Mean Diastolic Blood Pressure Values Research Articles

The Relationships Between Blood Pb Levels and Blood Pressure Among Lead-Exposed Workers in China: A Repeated-Measure Study.

To explore the differences in the increase of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in 3 consecutive years among lead (Pb) workers. Four hundred forty-eight Pb workers were enrolled in this repeated-measure study. Blood Pb, SBP, and DBP were measured in 2015 to 2017. Repeated measure of analysis of variance was used to compare the differences in the increase of SBP and DBP. The mean SBP values were 124.0/125.5/126.9 mm Hg, and the mean DBP values were 75.4/77.4/77.8 mm Hg from 2015 to 2017. The differences in the increase of SBP and DBP were 2.94/2.42 mm Hg during the 3-year period. The average annual increase of SBP or DBP showed an upward trend in different Pb dose groups ( F = 4.904, P = 0.002; F = 3.612, P = 0.013). Lead exposure caused average annual increases in SBP and DBP with 0.98 and 0.81 mm Hg, which provided basic data for health surveillance.

Blood Pressure Reference Values of Nigerian Full-term Neonates in the First Week of Life at a Nigerian Tertiary Hospital: A Cross-sectional Survey

Introduction: Knowledge of normative Blood Pressures (BP) is critical for appropriate neonatal care. Hypertension and hypotension are abnormalities of BP which could be a sign, outcome or complications of diseases or intervention carried out on neonates. Yet, there is a dearth of data on BP concerning Nigerian full-term neonates. Aim: To determine BP values of apparently healthy term Nigerian neonates in relation to their weight in the first eight days of life and also to determine the BP values of apparently healthy term neonates in the first eight days and also to correlate the BP with postnatal age, weight and to generate percentile of age/sex specific BP. Materials and Methods: This cross-sectional study was done from September 2012-April 2013, including 386 consecutive apparently healthy term newborns delivered at the UNIOSUN Teaching Hospital (UTH), Osogbo, Southwest Nigeria. Their weights and right arm Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) BPs measured using oscillometric method on days 1, 3, 5 and 8. Student’s t-test and Pearson correlation coefficient was used to statistically analyse the data. Results: Out of 386 newborns studied, the mean birth weight were 3.10±0.38 Kg; {3.24±0.37 kg for boys and 2.97±0.33 kg for girls}. The mean values of SBP on day 1 were 67.3±5.6 mmHg; 71.0±6.0 mmHg on day 3; 73.8±5.2 mmHg on day 5 and 77.2±2.9 mmHg on day 8, respectively. A similar trend was also noticed in the mean values of DBP with 36.9±5.0 mmHg on day 1; 41.5±5.2 mmHg on day 3; 43.7±5.3 mmHg on day 5 and 46.4±4.7 mmHg on day 8, respectively, the rise being significant (p-value <0.001). There were a positive correlations between the weight and DBP on the 5th day (r=0.128; p-value =0.012), between weight and SBP at 49-72 hours and on day 8 (r=0.105; r=0.168, respectively) as well as weight and MAP on day 8 (r=0.166). Conclusion: Neonatal BP in the first eight days following birth correlated positively to weight and age without significant gender differences.

Učinak varijante gena FTO (rs17817449) i menopauze na krvni tlak u hipertenzivnih i normotenzivnih žena u Slovačkoj

This cross-sectional study examines the effect of fat mass and obesity-associated gene polymorphism (FTO) and menopause on blood pressure in Slovak midlife women. We assessed a total of 575 women ranging in age from 39 to 65 years. Data were analyzed using the univariate analysis of covariance to test the effect of risk FTO gene variant (G allele) and menopausal status (MS) on blood pressure in the hypertensive (HT) and normotensive (NT) women groups. A significant association was recorded between studied FTO gene variant and DBP (diastolic blood pressure) but only in HT women group (p = 0.044). Women possessing at least one risk allele (GG or GT) had slightly higher mean values of DBP than those without this allele. In the next step, our results showed a statistically significant association between MS and the FTO genotype and their common effect on SBP in NT women group (p = 0.002). The late pre-, perimenopausal G- allele carriers had lower SBP values in comparison with TT genotype carriers (estimated marginal means, 116.9 vs. 122.9 mm/Hg), while postmenopausal G- allele carriers had higher SBP values compared to TT genotype carriers (estimated marginal means, 120.7 vs. 114.1 mm/Hg). We did not notice any significant associations between FTO, menopause and DBP. Our findings indicate that FTO rs17817449 along with menopause are significant factors associated with systolic blood pressure in Slovak normotensive women.

Assessment of Healthy Lifestyle Behaviors among First-Year Medical, Dentistry and Health Sciences Students in Turkey

This cross-sectional study, in which the first-year findings of a prospective followup study were presented, was conducted with 356 students enrolled in the firstyear of three faculties at a state university in Istanbul between November 1st and December 31st, 2019. With this study, it was aimed to evaluate the changes in certain healthy lifestyle behaviors, risky behaviors and depression levels of students enrolled at the different faculties of a public university in Istanbul during their university life. The data were obtained through a questionnaire of 65 questions, and the Beck Depression Inventory, which consisted of 21 questions. They were administered under supervision by providing preliminary information to the students. The mean body mass index, mean systolic blood pressure and mean diastolic blood pressure values of the students were 23.23 + 4.1, 108.97 + 15.21 and 66.98 + 10.08, respectively. The mean daily sleep time was 6.77 + 1.21 hours, the mean TV viewing time was 0.77 + 1.13 hours, and the mean time they spent with a smartphone, tablet or computer was 3.67 + 2.50 hours. Among the students, 37.07% were smokers, 26.12% consumed alcohol, and 4.77% used addictive substances. Of the students, 31.46% considered themselves at risk for depression. At the universities, there is a need for the implementation of health promotion programs focusing on promoting physical activity and healthy nutrition and reducing risky behaviors. In addition, these programs should be strengthened with the trainings on changing behaviors.

Assessment of heart rate variability (HRV) in subjects with type 2 diabetes mellitus with and without diabetic foot: correlations with endothelial dysfunction indices and markers of adipo-inflammatory dysfunction

BackgroundSome studies have suggested that patients with diabetes and foot complications have worse cardiovascular and cerebrovascular risk profiles, higher degrees of endothelial dysfunction and arterial stiffness and a higher inflammatory background than patients with diabetes without diabetic foot complications. Patients with diabetes mellitus have an alteration in the sympathovagal balance as assessed by means of heart rate variability (HRV) analysis, which is also related to the presence of endothelial dysfunction. Other studies suggest a possible role of inflammation coexisting with the alteration in the sympathovagal balance in favor of the atherosclerotic process in a mixed population of healthy subjects of middle and advanced age.AimsThe aim of this study was to evaluate the degree of alteration of sympathovagal balance, assessed by HRV analysis, in a cohort of patients with diabetes mellitus with diabetic foot and in control subjects without diabetic foot compared with a population of healthy subjects and the possible correlation of HRV parameters with inflammatory markers and endothelial dysfunction indices.MethodsWe enrolled all patients with diabetic ulcerative lesions of the lower limb in the Internal Medicine with Stroke Care ward and of the diabetic foot outpatient clinic of P. Giaccone University Hospital of Palermo between September 2019 and July 2020. 4-h ECG Holter was performed. The following time domain HRV measures were analyzed: average heart rate, square root of the mean of successive differences of NN (RMSSD), standard deviation or square root of the variance (SD), and standard deviation of the means of the NN intervals calculated over a five-minute period (SDANN/5 min). The LF/HF ratio was calculated, reactive hyperemia was evaluated by endo-PAT, and serum levels of vaspine and omentin-1 were assessed by blood sample collection.Results63 patients with diabetic foot, 30 patients with diabetes and without ulcerative complications and 30 patients without diabetes were enrolled. Patients with diabetic ulcers showed lower mean diastolic blood pressure values than healthy controls, lower MMSE scores corrected for age, lower serum levels of omentin-1, lower RHI values, higher body weight values and comparable body height values, HF% and LF/HF ratio values. We also reported a negative correlation between the RHI value and HRV indices and the expression of increased parasympathetic activity (RMSDD and HF%) in subjects with diabetic foot and a statistically significant positive correlation with the LF/HF ratio and the expression of the sympathovagal balance.DiscussionPatients with diabetic foot show a higher degree of activation of the parasympathetic system, expressed by the increase in HF values, and a lower LF/HF ratio. Our findings may corroborate the issue that a parasympathetic dysfunction may have a possible additive role in the pathogenesis of other vascular complications in subjects with diabetic foot.

Some features of blood pressure variability in patients with arterial hypertension in various modes of antihypertensive therapy

Aim. The study objective was to compare different timing modes of hypertension medications dosing in patients with arterial hypertension in relation to blood pressure level and variability.Materials and methods. The study included 103 subjects with previously diagnosed AH in whom 24h ambulatory blood pressure monitoring records of adequate quality were obtained. Participants were stratified to three groups based on timing of hypertension medications dosing – morning dosing (group 1), bedtime dosing (group 2), and as needed (group 3). The last one included patients with low compliance of prescribed medications and irregular antihypertensive drugs intake. The systolic and diastolic blood pressure variability indices – standard deviation (VAR1) and root-mean-square value of the difference between consecutive blood pressure measurements (VAR2) were calculated. The Kruskal-Wallis ANOVA or χ2-test, as appropriate, was used to compare the groups. A two-sided P value <0.05 was considered statistically significant. Analysis of data included corrections for multiple comparisons.Results. Statistically significant differences were found in mean 24-h diastolic blood pressure values between groups 1 and 3, 2 and 3 (P = 0.02), awake mean diastolic blood pressure values between groups 1 and 3 (P = 0.03) and for VAR1 night-time systolic blood pressure between groups 1 and 3, 2 and 3 (P < 0.05). There were no significant differences between any of the studied parameters between the groups with the morning and evening dosing of antihypertensive drugs.Conclusions. Treatment mode does not significantly affect the short-term variability of blood pressure, determined by the standard deviation from the mean blood pressure and the root-mean-square value of the difference between consecutive blood pressure measurements for a given time period.

Effects of chronic type 5 phosphodiesterase inhibition on penile microvascular reactivity in hypertensive patients with erectile dysfunction: a randomized crossover placebo-controlled trial.

This randomized crossover and placebo-controlled trial evaluated the effects of daily use of sildenafil citrate (SIL, 1-month 50 mg twice daily) on penile and systemic endothelial microvascular function in hypertensive patients presenting with erectile dysfunction. The effects of SIL on arterial pressure were evaluated using ambulatory blood pressure monitoring (ABPM). Fifty patients diagnosed with primary arterial hypertension and erectile dysfunction (aged 57.4 ± 5.6 years), recruited in a tertiary public hospital, were treated with SIL (50 mg twice daily) or placebo (PLA) for two 30-day periods with a 30-day washout between them. Laser speckle contrast imaging coupled with acetylcholine skin iontophoresis was used to evaluate penile and systemic (forearm) cutaneous microvascular reactivity. SIL treatment increased penile basal microvascular flow (P = 0.002) and maximal endothelial-dependent peak response to skin iontophoresis of acetylcholine (ACh, P = 0.006). The area under the curve of microvascular vasodilation induced by ACh was also significantly increased (P = 0.02). Lastly, SIL treatment did not modify systemic microvascular reactivity. Twenty-four-hour ABPM (P = 0.0002) and daytime (P = 0.002) and nighttime (P = 0.001) mean diastolic blood pressure values were significantly reduced after SIL treatment. The scores of the Simplified International Index of Erectile Function (P < 0.0001) and the number of patients with positive responses to Sexual Encounter Profile question 3 (P < 0.0001) also increased after SIL treatment. Penile endothelium-dependent microvascular reactivity improved after continuous use of sildenafil in hypertensive patients with erectile dysfunction; the treatment also reduced blood pressure, suggesting that, in addition to improving erectile function, daily use of sildenafil could improve blood pressure control.

EVALUATION OF CARDIOVASCULAR AUTONOMIC FUNCTIONS IN MIGRAINE INDIVIDUALS IN TERTIARY CARE HOSPITAL

Introduction: Migraine is a chronic neurological disorder characterized by recurrent disabling attacks of a headache with heterogeneous characterized by headache and hypersensitivity to sensory stimuli. Migraine attacks can depend upon from multitude of causative factors like diet, stress, fatigue, environmental changes and hormonal changes among others. It causes painful condition where individuals suffer from recurrent episodes of headache, which could be very severe. Pain sensations are discerned at various levels of the nervous system. Migraine as one of the top 20 leading neurological causes of disability according to WHO. About 12% of world’s population suffers from migraine and in India about of 1200 million populations there are 150-200 million migraineurs under treatment. About 20% in females and 6% in males has prevalence of migraine. Migraine is define as a heterogeneous disorder where there is variation in attacks in duration, frequency, severity, character and associated with physical and emotional disability. There is anxiety and panic disorder with sympathetic over activity with stress being the most important triggering factor. Migraine is also associated with ischemic stroke. Autonomic nervous system (ANS) plays central role in the cascade of events leading to migraine attack. &#x0D; Aim: The main aim of this study is to testing migraine on cardiac autonomic functions and finding the sympathetic or parasympathetic dysfunction in the heart that relates with the pathogenesis of migraine. &#x0D; Material and methods: This study was carried out in the Dept. of Physiology at Chandulal Chandrakar Memorial Medical College Kachandur, Durg.. In this study total 60 individuals were included from ages 20 to 50 years with 30 in each group. Two groups were included in this study. Migraine fulfilling International Headache Society (IHS) criteria for migraine consists of newly diagnosed cases were included in this study. Participant’s individuals were instructed about various manoeuvres that would be employed and allowed to practice these manoeuvres. ECG was acquired by continuous recording for 5 min (320 s) which is needed for short term ECG analysis. Mean respiratory rate (RR), mean HR, total power, low frequency (LF), high frequency (HF), and LF/HF were estimated as proposed by Wang and Mishra(2006). Both the sympathetic and parasympathetic reactivity of ANS test were done with Orthostatic standing test (OST) as well as deep breathing (DB) which tests the intactness of parasympathetic function were performed after giving enough rest in between the tests. Isometric handgrip (IHG) test and cold pressor (CP) test were also performing for evaluating the sympathetic reactivity. &#x0D; Result: Total 30 patients were include in each group with mean age of control group 33.3 ± 5.6 and mean age of case group 30.9 ± 8.6. 24 cases in controls and 26 in cases group there is Female dominant which shown females are more prone to migraine. While compares the resting HR, diastolic blood pressure (DBP) and systolic blood pressure (SBP), between the cases and controls as shown in table no 1. There was not significant between Mean value for HR and mean value of DBP between cases and control. However mean value of SBP showed a P = 0.001 which was highly significant. The mean value of HR, RR interval and total power were also not statistically significant as P &gt; 0.05. &#x0D; Conclusion: Evaluation of cardiovascular functions in migraine reveals sympathetic hypofunction with an intact parasympathetic activity which as indicated by a significant reduction of sympathetic modulation of RR intervals. Better understanding of the role of sympathetic function and its dysfunction may help to prevent or successfully treat migraine and other headaches.&#x0D; Keywords: Migraine, Autonomic function, Sympathetic activity, Headache

Association between perfluoroalkyl substance concentrations and blood pressure in adolescents

The effects of exposure to some environmental chemicals on blood pressure have been determined, but the association between non-occupational exposure to perfluoroalkyl substances (PFASs) and blood pressure in adolescents remains unknown. The association between blood pressure and PFAS concentrations was studied by analysing data from 2251 participants filtered from the population enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2012. After adjusting for age, sex, race, BMI, cotinine level, dietary intake of calcium, caloric intake, sodium consumption, potassium consumption and sampling year, we estimated the coefficients (betas) and 95% confidence intervals (CIs) for the relationship between PFAS concentrations and blood pressure with multiple linear regression models. Potential non-linear relationships were assessed with restricted cubic spline models. Blood levels of perfluorooctane sulfonic acid (PFOS) had a strong positive association with diastolic blood pressure (DBP) in adolescents in the linear model, while the result was not significant in the non-linear model. No significant association was observed between the concentration of any other PFASs and blood pressure. According to the fully adjusted linear regression model (P = 0.041), the mean DBP values in boys in the higher PFOS quintile were 2.70% greater than the mean DBP values of boys in the lowest PFOS quintile. Furthermore, serum PFOS concentrations predominantly affected blood pressure in male adolescents compared with female adolescents. These results provide epidemiological evidence of PFOS-related increases in DBP. Further research is needed to address related issues.

Outcomes of a pharmacist‐managed clinic for underserved persons with unmanaged type 2 diabetes mellitus

A multidisciplinary approach is recommended for the management of type 2 diabetes mellitus (DM). To evaluate the impact of a pharmacist intervention on haemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), and diabetes-related hospitalisations in an underserved cohort with unmanaged type 2 DM. This analysis was a retrospective cohort study. Criteria for inclusion were persons with unmanaged type 2 DM defined as HbA1c values ≥8% at time of enrolment, ≥18 years old, and enrolment in a pharmacist-managed clinic for ≥12 months. Pre- and post-intervention differences in HbA1c, SBP and DBP values were assessed using repeated measures analysis of variance (ANOVA). The risk of diabetes-related hospitalisations was estimated during the 12 months prior and during the 12 months post-intervention, and the relative risk (RR) was calculated. Mean HbA1c values at 3, 6 and 12 months post-intervention were lower than baseline values (p < 0.05). There was no significant difference in mean HbA1c values at 6 or 12 months compared to 3 months post intervention. Mean SBP values at 3, 6 and 12 months were lower than baseline (p < 0.05). Likewise, mean DBP values at 6 and 12 months were lower than baseline (p < 0.05). The estimated RR of diabetes-related hospitalisations was 0.40 (95% CI: 0.20-0.83; p = 0.013). Enrolment in a pharmacist-managed diabetes program was associated with a significant reduction in HbA1c, SBP and DBP and reduction in risk of diabetes-related hospitalisations in an underserved cohort of patients with diabetes over a 12-month period.

Efficacy and Safety of Valsartan or Chlorthalidone vs. Combined Valsartan and Chlorthalidone in Patients With Mild to Moderate Hypertension: The VACLOR Study.

Objective:To evaluate the efficacy and safety of valsartan (V) or chlorthalidone (C) monotherapy in comparison with a fixed combination of valsartan and chlorthalidone (V + C).Methods:This 12-week multicenter randomized three-arm open-label study randomly allocated 72 patients to V or C as monotherapy or a combination of V + C. The aim was to measure changes in office systolic blood pressure (SBP) and diastolic blood pressure (DBP) and in 24-hour ambulatory blood pressure monitoring (ABPM) from baseline to week 12, in addition to medication tolerability.Results:The proportion of patients achieving target BP in office at week 12 was not statistically different for the three groups. However, comparisons of daytime and nighttime 24-hour ABPM values from baseline to week 12 revealed significant differences in nighttime mean SBP for the three groups, due to a significantly greater reduction in the values in patients assigned to the V + C group (−14.7 vs. −8.7 vs. −10.7, P = .042, V+C; V; C, respectively). Although patients assigned to the V + C group also had greater nighttime reduction in mean DBP values compared with those in the other groups, this difference was not statistically significant. The incidence of adverse events did not differ significantly.Conclusion:In patients with hypertension treated with V, C, and both medications combined, the fixed combination of V + C provided a significantly greater reduction of late night to early morning BP values when interventions were assessed with 24-hour ABPM.Trial registration:clinicaltrials.gov Identifier: NCT.01850160, https://clinicaltrials.gov/ct2/show/NCT01850160

PP.05.03] EVALUATION OF DRUG CONTROL EFFICACY OF ARTERIAL HYPERTENSION IN THE PRIMARY HEALTHCARE SYSTEM OF YEREVAN

Objective: Aim of the presented study was an evaluation of drug control efficacy of arterial hypertension (AH) in the Primary Health Care (PHC) system of Yerevan city (Armenia). Design and method: Cohort of 1532 patients with AH, which had been followed up by PHC system medical practitioners and received regular antihypertensive medications (monotherapy or combined treatment), without target blood pressure (BP) level achievement. Patients were defined as uncontrolled AH, when systolic (SBP) and diastolic BP (DBP) levels exceeded 140 and 90 mm Hg, respectively, in a result of three different visits. Statistical analyzes were conducted with IBM SPSS v.22 software. P value of < 0.05 was considered as statistically significant. Results: 507 men and 1025 women with 64.2 ± 10.6 and 64.5 ± 9.7y mean ages, without gender differences (p = 0.54), were analyzed. A number of 80y and more aged patients were 86 (5.6%; 95% CI 4.6, 6.9%) among examined individuals. Mean levels of SBP for men and women were 166.9 ± 17.4 mmHg and 167.0 ± 16.1 mmHg accordingly, without gender differences (p = 0.92). In addition, there wasn’t observed any statistical difference for mean values of DBP 97.6 ± 10.4 mmHg and 97.6 ± 9.9 mmHg accordingly (p = 0.96). Distribution of uncontrolled AH according to the age groups stated that 60–79 aged individuals prevailed in a group of patients having uncontrolled AH. Number of such individuals was 947 (61.8%; 95% CI 59.4, 64.2%), without gender differences (p = 0.35). Antihypertensive treatment analysis showed that angiotensin converting enzyme (ACE) inhibitors were assigned in more than 80% of cases of monotherapy equally for both men and women, meanwhile the most frequent antihypertensive drug combination was ACE inhibitors and thiazide like diuretics (more than 30% of cases for all combinations), which amounted 20.5% of the cohort. Conclusions: Drug control efficacy of AH still remains incompletely y realized in the primary healthcare system of Yerevan as there is a huge prevalence of patients with uncontrolled AH. This testifies that up to now PHC system medical practitioners insufficiently use rational combinations of antihypertensive drugs.

Hemodynamic changes during exchange transfusion in early neonatal period

Background: Exchange transfusion(ET) has remained the gold standard for rapid lowering of higher bilirubin levels, it is not risk free and mortality rate vary from 0.5 to 3.3%. The present study was carried out to study hemodynamic parameters changes during ET in neonates. Materials and Methods: 22 neonates who suffered from hyperbilirubinemia and required double volume ET were enrolled in this prospective study. ET was carried out according to standard practice guidelines. Clinical hemodynamic parameters including heart rate, respiratory rate, blood pressure, temperature and ECG, % saturation of oxygen (SpO2) and CVP were monitored continuously before 15 min (pre exchange) during 60-120 min(mid exchange) and after 30 min(post exchange). All data was analysed statistically. Results: There was significant increase in mean heart rate152.78(19.88),155.12(20.50), mean respiratory rate 46.02(8.87),50.92(6.98) and drop in mean Spo2 91.19(4.17),90.67(4.28) in mid-exchange and post-exchange values respectively as compared to pre exchange values138.72(17.74),36.79(7.58),93.51(3.28) for mean heart rate, respiratory rate and mean SpO2 respectively. There was significant increase in mean diastolic blood pressure values in post-exchange 45.43(13.88) as compared to pre exchange values 41.83(9.80). Mid-exchange value 8.66(2.12) of mean central venous pressure was significantly lower from pre-exchange 10.10(1.92) and post-exchange 9.56(1.98) values. ECG changes did not show any significant changes during ET. Conclusion: There were significant adverse effects on all hemodynamic clinical parameters. Monitoring of neonate is essential during ET which will prevent complications of ET. Current recommendations for performing ET are based on balance between the risk of encephalopathy and the adverse events related to the procedure holds true.

Clinical and laboratory markers in the recovery from severe preeclampsia.

To examine the recovery from severe Preeclampsia toxemia (PET) in women treated with magnesium sulfate (MgSO4) during the first 24h postpartum as reflected by the changes in various clinical and laboratory markers. The study population included all women diagnosed with severe PET that gave birth at the Soroka University Medical center between 2013 and 2014, and were treated with MgSO4 in the first 24h postpartum. Data were collected from the institutional computerized records. The different parameters were examined in 6h intervals and were compared using appropriate statistical tests. Change in various postpartum laboratory and clinical parameters. During the study period there were 132 singleton deliveries with severe PET treated with a 24-hours postpartum MgSO4 regimen. Most of the women were primigravida and delivered vaginally. Both mean systolic and mean diastolic blood pressure values have shown recovery to normal values after the first 6h of treatment (P<0.001). Urine output and proteinuria have demonstrated later recovery (after 12h). When assessing the natural recovery of severe PET features, the earliest parameter to recover during the first 24h postpartum is hypertension followed by urine output and the proteinuria. Further larger studies are needed in order to confirm these results. Moreover, the use of these parameters may allow using shorter MgSO4 treatment regimens for appropriate women showing earlier recovery and facilitating quicker mother-baby bonding and emotional recovery.

A quantitative comparison of physiologic indicators of cardiopulmonary resuscitation quality: Diastolic blood pressure versus end-tidal carbon dioxide

AimThe American Heart Association (AHA) recommends monitoring invasive arterial diastolic blood pressure (DBP) and end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR) when available. In intensive care unit patients, both may be available to the rescuer. The objective of this study was to compare DBP vs. ETCO2 during CPR as predictors of cardiac arrest survival. MethodsIn two models of cardiac arrest (primary ventricular fibrillation [VF] and asphyxia-associated VF), 3-month old swine received either standard AHA guideline-based CPR or patient-centric, BP-guided CPR. Mean values of DBP and ETCO2 in the final 2min before the first defibrillation attempt were compared using receiver operating characteristic curves (area under curve [AUC] analysis). The optimal DBP cut point to predict survival was derived and subsequently validated in two independent, randomly generated cohorts. ResultsOf 60 animals, 37 (61.7%) survived to 45min. DBP was higher in survivors than in non-survivors (40.6±1.8mmHg vs. 25.9±2.4mmHg; p<0.001), while ETCO2 was not different (30.0±1.5mmHg vs. 32.5±1.8mmHg; p=0.30). By AUC analysis, DBP was superior to ETCO2 (0.82 vs. 0.60; p=0.025) in discriminating survivors from non-survivors. The optimal DBP cut point in the derivation cohort was 34.1mmHg. In the validation cohort, this cut point demonstrated a sensitivity of 0.78, specificity of 0.81, positive predictive value of 0.64, and negative predictive value of 0.89 for survival. ConclusionsIn both primary and asphyxia-associated VF porcine models of cardiac arrest, DBP discriminates survivors from non-survivors better than ETCO2. Failure to attain a DBP >34mmHg during CPR is highly predictive of non-survival.

Monitoring development of autonomic dysreflexia during urodynamic investigation in patients with spinal cord injury

Objectives: We aimed to investigate whether autonomic dysreflexia (AD) develops during urodynamic investigation in patients with spinal cord injury (SCI) with neurological level below thoracic (T) 6 together with the frequency and related factors for AD development.Study Design: Prospective study.Methods: The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) of 51 SCI patients with a neurological level below T6 were measured and recorded at the beginning and every two minutes during the filling phase of the urodynamic study. The changes between the SBP, DBP and HR values at the beginning and end of the filling phase were analyzed.Results: Autonomic dysreflexia developed only in one of the 51 patients included into the study. The BP of this patient increased from 105/76 mmHg to 145/102 mmHg and the HR dropped from 88 beats/minute (bpm) to 69 bpm together with development of the AD symptoms. The patient was a 47-year-old male with a neurological level at T8. A significant difference was found between the mean SBP and the mean DBP values at the beginning and end of the filling phase.Conclusions: Although rare, AD can be seen during urodynamic investigation in patients with a neurological level below T6, especially when close to the T6 level. Therefore, we suggest that the patients with a neurological level below T6 and especially closer to T6 level should be followed-up in terms of development of AD. The clinicians should take into account the HR values in addition to the the SBP and DBP values at follow-ups.

PP.17.13

Objective: Mobil-O-Graph and Spacelabs 90217 are two validated devices for ambulatory blood pressure (BP) monitoring. However, currently only one small study has compared BP values recorded from these devices. The present study compared the values of systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) measured by both devices under ambulatory conditions in healthy volunteers. Design and method: We studied 40 healthy volunteers aged 18–30 years old, who were randomized in two groups. In both groups, a 6-hour ambulatory measurement was performed starting from 9:00 AM. In group A, the Spacelabs device was applied on the dominant arm and the Mobil-O-Graph device was applied on the non-dominant arm for the first 3 hours, followed by a reverse positioning of the devices for the following 3 hours. In group B, the same procedure was followed but the Mobil-O-Graph device was applied on the dominant arm and the Spacelabs device was applied on the non-dominant arm for the first 3 hours and vice versa. The two devices measured BP simultaneously every 20 min. Results: The mean SBP levels recorded with the Mobil-O-Graph did not differ significantly from those derived from the Spacelabs device (Mobil-O-Graph: 118.3 ± 11.0 mmHg, Spacelabs: 117.9 ± 11.4 mmHg, p = 0.864). The mean values of DBP recorded with Mobil-O-Graph were higher only by 1 mmHg and the difference was not significant (Mobil-O-Graph: 74.7 ± 8.0 mmHg, Spacelabs: 73.7 ± 7.4 mmHg, p = 0.571). However, the mean values of MAP differed significantly between the two devices (Mobil-O-Graph: 94.7 ± 8.7 mmHg, Spacelabs: 87.9 ± 7.9 mmHg, p = 0.001). All 3 parameters estimated by Mobil-O-Graph showed highly significant (p < 0.001) correlations with the relevant measurements of Spacelabs (SBP, r = 0.933; DBP, r = 0.953; MAP, r = 0.955). The Bland-Altman Plots showed acceptable agreement between the two devices for SBP and DBP. Conclusions: The Mobil-O-Graph and Spacelabs devices did not differ significantly in terms of SBP and DBP measurements under ambulatory conditions. However, a significant difference in the values of MAP between the two devices was observed. Whether this observation could be attributed to a difference in the internal algorithm of both devices remains unknown.

The effect of resistance exercise on mean blood pressure in the patients referring to cardiovascular research centre.

Background:One of the most important risk factors for cardiovascular disease is hypertension. 1 billion people in the world and 25–35% of the adult population in Iran suffer from hypertension. Despite the emphasis on medicational treatments, non-medicational treatments and modification of lifestyle, including physical activity and exercise, are important for the control and treatment of hypertension and lead to a reduction in cardiovascular diseases. Among the various types of exercises, resistance exercise has been considered important by the cardiologists. The present study investigates the effect of resistance exercise on mean blood pressure in the cardiovascular patients.Materials and Methods:In a randomized clinical trial, 40 patients admitted to the rehabilitation unit of cardiovascular research center were assigned to study and control groups. Demographic data were collected. Their blood pressure values were measured and recorded once 1 day before the beginning of the intervention and another time 1 day after its completion. All study subjects participated in two 45–60 min exercise sessions for eight straight weeks. The control group followed routine rehabilitation unit protocol that was aerobic exercise. The study group subjects performed resistance exercise in addition to routine exercise. The weight was determined in the first session of the intervention. At the beginning, the number of the repetitions in the range of motion was 10, which was increased gradually to 15. After it reached 15 repetitions, the amount of weight was increased by 3–5% and the number of sets increased.Results:One day before the beginning of the intervention, mean systolic blood pressure was 128.21 (15.39) mmHg in the study group and 120.00 (20.51) mmHg in the control group. Mean diastolic blood pressure was 82.50 (9.35) mmHg in the study group and 82.00 (13.11) mmHg in the control group. There were no differences between the groups in terms of mean systolic and diastolic blood pressure (P > 0.05). After the end of the intervention, mean systolic blood pressure values were 116.42 (7.18) mmHg and 112.00 (12.60) mmHg in the study and control groups, respectively. There were no significant differences between the groups (P = 0.24). Mean diastolic blood pressure values were 81.78 (7.99) mmHg in the study group and 78.25 (12.48) mmHg in the control group. There was no significant difference between the groups (P = 0.35). At the end of the intervention, mean systolic blood pressure in the study group decreased significantly (P = 0.02).Conclusions:In the present study, the effect of resistance exercise on mean systolic blood pressure showed a significant difference, caused by the aerobic exercise.

A nationwide report on blood pressure of children and adolescents according to socioeconomic status: The CASPIAN-IV study.

Background:Hypertension is a major leading factor for global burden of diseases. Blood pressure (BP) tracks from childhood to adulthood. So, it is important to investigate its aff ecting factors. In this study we aimed to compare the BP status in the Iranian pediatric population according to the socioeconomic status (SES) of their living area.Materials and Methods:In this nationwide study, a representative sample of 14,880 students, aged 6-18 years was chosen by multistage random cluster sampling from 30 provinces in Iran. Anthropometric indices and BP were measured. A validated questionnaire, including the questions of the World Health Organization Global School-based Student Health Survey was completed. Findings were compared across the four regions of the country, categorized based on their elevating SES: Southeast, north-northeast, west, and central.Results:Participants consisted of 13,486 children and adolescents, that is, a participation rate of 90.6%, composed of 49.2% girls and 75.6% urban residents. The mean (standard deviation) age of participants was 12.47 (3.36) years. The region with highest SES (central) had the lowest rate of high BP (HBP), that is, 3.0% (95% of confidence interval [CI]: 2.4-3.9), and the region with lowest SES (southeast) had the highest rate, that is, 7.4% (4.4-12.2). The mean (95% CI) values of systolic BP for the four regions from lowest to highest SES were 100.5 (99.6-101.3), 100.9 (100.3-101.4), 101.7 (101.3-102), and 101.7 (101.2-102.1) mmHg. The corresponding mean Diastolic BP values were as follows: 65.4 (64.6-66.1), 63.4 (62.9-63.8), 65.6 (65.3-65.8), and 64.4 (64.0-64.7) mmHg.Conclusion:We found significant differences in mean BP and the frequency of HBP according to the SES of the living area. Further studies are necessary to find the underlying factors resulting in such differences.

PP135. Maternal serum levels of endothelial nitric oxide synthase and ADMA, an endogenous ENOS inhibitor in pregnancies complicated by severe preeclampsia

Preeclampsia is a major cause of maternal and fetal mortality and morbidity. Preeclampsia remains amongst the biggest challenges in obstetrics, but its aetiopathogenesis is still unclear. Recent observations support the hypothesis that imbalance between maternal angiogenic/anti-angiogenic factors concentrations is responsible for the clinical manifestations of the preeclampsia. It was also suggested that clinical manifestations of preeclampsia caused by endothelial malfunction including insufficient production of nitric oxide and that abnormality in nitric oxide synthesis or NO bioavailability may contribute to the development of preeclampsia. But the mechanism associated with alteration of nitric oxide formation in pregnancies complicated by preeclampsia is not well understood. The aim of this study was to determine the maternal serum concentrations of endothelial nitric oxide synthase (eNOS) and its endogenous inhibitor, asymmetric dimethylarginine (ADMA) in pregnancies complicated by severe preeclampsia in comparison with healthy normotensive pregnant women. A study was conducted including 29 uncomplicated women (the Control group) and 29 preeclamptic women (the Pre group). Preeclampsia was diagnosed by the increased blood pressure of >140mmHg systolic and >90mmHg diastolic in women who were normotensive before 20 weeks of gestation accompanied by proteinuria, defined as the urinary excretion of >0.3g protein in 24h specimen. Severe preeclampsia was defined as blood pressure >160/110mmHg on at least 2 occasions 6h apart with proteinuria >5g in a 24h urinary protein excretion. The maternal serum eNOS and ADMA concentrations were determined using a sandwich enzyme-linked immunosorbent assays. There were no statistically significant differences in gravidity, parity, maternal age and height in patient profiles between groups. Creatinine and urea levels were normal in all patients. Systolic and diastolic blood pressures were higher in preeclamptic pregnant women than in the control group. The mean systolic blood pressure values were 166.39±15.47mmHg in the Pre group and 115.72±10.34mmHg in the control group. The mean diastolic blood pressure values were 108.89±10.45mmHg in the Pre group and 75.34±6.22mmHg in the healthy controls. These differences were statistically significant (p<0.000001). Our study revealed increased maternal serum levels of asymmetric dimethylarginine in preeclamptic patients (p=0.007223). The mean values of maternal serum ADMA were 0.597±0.161mmol/L in the Pre group versus0.503±0.081mmol/L in the healthy pregnant patients. The levels of serum endothelial nitric oxide synthase were lower in women with pregnancies complicated by severe preeclampsia than in the healthy women from the control group, but these differences were not statistically significant (p=0.118770). The mean values of serum eNOS were 134.06±76.73U/ml in the Pre group and 187.70±165.41U/ml in the Control group. Elevated levels of ADMA and the unchanged levels of eNOS in pregnancies complicated by severe preeclampsia allow the conclusion that the nitric oxide deficiency in this pregnancy disorder result not from a reduced level or activity of eNOS, but from elevated levels of asymmetric dimethylarginine, an endogenous eNOS inhibitor.