mmHg For SBP Research Articles

Comparison of indirect and direct blood pressure measurements in baboons during ketamine anaesthesia

The aim of this study was to assess agreement between different methods of blood pressure measurement in anaesthetised baboons. Systolic and diastolic blood pressure (SBP and DBP) were measured in anaesthetised baboons using intra-arterial radiotelemetry, automated oscillometry and mercury sphygmomanometry. Correlation between the different methods was assessed. The correlation between intra-arterial radiotelemetry and automated oscillometry was 0.9 (P<0.001) for SBP and 0.9 (P<0.001) for DBP. Between-method differences were -4.4±7.2mm Hg for SBP and -3.4±7.1mm Hg for DBP. For automated oscillometry vs. mercury sphygmomanometry, correlation was 0.4 for both SBP (P<0.001) and DBP (P<0.001). Between-method differences were 7.9±12.7mm Hg for SBP and 7.3±12.6mm Hg for DBP. Our study demonstrates that automated oscillometry may be an appropriate alternative to telemetry for measuring blood pressure in anaesthetised baboons.

Oscillometric 24-h ambulatory blood pressure reference values in Hong Kong Chinese children and adolescents

We aimed to establish community-based normal reference values of 24-h ambulatory blood pressure monitoring (ABPM) for Chinese children and adolescents. Furthermore, we investigated how excluding overweight children affects BP percentiles and compared them with German references. In this territory-wide cross-sectional prospective cohort study, 1445 Hong Kong Chinese children and adolescents aged 8-17 years with body height between 119 and 185 cm were recruited. Their ABPM assessment was performed using validated arm oscillometric recorders (A&D TM-2430) and complied with American Heart Association's recommendations. The reference tables were constructed using the LMS method to normalize skewed distribution of ABP data to sex and age or height. The ambulatory BP was higher among boys and the difference between boys and girls progressively widened with age. An increasing trend in daytime and night-time SBP and DBP with age and height was observed in both sexes. The age-specific and sex-specific 95th percentiles from nonoverweight children (n=1147; 79%) were lower than the whole cohort by up to 2.5 and 1 mmHg for SBP and DBP, respectively. In comparison, our overall and nonoverweight reference standards were generally higher than corresponding German references. The study provides ambulatory BP standards for Chinese children, with sex-related age-specific and height-specific percentiles. Further longitudinal studies are required for investigating its clinical utility in Chinese.

Higher blood hematocrit predicts hypertension in men

Little is known on the relationship between blood hematocrit level as an estimate of whole blood viscosity and the risk of hypertension. We investigated the relationship of higher hematocrit level with incident hypertension in men during a mean follow-up of 5 years. Participants were 3620 men (mean age 48 ± 6 years) who participated in two health examinations during 1998-2009. All participants were free of hypertension and within the normal range of hematocrit (39-50%) at baseline. The incidence of hypertension was defined as blood pressure values exceeding 140/90 mmHg of SBP and/or DBP at time of follow-up examination. During 17,856 person-years of follow-up, 351 new cases of hypertension developed. The relative risk (RR) of incident hypertension in men with hematocrit in the highest tertile vs. men with hematocrit in the lowest tertile was 1.45 (95% confidence interval, CI 1.11-1.90) after adjustment for confounding factors. Every 1% increment in hematocrit was associated with 7% (RR 1.07, 95% CI 1.02-1.13) higher incidence of hypertension after adjusting for risk factors. Men whose hematocrit increased over time had a 25% increased risk of developing hypertension (RR 1.25, 95% CI 1.01-1.57) compared with men with decreased hematocrit after adjustment for risk factors. These results demonstrate that higher hematocrit levels, even within the normal range, were associated with the incidence of hypertension independent of other risk factors in men.

Evaluation of effectiveness and safety of amlodipine/valsartan/hydrochlorothiazide single-pill combination therapy in hypertensive patients: an observational study

Objective:This study evaluated the effectiveness and safety of amlodipine/valsartan/hydrochlorothiazide (A + V + H) single-pill combination therapy in the treatment of hypertensive patients in daily practice.Design and methods:This prospective, open-label, observational study, enroled adults for whom their physician considered treatment with the single pill combination as indicated. The observational period per patient was ∼3 months. Results were evaluated using basic descriptive statistical methods.Main outcome:Data of 7132 patients were analyzed. At baseline, the mean blood pressure (BP) was 158.8 ± 17.7 mmHg (systolic, sBP) and 91.5 ± 10.7 mmHg (diastolic, dBP). The most common cardiovascular risk factors were positive family history, dyslipidemia, and diabetes mellitus. The most commonly used daily doses of A + V + H at study end were 5/160/12.5 mg (30.5%) or 10/160/12.5 mg (33.1%). At the last visit mean BP was 135.0 ± 11.8 mmHg (sBP) and 80.2 ± 7.3 mmHg (dBP). The mean BP reduction at last visit compared with baseline was −23.7 ± 17.5 mmHg (sBP) and −11.3 ± 10.6 mmHg (dBP); 43.5% of the patients reached normalization (BP <140/90 mmHg for non-diabetics or <130/80 mmHg for diabetics) and 71.3% reached therapeutic response (sBP <140 or ≥20 mmHg decrease vs baseline and dBP <90 or ≥10 mmHg decrease vs baseline in non-diabetic patients and sBP <130 mmHg or ≥20 mmHg decrease vs baseline and dBP <80 mmHg or ≥10 mmHg decrease vs baseline in patients with diabetes). Adverse events (AEs) were recorded in 2.3% of the patients, the most frequent being peripheral edema (0.6%) and dizziness (0.2%).Conclusions:In daily practice, A + V + H single-pill treatment effectively lowered the average BP in patients with essential hypertension and was well tolerated.

Effect of catheter-based renal sympathetic denervation on 24-h ambulatory blood pressure in patients with resistant hypertension

We investigated the effect of renal denervation on office blood pressure (OBP) and 24-h ambulatory blood pressure (BP) measurement (ABPM) at baseline and 6 months after intervention in 25 consecutive patients with resistant hypertension. Mean baseline 24-h ABPM and OBP were 158/88 mmHg and 169/96 mmHg, respectively. Patients were treated with an average of 4 ± 1 antihypertensive drugs. Among the 22 patients included in data analysis, mean ambulatory systolic and diastolic BP were reduced by 6 mmHg from 158 ± 17 to 152 ± 20 mmHg (p < 0.05) and by 3 mmHg from 88 ± 12 to 85 ± 14 mmHg (p = ns) after 6 months follow-up, respectively. Blood pressure reduction was most pronounced during daytime with a decrease of 9 mmHg from 164 ± 17 to 155 ± 19 (p < 0.05) in systolic (SBP) and 6 mmHg from 94 ± 14 to 88 ± 14 mmHg in diastolic BP (DBP) (p < 0.05). Night-time SBP mmHg and DBP were similar at baseline compared with follow-up. Systolic and diastolic OBP during follow-up were significantly reduced by 17 mmHg from 169 ± 20 to 152 ± 21 (p < 0.05) and by 9 mmHg from 96 ± 16 to 87 ± 13 mmHg (p < 0.05), respectively. These results provide new insight into the effect of renal denervation on ABPM day- and night-time blood pressure profile in comparison with OBP. The decrease in ABPM was identified during daytime registration and was less pronounced compared with reduction of OBP.

Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi.

Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup.

Lack of difference between nebivolol/hydrochlorothiazide and metoprolol/hydrochlorothiazide on aortic wave augmentation and central blood pressure

The vasodilating beta-blocker nebivolol is thought to be superior in lowering wave reflection and central blood pressure (BP) compared to nonvasodilating beta-blockers. The results from studies comparing nebivolol with either metoprolol or atenolol, with or without hydrochlorothiazide (HCTZ), are not unequivocal. We examined the effects of nebivolol 5 mg and metoprolol 100 mg with HCTZ 12.5 mg on aortic wave augmentation, central BP and hemodynamics using a randomized, double-blind, crossover design. We included 22 patients (17 men, age 59.9 ± 6.4 years) with office SBP of 155 ± 16 mmHg and DBP of 93 ± 10 mmHg. Radial applanation tonometry and noninvasive, continuous finger arterial BP measurement was performed at baseline and after 4 weeks of treatment with either drug regimen, separated by a 4-week washout period. Neither treatment affected aortic wave augmentation significantly. Augmentation index increased 1.0 ± 7.8% (P = 0.5) for nebivolol/HCTZ and 2.4 ± 6.6% (P = 0.07) for metoprolol/HCTZ. Nebivolol/HCTZ lowered central SBP by 15.8 ± 14.9 mmHg and DBP 10.5 ± 8.4 mmHg, and with metoprolol/HCTZ by 13.5 ± 12.3 mmHg for SBP and 9.5 ± 6.8 mmHg for DBP (all P < 0.001). Heart rate was lowered 8.1 ± 5.4 beats/min by nebivolol/HCTZ and 8.6 ± 4.9 beats/min by metoprolol/HCTZ. Peripheral BP was reduced to a similar extent as central BP. Peripheral BP decreased by 16.3 ± 14.9 mmHg systolic and 10.1 ± 8.2 mmHg diastolic with nebivolol/HCTZ, and by 15.2 ± 13.0 mmHg systolic and 9.1 ± 6.9 mmHg diastolic with metoprolol/HCTZ. Both treatment modalities had a similar effect on stroke volume, cardiac output, left-ventricular contractility and peripheral resistance. Nebivolol was not superior to metoprolol in reducing aortic wave augmentation or central BP when combined with HCTZ.

Potent Antihypertensive Action of Dietary Flaxseed in Hypertensive Patients

Flaxseed contains ω-3 fatty acids, lignans, and fiber that together may provide benefits to patients with cardiovascular disease. Animal work identified that patients with peripheral artery disease may particularly benefit from dietary supplementation with flaxseed. Hypertension is commonly associated with peripheral artery disease. The purpose of the study was to examine the effects of daily ingestion of flaxseed on systolic (SBP) and diastolic blood pressure (DBP) in peripheral artery disease patients. In this prospective, double-blinded, placebo-controlled, randomized trial, patients (110 in total) ingested a variety of foods that contained 30 g of milled flaxseed or placebo each day over 6 months. Plasma levels of the ω-3 fatty acid α-linolenic acid and enterolignans increased 2- to 50-fold in the flaxseed-fed group but did not increase significantly in the placebo group. Patient body weights were not significantly different between the 2 groups at any time. SBP was ≈ 10 mm Hg lower, and DBP was ≈ 7 mm Hg lower in the flaxseed group compared with placebo after 6 months. Patients who entered the trial with a SBP ≥ 140 mm Hg at baseline obtained a significant reduction of 15 mm Hg in SBP and 7 mm Hg in DBP from flaxseed ingestion. The antihypertensive effect was achieved selectively in hypertensive patients. Circulating α-linolenic acid levels correlated with SBP and DBP, and lignan levels correlated with changes in DBP. In summary, flaxseed induced one of the most potent antihypertensive effects achieved by a dietary intervention.

Hypertension management algorithm for type 2 diabetic patients applied in primary care.

BackgroundHypertension frequently coexists with type 2 diabetes (DM), and increases the risk of cardiovascular outcomes. The aim of the study was to obtain/maintain blood pressure (BP) goals (ADA/JNC 7) according to a stepwise algorithm using the medication supplied by the Brazilian government.MethodsA one-year, single-arm interventional study conducted with type 2 diabetes patients. Intervention consisted of intensification of lifestyle changes and sequential prescription of drugs: diuretic; ACE inhibitors; β-adrenergic blocking agent and calcium channel blocking agent if BP >130/80 mmHg.ResultsSeventy-eight patients completed the trial. During intervention, the number of antihypertensive tablets rose (3.6 ± 3.5 vs. 5.9 ± 3.5 pills/patient; p <0.001), as the number of antihypertensive classes increased (1.8 ± 1.0 vs. 2.70 ± 1.2; p < 0.01) and the overall drop of BP was 11 mmHg for SBP (145.0 ± 22.8 vs. 133.7 ± 20.9 mmHg; p < 0.01) and 5 mmHg for DBP (78.7 ± 11.5 vs. 73.7 ± 10.5 mmHg; p = 0.001). Although the number of patients with BP in target almost doubled [14 (18.7%) vs. 30 (38.5%) p = 0.008], less than 40% of the patients achieved the proposed goals.ConclusionsA BP algorithm applied to type 2 diabetic and hypertensive patients is able to lower BP, however more than half of the patients did not achieve the ADA/JNC 7 targets demonstrating the complexity of BP control in this population.Trial registrationClinicalTrials.gov: NCT06260

Abstract 46: FOXP3+ T Regulatory Lymphocytes Counteract Angiotensin II-Induced Vascular Injury

Introduction: T lymphocytes participate in the low-grade inflammatory response that causes vascular injury in angiotensin (Ang) II-induced hypertension. Ang II-induced hypertension and endothelial dysfunction are blunted in T and B lymphocyte-deficient ( Rag1 -/- ) mice, and restored with reconstitution of T cells. However, the role of T regulatory lymphocytes (Treg) in Ang II-induced vascular injury is unclear. We hypothesized that adoptive transfer of FOXP3-deficient (Scurfy) T lymphocytes vs. wild-type (WT) cells will exacerbate Ang II-induced vascular damage in Rag1 -/- mice. Methods: Eleven-week old male Rag1 -/- mice were injected IV with PBS/2% FBS (control), 10 7 WT or Scurfy T lymphocytes, and 2 weeks later underwent sham surgery or were infused with Ang II (490 ng/kg/min, s.c.) using mini-osmotic pumps for 14 days (n=3-8). Systolic (SBP) and diastolic (DBP) blood pressure were measured by telemetry. Vascular function and structure were assessed in second order mesenteric arteries by pressurized myography. Reactive oxygen species (ROS) production and fibronectin and collagen I and III expression were determined in aorta. Results: Ang II induced a 40 mmHg SBP rise in Rag1 -/- mice for all treatment groups, but DBP rise was ~10 mmHg greater for WT and Scurfy T cell-injected mice than for control mice ( P &lt;0.01). Adoptive transfer of WT T cells restored Ang II induced-endothelial dysfunction in mesenteric arteries ( P &lt;0.05), which was exaggerated in Scurfy T cell-injected mice ( P &lt;0.01). Ang II induced a greater increase in ROS production in aortic perivascular fat of Scurfy T cell-injected mice compared to WT T cell-injected mice ( P &lt;0.05). Ang II induced mesenteric artery stiffness ( P &lt;0.01) and hypertrophic remodeling ( P &lt;0.05) in control and Scurfy T cell-injected mice, but not in WT T cell-injected mice. Ang II increased fibronectin expression to a greater extent in the aorta of control and Scurfy T cell-injected mice compared to WT T cell-injected mice ( P &lt;0.01). Collagen I and III content was greater in the aorta of control and Scurfy T cell-injected mice than in WT T cell-injected mice ( P &lt;0.01), but expression was unaltered by Ang II treatment. Conclusion: Foxp3+ T regulatory lymphocytes have a protective role against Ang II-induced vascular remodeling.

Association of current carotid elastic modulus and prior body mass index in elderly people - results from the SAPALDIA cohort study

Purpose: Cardiovascular mortality has a close association with body mass index (BMI). A subclinical vascular biomarker for atherosclerosis is the elastic modulus introduced by Peterson (EP). However, whether BMI is associated with EP has not been investigated. Therefore, the aim of the study was to investigate the association of prior BMI and current EP examined by ultrasound device in participants of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases In Adults (SAPALDIA). Methods: BMI [kg/m2] was measured in 8047 participants of the first follow up of SAPALDIA (SAP2) in 2002 and classified as normal weight (18.5-24.9 BMI), overweight (25-29.9 BMI) and obese (>30 BMI). Further, age, sex, smoking status, brachial systolic (sBP) and diastolic blood pressure (dBP), total cholesterol (TC) and high-density cholesterol (HDL) were examined. In the second follow up in 2010/11 (SAP3) ultrasound clips of the common carotid artery were accomplished in 3490 participants. Lumen diameter (LD) was analyzed over a standardized 1cm segment proximal to the bifurcation over at least one heart cycle. dBP and sBP was measured directly after ultrasound examination. EP was defined as (diastolic LD) × (sBP – dBP)/(systolic LD – diastolic LD). Overall, the study sample included 1815 participants (44.4% men, 55.6% women) with complete measurements. The associations between log-transformed EP and BMI categories were assessed using multiple linear regression analysis with additional adjustment for above mentioned prior cardiovascular risk factors and study centers. Results: Means and standard deviations in SAP2 were: 55.1 (8.1) years for age, 127.0 (18.8) mmHg for sBP, 80.1 (10.7) mmHg for dBP, 6.1 (1.1) mmol/l for TC and 1.5 (0.4) mmol/l for HDL. In the sample, 48.8% were of normal weight, 38.2% overweight and 13% obese. Means and standard deviations in SAP3 were 155.3 (75.0) kPa for EP, 135.1 (18.5) mmHg for sBP and 78.1 (9.4) mmHg for dBP. Adjusted geometric means with 95% confidence intervals for EP [kPa] were 139.2 (136.2, 142.2) for normal weight, 145.7 (142.3, 149.2) for overweight, 147.7 (141.8, 153.9) for obese subjects. Overweight (p=0.013) and obese subjects (p=0.023) differed significantly from normal weight subjects, but there was also a significant difference of EP between overweight and obesity (p=0.018). Conclusions: The results showed significantly higher EP values of the carotid artery for each increase in BMI category. This indicates that prior overweight and obesity is associated with current reduced vascular health status which indicates a harmful long term effect of increased BMI.

Comparative assessment of target office blood pressure attainment and the results of its home monitoring in uncomplicated hypertension participants of real-life longitudinal PERFECT-BP study

Purpose: to compare target office and normal home blood pressure (BP) attainment rates in uncomplicated hypertension (UH) participants of longitudinal program of compliance and BP control optimization by implementation of simplified treatment algorithm together with home BP monitoring (HBPM) and educational material in real-life setting (PERFECT-BP). Methods: Per protocol cohort of PERFECT-BP prospective observational study included 431 pts aged 57,6±0,5 years, 43,9% male, 17,2% with type 2 diabetes with new diagnosed (18,3%) or treated but uncontrolled UH (BP <200/120 mm Hg). Pts were provided with new standardized precalibrated automatic BP devices Microlife BP3AG1with individually selected cuff, written instructions for lege artis home BP measurements and educational materials. At visit 1, after training in the use of BP device and educational session, pts were prescribed or switched to 1 FDC tab pd of perindopril/amlodipine (dosed 5/5, 5/10, 10/5 or 10/10mg – at discretion of MDs) and instructed to perform HBPM twice pd (before breakfast and going to bed) for at least 7 consecutive days a week before each visit, and record it in a log. Step 2 of target office BP attainment (<140/90 mm Hg) was uptitration to the highest tolerated FDC dose, step 3 – plus indapamid-R 1.5 mg pd, step 4 – spironolactone 25 mg pd, step 5 – moxonidine or doxasosine. Office BP measurements were performed with standardized automatic Microlife BPW20. Results: In 6 months office SBP lowered from 165,7±0,7 to 131,1±0,5 mm Hg and DBP from 96,9±0,5 to 79,1±0,3 mm Hg (p<0,001). This was achieved with triple therapy in 29,9% pts, and ≥4 drugs in 2,3% pts. At 6 month home BP as a mean of 14±0,2consecutive measurements before the office visit was 129,5±0,4 mm Hg for SBP and 77,9±0,3 mm Hg for DBP. Though target office BP was attained in 347 (80,5%) of pts, it was associated with normal home BP (<135/85 mm Hg) only in 265 (61,5%) of pts while 82 (19%) had home BP and 17 (4%) of pts with elevated office BP had normal home BP. Both office and home BP stayed elevated in 67 (15,5%) of pts. Conclusion: In 23,6% of UN pts, who after 6 month antihypertensive treatment in real-life setting attained target office BP <140/90 mm Hg, it was associated with home BP (≥135/85 mm Hg) obtained by HBPM, while 20,2% of pts with elevated office BP attained normal home BP.

Aortic Distensibility in Type 1 Diabetes

OBJECTIVETo evaluate the relationship between long-term glycemia, traditional cardiovascular disease (CVD) risk factors, and ascending aortic stiffness in type 1 diabetes.RESEARCH DESIGN AND METHODSEight hundred seventy-nine subjects in the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study were evaluated. The stiffness/distensibility of the ascending thoracic aorta (AA) was measured with magnetic resonance imaging. Associations of AA distensibility and CVD risk factors, mean HbA1c, and cardiovascular complications including macroalbuminuria were assessed using multivariate linear regression models.RESULTSThe mean age of the subjects was 50 ± 7 years (47% women, mean diabetes duration of 28 years). Over 22 years of follow-up, 27% of participants had cardiovascular complications. After adjusting for gender and cohort, AA distensibility was lower with increasing age, mean systolic blood pressure, LDL, and HbA1c measured over an average of 22 years (−26.3% per 10 years, −11.0% per 10 mmHg SBP, −1.8% per 10 mg/dL of LDL, and −9.3% per unit mean HbA1c [%], respectively). Patients with macroalbuminuria had 25% lower AA distensibility compared with those without (P < 0.0001). Lower AA distensibility also was associated with greater ratio of left ventricular mass to volume (−3.4% per 0.1 g/mL; P < 0.0001).CONCLUSIONSOur findings indicate strong adverse effects of hypertension, chronic hyperglycemia and macroalbuminuria on AA stiffness in type 1 diabetes in the DCCT/EDIC cohort.

Accuracy of the CNAP monitor, a noninvasive continuous blood pressure device, in providing beat-to-beat blood pressure readings in the prone position

Study ObjectiveTo assess the accuracy of a noninvasive continuous arterial pressure (CNAP) monitor in patients who are positioned prone in the operating room. DesignProspective study. SettingOperating room at a children's hospital. Patients20 pediatric patients, aged 13.8 ± 2 years, and weight 63.7 ± 18.8 kg, scheduled for surgery in the prone position, and for which arterial catheter placement was planned. InterventionsMeasurements were recorded with an arterial line (AL) and a new noninvasive continuous blood pressure (BP) monitor. MeasurementsSystolic (SBP), diastolic (DBP), and mean arterial (MAP) pressure readings were captured from an arterial cannula and the CNAP device every minute during anesthesia. Main ResultsThe study cohort consisted of analysis of 4104 pairs of SBP, DBP, and MAP values, which showed an absolute difference between the AL and CNAP device readings of 7.9 ± 6.3 mmHg for SBP, 5.3 ± 4.3 mmHg for DBP, and 4.6 ± 3.9 mmHg for MAP. Bland-Altman analysis of MAP values showed a bias of 0.26 mmHg, with upper and lower limits of agreement of 12.18 mmHg and -11.67 mmHg, respectively. CNAP readings deviated from arterial values by ≤ 5 mmHg in 67% of MAP values, 59% of DBP values, and 43% of SBP readings. The difference was ≤ 10 mmHg for 94% of MAP readings, 90% of DBP values, and 73% of SBP readings. ConclusionsDuring prone positioning, the CNAP monitor provided clinically acceptable accuracy for MAP values, similar to those reported in adults in the supine position.

Preterm Birth and the Metabolic Syndrome in Adult Life: A Systematic Review and Meta-analysis

Preterm birth is associated with features of the metabolic syndrome in later life. We performed a systematic review and meta-analysis of studies reporting markers of the metabolic syndrome in adults born preterm. Reports of metabolic syndrome-associated features in adults (≥18 years of age) born at <37-week gestational age and at term (37- to 42-week gestational age) were included. Outcomes assessed were BMI, waist-hip ratio, percentage fat mass, systolic (SBP) and diastolic (DBP) blood pressure, 24-hour ambulatory SBP and DBP, flow-mediated dilatation, intima-media thickness, and fasting glucose, insulin, and lipid profiles. Twenty-seven studies, comprising a combined total of 17,030 preterm and 295,261 term-born adults, were included. In adults, preterm birth was associated with significantly higher SBP (mean difference, 4.2 mm Hg; 95% confidence interval [CI], 2.8 to 5.7; P < .001), DBP (mean difference, 2.6 mm Hg; 95% CI, 1.2 to 4.0; P < .001), 24-hour ambulatory SBP (mean difference, 3.1 mm Hg; 95% CI, 0.3 to 6.0; P = .03), and low-density lipoprotein (mean difference, 0.14 mmol/L; 95% CI, 0.05 to 0.21; P = .01). The preterm-term differences for women was greater than the preterm-term difference in men by 2.9 mm Hg for SBP (95% CI [1.1 to 4.6], P = .004) and 1.6 mm Hg for DBP (95% CI [0.3 to 2.9], P = .02). For the majority of outcome measures associated with the metabolic syndrome, we found no difference between preterm and term-born adults. Increased plasma low-density lipoprotein in young adults born preterm may represent a greater risk for atherosclerosis and cardiovascular disease in later life. Preterm birth is associated with higher blood pressure in adult life, with women appearing to be at greater risk than men.

Lead (Pb) is Now a Non-Threshold Substance: How Does this Affect Soil Quality Guidelines?

ABSTRACT Risk-based concentrations (RBCs) for lead (Pb) in soil were estimated using equations for development of Canadian soil quality guidelines. Based on the latest toxicological assessments by various health agencies, risk specific doses for Pb were defined for children (for impacts on intelligence quotient [IQ]) and adults (for impacts on systolic blood pressure [SBP] as well as protection of fetal effects in the case of pregnant women). The analysis suggests that a RBC in soil of 180 μg/g (dry weight) for residential and other areas where children routinely play is protective of a 1 IQ point decrement on a population basis and may actually be associated with decrements of less than 0.2 to 0.35 IQ points when the weight of evidence is considered. For soils that children do not contact on a frequent basis, RBCs as great as 8800 μg/g are considered to be protective of a 1 mmHg SBP increase in adults (as well as IQ effects to the fetus). It is stressed that non-soil sources of Pb may be even more important than soil. The approach may also be useful in jurisdictions outside of Canada as the importance of considering IQ decrements on a population basis rather than an individual basis and uncertainties in soil ingestion rates are considered.

Accuracy of the pulse delay time technique with triple cuff for objective indirect blood pressure measurement

We developed a new technique to measure blood pressure (BP) - the triple cuff and pulse delay time technique (TC-PDT) - which measures delay time with a single sensor at a single site unlike the existing delay time methods. This study aimed to evaluate the adequacy and accuracy of TC-PDT. TC-PDT measures delay time, which represents the difference in the arrival time of the arterial pulse wave between the proximal and distal areas of the cuff and provides clear criteria for BP determination based on the mechanism. Adequacy of delay time in TC-PDT was confirmed in comparison with established delay time of the pulse transit time technique (PTT). TC-PDT accuracy was evaluated according to the standard guidelines. In TC-PDT, delay time showed changes in parallel with those observed in PTT. The correlation coefficient between BP by TC-PDT and that by PTT was 0.98 (P < 0.01) for SBP and 0.93 (P < 0.01) for DBP. According to the International Protocol guidelines (2002), the BP measurements of 33 patients met the recommended values for phase 1, 2.1 and 2.2 measurements. As per the Association for the Advancement of Medical Instrumentation (AAMI) SP10 guidelines (2002), the mean difference in BP measured by TC-PDT and that measured by the auscultatory technique in 85 patients was 1.0 ± 5.1 mmHg for SBP and -0.4 ± 4.5 mmHg for DBP, which conformed to the requirements. TC-PDT is adequate to measure delay time and provides adequate and accurate measurements of BP. This device has the potential to be a standard tool for indirect BP measurement.

Yoga and Hypertension.

Yoga and Hypertension.

THE EPIDEMIOLOGICAL CHARACTERISTICS OF BLOOD PRESSURE DISTRIBUTION AMONG RURAL RESIDENTS IN TIANJIN OF CHINA

ObjectivesTo evaluate the up-to-date epidemiological characteristics of blood pressure distribution among rural residents in Tianjin of ChinaMethodsA cross-sectional survey was conducted between September and October 2011. Of 1937 individuals aged...

534 HEMODYNAMIC CHANGES DURING ACUTE SALT LOADING IN PATIENTS WITH RESISTANT HYPERTENSION

Objective: To assess the changes of hemodynamic parameters during acute salt-loading (SL) in patients with resistant hypertension (RHTN) and its associations with salt-sensitivity of blood pressure (BP). Design and Methods: We studied 34 patients (17 males, 17 females; 56 ± 6 yrs) with RHTN (taking combination antihypertensive therapy (lisnopril 20 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg per day and BP over 140/90 mm Hg) and 6 healthy normotensive subjects (3 males, 3 females; 54 ± 2 yrs). SL was performed via i.v. infusion of 1000 mL saline for 1 hour. Beat-to-beat BP was registered using Finometer Pro device (Amstredam). Results: Within 1 hour of SL patients with RHTN exhibited elevation of systolic (SBP) and diastolic BP (DBP) (from 188 ± 6 to 161 ± 4 mm Hg for SBP and from 104 ± 2 to 89 ± 2 mm Hg for DBP, both p < 0.01 vs baseline). In one hour after SL BP returned close to baseline level (158 ± 4 and 86 ± 2 mm Hg, respectively). At baseline total peripheral vascular resistance in RHTN was significantly higher compared to controls (1767 ± 24 vs 1212 ± 28 dyn × s × sm−5; P < 0.05). Moreover, at peak of saline infusion BRS was also higher in patients with RHTN than in controls (2212 ± 35 vs 1573 ± 44 dyn × s × sm−5; P < 0.01). In hypertensive patients total peripheral vascular resistance changes positively correlated with the magnitude of NaCl-induced elevation of SBP (r = 0.61; P = 0.01) and DBP (r = 0.52; P = 0.02) BP. Hypertensive patients were subdivided on two groups: salt-resistant (SL-induced BP elevation <20 mm Hg for both SBP and DBP (n = 15)) and salt-sensitive (SL-induced BP elevation ≥ 20 mm Hg for SBP and/or DBP (n = 19)). Total peripheral vascular resistance at baseline was similar in both groups. In salt-sensitive patients a significant correlation of total peripheral vascular resistance delta with peak SBP delta was observed (r = 0,88, P < 0.01), while in slat-resistant no relation was documented. The final BRS was higher in salt-sensitive that in salt-resistant group (2560 ± 28 vs 2030 ± 24 dyn × s × sm−5; P < 0.001). Conclusion: In patients with RHTN total peripheral vascular resistance is increased and is positively associated with the level of pressor response to SL. The increase of total peripheral vascular resistance during SL is observed only in salt-sensitive RHTN.