke volume and cardiac output showed a strong trend (p=0.06 and 0.08 respectively) to increase after rhACE2-treatment. Following ACE2 (n=5) or vehicle infusion (n=8) ATII was infused at constant infusion rates from 0.2μg/kg/min to 40μg/kg/min. ACE2 pretreatment shifted the EC50 for the ATII induced increase in systolic blood pressure by almost one order of magnitude from 1.11μg/kg/min (CI 0.42 to 2.9) to 10.9μg/kg/min (CI 7.2 to 16.7) (p=0.014). Similarly the EC50 values for the ATII mediated decrease in ejection fraction and preload adjusted maximal power as well as the increase of end systolic volume were significantly shifted to higher ATII doses. To study post-MI remodeling mice were treated twice daily with intraperitoneal injections of 1mg/kg rhACE2. Echocardiography was performed 2 weeks following LAD. Mice treated with rhACE2 (n=15) showed a significantly improved fractional shortening (14.3±1.6%) compared to vehicle treated mice (10.3±1.1%, n=12, p=0.049). These data show that rhACE2 is highly potent in reducing the negative effects of ATII in vivo which might translate in improved post-MI remodeling. rhACE2 could become an alternative treatment option for several diseases related to an activated RAAS.

Blood pressure is not associated with haematoma enlargement in acute intracerebral haemorrhage

We performed an observational study that compared baseline and subsequent blood pressure (BP) measurements and its association with haematoma enlargement (HE) in patients with intracerebral haemorrhage (ICH). We prospectively studied consecutive patients with supratentorial spontaneous ICH within the first 6 h after the onset of symptoms. HE was defined as an increase >or=33% in the volume of haematoma on the CT obtained 24-48 h after the onset of symptoms as compared with the CT at admission. We recorded systolic BP (SBP), diastolic BP (DBP) and mean BP (MBP) at admission and at 6, 12, 18 and 24 h after onset; the maximum SBP, DBP and MBP during the study period; the maximum SBP and DBP within intervals; the mean of all BP readings; administration of antihypertensive agents. We studied 60 patients whose mean age was 72.1 +/- 11.3 years. HE was observed in 27 (45%) patients. No statistically significant differences were observed in any of the analyses that compared BP parameters between the HE and non-HE groups (two-way anova). In an exploratory analysis, we did not find an association between BP and HE within the first 24 h after an acute ICH.

Étude comparative de l’ischémie d’effort entre patients coronariens et patients atteints de rétrécissement aortique

Objective To compare exercise and recovery data between a population of patients with proven CAD and patients with pure aortic stenosis (AS). Patients and methods Exercise testing results (bicycle ergometry) of 45 patients with AS (34 men, 66 ± 12 years, 56 ± 20 mmHg peak-to-peak gradient and valve area 0.78 ± 0.48 cm 2) were compared to exercise testing results of 50 patients with CAD (41 men, 65 ± 9 years, greater or equal to 70% stenosis on one vessel in 62%, two vessels in 30%, three vessels in 8%). Results During exercise, 38% patients with AS and 82% patients with CAD had clinical symptoms. In the AS group, exercise duration was longer, heart rate (HR) was higher, maximal systolic and diastolic blood pressure were lower than in CAD group. The increase of systolic blood pressure was lower in the AS group (34 ± 21 mmHg versus 47 ± 27 mmHg, p < 0.02). Maximal load achieved was not significantly different. Exercise ST depression appeared in 76% of AS group and 88% of CAD group (NS). No difference was found in ST depression, Detrano index and ST segment/HR slope. During recovery, no difference was found in HR variations. Clockwise rotation of the ST/HR recovery loop was more frequent in CAD group (35 patients versus 19 patients, p < 0.001). Conclusion Most of the exercise and recovery data are similar in patients with AS and CAD. Significant discriminating criteria were the increase of systolic blood pressure during exercise and ST/HR recovery loop.

Continuous Hemodynamic Response to Maximal Dynamic Strength Testing in Older Adults

de Vos NJ, Singh NA, Ross DA, Stavrinos TM, Orr R, Fiatarone Singh MA. Continuous hemodynamic response to maximal dynamic strength testing in older adults. Objective To quantify acute changes in blood pressure and heart rate during a maximal dynamic strength—single-repetition maximum lift (1-RM)—testing session in older adults with a low burden of chronic disease. Design Descriptive, cross-sectional study. Setting University rehabilitation center. Participants Volunteer sample of 43 community-dwelling, nonresistance-trained older adults aged 60 years and older (mean, 68±6y). Interventions Not applicable. Main Outcome Measures Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate was obtained by plethysmography at rest and during 1-RM strength testing on leg press, knee extension, and knee flexion resistance machines. Results Average resting SBP (132±28mmHg), DBP (54±15mmHg), and heart rate (65±11 beats/min) were independent of hypertensive diagnosis and overweight status. Maximal SBP, DBP, and heart rate increased significantly during the 1-RM in all exercises compared with rest ( P<.001). Highest values of SBP (236±51mmHg) and DBP (140±46mmHg) were measured during the leg press at 99.5%±6.7% of 1-RM. Lowest values of SBP (79±25mmHg) and DBP (38±15mmHg), and the highest (123±44 beats/min) and lowest heart rate (41±23 beats/min) were measured during the knee extension at 97.4%±8.1% of 1-RM. Absolute falls in SBP were greatest in treated hypertensive participants. No cardiovascular symptoms or events occurred in 129 1-RM tests. Conclusions Large, very transient, asymptomatic excursions in blood pressure and heart rate were measured during 1-RM testing. The most robust hemodynamic response occurred during the leg press. Thus the leg press may be the most important exercise to focus hemodynamic monitoring efforts upon during strength testing in clinical cohorts.

EFFECT OF METOPROLOL ON COGNITIVE FUNCTION IN HYPERTENSIVE PATIENTS OF YOUNG TO MIDDLE AGE

Aim. To evaluate the effect of metoprolol tartrate on blood pressure (BP) and cognitive function in young to middle aged patients with essential hypertension (HT). Material and methods. 40 men (age of 49,0±1,9 y.o.) with HT of I-II stage not taking antihypertensive medication regularly were enrolled into the study. All patients were given metoprolol tartrate (start dose 50-100 mg/d). Variables of 24-h BP monitoring and clinic BP, left ventricular mass index (measured by echocardiography) and characteristics of cognitive function (memory, attention, thinking and neurodynamic) were assessed at the start, after 1 and 6 months of therapy. Results. Good and satisfactory antihypertensive effect was achieved in 75% of hypertensive patients with metoprolol (186,6±13,4mg/d) monotherapy. Metoprolol significantly decreased maximum day-time systolic and diastolic BP, maximum night-time diastolic BP, mean day-time systolic and night-time diastolic BP, time-index, load-index and variability-index for night-time diastolic BP, day-time and night-time pulse BP. Left ventricular mass index reduced significantly (p&lt;0,0001). After 6 months of therapy significant improvement of memory, attention, thinking and neurodynamic was observed Conclusion. Metoprolol had beneficial effect on cognitive function in hypertensive patients, which demonstrate its cerebroprotective properties in addition to antihypertensive action. Metoprolol can reduce the risk of dementia in young to middle aged patients with HT.

Heart Rate and Blood Pressure Response in Adult Men and Women During Exercise and Sexual Activity

The purpose of this study was to assess the heart rate (HR) and blood pressure (BP) response of sexual activity compared with treadmill exercise in adult men and women. Nineteen men, 55 +/- 8 years, and 13 women, 51 +/- 7 years, underwent a maximal Bruce protocol treadmill stress test followed by home-monitored sexual activity using noninvasive HR and BP recording devices. The mean treadmill times were significantly shorter than the mean times of sexual activity for men and women (p <0.001 and p = 0.002, respectively). For the men, average maximum HR, systolic BP, and HR-BP product during sexual activity were 72%, 80%, and 57% of respective measurements during treadmill exercise. For the women, maximum HR, systolic BP, and HR-BP product during sexual activity were 64%, 75%, and 48% of respective measurements during treadmill exercise. Age correlated inversely with duration of treadmill exercise (a 9-second decrease in duration per increasing year of age; p = 0.036), and with the duration of sexual activity (a 1-minute decrease in duration per increasing year of age; p = 0.024). Treadmill exercise duration predicted sexual activity duration (a 2.3-minute increase in sexual activity duration per each minute treadmill duration; p = 0.026). In conclusion, sexual activity provides modest physical stress comparable with stage II of the standard multistage Bruce treadmill protocol for men and stage I for women.

Abstract 2741: Paradoxical Reduction in Pulse Wave Reflection Following Maximal Exercise in Patients with Type 2 Diabetes Mellitus: Association with Exercise Central Blood Pressure

Background: Patients with type 2 diabetes mellitus (T2DM) have increased large artery stiffness and exaggerated brachial and central systolic blood pressure (SBP) responses to exercise. Elevations in exercise central SBP may be a result of increased arterial wave reflections and this study aimed to test this hypothesis. Methods: Maximal exercise stress tests were conducted in 50 T2DM patients (55 ± 8y, 70% males) and 50 controls (56 ± 8y, 70% males) matched by age, gender, maximal exercise brachial SBP and heart rate. Brachial and central BP were measured at rest and immediately post-exercise. Augmentation index (AIx), augmented pressure (AP; markers of wave reflection) and central SBP were recorded by radial tonometry. Results: Despite no significant differences between groups in maximal exercise brachial or central SBP, AIx and AP were significantly lower in T2DM patients (Table ). Exercise central SBP was inversely and independently associated with exercise AIx in the T2DM patients (β= -0.32; p=0.05) but not controls (β= -0.10; p=0.49). The presence of T2DM was also identified as a weak but significant independent determinant of exercise AIx (β= -0.19) and central SBP (β= 0.10; p&lt;0.05 both). Conclusions: Patients with T2DM have 1) a paradoxical reduction in wave reflection at maximal exercise and 2) a significant inverse association between wave reflection and exercise central SBP that is not observed in controls. The reduced reflected pressure waves may indicate an increase in peripheral vasodilation to offset high exercise central BP. Exercise hemodynamics in T2DM patients and controls

Abstract 3661: “Energy Drink” Consumption Causes Increases in Blood Pressure and Heart Rate

Introduction: “Energy drinks” are very popular and are used frequently, especially by young adults. Most marketed energy drinks contain high levels of caffeine and taurine. Both caffeine and taurine have been shown to have direct effects on cardiac function and hemodynamic status. Hypothesis: We assessed the hypothesis that a commonly used energy drink alters blood pressure, heart rate and EKG parameters in healthy volunteers. Methods: Healthy volunteers (n = 15, 53% female, 25.9 ± 5.9 years, 69.8 ± 14.8 kg) abstained from caffeine for 48 hours prior to and throughout the study period. On study day 1 (D1), blood pressure (BP), heart rate (HR) and an EKG were measured at baseline. Participants then consumed 500 mL (2 cans) of an energy drink containing caffeine (80 mg) and taurine (1000 mg) and BP, HR and EKG measurements were repeated at 30 minutes, 1, 2, 3, and 4 hours after consumption. Participants then consumed 2 cans of energy drink daily for the next 5 days (D2–D6). On day 7 (D7) the procedures followed on D1 were repeated. Average baseline measurements on days 1 and 7 were compared to maximum values during that observation period. Results: On both D1 and D7, maximum mean systolic BP, HR and corrected QT-interval (QTc) occurred at 4 hours. Maximum diastolic BP occurred at 2 hours on D1 and D7. Baseline and maximum mean values are presented in Table 1 . Within 4 hours of energy drink consumption on D1 and D7 respectively, systolic BP increased by 7.9% (p = 0.006) and 9.6% (p &lt; 0.001), HR increased by 7.8% (p = 0.009) and 11.0% (p &lt; 0.001) and QTc increased by 4.5% (p = 0.368) and 5.5% (p = 0.052). Diastolic BP increased by 7.0% (p = 0.046) and 7.8% (p = 0.063) within 2 hours of energy drink consumption. Conclusions: In conclusion, although no significant EKG changes were observed, subjects’ HR increased 5–7 bpm and systolic BP increased 10mmHg after consuming an “energy drink”. This level of change is likely clinically significant in patients with cardiac disease or those who consume such drinks regularly. Table 1. Baseline and Maximum Values (mean ± SD)

Exercise Hemodynamics in Pediatric Patients After Repair of Coarctation

PURPOSE: Patients with coarctation of the aorta are often treated by surgical resection and end to end anastamosis. More recently, this lesion has been remedied by percutaneous stent placement. We compared the exercise hemodynamics of stent treatment versus end to end anastamosis repair. METHODS: We evaluated 10 patients (7 males, median age 13.3 yrs, STENT group) treated with a stent versus 18 patients (12 males, median age 13.7 yrs, SURGERY group) repaired by end to end anastamosis and compared them to 16 normal patients (7 males, median age 13.9 yrs, CONTROL group). All patients were exercised with the James cycle ergometer protocol to volitional fatigue. Arm-leg blood pressures were taken supine at rest and 1 minute post exercise. RESULTS: There was no significant difference in the height, weight and age between the three groups. The STENT group was 1.17 +/− 0.7 years post-op and the SURGERY group was 11.2 +/− 4.0 years post op. Total working capacity (TWC), Exercise Time, maximal HR, maximal VO2, and maximal Cardiac Output were not significantly different between the groups. Maximal systolic blood pressure and arm-leg gradient 1 minute post exercise in STENT and SURGERY were significantly increased when compared to CONTROL, but not from each other.TableCONCLUSION: Coarctation repair by stent placement avoids the risk of a thoracotomy, and yields post-repair exercise hemodynamics similar to that of surgery patients. However, there is a significantly higher systolic blood pressure at max exercise and a greater arm-leg gradient one minute post exercise in coarctation patients compared to controls. Regardless of the type of corrective procedure, patients with coarctation of the aorta demonstrate similar responses to exercise.

Does Mitral Stenosis Impact Exercise Capacity in Children with Mild to Moderate Aortic Stenosis?

PURPOSE: Mild to moderate aortic stenosis does not typically impact exercise capacity in children. The purpose of this study was to determine the impact of mitral stenosis (MS) on exercise capacity in patients with mild to moderate aortic stenosis (AS). METHODS: Isolated mild to moderate AS patients and combined MS/AS patients underwent maximal exercise echocardiography using the James protocol. Subjects with structurally normal hearts (Norm) served as controls. Baseline and peak exercise data and echo valvar gradients were compared using one-way ANOVA and the Bonferroni t procedure. RESULTS: 13 studies in 10 patients with isolated AS (mean age 15.3 years) were compared to 13 studies in 8 patients with combined MS/AS (mean age 14.6 yrs) and 26 normal subjects (mean age 14.2 yrs). Demographics, total working capacity (TWC), maximal systolic blood pressure (SBP) and respiratory quotient (MaxRQ) were not significantly different among the groups. There was no significant change in mean aortic gradient from rest to peak exercise in MS/AS and AS groups (19±11 to 29±9, 25±11 to 24±15mmHg). There was a significant increase in mean mitral gradient from rest to peak exercise in the MS/AS group (5±2 to 16±8 mmHg, p<0.001). The MS/AS group demonstrated a significantly decreased MaxHR compared to Norm and significantly decreased maximal oxygen consumption (MVO2) and cardiac output (MaxQ) compared to both AS and Norm groups.TableCONCLUSION: In pediatric patients with mild to moderate aortic stenosis, the presence of mild mitral stenosis negatively impacts aerobic capacity and cardiac output at peak exercise. This suggests the possibility that mitral stenosis perturbs the adaptive mechanisms utilized by these subjects during peak exercise.

White Coat Hypertension in Childhood: Evidence for End-Organ Effect

To evaluate the hypothesis that white coat hypertension (WCH) represents a prehypertensive state by correlating ambulatory blood pressure monitoring (ABPM) results with BP response to treadmill exercise (TE) and echocardiographic measurement of left ventricular mass index (LVMI) in children with high blood pressure (HBP). We evaluated 119 consecutive children age 6 to 18 years (mean = 13.3 years; 65% male) referred for HBP. Office systolic BP (SBP) exceeded the 95th percentile for age/sex/height in all of the children; 10% also had elevated diastolic BP (DBP). WCH was defined as elevated office SBP +/- elevated DBP with normal mean awake ABPM-SBP. ABPM classified 62 subjects as having WCH and 57 as having HBP. Office BP did not differ between the 2 groups. As defined, awake ABPM-SBP was lower in the WCH group (males: HBP, 142 +/- 12 vs WCH, 124 +/- 5; females: HBP, 137 +/- 8 vs WCH, 121 +/- 5). Awake and asleep DBP and asleep SBP were significantly lower in the WCH group. On TE, maximal SBP exceeded norms for age/sex/body surface area in 63% of the HBP group and 38% of the WCH group. LVMI exceeded the 95th percentile for age/sex in 59% of the males and 90% of the females in the HBP group and in 33% of the males and 36% of the females in the WCH group. Exaggerated exercise BP and/or increased LVMI in 62% of those subjects with WCH suggest that this diagnosis in children may represent a prehypertensive state.

Towards an understanding of the mechanics underlying aortic dissection

Acute aortic dissection and associated aortic catastrophes are among the most devastating forms of cardiovascular disease, with a remarkably high morbidity and mortality despite current medical and surgical treatment. The mechanics underlying aortic dissection are incompletely understood, and a further understanding of the relevant fluid and solid mechanics may yield not only a better appreciation of its pathogenesis, but also the development of improved diagnostic and therapeutic strategies. After illustrating some of the inadequacies with respect to the extant work on the mechanics of aortic dissection, we alternatively postulate that the clinical hemodynamic disturbances that render the aorta susceptible to the initiation of dissection are principally elevated maximum systolic and mean aortic blood pressure, whereas the hemodynamic disturbances that facilitate propagation of dissection are principally elevated pulse pressure and heart rate. Furthermore, abnormal aortic mechanical properties and/or geometry are requisite for dissection to occur. Specifically, we propose that the degree of anisotropy will directly influence the probability of future aortic dissection. Imaging of the aorta may provide information regarding aortic anisotropy and geometry, and in combination with a hemodynamic risk assessment, has the potential to be able to prospectively identify patients at high risk for future aortic dissection thereby facilitating prophylactic intervention. The aim of the paper is to identify the main mechanical issues that have a bearing on aortic dissection, and to suggest an appropriate mathematical model for describing the problem.

Electrocardiographic and Hemodynamic Effects of Coenzyme Q10 in Healthy Individuals: A Double-Blind, Randomized Controlled Trial

Coenzyme Q10 (CoQ10) is an endogenous cofactor required for mitochondrial energy production and touted to treat heart failure and prevent statin-induced myopathy. In guinea pig ventricular myocytes, CoQ10 prolongs action potential duration, an effect that might prolong the QTc interval in humans. Additionally, CoQ10 reduced blood pressure in patients with essential hypertension. To determine the electrocardiographic (ECG) and hemodynamic impact of CoQ10 in healthy individuals. Healthy volunteers (N = 26; 62% male, age 24 +/- 3 y) were randomized to receive a single dose of CoQ10 50 mg and matching placebo in a crossover fashion with a 7 day washout period between treatments. Twelve-lead ECGs, systolic and diastolic blood pressure, and other hemodynamic parameters (cardiac index and systemic vascular resistance index) were evaluated immediately before (baseline) and 1, 3, 5, and 8 hours after ingestion of the study drug. ECG parameters (P wave and QRS complex duration; PR, QT, QTc, and RR intervals) were measured in lead II by one blinded investigator. For each time point, duplicate blood pressure levels were taken manually and then averaged. Hemodynamic parameters were measured using bioelectrical impedance cardiography. CoQ10 had no effect on any of the evaluated ECG parameters. The maximum postdosing systolic blood pressure showed a statistically significant increase with CoQ10 (117 +/- 10 vs 119 +/- 10 mm Hg; p = 0.037), an effect driven by increases in cardiac index (3.09 vs 2.95 L/min/m(2); p = 0.017). However, blood pressure elevation was most evident at the 5 hour timepoint (116 +/- 10 vs 113 +/- 11 mm Hg; p = 0.049) and was only transient. There were no differences between groups for maximum postdosing diastolic blood pressure. One dose of CoQ10 does not have any effect on ECG variables and exhibits only mild and transient effect on systolic blood pressure in young, healthy people.

Transurethral Sphincterotomy Provides Significant Relief in Autonomic Dysreflexia in Spinal Cord Injured Male Patients: Long-Term Followup Results

An evaluation of the results of transurethral sphincterotomy in spinal cord injured patients for the relief of autonomic dysreflexia is presented. The study describes experience with the treatment of 46 consecutive spinal cord injured males presenting with frequent symptoms of autonomic dysreflexia and inadequate voiding. The selection criteria include patients injured above the thoracic 6 level with subjective symptoms of autonomic dysreflexia who did not want to be catheterized or were unable to perform intermittent catheterization. Patients were studied with complex urodynamics before and at least 3 months after undergoing transurethral sphincterotomy. During cystometrogram the maximum increase in systolic and diastolic blood pressure was recorded. After transurethral sphincterotomy patients were followed for a mean of 5.4+/-3.1 years (range 1 to 12). There was subjective relief in autonomic dysreflexia following transurethral sphincterotomy in all patients, which correlated well with a significant decrease in systolic and diastolic blood pressure (p<0.0001). Mean decrease in maximal systolic and diastolic blood pressure after transurethral sphincterotomy was 55+/-25 and 29+/-17 mm Hg, respectively. Mean post-void residual urine decreased significantly from 233+/-151 to 136+/-0.34 ml after transurethral sphincterotomy. However, there was no significant change in mean maximum voiding pressures. Blood pressure monitoring during cystometrogram provides an objective assessment of the presence of autonomic dysreflexia due to neurogenic bladder dysfunction, enabling better therapeutic management to control autonomic dysreflexia. Persistence of significant autonomic dysreflexia needs urodynamic evaluation if other factors for autonomic dysreflexia have been excluded.

Relationship between Radial and Central Arterial Pulse Wave and Evaluation of Central Aortic Pressure Using the Radial Arterial Pulse Wave

Since a decrease of central aortic pressure contributes to the prevention of cardiovascular events, simple measurement of not only brachial blood pressure but also central aortic pressure may be useful in the prevention and treatment of cardiovascular diseases. In this study, we simultaneously measured radial artery pulse waves non-invasively and ascending aortic pressure invasively, before and after the administration of nicorandil. We then compared changes in central aortic pressure and radial arterial blood pressure calibrated with brachial blood pressure in addition to calculating the augmentation index (AI) at the aorta and radial artery. After nicorandil administration, the reduction in maximal systolic blood pressure in the aorta (Deltaa-SBP) was -14+/-15 mmHg, significantly larger than that in early systolic pressure in the radial artery (Deltar-SBP) (-9+/-12 mmHg). The reduction in late systolic blood pressure in the radial artery (Deltar-SBP2) was -15+/-14 mmHg, significantly larger than Deltar-SBP, but not significantly different from Deltaa-SBP. There were significant relationships between Deltaa-SBP and Deltar-SBP (r=0.81, p<0.001), and between Deltaa-SBP and Deltar-SBP2 (r=0.91, p<0.001). The slope of the correlation regression line with Deltar-SBP2 (0.83) was larger and closer to 1 than that with Deltar-SBP (0.63), showing that the relationship was close to 1:1. Significant correlations were obtained between aortic AI (a-AI) and radial AI (r-AI) (before nicorandil administration: r=0.91, p<0.001; after administration: r=0.70, p<0.001). These data suggest that the measurement of radial artery pulse wave and observation of changes in the late systolic blood pressure in the radial artery (r-SBP2) in addition to the ordinary measurement of brachial blood pressure may enable a more accurate evaluation of changes in maximal systolic blood pressure in the aorta (a-SBP).

The effects of acute pretreatment with high-dose memantine on the cardiovascular and behavioral effects of cocaine in humans.

This study examined the acute effects of pretreatment with high-dose memantine, an N-methyl-D-aspartate antagonist, on the effects of cocaine in humans. Six African American men completed this laboratory study, in which, following pretreatment with memantine (0 or 60 mg), they had 5 opportunities to smoke cocaine base (0, 12, 25, or 50 mg) or receive an alternative reinforcer ($5.00 merchandise voucher). Cocaine alone produced the well-documented dose-dependent increases in cardiovascular activity and ratings of positive mood. Maximal systolic blood pressure was elevated during memantine pretreatment days. Peak ratings of "I feel stimulated" and "I feel anxious" were also higher with memantine pretreatment. However, memantine pretreatment did not alter the choice to self-administer cocaine. These data suggest that memantine pretreatment may not be helpful in the treatment of cocaine dependence.

관상동맥질환을 동반한 운동유발성 고혈압 환자에서 좌심실비대와 신체구성 및 점증부하 운동시 수축기 혈압

관상동맥질환을 동반한 운동유발성 고혈압 환자에서 좌심실비대와 신체구성 및 점증부하 운동시 수축기 혈압