Normal Diastolic Blood Pressure Research Articles

Isolated systolic hypertension in young adults and its relationship with ambulatory blood pressure measurements

Introduction: The definition of Isolated Systolic Hypertension (ISH) is accepted by guidelines, which adopt a blood pressure (BP) cutoff point of 140/90 mmHg, with elevated Systolic Blood Pressure (SBP) and normal diastolic blood pressure (DBP) in the clinic. This phenotype represents the most common form of Hypertension (HT) in young individuals. The prognosis of ISH differs according to various explanatory mechanisms. Some associations of this phenotype with Ambulatory Blood Pressure Monitoring (ABPM) have been described, but little emphasis has been placed on its association with nocturnal BP values. To the best of our knowledge, there is no epidemiological data on young patients establishing this relationship in Latin America. Objective: To describe the characteristics of ISH in our population of young patients and analyze its relationship with different ABPM phenotypes. Materials and methods: Consecutive adult individuals between 16 and 40 years of age, without antihypertensive treatment, were evaluated in a cross-sectional study. They were referred for ABPM to a tertiary hospital between July 2013 and August 2022. Each individual underwent an initial interview, three BP measurements using current standards with OMROM HEM 705 devices, and subsequent ABPM with Spacelabs 90207. A general description of the sample was provided, and an analysis was conducted based on different patient phenotypes determined by clinic BP measurements in relation to various ABPM phenotypes. Results: A total of 395 individuals (69% women, 29 ± 6.5 years) were finally evaluated. The frequencies according to clinic phenotypes were as follows: Normotensive = 77%, ISH = 6%, HT = 17%. Among the ISH group, 29.2% had white coat hypertension (WCH). The Kappa agreement was 31% for clinic phenotypes vs. ABPM. Among ISH patients, 37% had at least one elevated period (daytime or nighttime), and 12.5% had elevated BP only during the nighttime.

Triglyceride-glucose index change and chronic kidney disease progression in a Chinese hypertensive population.

The impact of triglyceride-glucose (TyG) index variations on chronic kidney disease (CKD) progression remains unexplored. To investigate the effects of the TyG index and its dynamic changes on CKD progression. This prospective cohort study included data from 8,418 hypertensive participants. The exposure variable in this study was defined as the difference between the TyG index at the last visit from that at baseline. The study's outcome variable was the progression of CKD, defined as follows: for subjects with an estimated glomerular filtration rate (eGFR) ≥60 mL/min, a ≥30% decrease in eGFR with a final follow-up value <60 mL/min; for those with an eGFR <60 mL/min, a ≥50% decrease in eGFR; or terminal renal failure requiring dialysis. During a median follow-up period of 48 months, 1077 patients were diagnosed with CKD progression. In the fully adjusted Model 3, patients with a change in the TyG index <0 exhibited a significantly decreased 13% risk of CKD progression (HR: 0.87, 95% CI: 0.76-0.98) compared to those with a change in the TyG index≥0 group. Subgroup analyses showed that changes in the TyG index significantly increased the risk of CKD progression only in patients with diastolic blood pressure (DBP) <90mmHg. In the path analysis, baseline TyG was associated with follow-up eGFR (the standard regression coefficient was 1.26 [95% CI, 0.45-2.06]). Our findings suggest that TyG variability may serve as a useful tool for identifying individuals at risk of CKD progression, particularly hypertensive patients with normal DBP levels.

Body Mass Index and Blood Pressure Profile of Newly Enrolled Health Sciences Students in a Medical University of Karachi, Pakistan

Objectives: To measure the Body Mass Index (BMI) and Blood pressure (BP) of newly enrolled undergraduate students in a medical university in Karachi, Pakistan, and to assess any association between BMI and BP levels among them. Methods: A cross-sectional study was conducted on pre-existing three-year data of 1403 students. The age, gender, BMI, and BP were recorded. The BMI of students was classified according to the Asian cutoff and BP was categorized using the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) classification. Data was analyzed using SPSS version 24. Descriptive statistics were used to present quantitative and qualitative variables. The association was measured using the Chi-square test of significance. A p-value of &lt; 0.05 was taken as significant. Results: Total n= 1403 students with a mean age of 19 + 1.4 years students were enrolled including 397 (28.3%) males and 1006 (71.7%) females. A total of 667 (47.5%) students had a normal weight while 216 (15.4%) students were underweight, and 512 (36.5%) were either overweight or obese. Mean systolic BP was 111.42 + 10.7 mmHg and mean diastolic BP was 73.45 + 7.96 mmHg. Most students had normal systolic BP 901 (64.2%) while 501 (35.7%) had prehypertension or stage- I or II hypertension (HTN). The majority of the students had normal diastolic BP 1357 (96.7%) and 45 (3.3%) had stage- I or II HTN. There was a significant association between BMI and BP (0.0001). Conclusion: A significant number of the students are either under or overweight. There is a significant relationship between BMI and BP levels.

P104: Heterogeneity of Response to methylphenidate in apathetic patients in the ADMET 2 Trial

Background:Apathy is the most common neuropsychiatric symptom in Alzheimer’s disease (AD), however there are no approved treatments. In the recent Apathy in Dementia Methylphenidate Trial 2 (ADMET 2), methylphenidate treatment resulted in a significant reduction in apathy with a small to medium effect size. We assessed response in ADMET 2 to identify individuals likely to benefit from methylphenidate.Methods:In ADMET 2, AD patients with clinically significant apathy were randomized to methylphenidate or placebo. Twenty-three potential predictors of treatment outcome chosen a priori for evaluation were divided into levels (e.g. anxiety present/absent). For each predictor, change in Neuropsychiatric Inventory apathy (NPI-A) due to methylphenidate for each level was estimated. Predictors with larger differences in effect (&gt;= 2pt NPI-A) between levels were selected. Participants were then grouped into 10 subgroups by their index scores, constructed based on model-based prediction of response (NPI-A &gt;=4).Results:In total 177 participants (66% male, mean (SD) age 75.7 (8.0), Mini-Mental State Examination 18.9 (4.8)) had 3 month follow-up data. Six potential predictors met criteria for multivariate modelling. The median Index score was -1.33 (range: -8.35 to 6.83). Methylphenidate was more efficacious in participants with no NPI anxiety (change in NPI-A - 2.21, Standard Error (SE):0.60, p=0.0004) or agitation (-2.63, SE: 0.68, p=0.0002), and who were on cholinesterase inhibitors (ChEI) (-2.44, SE:0.62, p=0.0001), between 52-72 years of age (- 2.93, SE:1.05, p=0.007), had normal diastolic blood pressure (-2.43, SE: 1.03, p=0.02), and more functional impairment (-2.56, SE: 1.16, p=0.03) as measured by the Alzheimer’s Disease Cooperative Study Activities of Daily Living scale. After 3 months of methylphenidate, 79% of participants with a higher index score (&gt;median) responded (&gt;= 4pt NPI-A) and 49% of those with a lower index score responded.Conclusions:Individuals who were less anxious or agitated, younger, on a ChEI, had normal diastolic blood pressure, and with more impaired function were more likely to benefit from methylphenidate when compared to placebo. Consistent with its potential activating effects, methylphenidate may be particularly beneficial for apathetic AD participants with lower baseline anxiety and agitation.

Efficacy and feasibility of catheter-based adrenal ablation on Cushing's syndrome associated hypertension

Objective: To explore the value of catheter-based adrenal ablation in treating Cushing's syndrome (CS)-associated hypertension. Methods: A clinical study was conducted in patients with CS, who received catheter-based adrenal ablation between March 2018 and July 2023 in Daping Hospital. Parameters monitored were blood pressure (outpatient and 24-hour ambulatory), body weight, clinical characteristics, serum cortisol and adrenocorticotropic hormone (ACTH) at 8 am, 24-hour urinary free cortisol (24 h UFC), fasting blood glucose and postoperative complications. Procedure effectiveness was defined as blood pressure returning to normal levels (systolic blood pressure<140 mmHg (1 mmHg=0.133 kPa) and diastolic blood pressure<90 mmHg), cortisol and 24 h UFC returning to normal and improvement of clinical characteristics. The parameters were monitored during follow up in the outpatient department at 1, 3, 6, and 12 months after catheter-based adrenal ablation. Results: A total of 12 patients (aged (40.0±13.2) years) were reviewed. There were 5 males, with 5 cases of adenoma and 7 with hyperplasia from imaging studies. Catheter-based adrenal ablation was successful in all without interruption or surgical conversion. No postoperative complication including bleeding, puncture site infection, adrenal artery rupture or adrenal bleeding was observed. The mean follow up was 28 months. Compared to baseline values, body weight declined to (59.48±11.65) kg from (64.81±10.75) kg (P=0.008), fasting blood glucose declined to (4.54±0.83) mmol from (5.53±0.99) mmol (P=0.044), outpatient systolic blood pressure declined to (128±21) mmHg from (140±19) mmHg (P=0.005), diastolic blood pressure declined to (78±10) mmHg from (86±11) mmHg (P=0.041), and the mean ambulatory daytime diastolic blood pressure declined to (79±12) mmHg from (89±8) mmHg (P=0.034). Catheter-based adrenal ablation in 8 patients was defined as effective with their 24 h UFC significantly reduced after the procedure (1 338.41±448.06) mmol/L from (633.66±315.94) mmol/L, P=0.011). The change of 24 h UFC between the effective treatment group and ineffective group was statistically significant (P=0.020). The postoperative systolic blood pressure in the treated adenoma group was significantly lower than those of hyperplasia group (112±13) mmHg vs. (139±20) mmHg, P=0.026). Conclusions: For patients with CS-associated hypertension who are unwilling or unable to undergo surgical treatment, catheter-based adrenal ablation could improve the blood pressure and cortisol level. Catheter-based adrenal ablation could be a safe, effective, and minimally invasive therapy. However, our results still need to be validated in further large-scale studies.

High-normal systolic blood pressure in early midlife is a stronger risk factor for incident hypertension later in life for women than men

Abstract Background We have previously found that having high-normal blood pressure (BP) in early midlife is a stronger risk factor for incident hypertension later in life for women than for men. Whether this risk is related both to high-normal systolic and diastolic BP is not known. Purpose To explore whether there is a sex difference in risk of incident hypertension related to high-normal systolic and diastolic BP in early midlife. Methods In the community-based Hordaland Health Study, 1025 women and 703 men were examined at age 42 years (baseline) and re-examined after 26 years. Patients with hypertension at baseline were excluded. Attended BP was measured in triplets, and clinic BP taken as the average of the two last measurements. High-normal systolic BP was identified as systolic BP of 130-139 mmHg and high normal diastolic BP as diastolic BP 85-89 mmHg. Incident hypertension was identified as BP ≥140/90 mmHg or patient reported use of antihypertensive drugs on the follow-up visit. The associations of systolic and diastolic BP at baseline with incident hypertension at follow-up were explored in sex specific multivariable logistic regression analyses. Multivariable analysis looking at high-normal diastolic BP was adjusted for baseline BMI, systolic BP, high-normal diastolic BP , heart rate, physical activity, daily smoker, cholesterol, triglycerides. Multivariable analysis looking at high-normal systolic BP was adjusted for baseline BMI, diastolic BP, high normal systolic BP , heart rate, physical activity, daily smoker, cholesterol, triglyceride. Results are presented as odds ratios (OR), 95% confidence intervals (CI) and p-values. Results At baseline, average BP was 119/73 mmHg in women and 126/76 mmHg in men (p&amp;lt;0.001). A high-normal systolic BP was found in 16% of women and 35% of men (p&amp;lt; 0.001). A high-normal diastolic BP was found in 7% of women and 11% of men(p=0.008). After 26 years of follow-up, 39% of women and 45% of men had developed hypertension (p&amp;lt;0.05). In multivariable logistic regression analyses, high-normal systolic and diastolic BP at baseline predicted incident hypertension at follow up in both sexes (Table 1). High-normal systolic BP was a significantly stronger predictor for incident hypertension in women (OR 2.32, CI 1.5-3.5) with p&amp;lt;0.01 for sex interaction (Table 1). In men, high-normal diastolic BP at baseline, was the strongest predictor of incident hypertension (OR 2.1, 95% CI 1.2-3.7), but no sex-interaction was found for high-normal diastolic BP, possibly due to low numbers. Conclusions Having a high-normal systolic BP in early midlife is a greater risk for developing hypertension later in life for women than men.Table 1

Abstract 15010: Relationship Between Low Diastolic Blood Pressure, All-Cause Mortality and Cardiovascular Outcomes: A Meta-Analysis

Background: Reduction of diastolic blood pressure (DBP) below 70mmHg may decrease perfusion to the heart and worsen cardiovascular (CV) outcomes. However, studies assessing the association between low DBP and clinical outcomes have yielded inconsistent results. Aim: To meta-analyze the association between low DBP and CV outcomes. Methods: We searched the MEDLINE, Scopus, and Cochrane CENTRAL databases up until December 2022 for studies reporting the risk of all-cause mortality (ACM) or CV outcomes in patients with low versus normal DBP. Patients with a DBP of 70-80mmHg were considered the control and were compared to those with a DBP of 60-69mmHg and &amp;lt;60mmHg. Outcomes of interest were all-cause mortality (ACM), major adverse cardiac events (MACE), myocardial infarction (MI), and ischemic stroke. Subgroup analysis was performed to assess whether pre-existing CV disease was an effect modifier. Findings from studies were pooled using a random-effects model to derive hazard ratios (HRs) and 95% confidence intervals. Results: Ten studies (n = 1,998,223 participants) met the eligibility criteria. A mean achieved DBP&amp;lt;60mmHg was associated with a significantly increased risk of ACM (HR: 1.48 [1.26, 1.74]; P &amp;lt; 0.001) compared with a mean achieved DBP of 70-80mmHg ( Fig. 1a ). This association was significantly stronger in patients with pre-existing CV disease (P-interaction &amp;lt; 0.001). A DBP&amp;lt;60mmHg was also associated with a higher risk of MACE (HR: 1.84 [1.28, 2.65]; P &amp;lt; 0.001) and MI (HR: 1.49 [1.13, 1.97]; P &amp;lt; 0.001). However, a DBP&amp;lt;60mmHg had no significant association with ischemic stroke. A mean achieved DBP 60-69mmHg was associated with a significantly increased risk of ACM (HR: 1.11 [1.03, 1.20]; P &amp;lt; 0.001; Fig. 1b ), but not MACE, MI, or ischemic stroke. Conclusion: Reduction of DBP below 70mmHg, particularly below 60mmHg, is associated with an increased risk of mortality. This association is stronger in patients with pre-existing CV disease.

Effect of electroacupuncture on myocardial fibrosis in spontaneously hypertensive rats based on cholinergic anti-inflammatory pathway

To observe the effect of electroacupuncture (EA) at "Neiguan" (PC 6) on myocardial fibrosis in spontaneously hypertensive rats (SHR), and explore preliminarily the mediating role of cholinergic anti-inflammatory pathway (CAP) and its downstream nuclear factor κB (NF-κB) signaling pathway. Six 12-week-old WKY male rats were employed as the normal group. Eighteen 12-week-old SHR were randomly divided into 3 groups, i.e. a model group, an EA group and a blocking group (EA after blocking α7 nicotinic acetylcholine receptor [α7nAchR]), with 6 rats in each one. In the EA group, EA was delivered at "Neiguan"(PC 6) and the site 0.5 cm from its left side, with disperse-dense wave, 2 Hz/15 Hz in frequency and 1 mA in current intensity. One intervention took 30 min and was given once every 2 days, lasting 8 weeks. In the blocking group, prior to each EA, the α7nAchR specific blocker, α-bungartoxin was injected intravenously in the tails of the rats. After EA intervention, the systolic blood pressure (SBP), the diastolic blood pressure (DBP) and the mean arterial pressure (MAP) were measured with non-invasive blood pressure monitor. Using echocardiogram, the left ventricular (LV) anterior wall end-diastolic thickness (LVAWd) , LV posterior wall end-diastolic thickness (LVPWd) and the LV end-diastolic internal diameter (LVIDd) were measured. The level of hydroxyproline (Hyp) in the myocardial tissue was determined by using alkaline hydrolysis, and that of acetylcholine (Ach) was detected by ELISA. With the real-time PCR adopted, the mRNA expression of NF-κB p65, tumor necrosis factor α (TNF-α), interleukin (IL)-1β and IL-6 were determined. Compared with the normal group, SBP, DBP, MAP, LVAWd and LVPWd were increased (P<0.01), and LVIDd was decreased (P<0.01) in the rats of the model group. SBP, DBP, MAP and LVAWd were dropped (P<0.01, P<0.05), and LVIDd rose (P<0.01) in the EA group when compared with those in the model group. The differences in the above indexes were not statistically significant between the blocking group and the model group (P>0.05). Compared with the normal group, Hyp level and the mRNA expression of NF-κB p65, TNF-α, IL-1β and IL-6 in the myocardial tissue increased (P<0.01, P<0.05) and Ach level decreased (P<0.01) in the model group. Hyp level, the mRNA expression of NF-κB p65, TNF-α, IL-1β and IL-6 in the myocardial tissue were reduced (P<0.05, P<0.01) and Ach level rose (P<0.01) in the EA group when compared with those in the model group. These indexes were not different statistically between the blocking group and the model group (P>0.05). CAP may be involved in ameliorating the pathological damage of myocardial fibrosis during EA at "Neiguan"(PC 6). The underlying effect mechanism is associated with up-regulating the neurotransmitter, Ach and down-regulating mRNA expression of NF-κB p65 and pro-inflammatory factors such as TNF-α, IL-1β and IL-6 in myocardial tissue.

Redefining Hypotension in Older Adults: Implications for the Prevention of Age Related Cognitive Decline

Chronically low blood pressure in older adults is associated with significantly increased long-term risks of dementia and all-cause mortality risk. Yet low blood pressure is generally not treated until an individual begins to experience the acute symptoms arising from very low cerebral perfusion. However, these acute symptoms, such as dizziness, balance difficulty, syncope, increased fall occurrence, vision impairment, and nausea, begin to occur only at very low blood pressure levels, such that mean arterial pressure levels as low as 65mmHg are often considered to be of limited concern. If the long-term consequences of chronic low blood pressure are to be prevented, an alternative approach to defining what constitutes too low a blood pressure for older adults, i.e. hypotension, will be required. Cognitive aging is a significant health concern for many older adults as it has significant impact on quality of life, and is widely considered a precursor to dementia. Here, we utilize an FDA cleared computer aided cognitive assessment tool to identify the relationship between resting brachial blood pressure in the upright seated position, and cognitive function in a convenience sample of independently living older adult men and women. We observed that resting diastolic blood pressure is significantly and positively correlated with cognitive function in adults over the age of 60 years. Specifically, cognitive performance was found to be significantly impaired for diastolic blood pressure levels below approximately 80 mmHg. Diastolic blood pressures (DBP) below 80 mmHg in older adults have consistently been shown to increase the risk of dementia as well as all-cause mortality, but the influence of below normal DBP on quality of life (QoL) in older adults has not been extensively addressed. The present work shows that adults over age 60, with a DBP below 80 mmHg, are significantly more likely to demonstrate mild to moderate cognitive impairment, and correspondingly, the associated impacts on QoL. These results lead to the suggestion that maintenance of diastolic blood in older adults in the 80-90 mmHg range will not only improve quality of life in this population, but may also provide substantial clinical benefit in terms of preventing, or reversing, age-related cognitive decline.

Abstract P150: Dynamic Alu Cpg Methylation Change In Elevated Diastolic Blood Pressure

Hypertension is recognized as age-related disease. However, its interaction with aging at the epigenetic level is still not fully understood. Hypomethylation of Alu elements, the most abundant class of interspersed repetitive sequence in the genome, is associated with global hypomethylation, an important epigenetic event of aging. Dermal fibroblasts have been observed to be affected by hypertension. In vitro study has shown that hypertension accelerated expression of age-related phenotypes. Therefore, in our study, we aimed to examine the relationship between blood pressure, age and Alu methylation status using dermal fibroblasts as a model. Biopsies of dermal fibroblasts were performed on 39 patients with various ages and blood pressure statuses. The patients were grouped into three categories based on their systolic blood pressure (SBP) and diastolic blood pressure (DBP): Normal (SBP = 130 mmHg; DBP = 85 mmHg), High Normal (SBP = 130-139 mmHg; DBP = 85-89 mmHg) and Hypertensive (SBP ≥ 140 mmHg; DBP ≥ 90 mmHg). Combined Bisulfite Restriction Analysis was performed to determine the Alu methylation level and pattern. The data was analyzed using Two Way ANOVA factoring in age groups. The Alu methylation level in the normal, high normal and hypertensive groups according to SBP is 30.3 ± 2.15%, 30.2 ± 2.15%, and 30.1 ± 2.06% and 29.6 ± 1.85%, 31.1 ± 1.78%, and 30.2 ± 2.48% according to DBP (data displaying in mean ± SD). The percentages of u C u C methylation pattern were 42.8 ± 5.57%, 42.7 ± 3.84%, 41.9 ± 4.84%, 44.2 ± 5.19%, 40.4 ± 2.95%, and 42.3 ± 4.79% for normal, high normal and hypertensive group, by SBP and DBP respectively. There were statistically significant differences between groups of DBP status with methylation level lowest in the high normal group. u C u C methylation pattern was the highest in high normal DBP group (p-value &lt; 0.05). There was also a statistically significant interaction between age and DBP level to Alu methylation. However, there was no statistically significant difference between SBP groups. We conclude that there is a dynamic Alu methylation change in the elevation of DBP with overarching trend of Alu hypomethylation. This phenomenon suggests that Alu methylation may have a role in how hypertension accelerate cellular aging in different tissues.

Upregulation of Interleukin-2 Among Hypertensive Subjects in Bayelsa State, Nigeria

Hypertension is a killer disease that increases with age. Several inflammatory biomarkers have been associated with hypertension. However conflicting reports exist on the relationship of interleukin-2 with hypertension. The objective of the present study was to determine the association of hypertension with interleukin-2 (IL-2) as well as the distribution of blood pressure among adults in Bayelsa State, Nigeria. Randomly selected 270 adults were screened for hypertension using Andon blood pressure monitor and real time PCR was used to quantify IL-2 gene expression. A structured questionnaire was used to collect sociodemographic information. A normal systolic and diastolic blood pressure distribution was found. Mean systolic and diastolic blood pressure were 123.69±22.65 and 77.60±13.53 mmHg respectively. The prevalence of hypertension was 47.4% (isolated systolic hypertension, 10.4%; isolated diastolic hypertension, 4.4%; co-occurring systolic and diastolic hypertension, 32.6%). Exactly 71.09% of hypertensive subjects were unaware that they were hypertensive. Age related increase in hypertension was found. Compared with normal control, a significant upregulation in IL-2 gene expression was found among hypertensive subjects (p &lt; 0.05). In conclusion, the present study showed that a high prevalence of hypertension and low hypertensive status awareness exist in rural areas in Bayelsa State, Nigeria. It also showed that hypertension is associated with a significant upregulation in IL-2 gene expression. Hypertension interventions to rural areas and the use of IL-2 as a target biomarker for novel antihypertensive drug design is implicated in the present study. Keywords: [Hypertension, interleukin-2, rural areas, Bayelsa State, Nigeria]

MỐI LIÊN QUAN GIỮA THỪA CÂN, BÉO PHÌ VÀ TIỀN CAO HUYẾT ÁP, CAO HUYẾT ÁP Ở HỌC SINH TRƯỜNG TRUNG HỌC PHỔ THÔNG ĐỒNG HÒA, THÀNH PHỐ HẢI PHÒNG

The increasing prevalence of high blood pressure in adolescents is an alarming global health problem, coupled with the rise in obesity and sedentary lifestyles. The aim of this study was to examine the associations between overweight, obesity, and pre-hypertension, and hypertension among adolescents aged 15 - 17 years in Hai Phong city. The case-control study was conducted on 1,000 students at Dong Hoa High School, Hai Phong city. The control group consisted of 730 students with normal systolic and diastolic blood pressure. The case group included 270 students with pre-hypertension and hypertension according to the diagnostic criteria of the American Academy of Pediatrics. The study results showed that the proportion of students with pre-hypertension and hypertension was quite high, 12.2% and 14.8%, respectively. The prevalence of pre-hypertension and hypertension in male students was significantly higher than in female students (P &lt; 0.001). After adjusting for age and sex, overweight and obesity were statistically significantly associated with the risk of pre-hypertension, and hypertension with OR values of 2.2 (95%CI: 1.4-3.4) and 7.1 (95%CI: 3.0 - 16.5), respectively. Thus, overweight and obesity increases the risk of pre-hypertension and hypertension in adolescents aged 15 - 17 at Dong Hoa High School, Hai Phong city.

Demographic Profile, Presenting Complaints and Clinical Findings of Dengue Fever Patients in a Tertiary Care Hospital of Bangladesh

Background &amp; Objective: Dengue is an important tropical infection caused by an arbovirus having four serotypes (DENV-1, DENV-2, DENV-3, DENV-4) transmitted through the bite of infected female Aedes mosquito. Dengue is a challenging disease with multisystemic, varied, atypical, and sometimes life-threatening presentations. It presents as varied clinical spectrum of dengue fever (DF), dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS) and expanded dengue syndrome (EDS) with atypical presentations, thus posing a diagnostic dilemma. Each year, thousands of dengue infections are reported and there are several outbreaks of dengue in several countries including Bangladesh and this imply the global importance of this infection. The objectives of this study were to determine the sociodemographic variables, presenting complaints and clinical findings of patient suffering from dengue fever during an epidemic outbreak.&#x0D; Methods: This hospital review analyzed the hospital records of dengue fever cases of BIRDEM General Hospital, Dhaka from June 2019 to December2019. Patients with suspected dengue fever attending at the outdoor/emergency or admitted indoor were taken as case. Data was collected from hospital records. Study protocol was approved by the Institutional Review Board and informed consent was taken from the subjects. All the relevant data regarding history and examination findings of the patients, the laboratory reports were collected. Statistical package for social science (SPSS) version 22, a computer-based software was used for all data entry and statistical analysis.&#x0D; Results: Total 292 dengue patients were enrolled in this study. Mean age of all patient was 35.63±15.22 years (11-85 year) with male predominance (54.8%). Maximum patients were hailed from urban residence (83.9%), non-smoker (73.6%), had active lifestyle (63.4%) and normal body mass index (68.5%). Overall, 65.1% patients had no comorbidity and 89.4% had no concurrent acute illness.Majority of the patients had high grade fever (76%) for 2-5 days (71%). Bodyache (63.7%), headache (42.1%), vomiting (41.1%), loose motion (16.8%) and abdominal pain (14.7%) were the top five chief complaints along with fever. Most of the patients had normal systolic (86.3%) and diastolic (92.5%) blood pressure.&#x0D; Conclusion: Although the results of this study cannot be generalized to other cities of Bangladesh, our findings will allow public health agencies in Bangladesh to concentrate their efforts to battle dengue and also suggests that monitoring where Aedes are found will help identify populations at risk". Our study will guide doctors of all level to early diagnose dengue patient and will help them to detect the severe cases early. So that early intervention can decrease the morbidity and mortality.

Clinical and Genetic Characteristics of Preeclampsia.

Preeclampsia (PE) is a severe complication of pregnancy accompanied by arterial hypertension, edema, or proteinuria with impaired functioning of various organs and systems. It is also an important medical and social problem, which has been one of the leading causes of maternal and perinatal mortality and morbidity worldwide. Despite the achievements of modern medicine, the etiology of this pathology is still unknown. Recently, many scientists have especially focused on the study of genetic factors underlying the etiopathogenesis of PE, namely, the contribution of individual polymorphic loci of various candidate genes. The current study aimed to investigate the clinical characteristics of PE and the contribution of the polymorphic loci rs1042838 of Progesterone Receptor (PGR) gene and rs8068318 of the T-Box Transcription Factor 2 (TBX2) gene to the development of PE. The study was conducted on 219 women with PE with the mean±SD age of 26.52±5.51 years and 329 women with the physiological course of pregnancy as the control group with the mean±SD age of 26.27±4.88 years. In total, 64.20%, 68.29%, 16.44%, 98.63%, and 35.48% of women with PE had increased systolic and normal diastolic blood pressure (SBP and DBP) values, proteinuria, edema, and overweight (BMI≥25), respectively. In the control group, 100%, 1.53%, 1.12%, and 35.48% of cases had normal SBP values with no proteinuria, DBP>90 mm Hg, edema, and overweight (BMI≥25), respectively. An association was observed between the CC genotype of the rs8068318 polymorphism of the TBX2 gene with the risk of developing PE in women with PE (OR=2.12, 95%CI: 1.14-3.92, P=0.02). In addition, there was an association between the rs8068318 TBX2 polymorphic locus with lower SBP (Me=140, Q25 - Q75 130 - 142.5, P=0.01) and PBP (Me=50, Q25 - Q75 40 - 55, P<0.01). According to the GeneCards database, the TBX2 gene, a member of a phylogenetically conserved gene family, is located on the long arm of chromosome 17 and encodes the TBX2 T-box transcription factor protein, which is a regulator of the transcriptional activity of various genes (i.e., it suppresses the expression of CDKN2A (p19/ARF), inhibits cyclin-dependent kinase p21 Cip1 (CDKN1A), and affects the expression of MYC, RAS, BRCA1, and BRCA2 genes).

The effect of L-thyroxine replacement on blood pressure and heart rate in children with hypothyroidism: correlation with free thyroxine and thyrotropin levels

Introduction Thyroid hormones have direct and indirect cellular effects on the cardiovascular system. Chronic administration of L-thyroxine (LT4) to children with hypothyroidism may affect cardiovascular dynamics.Aim This cross-sectional observational study measured the blood pressure (BP) and heart rate (HR) of 25 randomly selected children with hypothyroidism in relation to their serum-free thyroxine (FT4), thyroid-stimulating hormone (TSH) levels, and thyroxine dose μg/kg.Patients and methods In total, 25 randomly selected children with a mean age 9.6±4.5 years with the diagnosis of congenital or acquired hypothyroidism. They were on l-thyroxine therapy to keep serum-FT4 and TSH in the normal range for age. Their BP and HR (average of three readings), weight, height, dose of thyroxine, and their serum level of TSH and free T4 levels within 2 weeks before the clinic visit were recorded. The Z scores of the height, height standard deviation score (HSDS), body mass index standard deviation score (BMISDS), systolic (SBPSDS), and diastolic blood pressure standard deviation score (DBPSDS) were calculated (as per the 2004 guideline report on hypertension from the National Heart and Lung Institute), and HR [as per the Monitoring and Diagnosis Group at Oxford (MADOX) systematic review of 2011] was calculated for age and sex.Results The authors studied 25 children with hypothyroidism. Their dose of thyroxine was 2.11±0.7 μg/kg. Their mean serum-FT4 levels were 15.1±2.5 μg/l and TSH level was 3.9±2.8 mIU/ml. Their HtSDS (−0.57±1.4) and BMISDS (0.63±1.63) were within normal. All had normal diastolic blood pressure readings (within 2 standard deviations of the mean for age and sex). Two of the individuals had systolic BPs greater than 2SDS above the mean for age and sex, with normal BMISDS. Both had normal FT4 and TSH levels. One patient had tachycardia [HR=146/min (Z-score +3.2 for age)]. His FT4 and TSH levels were normal. There was a positive correlation between thyroxine dose/kg and serum level of FT4 (r=0.52), HR (r=0.56), SBPSDS (r=0.38), and DBPSDS (r=0.24). There was no significant correlation between the HtSDS on the one hand and FT4, TSH, or thyroxine dose on the other hand. The BMISDS was negatively correlated with TSH level (r=−0.4).Conclusion In this study on hypothyroid children on l-thyroxine therapy, 2 had high systolic BP and one had tachycardia. The significant correlation between the thyroxine dose, FT4 level, and BP and HR should alert the pediatrician to monitor BP and HR closely in relation to TSH and FT4 levels of these patients.

Systolic and diastolic blood pressure, prostate cancer risk, treatment, and survival. The PROCA-life study.

BackgroundInflammation has been linked to prostate cancer and hypertension, but it remains equivocal whether elevated blood pressure (BP) influence prostate cancer risk and survival.MethodUsing Cox regression models, we examined the association between prediagnostic BP and prostate cancer risk among 12,271 men participating in the Prostate Cancer throughout life (PROCA‐life) study. Systolic and diastolic BP were measured. A total of 811 men developed prostate cancer, and followed for additional 7.1 years, and we studied the association between prediagnostic BP and overall mortality among patients with prostate cancer.ResultsMen (>45 years) with a systolic BP >150 mmHg had a 35% increased risk of prostate cancer compared with men with a normal systolic BP (<130 mmHg) (HR 1.35, 95% CI 1.08–1.69). Among patients with prostate cancer, men with systolic BP >150 mmHg had a 49% increased overall mortality compared with men with a normal systolic BP (HR 1.49, 1.06–2.01). Among patients with prostate cancer treated with curative intent, those with a high diastolic BP (>90 mmHg) had a threefold increase in overall mortality risk (HR 3.01, 95% CI 1.40–6.46) compared with patients with a normal diastolic BP (<80 mmHg).ConclusionOur results support that systolic and diastolic BP are important factors when balancing disease management in patients with prostate cancer.

Blood Pressure Control and Cardiovascular and Mortality Risk in VA Nursing Home Residents

Optimal blood pressure (BP) control in nursing home residents is controversial and this population has been excluded from trials. We evaluated the associations of BP level with cardiovascular (CV) events and all-cause mortality across antihypertensive medication categories in Veterans Affairs (VA) nursing home residents. Data for 18,589 residents aged 65 years and older was obtained from the VA Corporate Data Warehouse from October 2006 through September 2017. Baseline systolic BP (SBP) and diastolic BP (DBP) were divided into categories and analyses were stratified by antihypertensive therapy (0, 1, and ≥2 medications). Over a median follow-up of 1.8 years, CV events occurred in 3,519 (19%) residents and 15,897 (86%) residents died. In participants on no BP medications, high SBP (>150 mmHg) was associated with a greater risk of CV events (adjusted [cause-specific] hazard ratio, 1.39; 95% confidence interval, 0.94-2.06) compared with normal SBP (110-130mmHg). By contrast, in participants on ≥2 BP medications, the subgroup with low SBP (<110 mmHg) had a higher CV risk (1.38; 1.20-1.57). For DBP, in participants without BP medications, there were no differences in CV risk across DBP subgroups. Whereas among those on 1 or ≥2 medications, DBP <60 mmHg was associated with a higher CV risk (1.26; 1.03-1.55 and 1.35; 1.18-1.54, respectively) compared with normal DBP (70-80 mmHg). Participants with low SBP (<110 mmHg) and DBP (<70 mmHg) had an increased mortality risk regardless of the number of medications. These findings suggest a potential risk of low BP among nursing home residents on multiple antihypertensive medications.

TINGKAT STRES DAN INDEKS MASSA TUBUH TERHADAP TEKANAN DARAH MAHASISWA

Hypertension is a disease that can occur from a young age. Students who are in the young adult age group with an unhealthy lifestyle are prone to severe hypertension. Many risk factors for hypertension include stress levels and body mass index (BMI). Knowing that matters related to blood pressure can be used as a preventive measure to prevent complications of hypertension. This study was to determine the relationship between stress levels and body mass index with blood pressure in students of STIKES Dirgahayu Samarinda. This quantitative research was a correlation analytic study with a cross sectional study design. Purposive sampling was used for sampling method, and as an analysis, researcher used the Spearman rho test and multiple correlation test. Respondents aged 17-25 years, mostly female (82%), low socioeconomic level (47.1%), non-smokers (86.8%), exercising at least once / month (50.3%), and have a family history of hypertension (54.5%). The majority of respondents' stress levels were included in moderate anxiety (58.2%), with normal BMI values (69.3%), normal systolic blood pressure (61.9%) and normal diastolic blood pressure (48.1%). Stress level and body mass index are simultaneously related to blood pressure, both systolic blood pressure and diastolic blood pressure, with a p value of 0.000 &lt;0.05. There is a relationship between stress levels and body mass index with the blood pressure of STIKES Dirgahayu Samarinda students.

One-Year Change in Diastolic Blood Pressure and Aortic Disease-Related Mortality in a Japanese General Population Aged 50-75 Years.

Aortic diseases (ADs), including aortic dissection, aortic aneurysm, and aortic rupture, are fatal diseases with extremely high mortality rates. Hypertension has been reported to be associated with AD development; however, it remains unclear whether a 1-year change in diastolic blood pressure (DBP) is a risk factor for AD-related mortality in the general population.Methods and Results:This study used a nationwide database of 235,076 individuals (aged 50-75 years) who participated in the annual "Specific Health Check and Guidance in Japan" for 2 consecutive years between 2008 and 2010. There were 55 AD-related deaths during the follow-up period of 1,770 days. All subjects were divided into 4 groups based on the baseline DBP and change in DBP at 1 year: persistent high DBP, increasing DBP, decreasing DBP, and normal DBP. Kaplan-Meier analysis demonstrated that the persistent high DBP group had the greatest risk among the 4 groups. Multivariate Cox proportional hazard regression analysis demonstrated that both DBP and 1-year change in DBP were significantly associated with AD-related deaths. The prediction capacity was significantly improved by the addition of 1-year change in DBP to confounding risk factors. This study demonstrated for the first time that a 1-year change in DBP was associated with AD-related deaths in the general population. Monitoring changes in DBP are of critical importance in the primary prevention of AD-related deaths in apparently healthy subjects aged 50-75 years.

Prevalence of Hypertension and Prehypertension in Iranian Children

Background: Hypertension (HTN) is a significant public health problem worldwide. Early diagnosis of HTN and its related risk factors has been considered as one of the main requirements of general healthcare in children. Objectives: This study aimed to examine the nomograms of normal systolic and diastolic blood pressure (BP) and the prevalence of asymptomatic HTN and pre-HTN in a population of school-aged children. Methods: Systolic and diastolic BP, height, and weight were measured in 5811 healthy school-aged children (2904 males and 2907 females) during healthcare visits. HTN was defined as systolic or diastolic BP ≥ 95th percentile for age, gender, and height of the screened population on ≥ 3 occasions. Pre-HTN was considered as systolic or diastolic BP between 90 - 95 percentile. Results: HTN and pre-HTN were detected in 8.4% and 7.8% of the children, respectively. The prevalence of HTN was 8.6% among the males and 8.2% among the females. Systolic HTN and pre-HTN were detected in 5.8 and 6.4% of the cases compared to diastolic HTN and pre-HTN observed in 5.9 and 6.1% of the participants, respectively. In addition, HTN was detected in 27.9% of children with obesity. Conclusions: According to the high incidence of asymptomatic HTN and pre-HTN in asymptomatic children, it is recommended to perform routine BP measurement during medical care visits of all healthy school children and to prevent and treat obesity in childhood.