Decrease In Mean Blood Pressure Research Articles

PREGNANT WOMEN STRUGGLING WITH HIGH BLOOD PRESSURE AND STRESS IN PREGNANCY AND ROLE OF NITRIC OXIDE SUPPLEMENTS L-ARGININE FOR PROLONG PERIOD

INTRODUCTION: Mental stress can contribute to the exacerbation of hypertension in pregnant women and preeclampsia by the release of stress hormones such as adrenaline and cortisol level. Less nitric oxide (NO)-dependent vasodilation and excess formation of reactive oxygen species could explain poor placenta perfusion already in PIH and Preeclampsia due to impaired endothelial function. Studies have indicated that Nitric oxide supplement L-arginine can lead to beneficial effects on various cardiometabolic markers, including blood pressure and vascular function especially in pregnant mothers. OBJECTIVE: The primary objective of this meta-analysis study of placebo-controlled trials was to assess and ascertain the evidence of effectiveness of L-arginine and its use in enhancing nitric oxide synthesis to translate into tangible improvement in Hypertension and preeclampsia management, Nitric oxide supplement L-arginine’s ubiquitous molecule’s role is a subject of debate and research with focus on both systolic and diastolic values, pregnancy outcomes and understanding of its role in Hypertension resistant to currently available therapies. METHODS: In this study focused on role of L-arginine on high blood pressure during pregnancy, we did a thorough research, effective communication of information from relevant and up-to-date research articles, studies from reputable sources and great places of academic database like PubMed, Google Scholar, medical journals. Around 16 trials were searched in Pub-Med and Google scholar. A total of six trials were included in this meta-analysis. RESULTS: Result of this meta-analysis shows Nitric Oxide L-arginine supplementation showed a mean decrease in diastolic blood pressure and can lead to beneficial effect on blood pressure and vascular function especially in pregnant mothers with stress, mean increase up to 1. 23 weeks (p = 0. 002) for gestation period to delivery but did not showed reduction in systolic blood pressure as compared to placebo. CONCLUSION: This meta-analysis study supports the notion that availability of this substrate for NO synthesis prolongs the latency to development of preeclampsia and decrease the hypertension in a high-risk pregnant woman with Hypertension and stress.

Triple fixed-dose combination of amlodipine, indapamide and perindopril for hypertension in patients with stable coronary artery disease and abdominal obesity

Aim. In an open-label clinical trial, to evaluate the effectiveness and impact on metabolic parameters of triple antihypertensive combination therapy with amlodipine, indapamide and perindopril arginine (perindopril A) in patients with hypertension (HTN) and stable coronary artery disease (CAD) in combination with abdominal obesity (AO), who have not had an adequate response to dual antihypertensive therapy for at least 4 weeks.Material and methods. The study included 68 adult patients aged 42 to 64 years (51 (47; 60) years) with AO, stable CAD and uncontrolled HTN, despite treatment with two drugs: an angiotensin-converting enzyme (ACE) inhibitor and a thiazide and thiazide-like diuretic. In the study, patients, in accordance with the general characteristics of the drug, after prescribing a free triple-dose combination of amlodipine, indapamide, perindopril in appropriate dosages, received one of the following combination of amlodipine/indapamide/perindopril for 24 weeks: group 1 (n=34) — 10/2,5/10 mg and group 2 (n=34) — 5/1,25/5 mg, one tablet daily. The analysis of the primary endpoint was to assess the change in mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the sitting position from baseline to 24 weeks. Secondary efficacy endpoints included the proportion of patients achieving target mean SBP and DBP values for this category in the sitting position of 120-130 mm Hg and 70-79 mm Hg, respectively, at 12, 16, 20 and 24 weeks. Safety was assessed throughout the study. The effect on metabolic parameters was assessed at 24 weeks of the study.Results. Sixty-seven (98,5%) patients completed the study. The mean decrease in blood pressure from the initial level (group 1159/96 mm Hg; group 2161/95 mm Hg) to 24 weeks (group 1 126/76 mm Hg; group 2 132/84 mm Hg) was significant (p<0,0001 for all). The proportion of patients who reached the target mean values of SBP (120-130 mm Hg) and DBP (70-79 mm Hg) in the sitting position by 24 weeks was 80,16% and 79,28% in group 1, respectively; in group 2 — 65,32% and 70,06%, respectively. No serious adverse events were recorded. Its administration, regardless of the doses of individual components in combination, was accompanied not only by metabolic neutrality in relation to carbohydrate, lipid and purine metabolism, a decrease in chronic inflammation, but was also associated with a decrease in serum leptin concentration and subcutaneous adipose tissue, an increase in tissue sensitivity to leptin, as well as a decrease in the size of adipocytes in subcutaneous fat.Conclusion. Triple fixed-dose of amlodipine/indapamide/perindopril in two different dosages is effective, safe and well tolerated in patients with HTN and stable CAD in combination with AO.

Evaluation of Hypertension and Renal Function in Preeclamptic Women: A Follow-Up Study at 6th Week of Postpartum

OBJECTIVES: Chronic hypertension stands as the primary contributing factor for cardiovascular ailments among women who have experienced preeclampsia. The purpose of this research is to examine how often preeclamptic symptoms persist at the postpartum 6th week. STUDY DESIGN: The study included 50 singleton pregnant women in the third trimester who were diagnosed with preeclampsia according to ACOG criteria, were older than 18 years, had no known hypertension before the 20th gestational week, had no additional systemic disease, did not use medication, had no fetal chromosomal or structural abnormalities and delivered within 24-48 hours of hospitalization. RESULTS: The mean age of preeclamptic pregnant patients was 29.26±7.15 years, the mean gestational week was 35.6±2.8, and the mean BMI was 31.3±4.9. Twenty (40%) of 50 preeclamptic patients had severe preeclampsia. The mean decrease in systolic blood pressure was 34.6±15.2 mmHg, while the mean decrease in diastolic blood pressure was 22.88±11.68 mmHg (p<0.001). The decrease in systolic and diastolic blood pressure at postpartum 6th week was statistically significant. The mean change in 24-hour urine protein value at postpartum 6th week was 2313.52 ± 2696.48 and the difference was statistically significant (p<0.001). There were 14 patients (28%) with persistent hypertension and 19 patients (38%) with persistent proteinuria. CONCLUSIONS: Although preeclampsia is considered a complication of pregnancy, persistent hypertension, and proteinuria after delivery show us that preeclampsia is a disease that threatens maternal health even after delivery. These women should be followed up long-term period.

THU568 The Impact of Surgical versus Medical Therapy on Renin Plasma Activity, Renal Function, and Hypertension Control in Patients with Primary Aldosteronism

Abstract Disclosure: S. Rolak: None. N. Venkatesan: None. R. Gregg Garcia: None. W.F. Young: None. I. Bancos: None. Background: Bilateral primary hyperaldosteronism (PA) is treated with mineralocorticoid receptor antagonist (MRA) therapy. However, the best way to monitor the success of MRA therapy is unclear. Aims: To compare the impact of curative adrenalectomy versus MRA therapy in patients with PA on plasma renin activity (PRA), renal function, and hypertension control. Methods: Single center retrospective study of patients with unilateral PA treated with adrenalectomy or bilateral PA treated with MRAs, 2017-2021. Patients underwent adrenal vein sampling to confirm laterality. Hypertension control was defined based on blood pressure measurements and the standardized hypertension daily dose (HDD). Minimum follow-up was defined as first nonsuppressed PRA or >1 month from therapy. Results: Of 73 patients, 53 underwent unilateral adrenalectomy for unilateral PA (median age 57, range 25-71 years, 36% women) and 20 had bilateral PA treated with MRA (median age 49, range 30-70 years, 70% women). At baseline, when compared to the bilateral PA, patients with unilateral PA had higher plasma aldosterone concentrations (median 31 ng/dL vs 19 ng/dL, P= 0.001), similarly suppressed PRA, and similar estimated glomerular filtration rate (eGFR). Uncontrolled hypertension (>130/90 mmHg) was seen in 40 (75%) of patients with unilateral PA and 14 (70%) patients with bilateral PA, despite a more intensive antihypertensive regimen in unilateral PA (median HDD 5, range 1-18 vs median HDD 3.5 in bilateral PA, range 0.5-9; P=0.016). Hypokalemia was present in 50 (94%) patients with unilateral PA and 15 (75%) in bilateral PA, P = 0.02.Following treatment, hyperkalemia developed in 10 (19%) patients post-adrenalectomy and in 2 (10%) patients treated with MRAs, P = 0.36. At a median follow up of 108 days, 24 (45%) patients treated with adrenalectomy and 16 (80%) patients treated with MRAs demonstrated PRA >1.5 ng/mL/hr, P = 0.008. eGFR decreased by at least 10 points in 15 (30%) patients treated with adrenalectomy vs in 11 (59%) patients treated with MRAs (P=0.033). Post-adrenalectomy, antihypertensive management lessened by a median of 2.5 HDD, while HDD increased in patients treated with MRAs by a median of 1.25, P<0.0001. Hypertension control improved, with a mean decrease in systolic blood pressure of -11 mmHg (95%CI -16.5-(-5.5)) without between group differences. Diastolic blood pressure decreased by a mean of -4.7 mmHg (95%CI -8.7-(-0.7)) in the adrenalectomy group but did not change in those treated with MRAs. Conclusions: Following curative adrenalectomy in unilateral PA, more than half of patients continue to have suppressed PRA. Despite less severe PA at baseline, patients treated with MRAs, as compared to those treated with adrenalectomy, demonstrate a higher prevalence of non-suppressed PRA, lower eGFR, similar hypertension control, and a more intense antihypertensive regimen during follow up. Presentation: Thursday, June 15, 2023

Post-spinal hypotension management for cesarean section in low resource settings: efficiency and safety of two very low-dose boluses of norepinephrine, a randomized double-blinded controlled trial

Spinal anesthesia is the gold standard anesthetic technique for cesarean section. However, its major complication is hypotension. Norepinephrine has recently been described as an efficient and safe alternative to Phenylephrine. The aim of this study was to determine the effective target bolus of Norepinephrine to prevent and treat post-spinal anesthesia hypotension. We conducted a prospective controlled randomized study including 126 parturients scheduled for cesarean delivery under spinal anesthesia. We compared two groups that received a prophylactic bolus of either 1μg/kg or 0.5μg/kg of Norepinephrine without fluid loading. The rescue intravenous bolus of Norepinephrine was half the dose of the prophylactic bolus. The main outcomes were the percentage of decrease in systolic and mean blood pressure. The secondary outcomes included the timing of the first hypotension, duration of hypotension, number of rescue boluses, total Norepinephrine consumption, incidence of hypotension and maternal adverse effects and fetal outcomes. Our primary outcome has shown similarities between groups; delta systolic blood pressure before delivery was 19.4% in group 1µg/kg versus 20.5% in group 0.5µg/kg. Both groups were similar for all secondary outcomes, except that the higher dose of Norepinephrine resulted in more hypertension. Fetal outcomes were similar in both groups. Bolus of 0.5μg/kg followed by rescue doses of 0.25μg/kg of Norepinephrine was efficient in preventing and treating spinal anesthesia-induced hypotension. These doses may be recommended for routine use in healthy parturients.

СПИРОНОЛАКТОН В СОСТАВЕ АНТИГИПЕРТЕНЗИВНОЙ ТЕРАПИИ ПЕРВОЙ ЛИНИИ: ВЛИЯНИЕ НА СОСУДИСТОЕ РЕМОДЕЛИРОВАНИЕ

Introduction. Previously, clinical studies have proven a pronounced antihypertensive effect of spironolactone in patients with true resistant hypertension. The effectiveness of spironolactone as part of first-line therapy, as well as the effect on vascular wall remodeling, has not been studied. Target. To study the effect of spiroconolactone as part of the first line of therapy when added to telmisartan on indicators of vascular wall stiffness in patients with hypertension at high/very high cardiovascular risk. Materials and methods 32 patients (54 (45; 59) years old) were randomly divided into two groups: in the main group receiving spironolactone at a dose of 25 mg in addition to telmisartan (ARB/spironolactone) and in the group receiving hydrochlorothiazide/ARB combination (control). group). Inclusion criteria: age of patients (30-65 years), hypertension at high/very high cardiovascular risk without antihypertensive therapy, no contraindications to prescribed drugs. At baseline and 6 months later, all patients underwent clinical (office) blood pressure (BP) measurements, ABPM, endothelium-dependent vasodilation (EDVD), vascular remodeling indicators: central blood pressure (CAP), augmentation index, pulse wave velocity (PWV). In patients in the ARB/spironolactone group, serum potassium levels were assessed at baseline and after 4 weeks of treatment. Results. In both groups, a significant decrease in clinical and average daily blood pressure was revealed, as well as a decrease in the augmentation index and CAP. PWV in the carotid-radial segment (CWCR) did not significantly decrease in both groups, while PWV in the carotid-femoral area (CWCF) decreased in the ARB/spironolactone group from 9.8 (9.0; 10.6) m/s to 8.6 (8.0; 10.2) m/s (p = 0.0007). The dynamics of SPWcr was 0.9 (1.3;-0.5) m/s in the ARB/HCT group. In all patients, blood potassium was within reference values. Conclusions. Spironolactone as part of first-line therapy, when added to ARBs in patients with hypertension at high/very high cardiovascular risk, led to a significant decrease in clinical and mean daily blood pressure, as well as a decrease in PWCF.

Ultrasound Guided Modefied Pectoral Nerve Block (PECII) versus Serratus Anterior Plane Block (SAPB) for Postoperative Analgesia in Modified Radical Mastectomy

Abstract Background Breast cancer is the most common cancer in women in both the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women. A procedure called Modified radical mastectomy is now a standard surgical treatment for early stage breast cancers. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases. Objective to evaluate the effectiveness of ultrasound guided Modefied pectoral nerve block (PEC II) versus Serratus Anterior plane block (SAPB) as a postoperative Analgesia in MRM. Regarding the time of the first analgesic dose and the total amount of analgesia consumed during the first 24 hrs inaddition to the pain score and incidence of complications. Patients and Methods After obtaining approval from the medical ethical committee in Ain Shams University, this study was conducted in Ain Shams University Hospitals. It included 70 female patients undergoing MRM were divided randomly into two groups, each group consisted of 35 patients; Group I patients received Modified PECS, Group II patients received Serratus Anterior Plane Block (SAPB). The two groups were compared regarding analgesic outcome by using the numeric rating score system, time for first for analgesic need and total consumption of opioid in the 1st 24 postoperative hours. Demographic data and post-operative hemodynamics were also assessed. Results The results of our study showed that there was no statistically significant difference between groups regarding demographic data. Also, there was a statistically significant decrease in Mean blood pressure (mmHg) in Group II compared with Group I from 1 hr. to 6 hrs postoperative. However, a statistically significant decrease in group II compared to group I regarding postoperative heart rate (beat/min) from 1 hr. to 6 hrs. Conclusion SAPB block was more effective in reducing postoperative pain scores for 1-6 hours and lower total 24-h postoperative opioid and analgesic consumption after MRM under general anesthesia, compared to Modefied PECS block.

Efficacy observation of pushing Qiaogong point with different intensities for treating stage I essential hypertension

ObjectiveTo observe the clinical efficacy of pushing Qiaogong point with varying intensities for treating stage I essential hypertension.MethodsA total of 72 patients diagnosed with stage I essential hypertension were enrolled in this study. They were divided into three groups using the random number table method, including a control group, a gentle pushing group, and a heavy pushing group, with 24 patients in each group. All three groups received the same therapeutic lifestyle interventions. The control group received no additional interventions, the gentle pushing group received additional pushing Qiaogong point with gentle strength, and the heavy pushing group received additional pushing Qiaogong point with heavy strength. The treatment duration was 4 weeks, followed by a 4-week follow-up period, during which blood pressure changes were observed and analyzed in all three groups.ResultsAfter treatment, the blood pressure levels in all three groups showed a significant decrease (P<0.05). The effective rate in the control group was 43.5%, in the gentle pushing group was 78.3%, and in the heavy pushing group was 33.3%. The reduction in blood pressure levels in the gentle pushing group was significantly superior to that in both the control group and the heavy pushing group, indicating inter-group statistical significance (P<0.01). The efficacy of the heavy pushing group was comparable to that of the control group, indicating no statistical significance (P>0.05). During the follow-up period, compared with the end of the treatment within the same group, the blood pressure levels remained stable in both the control group and the gentle pushing group, indicating no intra-group statistical significance (P>0.05). The heavy pushing group showed a significant decrease in diastolic blood pressure (DBP) and mean blood pressure (MBP) compared with the end of the treatment, indicating intra-group statistical significance (P<0.05). During the follow-up, the gentle pushing group had lower systolic blood pressure (SBP) and MBP compared with both the heavy pushing group and the control group, indicating inter-group statistical significance (P<0.01), while there was no inter-group statistical significance in comparing the DBP (P>0.05). There was no statistical significance in comparing the SBP, DBP, and MBP between the heavy pushing group and the control group (P>0.05).ConclusionPushing Qiaogong point with gentle strength combined with lifestyle interventions showed a higher effective rate and long-term blood pressure stability in the treatment of stage I essential hypertension. Pushing Qiaogong point with varying intensities showed varying effects on patients with stage I essential hypertension.

Efficacy of Allisartan Isoproxil in the Treatment of Mild-to-Moderate Essential Hypertension.

Allisartan isoproxil is a selective nonpeptide angiotensin II (AT1) receptor blocker developed by China, this study aimed to assess its clinical efficacy for essential hypertension(EH). Patients with mild-to-moderate EH, selected at 44 sites in China from September 9, 2016, to December 7, 2018, were administered 240mg allisartan isoproxil daily for 4 weeks. Patients with controlled blood pressure(BP) continued monotherapy for 8 weeks, others were randomly assigned (1:1) to A + D group (allisartan isoproxil 240mg + indapamide 1.5mg) or A + C group (allisartan isoproxil + amlodipine besylate 5mg) for 8 weeks. BP were measured at week 4, 8 and 12. 2126 patients were included. After 12 weeks of treatment, systolic blood pressure(SBP) and diastolic blood pressure(DBP) decreased by 19.24 ±12.02 and 10.63 ±8.89 mmHg, respectively, and the overall BP control rate was 78.56%. The sitting blood pressures (SBP/DBP) decreased by 19.12 ±11.71/10.84 ±8.73 mmHg in patients with 12 weeks allisartan isoproxil monotherapy (both p < 0.0001). The BP reductions and control rates were comparable between A + D and A + C groups. 48 patients with monotherapy-controlled BP underwent ambulatory blood pressure monitoring, with a mean decrease in ambulatory blood pressure of 10.04 ±10.87/5.50 ±8.07 mmHg after 12 weeks of treatment, and consistent reductions between day and night. SBP and DBP had trough-to-peak ratios of 64.64% and 62.63% and smoothness indices of 3.82 and 2.92, respectively. An allisartan-isoproxil-based antihypertensive regimen can effectively control BP in patients with mild-to-moderate EH.

Comparative evaluation of propofol, thiopentone and etomidate on induction time, intubation response and recovery time during laparoscopic surgery under general Anaesthesia

: Optimal choice of inducing agent can partially modify the post induction hypotension, having a reported incidence of 9-40% in various studies. So, we compared the induction and recovery profile of the routinely available induction agents.This prospective randomized, comparative study was carried out on 120, ASA 1 and II patients undergoing routine laparoscopic cholecystectomy. Patient received either thiopentone 5 mg/kg, propofol 2.0 mg/kg or 0.3mg/kg injection etomidate at induction in group T, P and E respectively. The time taken from the administration of inducing agent to loss of eyelash reflex was noted. Heart rate, systolic, diastolic and mean arterial pressure, SpO2 was recorded at 1, 2, 3, 4, 5, 6 minutes and every five minutes after intubation. Steward score and the vitals were noted every 5 minutes after extubation till 30 minutes. It was noted that how long it took to get a Steward score of 6.The mean induction time (sec) was 49.85 ±2.54 in group T, 43.45 ±2.66 in group P and 52.675 ±2.11 in group E. (p&amp;#60;0.0001). The increase in mean heart rate from baseline upon induction and intubation was (10%, 31% in group T), (3%, 23% in group E) and (-7%, 16% in group P) (p&amp;#60;0.0001). Post induction decrease in systolic, diastolic and mean blood pressures observed in group T was (-9%, -4.5%, -6%), (-12.8%, -9.8%, -11%), in group P and (-4.6%, -1.7%, -2.9%) in group E. (p&amp;#60;0.0001). Post intubation increase in systolic, diastolic and mean blood pressures was (21.76%, 18%, 19.7%) in group T, (16%, 8.1%, 11.7%) in group E and (9.6%, 0%, 4%) in group P. Mean recovery time in min was 5.87 ±0.23 min with propofol, 6.97 ±0.28 with etomidate and 8.96 ±0.28 with thiopentone. (p&amp;#60;0.0001). : Amongst the three agents, we recommend propofol as preferred agent for induction due to faster induction, better attenuation of intubation response, faster recovery and stable hemodynamic parameters.

"Arterial stiffness is not associated with changes in the circadian pattern of blood pressure in patients with type 1 diabetes mellitus and cardiovascular autonomic dysfunction".

Cardiovascular autonomic neuropathy (CAN) associates an abnormal circadian pattern in blood pressure (BP) regulation that might be aggravated by the coexistence of arterial stiffness. We aimed to evaluate the effect of arterial stiffness in the circadian rhythm of BP in patients with type 1 diabetes and CAN. Cross-sectional study including 56 consecutive patients with type 1 diabetes and CAN, with (n = 28) or without (n = 24) arterial stiffness as defined by an ankle-brachial index above 1.2. CAN was diagnosed by BP and heart rate responses to active standing and cardiovascular autonomic reflex tests. Absence of nocturnal decrease in BP-"non-dipping" pattern- was defined by a daytime to nighttime decrease in mean BP smaller than 10%. The study's subjects mean age was 40 ± 11 years-old, their mean duration of diabetes was 22 ± 10 years, and their mean A1c was 7.9 ± 1.5%. A "non-dipping" pattern was observed in 28 patients (54%) regardless of the presence or absence of arterial stiffness. Age, waist circumference, body mass index, and A1c, were introduced as independent variables into a multiple regression analysis. The stepwise model (R2: 0.113, p = 0.016) retained only A1c levels (β: ‒ 0.333, 95% confidence interval [CI]: -3.10 to -0.33) as significant predictor of the percentage of nighttime decrease in mean BP. A non-dipping pattern in BP is very common in patients with type 1 diabetes presenting with subclinical CAN and is associated with a poorer metabolic control. On the contrary, coexistence of arterial stiffness is not associated with abnormalities in circadian BP regulation.

Resort treatment of patients with arterial hypertension using transcranial magnetic therapy

Purpose of the study. Development of a new medical technology for the resort treatment of patients with arterial hypertension (AH) with the combined use of transcranial magnetic therapy (TMT). Material and methods. The study involved 60 patients with stage 1 AH, divided into 4 groups in accordance with the simple fixed randomization procedure. The patients in the control group (CG; n=30 people) received a basic complex of resort treatment (nebivolol, exercise therapy, group psychotherapy), while in the main group (MG; n=30 people), the patients were additionally prescribed TMT. The criteria for evaluating the effectiveness were as follows: the dynamics of indicators of daily blood pressure monitoring (DBPM), heart rate variability, and the parameters of the microcirculatory tissue system. Results. The dynamics of DBPM indicators shows that the positive changes in the estimated parameters in the MG were more pronounced and significantly different from the dynamics of the control group. The hypotensive effect of the course use of TMT in patients with stage 1 hypertension manifested itself in a decrease in SBP and DBP by an average of 10.2 % and 12.8 %, respectively (p&lt;0.05), as well as a decrease in mean blood pressure by 13.2 % (p&lt; 0.05). In general, as a result of the TMT course use, a significant decrease in the average daily and average night SBP levels was achieved. The evaluation of the clinical and functional state of the patients with hypertension 6 months after the end of resort treatment based on the combined TMT use proves the superiority of the proposed technique over the basic treatment regimen by 33 %. Conclusion. The use of TMT in the resort treatment of patients with stage 1 hypertension contributes to a significant increase in therapeutic measures: the hypotensive effect of the course use manifested itself in a decrease in SBP and DBP by 10.2 % and 12.8 %, respectively (p&lt;0.05), as well as a decrease in mean blood pressure by 13.2 % (p&lt;0.05).

The Relationship Between the Dipping Pattern and Coronary Artery Disease Severity Assessed by the SYNTAX Score in Patients With Hypertension.

Background The morbidity and mortality rates related to hypertension (HT) are still high despite the developments in this area. Nondipper hypertension (NDHT) is related to worse clinical outcomes. But the dipping pattern of HT is not still used for treatment targets. In this study, we investigated the effect of dipping patterns on coronary artery disease (CAD) complexity evaluated by the SYNTAX score (SS). Methodology Patients with stable CAD and HT were included in the study. All patients were monitored with 24-hour ambulatory monitoring, and dipping patterns were evaluated. Coronary artery complexity was determined by SS for all patients and compared along with different dipping patterns. Results A total of 331 patients with HT and stable CAD were evaluated in the study. The mean age of the patients was 62.6 ± 9.9 years, and 172 (52%) were male. The number and percentage of patients with dipper HT (DHT), NDHT, over-dipper HT (ODHT), and reverse-dipper HT (RDHT) were 89 (26%), 143 (43%), 11 (3%), and 88 (26%), respectively. When the groups were compared according to SS, the SS of the patients with RDHT were significantly higher (the SS were 6.33, 4.99, 3.09, and 2.7 for RDHT, ODHT, NDHT, and DHT, respectively, P = 0.003). The mean SS between the DHT group and the NDHT group (P = 0.03) and between the DHT group and the RDHT group (P = 0.01) was significantly different. The less decrease or increase in mean blood pressure (MnBP) values was significantly correlated with high SS. Conclusions NDHT, especially the reverse dipping pattern, is closely related to complex CAD. Meticulous consideration of dipping patterns can identify high-risk patients and improve clinical outcomes.

Rate of decline of fetal base excess after neuraxial anesthesia for scheduled cesarean delivery

In scheduled cesarean deliveries, the rate of decrease in the umbilical artery pH is related to the severity of maternal hypotension and the interval from spinal placement to delivery. Base excess values have greater use than umbilical artery pH values to time the duration of fetal acidemia because they demonstrate a linear rather than logarithmic correlation with the degree of acidosis. This study aimed to evaluate the rate of decline in the fetal base excess in scheduled cesarean deliveries that were converted to emergency cesarean delivery owing to fetal bradycardia following spinal anesthesia. All cases of scheduled cesarean deliveries in gestations at >34 weeks' gestation under spinal anesthesia that were converted to emergency cesarean deliveries owing to fetal bradycardia in the period May 2019 to May 2021 were reviewed. Included were those with (1) a preoperative reactive nonstress test and (2) fetal acidemia (umbilical artery pH <7.20). Excluded were those with anesthesia other than spinal and a birthweight below the 10th percentile for gestational age. Time intervals between the completion of spinal anesthesia and delivery were calculated and related to umbilical cord gas analytes. From a cohort of 1064 scheduled cesarean deliveries, 7 fulfilled the study criteria yielding 8 neonates. Mean ± standard error of the mean interval of spinal anesthesia to delivery was 15.0±1.9 minutes, and the decrease in mean blood pressure after spinal anesthesia was 39.1±3.0 mm Hg. Umbilical artery base excess ranged from -5.2 to -16.6 mmol/L (median, -8.0). Based on published normative data of prelabor fetal umbilical artery base excess (-2±0.6 mmol/L), the mean rate of base excess decrease was 0.38±0.25 mmol/minute. The rate of decrease in base excess when scheduled cesarean deliveries are converted to emergency cesarean deliveries owing to fetal bradycardia related to spinal anesthesia (1 mmol/2.6 min) matches the estimated rate of loss of base excess (1 mmol/2-3 minutes) reported in cases of severe bradycardia or sentinel events during labor.

A COMPARATIVE STUDY OF EFFICACY AND SAFETY OF AZILSARTAN 40MG AND TELMISARTAN 40MG IN STAGE I HYPERTENSIVE PATIENTS ATTENDING CARDIAC OPD AT TERTIARY CARE HOSPITAL

Objective: To study the efficacy and safety profile of Telmisartan 40 mg and Azilsartan 40 mg in stage I systemic Hypertension among patients attending cardiac OPD in a tertiary care center. Methods: An open-labeled comparative study was conducted in the Department of Cardiology, Osmania General Hospital, Hyderabad, for 24 mo. All patients with stage I systemic hypertension of either sex, aged 18-65 y, with blood pressures of &gt;140/90 mmHg and/or diabetes mellitus attending the cardiac outpatient department at Osmania General Hospital. After initial screening, diagnosed cases of essential hypertension were randomly allocated to either group 1 (Tablet Azilsartan 40 mg or group 2 (Tablet Telmisartan 40 mg). The patients were advised to report for follow-up for review on the 4th, 8th, 12th, and 24th week. Results: The mean decrease in the systolic blood pressure in both groups was statistically significant with a P value of&lt;0.05 at the 8th week, 12th week, and the end of the 24th week. The mean decrease in diastolic blood pressure in both groups was statistically significant with a P value of 0.01 at the end of the 24th week. The difference between the SBP and DBP at various intervals is statistically significant with an Anova P value of&lt;0.0000001. Conclusion: Both drugs controlled blood pressure at similar proportions. However, the mean of SBP and DBP for the Azilsartan group was lower than the Telmisartan Group. Both drugs were tolerated well, and no significant adverse effects were noted during the study.

Significant improvement in blood pressure control among older adults with hypertension in rural South Africa: findings from a prospective 5,000-patient cohort, 2014–2019

Abstract Background Sub-Saharan Africa is undergoing an epidemiologic transition dominated by a widespread epidemic of hypertension (HTN). Since 2014, we began studying a cohort of 5,059 individuals in rural South Africa, to describe the evolution of HTN among older adults, and understand the impact of targeted interventions by local health systems. Purpose Characterize the updated prevalence and incidence of HTN in a prospective cohort between baseline (2014) and follow-up (2019), and describe changes in blood pressure (BP) treatment. Methods HTN was defined as systolic blood pressure (SBP) ≥140 mm Hg, diastolic blood pressure (DBP) ≥90 mm Hg, or self-reported medication use. Prevalence and incidence rates were calculated using inverse-probability weights to account for mortality and attrition. Poisson regression was used to identify predictors of disease incidence. We calculated the percentage of individuals with controlled versus uncontrolled HTN (with 140/90 mm Hg as cutoff), self-reported medication use, and compared these values between 2014 and 2019. Results Compared to 2014 (n=5,059), study participants in 2019 (n=4,176) were expectedly older (mean age 61.7±13.1 vs 66.0±13.0 years) but had similar sex distribution (53.6% vs 53.5% females) and weighted rates of obesity (mean BMI 27.5±10.0 vs 27.0±6.5), with higher rates of smoking (9.1% vs 11.8%) and diabetes (11.1% vs 13.7%). The HTN prevalence did not increase over time (58.4% vs 59.8%), and there was a significant reduction in mean SBP (138.0 vs 128.5 mm Hg, p&amp;lt;0.001) and DBP (82.1 vs 79.6 mm Hg, p&amp;lt;0.001). In the subgroup of hypertensive individuals with measured BP and self-reported medication use in both 2014 and 2019 (n=796), the percentage who had controlled HTN on medications increased from 44.5% to 62.3% while the percentage who had uncontrolled HTN on medications or uncontrolled HTN not on medications decreased (48.5% to 32.2% and 7.2% to 3%, respectively) from 2014 to 2019 (Figure 1). The HTN incidence was 6.2 per 100 person-years, which was lower than prior reports from this area (8.4 per 100 person-years in 2010–2015); in multivariable models, age was the only significant predictor of incident HTN. In the subgroup of individuals who were healthy at baseline with measured BP and self-reported medication use in 2014 and 2019 (n=2,257), very few developed HTN by 2019 (15.2%); of those, the majority already had controlled HTN and was on medications by 2019 (Figure 2). Conclusions The prevalence of HTN did not increase in this aging cohort; in fact there was a clinically and statistically significant decline in mean BP and a substantial increase in the proportion of hypertensive patients with controlled HTN taking medications between 2014 and 2019. The prevalence of obesity, smoking and other risk factors did not decrease over time, suggesting that the mean BP decrease in this cohort is likely due to increased access and adherence to medications, promoted by local health systems. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute on Aging (P01 AG041710), and Department of Science and Innovation, the University of the Witwatersrand, South Africa.

Abstract P024: Longer Acting Antihypertensives Improve Blood Pressure Control

Introduction: Hypertension is a modifiable risk factor for cardiovascular and renal disease. It has been noted that blood pressure control has been decreasing over the past years throughout the US. In a quality improvement study, we are evaluating the effectiveness of longer acting antihypertensives in combination therapy with thiazide diuretic on blood pressure control in patients not sufficiently controlled. Methods: Participants included all clinic patients with diagnosed hypertension currently uncontrolled with BP &gt;140/90. Their medications were modified to include a longer acting angiotensin II receptor blocker (ARB) and thiazide diuretic. Follow up visits were requested for 1 month and 3 months. Results: A total of 60 patients were started on longer acting ARB-thiazide therapy, of which 17 patients were included in analysis as follow up results were available. On follow-up visit, there was a mean decrease in blood pressure of 43.8 mmHg (95% CI 34.8 to 52.8, p &lt;0.05) systolic and 18.9 mmHg (95% CI 11.9 to 25.9, p &lt;0.05) diastolic. Of the 17 patients, 11 patients were switched from an ARB or an ARB-thiazide to a longer acting ARB-thiazide with a mean decrease in blood pressure of 41.0 mmHg (95% CI 30.5 to 51.5, p &lt;0.05) systolic and 13.9 mmHg (95% CI 8.1 to 19.7, p &lt;0.05) diastolic. Of the 11 patients, 7 were previously on an ARB-thiazide and switched to longer acting ARB-thiazide with a mean decrease in blood pressure of 33.5 mmHg (95% CI 24.7 to 46.2, p &lt;0.05) systolic and 11.4 mmHg (95% CI 4.2 to 18.7, p &lt;0.05). Conclusion: Including long-acting ARB and thiazide in antihypertensive regimen provided a statistically significant decrease in blood pressure.

Cardiovascular risk management in gout patients: do patients benefit from screening in secondary care?

To estimate the 10-year cardiovascular disease (CVD) risk in gout patients in secondary care and to evaluate the effect of CVD risk screening on the 10-year CVD risk after 1 year. A prospective cohort study was performed in patients with gout from Reade Amsterdam. Data on gout and CVD history, traditional risk factors, medication, and lifestyle were collected at baseline and 1 year. The 10-year CVD risk was calculated with the use of the NL-SCORE. A paired sample t-test and McNemar test was performed to test for differences between baseline and the 1-year visit. A very high prevalence of traditional CV risk factors was seen in our secondary care gout patients. Nineteen percent without previous CVD were categorised in the high-risk group according the NL-SCORE. The prevalence of CVD increased from 16% to 21% after 1-year follow-up. A decrease was seen in total- and LDL-cholesterol after 1 year. No decrease in mean BMI, waist-hip ratio, blood pressure or NL-SCORE was observed. The current need for CVD risk screening of gout patients in secondary care was illustrated by the high prevalence of traditional risk factors in this cohort. Recommendations to patients and the general practitioner (GP) alone did not result in overall improvement of traditional CVD risk factors nor the 10-year CVD risk. Our results indicate that a more prominent role of the rheumatologist is necessary to optimise the process of initiation and management of CVD risk in gout patients.

Observation of hemodynamic variability and level of blood cortisol while induction with propofol and etomidate: A prospective, randomized, double blind study

: To observe the effects of propofol and etomidate induction on patients undergoing laproscopic cholecystectomies regarding serum cortisol level, hemodynamic parameters, pain on injection, myoclonus, and apnea on induction.: It is a prospective, randomized, double blind study. After approval from Institute Ethics Committee, sixty patients of age between 18 and 60 years with ASA grade I and II scheduled for laproscopic cholecystectomy under general anesthesia were randomly divided into two groups: Group A (n=30) would receive injection propofol 2 mg/kg i.v., Group B (n=30) would receive injection etomidate 0.3 mg/kg i.v. as induction agent. Vital parameters at induction, laryngoscopy and thereafter recorded. Pain on injection, myoclonus, apnea on induction were carefully watched. Serum Cortisol is measured at 1 hour before induction and at 2 hours and 24 hours after induction.: Demographic variables and baseline parameters were comparable in both groups.Propofol group show significant decrease in heart rate and mean blood pressure after induction in comparison to etomidate group. Pain on injection was more in group A while myoclonus activity was higher in Group B. Serum cortisol level is significantly lower in Group B post induction compared to Group A which comes to above baseline after 24 hrs but in normal range. Etomidate is a better induction agent than propofol in view of hemodynamic stability but also led to chemical evidence of adrenocortical insufficiency in patients with ASA grade I &amp; II undergoing elective laproscopic cholecystectomy under general anaesthesia which returns to normal in 24 hrs.

Esketamine as an Adjuvant to Ciprofol or Propofol Sedation for Same-Day Bidirectional Endoscopy: Protocol for a Randomized, Double-Blind, Controlled Trial With Factorial Design.

Background: Same-day esophagogastroduodenoscopy and colonoscopy procedures under sedation have been increasingly performed. This study aims to assess the effects of esketamine combined with ciprofol (a novel anesthetic/sedative agent) or propofol on respiratory and hemodynamic adverse events in patients undergoing same-day bidirectional endoscopy. Methods: This is a prospective, randomized, double-blind, placebo-controlled, 2 × 2 factorial trial. A total of 180 adult patients scheduled for same-day bidirectional endoscopy under sedation will be randomized, in a 1:1:1:1 ratio, to receive 1 of 4 sedation regimens: 1) ciprofol and esketamine, 2) propofol and esketamine, 3) ciprofol and normal saline placebo, or 4) propofol and normal saline placebo. The primary outcome is a composite of desaturation [peripheral oxygen saturation (SpO2) < 95%] and hypotension [mean blood pressure (MBP) < 65 mmHg or decrease in MBP ≥20% of baseline] during the sedation and in the recovery room. Secondary outcomes include episodes of desaturation, severe desaturation (SpO2 < 90%), hypotension, severe hypotension (decrease in MBP ≥30% of baseline), bradycardia, postoperative nausea and vomiting, dizziness or headache, hallucination or nightmare, injection pain, pain scores and fatigue scores, endoscopist satisfaction, and patient satisfaction. Data will be analyzed on the modified intention-to-treat basis. Discussion: We hypothesize that esketamine as an adjuvant to ciprofol or propofol sedation would improve cardiorespiratory stability. In addition, the potential interactions between interventions will be explored using the factorial design. The results of this trial will provide evidence for daily practice of sedation regimens for same-day bidirectional endoscopy. Clinical Trial Registration: Chinese Clinical Trials Registry, Identifier ChiCTR2100052523.