mmHg Research Articles

The Strain Response to Intraocular Pressure Increase in the Lamina Cribrosa of Control Subjects and Glaucoma Patients.

The purpose of this study was to measure biomechanical strains in the lamina cribrosa (LC) of living human eyes undergoing intraocular pressure (IOP) increase. Healthy control subjects and patients with glaucoma underwent optical coherence tomographic (OCT) imaging of the LC before and after wearing of swim goggles that increased IOP (57 image pairs, 39 persons). Digital volume correlation was used to measure biomechanical strains in optic nerve head tissue and change in depth of the anterior border of the LC. The mean IOP increase in both glaucoma and control eyes was 7.1 millimeters of mercury (mm Hg) after application of the goggles. Among glaucoma eyes, strains that were significant were: contractile Ezz (average = -0.33%, P = 0.0005), contractile Eθθ (average = -0.23%, P = 0.03), Emax (average = 0.83%, P < 0.0001), and Γmax (average = 0.95%, P < 0.0001), whereas the average anterior LC depth (ALD) decreased by 2.39µm (anterior; P = 0.0002). In glaucoma eyes, shear strain Ezθ was greater with worse mean deviation (MD) and visual function index (P = 0.044 and P = 0.006, respectively, multivariate models). Strain compliance for Erθ, Ezθ, and Eθθ all increased with greater MD worsening prior to imaging (P = 0.04, P = 0.007, and P = 0.03). LC strains were measurable 20 minutes after IOP increase, producing axial compression and greater peripheral strain than centrally. Some strain compliances were greater with worse existing visual field loss or with more progressive past field loss. Biomechanical strains are related to measures of glaucoma damage, supporting the hypothesis that optic nerve head biomechanical responses represent a noninvasive biomarker for glaucoma.

How to take and record a manual blood pressure measurement.

Accurate measurement of a patient's blood pressure (BP) is essential to identify hypotension or hypertension and to inform subsequent management and treatment decisions. The auscultatory, or manual, method remains the gold standard for non-invasive BP measurement, so it is vital that nurses are able to undertake this procedure accurately. This article explains how to take and record a manual BP measurement using an aneroid sphygmomanometer and a stethoscope. Nurses and nursing students undertaking this procedure must be equipped with the knowledge and skills to do so proficiently and work within their scope of practice. • BP measurement comprises two pressure readings, systolic and diastolic, which are measured in millimetres of mercury (mmHg) and expressed in documentation as a 'fraction'. • Inaccurate BP measurement, whether overestimation or underestimation, can result in diagnostic errors and incorrect risk assessment and decision-making. • Various factors can influence the accuracy of BP measurement, including patient positioning, cuff size, arm position and correct use of the stethoscope. • It is vital to ensure regular maintenance and recalibration of BP measuring equipment, in accordance with the manufacturer's instructions, to ensure accuracy of readings. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when taking a manual BP measurement. • How you could use this information to educate nursing students or your colleagues on the appropriate steps when taking and recording a manual BP measurement.

Clinical profile and immediate outcomes of balloon mitral valvotomy in low gradient rheumatic mitral stenosis

ObjectivesThe objective of this study was to assess the clinical, hemodynamic characteristics and immediate outcomes of Percutaneous Balloon Mitral Valvotomy (PBMV) in low gradient severe rheumatic mitral stenosis (LGMS) with normal cardiac index. BackgroundThe optimal management of LGMS remains incompletely understood. MethodsWe examined 200 consecutive patients with severe rheumatic mitral stenosis (MS) who underwent PBMV between January 2014 and March 2020. ResultsOf the 149 patients (who satisfied inclusion criteria), 51 (34.2 %) had LGMS. The mean diastolic pressure gradient (DPG) was 8.70 ± 1.34 mm of Hg in LGMS as compared to 16.2 ± 4.3 mm of Hg in HGMS (p < 0.001). Patients of LGMS were older (39.5 ± 9.7 vs.34.9 ± 11.0 years, p = 0.012), had lower baseline heart rate (76.8 ± 9.5 vs 81.9 ± 12.5, p = 0.010), higher Mitral valve area (MVA) (1.16 ± 0.19 vs 0.99 ± 0.21 cm2,p < 0.001),higher Wilkins score (5.8 ± 1.7 vs 4.9 ± 1.5, p = 0.002) and elevated left ventricular end diastolic pressure (LVEDP) (9.2 ± 2.8 vs 5.8 ± 1.2 mm of Hg,p=<0.001) but lower Pulmonary artery systolic pressure (PASP) (53.1 ± 14.5 vs 62.6 ± 17.8 mm of Hg, p = 0.001) and left atrial (LA) pressure (18.0 ± 3.1vs 22.0 ± 4.4 mm of Hg,p=<0.001). Although, the procedural success rate of PBMV was comparable between LGMS and HGMS (92.2 % vs 96.9 % p = 0.231) but increment in MVA and fall in DPG were significantly higher in HGMS in comparison to LGMS (p-value<0.05). ConclusionsSignificant MS may have "low" gradients during catheterization and yet be symptomatic, and thus low gradients cannot be alone used as a marker of disease severity. LGMS with normal CI is characterized by unique clinical and hemodynamic features. The immediate outcome of PBMV is comparable to HGMS but the hemodynamic parameters to monitor the success of PBMV are significantly different.

Prescribing Blood Flow Restricted Exercise: Limb Composition Influences the Pressure Required to Create Arterial Occlusion.

As blood flow restriction gains popularity across different populations (eg,young and older adults) and settings (eg,clinical and sports rehabilitation), the accuracy of blood flow restricted percentage becomes crucial. We aimed to compare manually measured arterial occlusion pressure (AOP) among young adults to understand whether lower limb composition affects the pressure required to achieve AOP. The results will shed light on the adequacy of published calculations used to estimate AOP in practical and research settings. An observational cross-sectional study design was implemented to examine the relationship between lower limb composition, lower limb circumference, and measured AOP. Twenty-two participants (12 males, 26 [4]y, 1.74 [0.07]m, 73.2 [12.5]kg) underwent a whole-body Dual-energy X-ray Absorptiometry scan before AOP (in millimeters of mercury) and lower limb circumference (in centimeters) were determined. In a supine position, a 10-cm wide cuff was manually inflated on the dominant leg to the point where a pulse could no longer be detected by a Doppler ultrasound of the posterior tibial artery to determine AOP. Lower limb composition (fat, muscle, and bone mass [in grams]) was obtained from the Dual-energy X-ray Absorptiometry scan. Lower limb muscle mass had a moderate negative relationship with AOP (r2 = .433, β = -0.004) and a moderate positive relationship with lower limb circumference (r2 = .497, β = 0.001). Lower limb circumference had the weakest relationship with AOP (r2 = .316, β = 0.050) of all measures. The reported relationships between lower limb muscle mass, lower limb circumference, and AOP suggest that as muscle mass increases, lower limb circumference also increases, yet AOP decreases. This implies that limb circumference should not be used as the primary measure for calculating AOP within the sampled population. We recommend individually measuring AOP when implementing blood flow restriction in all exercise modalities.

Severity of pulmonary hypertension and pregnancy outcomes: newer insights from the M-PAC registry

Abstract Background Pregnancy outcomes in women with pulmonary hypertension remain suboptimal. Pregnant women with pulmonary hypertension (PH) are placed in the modified WHO category IV, regardless of the severity or etiology of PH. Earlier studies have indicated that pregnancy outcomes may differ based on the etiology, with more favourable outcomes observed with PH related to left to right shunts. However, it is possible that the pregnancy outcomes may vary based on the severity of PH also. Purpose To analyse pregnancy outcomes in women with PH and investigate differences based on disease severity. Methods M-PAC Registry, is a single center prospective study of pregnancies in women with heart diseases, conducted between July 2016 and December 2019 in a low-and middle-income country from South Asia, whose methodology and outcomes have been published(1). The current study analysed pregnancies with PH enrolled in the M-PAC registry. The tricuspid regurgitation velocity obtained during transthoracic echocardiography, was used to estimate right ventricular systolic pressure (RVSP). Based on the estimated RVSP, PH was classified into three groups; mild (36-45 mm of Hg), moderate (46-64 mm of Hg) and severe (≥ 65 mm of Hg). The differences in the maternal and foetal outcomes among the groups were analysed. Results Of the 1029 pregnancies complicated by heart disease enrolled in the M-PAC registry, 352(34.2%)had PH. Among these 352 pregnancies, 186(52.8%) had mild, 73 (20.7%) had moderate and 93 (26.5%) had severe PH. Adverse maternal cardiac events occurred in 77 pregnancies (21.8%), with heart failure in 53(15.1%) and mortality in 10(2.8%). The composite adverse foetal event rate was 38.6%, foetal loss at 9.7%, low birth weight at 28.9%, and preterm labour at 7.1%. The mean (±standard deviation) RVSP was higher in pregnancies with adverse maternal outcome (58.81±16.9 vs 51.16±15.9; P &amp;lt; 0.001) or adverse foetal outcome (58.10±17.3 vs 49.52±14.9; P &amp;lt; 0.001)compared to those without. When comparing the three groups, pregnancies with mild PH exhibited significantly lower rates of adverse maternal and fetal events compared to those with severe and moderate PH (Fig-1 and Table-1). Mild PH was associated with outcomes similar to those without PH in the M-PAC registry. Conclusion The severity of PH significantly correlated with the adverse pregnancy outcomes. Women with mild PH tend to experience pregnancy outcomes comparable to those without PH, suggesting that pregnancy should not be deemed contraindicated in this subgroup. Therefore, re-evaluation of the placement of PH within the modified World Health Organization (mWHO) classification is warranted, considering the severity of PH.Figure 1:Pregnancy Outcomes &amp; PH SeverityTable-1 PH Severity &amp; Pregnacny Outcomes

Conservative Management of mild symptomatic descending thoracic aneurysm – A case report with 1year follow-up

Background: The thoracic aorta is made up of the ascending, descending, aortic arch, and aortic root. An aneurysm forms when the artery's usual diameter increases by fifty percent. Thoracic aneurysms affect 10 of every 100,000 elderly adults and are less common than their abdominal counterparts. Patients with thoracic aortic aneurysms (TAAs) rarely experience symptoms, and 95% of TAA patients are asymptomatic. Case history: A 47-year-old male patient who had a medical history of hypertension, dyslipidemia, and smoking. During the first visit, the patient presented with two months of dull back pain. The patient's blood pressure was 180/110 mm of Hg. Our initial assessment involved taking an X-ray and an echocardiography of the patient's chest. The data from his echocardiography and chest reveals that he has a thoracic aneurysm. After a confirmatory CT scan, the diagnosis of thoracic aortic aneurysm was made. Conclusion: In our case report, conservative method was successful in the management of a mild symptomatic descending thoracic aorta aneurysm. However, the size, growth pace, and underlying cause of an aortic aneurysm might all affect whether doctors recommend surgery to repair it. If an aneurysm ruptures or dissects, immediate surgery may be required. J Shaheed Suhrawardy Med Coll 2023; 15(1): 87-90

Time Interval Between Right Ventricular Early Diastolic Velocity by Tissue and Pulse Wave Doppler: An Index of Right Atrial Pressure in Pulmonary Hypertension Patients.

Background: A reversal of time difference between the onset of early diastolic velocity (e') during tissue Doppler imaging and the onset of mitral inflow (E) has been observed in cases of elevated left atrial pressure. Whether this interval (Te'-E) may be useful to assess right atrial pressure has never been investigated, neither in healthy subjects nor in pulmonary hypertension patients. Methods: Right ventricular Te'-E was assessed in patients with pre-capillary pulmonary hypertension and compared with healthy volunteers who underwent comprehensive echocardiography examination. Te'-E is the difference between the interval from R wave at the superimposed electrocardiogram to the e' wave during right ventricular tissue Doppler imaging and the interval from the R wave to transtricuspid E wave during pulsed wave Doppler imaging. Right atrial pressure was invasively measured in pulmonary hypertension patients. Results: Fifty-six patients were enrolled. Te'-E was prolonged in pulmonary hypertension subjects compared with healthy subjects (p < 0.001). Amongst the pulmonary hypertension patients, strong correlations were found between Te'-E and right atrial pressure (r = -0.885, p < 0.001), systolic pulmonary pressure (r = -0.85, p < 0.001) and the duration of tricuspid regurgitation (r = 0.72, p < 0.001). The area under the receiver operating characteristic curve of Te'-E in identifying right atrial pressure higher than 15 mm of mercury was 0.992 (sensitivity 100%, specificity 83%). Conclusions: In contrast to the left ventricle, there is a delay in the proto-diastolic filling in pulmonary hypertension patients, which correlates with the increase in systolic pulmonary arterial pressure, right atrial pressure, tricuspid regurgitation duration and restrictive diastolic pattern.

From BpTRU to OMRON: The impact of changing automated blood pressure measurement devices on adult population estimates of blood pressure and hypertension.

In Cycle 7 (2022), the Canadian Health Measures Survey (CHMS) introduced the OMRON (OM) IntelliSense HEM-907XL blood pressure (BP) monitor after using the BpTRU (BT) BPM-300 BP monitor for six cycles. This study assessed differences between adult BP values measured by both devices and whether equations could be developed to compare BP measurements taken using the two devices. In Cycle 6 (2018 to 2019) of the CHMS, BP was measured using BT and OM devices. Between-device estimates of systolic BP (SBP), diastolic BP (DBP), and hypertension prevalence were compared for 1,072 adults aged 18 to 79 years. Sex, age, body mass index (BMI), and the use of antihypertensive medication were examined in linear regression models to predict SBP and DBP values measured with OM based on those measured with BT. Average SBP measured with OM was 6 millimetres of mercury (mmHg) higher than average SBP measured with BT, and average DBP measured with OM was 2 mmHg lower than DBP measured with BT. Hypertension prevalence based on OM readings was 35.4%, compared with 34.0% based on BT readings. Between-device BP differences varied in magnitude by sex, age group, and BMI category. Average model-predicted estimates of BP were comparable to measured estimates, but predicted values were lower at higher levels of BP. Switching BP monitors will substantively affect population estimates of adult SBP and DBP but may have less impact on estimates of adult hypertension prevalence. The prediction equations proposed in this study can be applied to adult BP data from cycles 1 to 6 of the CHMS for comparison with BP measurements taken in Cycle 7, with some caveats. The impact of changing to the OM monitor in Cycle 7 should be acknowledged when reporting estimates of adult BP based on the CHMS.

Hemorrhagic hepatic infarction in a pregnant woman with severe preeclampsia: A case report

Introduction and importance: Severe preeclampsia is a medical condition that affects women during the last two trimesters of pregnancy. Hemorrhagic hepatic infarction is a hepatic complication and is rarely encountered in women with severe preeclampsia. This case report aims to present the characteristics of hemorrhagic hepatic infarction in a pregnant woman with severe preeclampsia. Case presentation: A 27-year-old pregnant woman with a 30-week gestation of amenorrhea was admitted with a blood pressure of 160/100 millimeters of Mercury (mm Hg), headaches, dizziness and oedema in the lower limbs. Clinical discussion: These complaints with clinical and paraclinical examinations led to the diagnosis of severe preeclampsia and she underwent an emergency cesarean section but 6 hours later, she presented with hypovolemic shock and this led to a new surgery. A surgery which made it possible to develop or discover a diffuse hepatic infarction with hemorrhagic infiltration of the gallbladder and the falciform ligament without active bleeding in the liver. Emergency management of preeclampsia was adopted and the postoperative course was simple with a good clinical outcome when the patient was discharged. Conclusion: Severe preeclampsia and hemorrhagic hepatic infarction are complications of pregnancy which require emergency treatment and above all these medical conditions require the termination of the pregnancy.

Decidual Granulomas in Placenta: A unique finding in Preeclamptic Pregnancy

Abstract Introduction/Objective Decidual granulomatous inflammation is a rare finding in the placenta, scarcely reported in the literature. We present an unusual case of a young woman with severe preeclampsia and histological presence of decidual granuloma, involving the placental membranes. Methods/Case Report A 34-year-old female, Gravida 2 Para 1, with prior term vaginal delivery without significant history presented at 26 weeks and 6 days of gestational age with decreased fetal movements. Her home blood pressure was 170 mm of Hg systolic and on presentation, was consistently within the range of &amp;lt;a href=“tel:192- 197/94-97”&amp;gt;192-197/94-97&amp;lt;/a&amp;gt; mm of Hg. Biophysical profile of the fetus was 2/10. Complete blood count showed leukocytosis with absolute neutrophilia and urinalysis revealed slight increase in urine protein/creatinine ratio. Clinical diagnosis of severe preeclampsia was made. After initial stabilization, the patient underwent Cesarean section resulting in a premature baby with an uneventful postoperative course. The placenta was sent for histopathological examination. Grossly, the placental disc showed unremarkable membranes with normal appearing fetal and maternal surfaces. Sectioning revealed a central 4.2 cm hemorrhagic area and six tan-white wedge-shaped nodules ranging from 0.8-1.8 cm, occupying approximately 5% and 40% of the maternal surface, respectively. Microscopic examination revealed patchy non-caseating granulomas limited to the decidua, patchy intra-placental hematomas, placental infarcts and chronic villitis. Other findings included scattered avascular villi, villous stromal vascular karyorrhexis, focally increased syncytial knots, and decidual arteriopathy. Gram stain, GMS and acid-fast stains yielded negative results, while immunohistochemical stain CD68 highlighted histiocytes in the granulomas. The final diagnosis of decidual granulomas including the aforementioned microscopic observations was made. Results (if a Case Study enter NA) NA Conclusion Though decidual granulomas are seen in association with infectious and rheumatologic disorders. They can also be observed in severe preeclampsia as in this setting; with unclear underlying pathogenesis, warranting a close follow-up of the newborn and the mother.

6668 Myxedema Coma and Takotsubo Cardiomyopathy

Abstract Disclosure: A.M. Skariah: None. S. Jain: None. Background: Takotsubo cardiomyopathy (TCM) also know as broken heart syndrome is a transient decrease in systolic cardiac function in the absence of obstructive CAD. TCM is likely related to hyperadrenergic conditions leading to increased cardiac sensitivity to catecholamine surge leading to cardiomyopathy. TCM is more associated with hyperthyroidism. Case presentation: Patient is an 84-year-old female with PMH of celiac disease,hypertension,prediabetes, and atrial fibrillation s/p cardioversion, on amiodarone. She was brought to the ER after having an unwitnessed fall. She was hypotensive 76/56 mm of Hg, hypothermic 35.5 degree C, HR 90 beats/min; labs significant for hyponatremia, macrocytic anemia, TSH 65.47uIU/ml, FT4 &amp;lt;0.4 ng/dl and mild QTC prolongation of 469ms. Family mentioned history of constipation, progressive weakness, poor oral intake, memory problems and cold sensitivity for a couple of months. Started on 1 pressor, 3 units of PRBC and 2 liters of IVF; BP improved; labs and history suggestive of myxedema coma with myxedema coma Popoveniuc score 85 suggestive of high suspicion for myxedema coma.She had TSH 50.39 uIU/ml and FT4 of 0.4 ng/dl for her memory issues workup 2 months prior to presentation but was not started on medication. Upon admission, started stress dose steroids followed by IV levothyroxine 100 mcg. Not started on LT3 given her old age and atrial fibrillation history. Received additional dose of LT4 100 mcg within few hours. TFT improved with TSH 35 uIU/ml and FT4 1 ng/dl after 2 doses. Later same day, shock worsened, and patient was on 3 pressors along with stress dose of steroids. Cardiology was consulted; recommended an Echocardiogram.Echo was done on day 2; EF 55-60 % with severe hypokinesis of apical myocardium consistent with TCM. Normal echocardiogram studies 4 months ago.Started on weight-based regimen of LT4 75 mcg IV on day 3 and switched to 100 mcg oral when patient tolerated pills.Patient was down to 2 pressors on day 3 and gradually off pressors by day 6. Repeat TFT -showed improvement TSH 12 uIU/ml and FT4 0.7 ng/dl—day 5. Eventually her mentation improved and was discharged on oral LT4. Conclusion: TCM is rare complication of treatment of myxedema coma. Our patient developed shock requiring 1 pressor which unexpectedly worsened to 3 pressors requirement after initial LT4 treatment. High doses of LT4 and LT3 which is part of myxedema coma treatment sensitizes myocardial tissue to catecholamines by increasing expression of beta adrenoreceptors in cardiac myocytes with subsequent ionotropic and chronotropic effects. This may contribute to cardiac stunning and TCM. It’s beneficial to evaluate patients with myxedema coma who develop worsening cardiac status after initiation of high dose of thyroid hormone replacement for TCM. Presentation: 6/2/2024

Normative Scores and Test-Retest Reliability of Neck Strength, Endurance, and Proprioception Tests in Children and Adolescents

OBJECTIVE: To determine normative scores, test-retest reliability, and minimal detectable change for the neck flexor endurance test (NFET), craniocervical flexion test (CCFT), and joint position error test (JPET) in children. DESIGN: Cross-sectional. METHODS: Two hundred typically developing children (10-15 years) were recruited. Participants were screened for cervical spine instability using the alar and transverse ligament tests prior to administering the NFET, CCFT, and JPET. Testing was performed twice on the same day, 6 hours apart. RESULTS: For the younger age group, average NFET scores were as follows: females = 9.1 seconds, males = 10.1 seconds. Mean CCFT scores decreased with an increase in pressure (22 millimeters of mercury [mmHg]: females = 6.1 seconds [1], males = 6.8 seconds [1]; 30 mmHg: females = 4.07 seconds [1.1], males = 4.1 seconds [0.9]). For the CCFT, reliability reduced as pressure increased. The JPET had moderate reliability (ICC2, k = 0.4-0.63) with the highest error in right rotation (females = 14.1 cm [5], males = 13.4 cm [4.7]). The NFET had excellent reliability (ICC2, k = 0.96 [0.94-0.97], P&lt;.001). CONCLUSION: The normative scores presented serve as a reference standard for future studies and for systematic screening and head and neck injury prevention. JOSPT Open 2024;2(4):348-353. Epub 20 May 2024. doi:10.2519/josptopen.2024.1135

Prevalence of Hypertension among Asymptomatic Patients During Screening in the Primary Health Care Center, Riyadh, Saudi Arabia

Background: Hypertension is a significant public health problem globally, its prevalence and incidence are commonly seen in the Mideast countries, particularly in Saudi Arabia. It is a chronic disease that can harm many systems with its prevalence varying across different populations. The asymptomatic pattern of hypertension makes it a challenging disease. Screening for hypertension in asymptomatic individuals is crucial for early detection and management to prevent complications. Aim: we aim in our study to clarify prevalence of hypertension between asymptomatic patients during screening at primary health care centers in Saudi Arabia.Methods: In Riyadh, Saudi Arabia, Prince Sultan Medical City, observational research was carried out. Participants in the study were asymptomatic people getting regular checkups at primary health care centers. Blood pressure (BP) was taken using standardized protocols, with hypertension being defined as a systolic blood pressure (SBP) reading of at least 140 millimeters of mercury and/or a diastolic blood pressure (DBP) measurement of no fewer than 90 millimeters of mercury. Data were collected and analyzed to determine the prevalence of hypertension individuals in the study population. Results: A total of three hundred asymptomatic patients were incorporated into the study. The mean patient age was 41.22 years, with 25.7 % being male and 74.3 % female. The overall incidence of hypertension between asymptomatic patients during screening was found to be 20%. Subgroup analysis using age, sex, and other relevant factors will also be presented in the final report. Conclusion: Our study sheds light on the high incidence of hypertension among asymptomatic individuals during evaluation at primary health care centers in Prince Sultan Medical City, Saudi Arabia. The findings underline the importance of routine BP screening in the early identification and treatment of hypertension, which reduces the prevalence of cardiovascular disease in the general population.

Assessment of the epidemiological risk factors of diabetic and hypertensive patients amongst the adult population

Background: 93 lakh people in India are undergoing diabetes and hypertension medication. It is true that the most important modifiable risk factors for type 2 diabetes and hypertension today are poor diet, cigarette smoking, and insufficient exercise. NCD-related deaths worldwide will increase by 17% by 2025, costing $47 trillion in lost productivity between 2011 and 2030. Methods: 300 diabetics, hypertensive and diabetic with hypertensive patients were selected from 8 urban wards and 8 rural panchayats of Bhopal by multi-stage random sampling. A semi-structured, pretested and validated questionnaire derived from WHO-STEPS survey was used to collect data in terms of socio-demographic variables, behavioural risk factors measurement and physical measurements. Mean and standard deviations were calculated for quantitative data, frequency and proportions were calculated for qualitative data. Chi-square value was calculated and p value less than 0.05 was considered statistically significant. Results: The mean age was 46.55±2.17 years. DBP found to be 3% more than 39% of males have systolic BP ≥140 mm of Hg. 33.6% fall under obese-I category. Current tobacco smokers, current alcohol consumption, heavy alcohol use, salt intake &gt;5 gm/day, BMI ≥30 (obese-II) was significantly associated with hypertension. Conclusions: The study’s findings indicate that the alarmingly high occurrence of risk factors for diabetes and hypertension among adults need immediate attention. This indicates the need for an extensive screening and awareness campaign to identify undetected cases in the community and to offer early treatment and continuous follow-up to prevent consequences.

Genetic Insights Into Perinatal Outcomes of Maternal Antihypertensive Therapy During Pregnancy

Limited information exists regarding the impact of pharmacotherapy in pregnancy due to ethical concerns of unintended fetal harm. Yet, maternal prescriptive drug use for chronic conditions such as hypertension is common. To investigate potential causal relationships between perturbing maternal genetic variants influencing antihypertensive drug targets and perinatal outcomes among offspring using mendelian randomization (MR). This 2-sample MR study used individual-level single-nucleotide variation (SNV) outcome data from mother-father-offspring trios with complete genetic and phenotypic information from the Norwegian Mother, Father and Child Cohort Study (MoBa) and summary-level SNV exposure data from UK Biobank participants sourced from the Integrative Epidemiology Unit OpenGWAS project. Pregnant individuals were recruited across Norway during their routine ultrasonography examination at 18 weeks' gestation between June 1999 and December 2008, and mothers, fathers, and offspring were followed up after birth. Novel genetic instruments for maternal antihypertensive drug targets that act via systolic blood pressure (SBP) were derived from individual-level data analyzed in January 2018. Two-sample multivariable MR analysis of these maternal drug targets and offspring outcomes were performed between January 2023 and April 2024. Maternal genetic variants associated with drug targets for treatments of hypertension, as specified in the National Health Service dictionary of medicines and devices. Offspring outcomes were Apgar score at 1 minute and 5 minutes, offspring developmental score at 6 months, birth length, birth weight z score, gestational age, head circumference, and congenital malformation. Maternal hypertensive disorders of pregnancy were a positive control. The MoBa sample contained 29 849 family trios, with a mean (SD) maternal age of 30.2 (18.6) years and a mean (SD) paternal age of 32.8 (13.1) years; 51.1% of offspring were male. Seven independent SNVs were identified as influencing maternal SBP via the antihypertensive drug target instruments. For higher levels of maternal SBP acting through the CACNB2 calcium channel blocker target, the estimated change in gestational age was 3.99 days (95% CI, 0.02-7.96 days) per 10-mm Hg decrease in SBP. There was no evidence of differential risk for measured perinatal outcomes from maternal SBP acting through drug targets for multiple hypertensive subclasses, such as between the ADRB1 β-adrenoceptor-blocking target and risk of congenital malformation (estimated odds ratio, 0.28 [95% CI, 0.02-4.71] per 10-mm Hg decrease in SBP). Maternal and paternal SBP acting through the EDNRA vasodilator antihypertensive target did not have a potential causal effect on birth weight z score, with respective β estimates of 0.71 (95% CI, -0.09 to 1.51) and 0.72 (95% CI, -0.08 to 1.53) per 10-mm Hg decrease in SBP. The findings provided little evidence to indicate that perturbation of maternal genetic variants for SBP that influence antihypertensive drug targets had potential causal relationships with measures of perinatal development and health within this study. These findings may be triangulated with existing literature to guide physicians and mothers in decisions about antihypertensive use during pregnancy.

Caffeine Abstinence in Habituated Users: Cardiovascular Responses to Exercise With Blood Flow Restriction.

Blood flow restriction resistance exercise studies often require caffeine abstinence to avoid cardiovascular effects that could change the blood flow restriction stimulus. However, effects may be attenuated for habituated users. To compare cardiovascular responses to blood flow restriction resistance exercise when habituated users consume or abstain from caffeine. Thirty participants completed a 3-visit within-subject study beginning with familiarization and caffeine intake questionnaire. Visits 2 and 3 consisted of blood flow restriction resistance exercise (3 sets bicep curls to failure, 30% 1-repetition max, 40% arterial occlusion pressure [AOP]), following participants' normal caffeine consumption (CAFF) or abstaining (ABS). AOP, systolic (SBP) and diastolic (DBP) blood pressure, and heart rate were measured preexercise and postexercise. Prevalues and preexercise to postexercise change scores for SBP, DBP, AOP (all millimeters of mercury), heart rate (in beats per minute), and repetitions were compared between conditions. Results are represented as mean (SD). Preexercise AOP was similar for CAFF (137.8 [14.4]) and ABS (137.1 [14.9], BF10 = 0.2), although pre-SBP was higher for CAFF (115.4 [9.8]) than ABS (112.3 [9.4], BF10 = 1.9). Pre-DBP was similar between conditions. The exercise-induced change in AOP was greater for CAFF (18.4 [11.2]) than ABS (13.2 [14.9]), though evidence was anecdotal (BF10 = 0.7). Exercise-induced changes in SBP, DBP, and heart rate were similar between conditions (all BF10 ≤ 0.40). More repetitions were completed for CAFF (63 [26]) than ABS (57 [17], BF10 = 2.1). The findings of this study suggest that for habituated users, maintaining daily caffeine habits will not have substantial effects on common cardiovascular variables relevant to blood flow restriction.

Emergency Department Blood Pressure Treatment and Outcomes in Adults Presenting with Severe Hypertension.

Patients who present to the emergency department (ED) with severe hypertension defined as a systolic blood pressure (SBP) ≥180 millimeters of mercury (mm Hg) or diastolic (DBP) ≥120 (mm Hg) without evidence of acute end-organ damage are often deemed high risk and treated acutely in the ED. However, there is a dearth of evidence from large studies with long-term follow-up for the assessment of major adverse cardiovascular events (MACE). We conducted the largest study to date of patients presenting with severe hypertension to identify predictors of MACE and examine whether blood pressure at discharge is associated with heightened risk. We enrolled ED patients with a SBP of 180-220mm Hg but without signs of end-organ damage and followed them for one year. The primary outcome was MACE within one year of discharge. Secondarily, we performed a propensity-matched analysis to test whether SBP ≤160mm Hg at discharge was associated with reduced MACE at 30 days. A total of 12,044 patients were enrolled. The prevalence of MACE within one year was 1,865 (15.5%). Older age, male gender, history of cardiovascular disease, cerebrovascular disease, diabetes, smoking, presentation with chest pain, altered mental status, dyspnea, treatment with intravenous and oral hydralazine, and oral metoprolol were independent predictors for one-year MACE. Additionally, discharge with an SBP ≤160mm Hg was not associated with 30-day MACE-free survival after propensity matching (hazard ratio 0.99, 95% confidence interval 0.78-1.25, P = 0.92). One-year MACE was relatively common in our cohort of ED patients with severe hypertension without acute end-organ damage. However, discharge blood pressure was not associated with 30-day or one-year MACE, suggesting that BP reduction in and of itself is not beneficial in such patients.

Hemodynamic evaluation of biomaterial-based surgery for Tetralogy of Fallot using a biorobotic heart, in silico, and ovine models.

Tetralogy of Fallot is a congenital heart disease affecting newborns and involves stenosis of the right ventricular outflow tract (RVOT). Surgical correction often widens the RVOT with a transannular enlargement patch, but this causes issues including pulmonary valve insufficiency and progressive right ventricle failure. A monocusp valve can prevent pulmonary regurgitation; however, valve failure resulting from factors including leaflet design, morphology, and immune response can occur, ultimately resulting in pulmonary insufficiency. A multimodal platform to quantitatively evaluate the effect of shape, size, and material on clinical outcomes could optimize monocusp design. This study introduces a benchtop soft biorobotic heart model, a computational fluid model of the RVOT, and a monocusp valve made from an entirely biological cell-assembled extracellular matrix (CAM) to tackle the multifaceted issue of monocusp failure. The hydrodynamic and mechanical performance of RVOT repair strategies was assessed in biorobotic and computational platforms. The monocusp valve design was validated in vivo in ovine models through echocardiography, cardiac magnetic resonance, and catheterization. These models supported assessment of surgical feasibility, handling, suturability, and hemodynamic and mechanical monocusp capabilities. The CAM-based monocusp offered a competent pulmonary valve with regurgitation of 4.6 ± 0.9% and a transvalvular pressure gradient of 4.3 ± 1.4 millimeters of mercury after 7 days of implantation in sheep. The biorobotic heart model, in silico analysis, and in vivo RVOT modeling allowed iteration in monocusp design not now feasible in a clinical environment and will support future surgical testing of biomaterials for complex congenital heart malformations.

The Experimental Pain Experienced in a Cold Pressor Task Is Influenced by Hemoglobin Levels in Young Adult Females.

The intensity of pain perceived for the same noxious stimulus is different in different persons, depending on the biological, psychological, and social factors related to the individual. In clinical practice, it is important to know the factors influencing pain perception. The presence of anemia may affect pain perception. This study was conducted on 73 female subjects of whom 25 were non-anemic, 24 had mild, and 24 had moderate anemia. Experimental pain was produced by cold pressor task (CPT). Pain response was evaluated in terms of cardiovascular reactivity (CVR - changes in blood pressure and heart rate), and pain sensitivity (PS - pain threshold, pain tolerance, and pain rating). Anemic subjects showed higher CVR to stress. The average increase in systolic blood pressure was 5.28 mm of Hg in non-anemic, compared to 3.25 in mildly anemic and 9.00 mm of Hg in moderately anemic subjects. The average increase in diastolic blood pressure was 2.24 mm of Hg in non-anemic, 2.5 in mildly anemic, and 4.83 mm of Hg in moderately anemic subjects. The average increase in heart rate was 2.88 beats per minute (bpm) in non-anemic, 4.83 in mildly anemic, and 7 bpm in moderately anemic subjects. Pain rating was higher in anemic subjects (average 7.21) compared to the non-anemic subjects (average 6.44). CPT-induced pain causes greater cardiovascular reactivity in anemic patients. The average pain rating is higher in anemic subjects.

Exploring the Comorbidity, Pathophysiology, and Integrated Treatment Strategies of Hypertension and Depression

Hypertension and depression are widely prevalent conditions with substantial comorbidity. Hypertension, characterized by persistently elevated arterial pressure, is associated with significant cardiovascular morbidity and mortality. Depression, a multifactorial mood disorder, adversely affects mental and physical health through mechanisms involving neuroinflammation, neurotransmitter imbalances, and hormonal dysregulation. The association between these disorders has been recognized since the mid-20th century.Historical medical literature from ancient Chinese and Indian systems identified symptoms indicative of hypertension, later classified as a distinct disease entity by Fredrick Akbar Mahomed in the 19th century. Notable epidemiological studies have elucidated the significant relationship between hypertension and depression, particularly among medical students and other high-risk populations.Research indicates that common pathophysiological mechanisms, including sympathetic nervous system overactivity, chronic inflammation, and endothelial dysfunction, underlie the comorbidity of hypertension and depression. Elevated levels of norepinephrine, proinflammatory cytokines, and oxidative stress contribute to the expression or worsening of both conditions. Shared genetic and environmental factors further compound this relationship, highlighting the need for integrated treatment strategies.Pharmacological interventions, including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have shown potential to improve mental health outcomes in patients with comorbid hypertension and depression. However, inconsistent findings regarding the impact of antihypertensive medications on depression necessitate further investigation. The comorbidity of these conditions complicates treatment adherence, leading to poorer health outcomes and increased healthcare costs.The clinical implications of this unidirectional or bidirectional comorbidity are considerable, affecting quality of life, treatment adherence, and overall health outcomes. Integrated care approaches, incorporating lifestyle modifications and combined pharmacological treatments, have shown promise in improving compliance and outcomes.Despite extensive research, limitations persist, including difficulties in establishing causality, inconsistent diagnostic criteria, and the influence of confounding variables. Future research should focus on clarifying the bidirectional relationship between these conditions, the impact of social determinants, and the efficacy of various treatment modalities. Identifying high-risk populations and refining intervention strategies are crucial for improving clinical outcomes in patients with comorbid hypertension and depression.This paper aims to review the current literature regarding the association and comorbidity of hypertension and depression.Abbreviations: ACE: Angiotensin-Converting Enzyme; ARBs: Angiotensin Receptor Blockers; DBP: Diastolic Blood Pressure; mm Hg: Millimeters of Mercury; QoL: Quality of Life; SBP: Systolic Blood Pressure