Normal Blood Pressure Research Articles

Case report: Clinical characteristics and Genetical analysis of HSD11B2 in three Chinese children with apparent mineralocorticoid excess: a case series

BackgroundApparent Mineralocorticoid Excess (AME) is a rare autosomal recessive disorder, characterized by a notably complex diagnostic process. To date, the majority of documented cases have been presented as individual case reports. This article aims to enhance the understanding of the course and prognosis of AME, by detailing the management protocols employed for patients with genetically confirmed diagnoses.MethodsAn analysis comprising three cases and a review of relevant literature were conducted to synthesize the insights and experiences derived from gathering clinical and laboratory data on patients.ResultsAll three patients were born to non-consanguineous parents, were small for gestational age and exhibited severe hypokalemia, metabolic alkalosis, hypertension, nephrocalcinosis, and hypercalciuria. The glomerular filtration rate was normal in all cases. One patient experienced complications related to hypertension. Genetic analysis revealed biallelic recessive variations in the HSD11B2 gene in all three patients. Treatment with oral spironolactone and potassium chloride resulted in the normalization of both blood pressure and serum potassium levels in all patients.ConclusionThis study presents the diagnostic and treatment experiences of three Chinese pediatric patients with AME type I. Through our analysis, four novel variants of the HSD11B2 gene were identified, thereby enhancing the genotype-phenotype spectrum associated with AME. Early genetic testing in patients suspected of having AME is beneficial for facilitating prompt diagnosis and the implementation of standardized treatment protocols. Such measures are essential for the prevention or mitigation of target organ damage, as well as for the reduction of associated morbidity and mortality

Stem cells prevent long-term deterioration of renal function after renal artery revascularization in a renovascular hypertension model in rats

Partial stenosis of the renal artery causes renovascular hypertension (RVH) and is accompanied by chronic renal ischemia, resulting in irreversible kidney damage. Revascularization constitutes the most efficient therapy for normalizing blood pressure (BP) and has significant benefits for renal function; however, the tissue damage caused by chronic hypoxia is not fully reversed. Mesenchymal stem cells (MSCs) have produced discrete results in minimizing RVH and renal tissue and functional improvements since the obstruction persists. This study aimed to evaluate the effects of administration of MSCs in combination with renal artery revascularization in rats subjected to RVH. The following groups were evaluated: control (SHAM), hypertensive (2K-1C), hypertensive treated with MSCs (MSC), hypertensive subjected to revascularization (REV), and hypertensive subjected to revascularization and treatment with MSCs (REV + MSC). The animals were followed up for 10 weeks. The animals in the MSC group received cell infusions at the 3rd, 5th, 7th and 9th weeks. In the REV and REV + MSC groups, the clip was removed by the 6th week (revascularization), and in the REV + MSC group, MSCs infusion was performed at the 6th and 8th weeks. Tail systolic blood pressure (SBP) was measured weekly, and histological parameters and renal function were evaluated at the end of the protocol. The clipped animals developed RVH, deterioration of total renal function (50% decrease in creatinine clearance), and significant proteinuria (15x increase). Treatment with MSCs had no detectable beneficial effects on kidney function or SBP. REV resulted in normalization of BP and a significant but partial reduction in proteinuria (80% vs. 2K-1C), but areas with renal fibrosis persisted. The combination of the two treatments was effective at normalizing all renal parameters as well as reversing proteinuria, reducing the number of ischemic glomeruli and atrophic tubules, indicating an improvement of the renal parenchyma. The results suggest that therapy with MSCs associated with revascularization can potentially help in the full recovery of renal function in the long term in patients with RVH.

Appropriate Blood Usage and Adherence to Guidelines in Orthopaedic Patients Managed at Moi Teaching and Referral Hospital, Eldoret, Kenya

Blood transfusion is required in the management of life threatening orthopaedic trauma hemorrhage. However, this practice is faced with erratic supply, increasing demand for safe blood and inappropriate transfusions which may expose patients to transfusion associated risks. Appropriate use of blood and related products as well as adherence to transfusion guidelines has been shown to ameliorate these challenges. This study set out to determine the appropriate blood and blood components usage and adherence to guidelines in orthopaedic patients managed at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Descriptive cross-sectional study design was and involved 132 transfused orthopedic trauma patients, recruited by consecutive sampling, between March 2019 and January 2020. Data was collected using interviewer administered structured questionnaire. Continuous data were summarized as median (inter-quartile range) and categorical data as frequency tables and proportions. Fisher’s Exact Test was used to assess associations between categorical variables and non-parametric Kruskal-Wallis Test was used for continuous independent variables. A p value < 0.05 was considered statistically significant. The results: Males were 101 (76.5%), median age was 36 (IQR 28, 47) years, majority of the patients, 95 (72%) were referrals, 64 (48.5%) were unskilled workers and 64 (48.5%) had primary school level of education. Most of the patients, 105 (79.5%) were injured in road traffic accidents. Most patients, 105 (79.5%) and 115 (87.1%) had normal pulse rate and systolic blood pressure respectively while 77 (58.3%) had increased respiratory rate. The median pre-transfusion haemoglobin was 8.90 (IQR 7.98, 10.35) g/dl and the commonest blood group was O positive. Patients with isolated femur fractures were 62 (47.0%). Patients who underwent primary open reduction and internal fixation were 61(46.2%). Majority of the patients, 127 (96.2%) received packed red blood cells. The proportion adherent to transfusion guidelines was 16.7% [95% CI: (10.75, 24.14)]. The factors associated with adherence were pre-transfusion haemoglobin and haematocrit levels, Fisher’s Exact and Kruskal-Wallis p value being < 0.001. Mild transfusion reactions were noted in 15 (11.4%) patients. Conclusions made were that most patients were males, transfused with packed red blood cells and majority of injuries sustained were due to road traffic accidents. The level of adherence to the institutional transfusion guidelines was low at 16.7%. Factors associated with transfusion guidelines adherence were pre-transfusion haemoglobin and haematocrit levels. The recommendation was that Moi Teaching and Referral Hospital Transfusion Committee should increase transfusion guidelines awareness among clinicians in orthopaedic trauma.

A case report of gastric antral vascular ectasia treated by endoscopic band ligation combined with lauromacrogol injection.

Gastric antral vascular ectasia (GAVE) is a rare acquired lesion characterized by vascular dilation in the gastric antrum, frequently results in occult or overt gastrointestinal bleeding. Endoscopic intervention remains the cornerstone of therapy. Argon plasma coagulation was previously considered a first treatment option. But recently, endoscopic band ligation (EBL) has emerged as an alternative, increasingly favored for its safety and efficacy. Nonetheless, a consensus on the most effective treatment approach has yet to be established. A 74-year-old female was hospitalized for persistent chest tightness and dyspnea for 1 year. Physical examination showed an anemic appearance with normal blood pressure. Upon admission to the hospital, the blood routine examination revealed severe anemia and the fecal occult blood test was persistently positive. The endoscopic observations and histological evidence led to a diagnosis of GAVE for the patient. Considering the poor response to prior pharmacotherapy, endoscopic intervention was selected for this hospitalization. The initial EBL alone did not yield particularly satisfactory results. Combining EBL with lauromacrogol injection as a subsequent treatment resulted in encouraging outcomes. At the 6-week follow-up, the patient exhibited a negative fecal occult blood test, normalization of hemoglobin level, and endoscopic images demonstrated near complete resolution of vascular ectasias. The combination of EBL with lauromacrogol injection has shown a satisfactory short-term outcome, providing a new option for the endoscopic management of GAVE. However, its long-term efficacy still requires further observation.

Research on the life stress and hypertension among young couples of childbearing age

Objective: To investigate the current status of life stress and hypertension among couples of childbearing age across diverse economic regions in China, and to explore relevant influencing factors. Methods: This study was a cross-sectional study, with subjects from the "Research on the standardized system of comprehensive prevention and control of birth defects based on preconception-prenatal-postnatal whole chain". From February to May 2021, urban and rural couples of childbearing age (18-49 years old) from Beijing, Henan, and Gansu provinces were enrolled, representing the eastern, central, and western regions of China, respectively. The detection rate, cognition and control of hypertension in the general population, as well as the detection rate of hypertension in different genders and regions were analyzed. Subjects were divided into hypertensive group and non-hypertensive group based on whether their blood pressure was≥140/90 mmHg (1 mmHg=0.133 kPa), and the general clinical data of the two groups were compared. Subjects were also divided into prehypertension and hypertension group and normal blood pressure group based on whether their blood pressure was≥130/80 mmHg, and the general clinical data of the two groups were compared, with subgroup analyses conducted by gender. Multifactorial logistic regression model was applied to identify factors associated with prehypertension and hypertension in both males and females. Results: A total of 1 942 couples of childbearing age, comprising 3 884 individuals, aged (29.8±5.2) years were enrolled, with 1 942 males (50.0%). The overall hypertension detection rate was 6.3% (246/3 884), with a detection rate of 10.5% (203/1 942) in males and 2.2% (43/1 942) in females. The hypertension detection rates in Beijing, Henan, and Gansu were 6.2% (92/1 482), 11.6% (139/1 200), and 1.2% (15/1 202), respectively. The overall detection rate of prehypertension and hypertension was 40.5% (1 574/3 884). Multifactorial logistic regression analysis showed that life pressure factors had no effect on female blood pressure levels (P>0.05), while a significant or high level of life/work pressure was a risk factor for prehypertension and hypertension in males (OR=2.30, 95%CI 1.06-4.99, P<0.05). Conclusion: The detection rate of prehypertension and hypertension among young couples of childbearing age in China is high, with poor awareness and control of hypertension. There are sex differences in the relationship between life pressure and blood pressure levels. Comprehensive consideration of individual living environments and mental health factors is crucial in blood pressure management. Measures to reduce life stress and enhance mental resilience should be implemented to address this public health issue.

Neonatal Shock: Current Dilemmas and Future Research Avenues

Neonatal shock presents a complex clinical challenge and is one of the leading causes of mortality. Traditionally, neonatal shock is equated to hypotension, and therapeutics are often initiated based on low blood pressure (BP) values alone. This fails to address the underlying goal of optimizing the tissue perfusion resulting in both over- and under-treatment of neonatal shock. Also, what defines a normal BP in neonates is still a contentious topic. Further, the most appropriate way of measuring BP in neonates with shock is still debated. Shock secondary to transient circulatory instability and patent ductus arteriosus, conditions that are unique to preterm neonates, have not been researched adequately. Treatment of myocardial dysfunction secondary to perinatal asphyxia, a leading cause of neonatal mortality, is still a conundrum. Quite similarly, there are only a handful of controlled trials evaluating therapeutics in some of the other commonly encountered conditions, namely, septic shock and hypoperfusion secondary to pulmonary hypertension. Even the universally practiced intervention of volume expansion with crystalloid boluses in shock is not backed by high-certainty evidence in neonates. Though the diagnostic modalities of functional echocardiography and near-infrared spectroscopy have aided greatly in the management of neonatal shock in recent years, these have not been proven to be associated with improved critical clinical outcomes such as mortality and major brain injury. To conclude, neonatologists often rely on limited evidence, mostly anecdotal, when treating neonatal shock. This review critically examines the current evidence with respect to various aspects of neonatal shock with an objective to identify the lacunae in the literature that may fuel future research, eventually paving the way to efficacious, safe and evidence-based clinical practice.

Exploring Drug-Drug Interactions between Losartan and Carbamazepine: A Pharmacokinetic and Pharmacodynamic Study.

Hypertension, which affects 1.28 billion people globally aged 30 to 79, is characterized by continuously high blood pressure (140/90 or more) and raises the risk of premature death. Losartan, an angiotensin receptor blocker (ARB), is suggested for patients under the age of 55 who cannot take ACE inhibitors as a first treatment option. Epilepsy, a chronic neurological illness marked by repeated seizures, affects more than 50 million individuals worldwide and is the third most common chronic brain disorder. Both hypertension and epilepsy are frequent chronic illnesses, with increased blood pressure greatly raising the risk of epilepsy due to its relationship with cerebrovascular disease, doubling the risk when compared to people with normal blood pressure. The effect on pharmacokinetic and pharmacodynamics of losartan on concomitant administration with carbamazepine was investigated. Wistar rats of either sex, with a minimum of six animals per group, were used in the investigation. The rats were treated with Losartan and Losartan-Carbamazepine for 30 days. Blood samples were taken via retro-orbital plexus at 0, 1, 2, 4, 6, and 12 hours after treatment concluded, and they were subjected to high-performance liquid chromatography for plasma analysis to calculate AUC, t1/2, and Clearance. A pharmacodynamic evaluation was done by inducing hypertension in rats using a 10% fructose solution and the effect of pretreated Losartan and Losartan-Carbamazepine on blood pressure was determined. In the Losartan and Carbamazepine treated group, there was a reduction in the AUC and t1/2 and a reported increase in the clearance value compared to Losartan alone treated rats. In fructose-induced hypertension model to evaluate the effect of losartan and carbamazepine on BP showed an increase in mean arterial pressure, plasma glucose, and a reduction in triglycerides level was noted in comparison to Losartan alone treated rats indicating therapeutic failure of Losartan. Based on these studies, it is concluded that CBZ has reduced the effectiveness of losartan and therefore, co-administration of these drugs should be avoided.

Prevalence of some cardiovascular risk factors: obesity, hypertension, and smoking among medical students.

Cardiovascular diseases (CVDs) are the principal cause of worldwide mortality, with 17.9 million deaths reported in 2019. In Saudi Arabia, CVDs account for 42% of all deaths, occurring on average 10 years earlier than in Western populations. Medical students are particularly susceptible to Cardiovascular disease CVD risk factors due to demanding academic schedules and lifestyle changes. This study aims to identify cardiovascular risk factors (CVRF) among medical students at King Faisal University, highlighting the need for preventive measures and curriculum modifications. This prospective cross-sectional study was conducted from February to April 2024 at King Faisal University, focusing on undergraduate medical students. Participants not enrolled in the College of Medicine, those who declined to complete the survey, or those who submitted incomplete responses were excluded. A total of 313 students participated in the study. Data collection involved physical evaluations and a validated questionnaire covering demographics, medical history, lifestyle, and diet. Measurements included waist circumference, weight, height, blood pressure, and pulse. Data was analyzed using IBM SPSS Statistics version 19. Among participants, 52.4% had a normal body mass index BMI, while 19.5% were overweight and 11.2% obese. Blood pressure measurements showed 45.7% had normal BP, but 44.4% were prehypertensive. A family history of CVDs was reported by 55.6% of students, with hypertension (HTN) and diabetes being the most common. Smoking was infrequent, with only 5.1% reporting regular habits. Dietary analysis showed moderate consumption of unhealthy foods, with 80% maintaining a moderately healthy diet. Physical activity assessment indicated significant portions engaged in light or moderate activities, but only a minority met recommended levels for vigorous activities. Significant associations were found between physical activity levels and academic year, personal history of diseases, and smoking behavior. Most students had normal body weight, but many were overweight or pre-hypertensive. Family histories of CVDs, particularly (HTN) and diabetes, were common. Smoking was rare, but diets included frequent unhealthy foods. These findings underscore the need for targeted health programs to reduce cardiovascular risks in this population.

Associations between skeletal muscle mass and elevated blood pressure are independent of body fat: a cross-sectional study in young adult women of African ancestry.

Although research on the relationship between lean body mass and blood pressure (BP) has been inconsistent, most studies reported that measures of lean body mass are associated with a higher risk of hypertension. We explored relationships between body composition (fat and skeletal muscle mass) and BP in 1162 young adult African women. DXA-derived measures of whole body, central and arm fat mass were associated with higher systolic and diastolic BP, while leg fat percentage was associated with lower systolic and diastolic BP. However, only the associations with diastolic BP remained after adjusting for appendicular skeletal muscle mass (ASM). ASM was associated with higher systolic and diastolic BP, before and after adjusting for whole-body fat percentage and VAT.While there was no overlap in targeted proteomics of BP and body composition, REN was lower in the elevated BP than the normal BP group and was inversely associated with diastolic BP (false-rate discovery adjusted p<0.050). Several proteins were positively associated with both VAT and ASM (LEP, FABP4, IL6, and GGH) and negatively associated with both VAT and ASM (ACAN, CELA3A, PLA2G1B, and NCAM1). NOTCH3, ART3, COL1A1, DKK3, ENG, NPTXR, AMY2B, and CNTN1 were associated with lower VAT only, and IGFBP1 was associated with lower ASM only.While the associations between body fat and BP were not independent of skeletal muscle mass, the associations between muscle mass and BP were independent of overall and central adiposity in young adult African women. Future interventions targeting muscle mass should also monitor BP in this population.

Does ongoing inflammation in recovered COVID-19 pneumonia cases aggravate underlying hypertension or unmasks new onset hypertension? A single center experience of 800 cases

&lt;b&gt;Introduction:&lt;/b&gt; New onset hypertension and aggravation of hypertension during the post-COVID-19 period are issues of concern having very limited data published on them. Hence, the current study was conducted with the aim of studying the blood pressure profiles as new onset hypertension, pre-existent hypertension and an aggravation of pre-existent hypertension in post-COVID-19 patients.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; Retrospective cohort study conducted between October 2021 to March 2022, included 800 post-COVID-19 patients above 18 years of age treated at the dedicated COVID-19 care center irrespective of their disease severity and comorbidity after a valid written consent. All the study cases were followed after six months of discharge from hospital. Protocolled recording of covariates such as blood pressure, anthropometric indices, ECG, blood sugar, lipid profile and uric acid were done at entry point. Retrospective data collection of indoor records was done such CT severity assessment as mild (score &amp;lt; 8), moderate (score 9-15) and severe (score &amp;gt; 15); inflammatory markers IL-6, Ferritin, CRP, LDH and D-dimer, interventions used during hospitalization such as oxygen supplementation and oxygen plus BIPAP/NIV. Statistical analysis was done by using a Chi-square test.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; In study of 800 post-COVID-19 cases, pre-existent hypertension in 10% (80/800), new onset hypertension in 8.5% (68/800), aggravation of pre-existent hypertension in 47.5% (38/80) cases. Significant association was observed between interventions used as hypertension profile such as cases with oxygen requirement new onset HTN 32/68 (47.05%), pre-existent hypertension in 10/42 (23.80%), aggravation of pre-existent hypertension in 16/38 (42.10%) and oxygen plus BIPAP/NIV requirement in new onset HTN 27/68 (39.70%), pre-existent hypertension in 10/42 (23.80%), aggravation of pre-existent hypertension in 16/38 (42.10%) cases (p &amp;lt; 0.0001). Significant association was observed in blood pressure switch during pre-COVID-19 to post-COVID-19 state during follow up from normotensive to hypertensive range (p &amp;lt; 0.00001). Comorbidities such as DM, hyperlipidemia and IHD showed significant association with blood pressure profile in study cases in post-COVID-19 setting (p &amp;lt; 0.00001). Inflammatory markers during hospitalization (IL-6, CRP, LDH, ferritin, and D-dimer) and uric acid analysis during follow-up documented significant association with new onset HTN, pre-existent hypertension, aggravation of pre-existent hypertension and no hypertension or normal blood pressure cases during post-COVID-19 follow-up (p &amp;lt; 0.00001).&lt;br /&gt; &lt;b&gt;Conclusions:&lt;/b&gt; COVID-19 infection is probably a risk factor for new onset hypertension and increased prevalence of hypertension was observed in the post-COVID-19 period and considered as unmasking effect on hypertension. Additionally, disease related inflammatory burden, stress and anxiety are associated with aggravation of hypertension in pre-existent cases.

Decoding Monogenic Hypertension: A Review of Rare Hypertension Disorders.

Hypertension is a growing concern worldwide, with increasing prevalence rates in both children and adults. Most cases of hypertension are multifactorial, with various genetic, environmental, socioeconomic, and lifestyle influences. However, monogenic hypertension, a blanket term for a group of rare of hypertensive disorders, is caused by single-gene mutations that are typically inherited in an autosomal dominant fashion, and ultimately disrupt normal blood pressure regulation in the kidney or adrenal gland. Being able to recognize and understand the pathophysiology of these rare disorders is critical for properly diagnosing hypertension, particularly in children and young adults, as treating each form of monogenic hypertension requires specific and targeted treatment approaches. A scoping literature review was conducted on the available knowledge regarding each of the disorders currently categorized as forms of monogenic hypertension. This narrative review serves to highlight the epidemiology, pathophysiology, clinical presentation, recent case reports, and most current methods of evaluation and treatment for familial hyperaldosteronism types I-IV, Gordon Syndrome. Liddle Syndrome, syndrome of apparent mineralocorticoid excess, congenital adrenal hyperplasia, Geller syndrome, and brachydactyly type E. Recent and future advances in genetic analysis techniques will further enhance the diagnosis and early management of these disorders, preventing the consequences of uncontrolled hypertension.

Gender Differences in Blood Pressure Control Among Hypertensive Patients: A Cross-Sectional Study at a Tertiary Hospital.

Our study aims to assess gender differences in blood pressure (BP) control among hypertensive patients in Jordan and identify factors influencing these differences. We conducted a cross-sectional study at Jordan University Hospital (JUH), collecting data from 601 hypertensive patients following up in JUH clinics. Patients were eligible if they were >18 years old, diagnosed with hypertension, taking anti-hypertensive medication for at least 6 months, and had no chronic kidney disease. BP control was defined as systolic BP <140mmHg and diastolic BP <90mmHg. Poor BP control was observed in 59.1% of females and 62.7% of males. Females demonstrated better BP control, even though they had lower incomes, lower education levels, and higher BMIs compared to males. Among females, good medication adherence (p = 0.042) was linked to improved control, while stress and a history of preeclampsia were negatively associated (p = 0.01 and p = 0.030, respectively). Among males, concurrent systemic medication use (p = 0.025) was a positive predictor of BP control, whereas smoking negatively impacted BP control (p = 0.019). Home BP monitoring was common but did not improve control in either gender. In conclusion, females showed better outcomes in BP management, largely due to treatment adherence. A history of preeclampsia and high stress was linked to poorer control in females. Both genders were aware of normal BP levels, but females were more preemptive in maintaining control. To improve hypertension care, we should consider these differences when treating patients.

HIF-1α mediates hypertension and vascular remodeling in sleep apnea via hippo–YAP pathway activation

BackgroundSleep apnea syndrome (SAS) is associated with hypertension and vascular remodeling. Hypoxia-inducible factor-1α (HIF-1α) and the Hippo–YAP pathway are implicated in these processes, but their specific roles remain unclear. This study investigated the HIF-1α/Hippo-YAP pathway in SAS-related hypertension.MethodsWe established a rat model of SAS-induced hypertension via chronic intermittent hypoxia (CIH). Rats were treated with siRNA targeting HIF-1α. Blood pressure, inflammation, oxidative stress, vascular remodeling, and VSMC function were assessed. In vitro experiments with A7r5 cells and human aortic smooth muscle cells (HAoSMCs) explored the effects of HIF-1α silencing and YAP1 overexpression.ResultsCompared with the control group, the CIH group presented significant increases in both HIF-1α and YAP1 expression, which correlated with increased blood pressure and vascular changes. HIF-1α silencing reduced hypertension, oxidative stress, inflammation, and the severity of vascular remodeling. Specifically, siRNA treatment for HIF-1α normalized blood pressure, decreased the levels of oxidative damage markers (increased SOD and decreased MDA), and reversed the changes in the levels of inflammatory markers (decreased high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and soluble E-selectin (sE-s)). Structural analyses revealed reduced vascular smooth muscle cell proliferation and collagen deposition, along with normalization of cellular markers, such as α-SMA and TGF-β1. Furthermore, the Hippo–YAP pathway appeared to mediate these effects, as evidenced by altered YAP1 expression and activity upon HIF-1α modulation.ConclusionsOur findings demonstrate the significance of the HIF-1α/Hippo-YAP pathway in CIH-induced hypertension and vascular remodeling. HIF-1α contributes to these pathophysiological processes by promoting oxidative stress, inflammation, and aberrant VSMC behavior. Targeting this pathway could offer new therapeutic strategies for CIH-related cardiovascular complications in SAS patients.

Evaluation of the Effects of Mulberry Leaf Extracts Morus alba L. on Cardiovascular, Renal, and Platelet Function in Experimental Arterial Hypertension.

Numerous epidemiological studies have demonstrated that consuming foods rich in polyphenols and flavonoids can have beneficial effects on various diseases, including arterial hypertension (HTN). Recent research from our laboratory has shown that certain flavonoids exhibit antihypertensive properties in several animal models of HTN. Our objective was to evaluate the effect of Morus alba L. (white mulberry) extracts in an experimental HTN model characterized by nitric oxide (NO) deficiency. Male Sprague-Dawley rats were divided into four groups: a control group, hypertensive rats treated with an NO synthesis inhibitor (L-NAME) in drinking water for six weeks, L-NAME rats treated with Morus alba L. extract, and L-NAME rats treated simultaneously with captopril. After six weeks of treatment, we measured blood pressure, endothelial vascular function in the aorta, and platelet aggregation function. Morus alba L. extract partially prevented the development of arterial hypertension due to NO deficiency, although it did not completely normalize blood pressure as captopril did. The extract reduced the excessive vasoconstrictor response to phenylephrine in aortic rings and improved vasodilation in response to acetylcholine, with both effects dependent on increased NO production. Morus alba L. extract also reduced the increased platelet aggregation in response to ADP and collagen in hypertensive animals, although it did not fully normalize this function. Morus alba L. extract demonstrates antihypertensive effects, improves vascular reactivity, and reduces platelet aggregation in a model of arterial hypertension. These effects are primarily related to an increase in nitric oxide activity.

Muscular Performance and Blood Pressure After Different Pre-Strength Training Strategies in Recreationally Strength-Trained Women: Cross-Over Trial.

This study aimed to investigate the acute effects of different pre-ST strategies on muscular performance and blood pressure (BP) responses in recreationally strength-trained women. Twelve overweight women with normal BP were recruited and performed six experimental protocols in a randomized order: (1) control protocol (CC), where BP was assessed without exercises performed; (2) ST; (3) foam rolling warm-up followed by ST (FR + ST); (4) specific warm-up followed by ST (SW + ST); (5) aerobic exercise followed by ST (AE + ST); and (6) stretching exercises followed by ST (SE + ST). ST consisted of three sets at 80% of 10 repetition maximum with a self-suggested rest interval between sets for bench press, back squat, bench press 45°, front squat, lat pull-down, leg press, shoulder press, and leg extension. All experimental protocol had a lower total training volume, fatigue index, and repetitions performance in relation to ST (p < 0.05). No significant reduction was observed in systolic and diastolic BP for any protocol or exercise, although the effect size magnitudes ranged from trivial to large. Decreases in maximum repetitions, resistance to fatigue, and total training volume were performed before ST as warm-up strategies. However, these strategies indicated a clinical reduction in BP with a large and meaningful magnitude (effect size) in recreationally strength-trained women with normal to elevated BP. The results of this investigation may help to influence decision-making by practitioners who desire to elicit a post-exercise hypotension response in both subjects with normal BP and hypertension.

Therapeutic Effect of Glucose-Insulin-Potassium (GIK) Infusion Therapy in the Treatment of Acute Aluminum Phosphide Poisoning: An Institutional Study.

Acute aluminum phosphide (ALP) poisoning presents a significant global medical challenge, particularly in regions where it is commonly used as a pesticide. Despite medical advancements, mortality rates from ALP poisoning remain high. Glucose-insulin-potassium (GIK) infusion therapy has emerged as a potential treatment for ALP poisoning due to its ability to counteract its toxic effects on metabolism and heart function. However, there is limited institutional data on the effectiveness of GIK therapy in treating ALP poisoning. Hence, this study aims to evaluate the therapeutic impact of GIK infusion therapy in managing acute ALP poisoning within our institution. The research aims to provide valuable insights into the efficacy of GIK therapy, with the potential to enhance patient outcomes and guide clinical practices in ALP poisoning management. This cross-sectional study was conducted at the Resuscitation Unit of the Emergency Department of Lady Reading Hospital (LRH), Peshawar, from February 1, 2021, to May 31, 2021, using convenient sampling of all patients with aluminum phosphide (ALP) poisoning meeting the inclusion criteria. The study group included 15 ALP poisoning cases treated with GIKinfusion therapy combined with standard supportive measures and examined individuals with ALP poisoning admitted to the Resuscitation Unit during a specific period, comparing their outcomes to those observed before the introduction of GIK therapy. Randomization was based on time span, as GIK therapy was introduced in October 2020. Inclusion criteria encompassed a confirmed history of ALP poisoning with at least one deranged vital parameter, including patients of all genders and age groups. At the same time, we excluded patients with normal blood pressure on arrival, no deterioration four hours post-presentation, or those who expired before arrival. Data on hospital registration number, gender, age, arrival date, serial blood pressures, supportive measures, GIK infusion usage, and outcomes were analyzed using SPSS version 20.0 to assess the therapeutic impact of GIK infusion therapy. Among 15 ALP poisoning cases, 20% resulted in fatalities, with 80% either transferred to acute units (40%). Mortality was highest (66%) in the 20-29 age group, contrasting with no deaths in the 1-19 age group. Additionally, 33% mortality occurred in the 30-39 age group. Only 25% of patients with blood pressure below 91/61 succumbed. GIK therapy led to hemodynamic stability, prolonged unit stays, and increased transfers. Patients in acute units had longer stays compared to discharged or expired cases, reflecting the nuanced dynamics of ALP poisoning management. This research aimed to systematically examine the effect of GIK infusion therapy on ALP poisoning cases at LRH, Peshawar, offering insights into its effectiveness compared to previous cases and reducing mortality by enhancing cardiac function.

Acute Anterior Wall Myocardial Infarction in a Gallbladder Cancer Patient: A Case of Sudden Coronary Thrombosis Post-normal Angiogram

Cancer patients face a heightened risk for thromboembolic events, including arterial thromboembolism such as myocardial infarction (MI). Thrombosis is a major cause of mortality in these patients due to the hypercoagulable state induced by malignancy and its treatments. Pro-inflammatory cytokines and pro-coagulants secreted by tumor cells lead to endothelial damage and an increased risk of thrombus formation. Despite extensive research on venous thromboembolism in cancer, arterial thromboembolism remains less studied. This case report highlights an acute anterior wall MI in a patient with metastatic gallbladder cancer, who developed a sudden thrombotic event despite having a normal coronary angiogram shortly before. A 52-year-old female with metastatic gallbladder cancer presented to the emergency department with acute chest pain. Her cancer, diagnosed 6 months earlier, had been managed with cholecystectomy and subsequent chemotherapy. Fifteen days before her current admission, she had undergone a coronary angiogram due to atypical chest pain, which showed no significant coronary artery disease. At presentation, the patient reported, sudden chest pain radiating to the left arm. She was hemodynamically stable with normal blood pressure and heart rate. The physical examination was unremarkable. Electrocardiogram segment elevation (ST)-segment elevation in anterior leads (V2-V6) and limb leads (II, II, and augmented vector foot [aVF]), indicative of an acute anterior wall MI. Elevated cardiac biomarkers confirmed myocardial injury. A two-dimensional echocardiogram showed mild hypokinesia of the distal interventricular septum and the apex. A repeat coronary angiogram identified a thrombus in the left anterior descending artery, which was not present in the previous angiogram. The rapid appearance of the thrombus pointed to an acute thrombotic event. This case illustrates the aggressive nature of thrombotic events in cancer patients. Despite a normal angiogram 2 weeks prior, the patient developed a sudden coronary thrombus, reflecting the hypercoagulable state associated with malignancy. The management involved thrombus aspiration and tirofiban, which effectively resolved the acute event. This aligns with existing literature, emphasizing the need for vigilant monitoring and proactive management in cancer patients to address the risk of rapid-onset thrombotic events. Cancer patients can experience sudden and severe thrombotic events, even with recent normal coronary evaluations. This case highlights the importance of ongoing cardiovascular assessment and tailored therapeutic strategies in managing cancer-associated thrombosis, underscoring the need for a collaborative approach between oncologists and cardiologists.

The Cardiac Output-Cerebral Blood Flow Relationship Is Abnormal in Most Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients with a Normal Heart Rate and Blood Pressure Response During a Tilt Test.

Orthostatic intolerance is highly prevalent in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and is caused by an abnormal reduction in cerebral blood flow (CBF). In healthy controls (HCs), the regulation of CBF is complex and cardiac output (CO) is an important determinant of CBF: a review showed that a 30% reduction in CO results in a 10% reduction in CBF. In previous and separate ME/CFS studies, we showed that CO and CBF decreased to a similar extent during tilt testing. to test the relationship between CBF and CO, which seems to be abnormal in ME/CFS patients and is different from that in HCs. In this retrospective study we analyzed this relationship in a large group of patients. To compare the patient data with those of HCs, we focused on patients with a normal heart rate (HR) and blood pressure (BP) response to upright tilt. Also, the influence of clinical data was analyzed. A total of 534 ME/CFS patients and 49 HCs underwent tilt testing with measurements of HR, BP, CBF, CO, and end-tidal PCO2. To measure CBF, extracranial Doppler flow velocity and vessel diameters were obtained using a GE echo system. The same device was used to measure suprasternal aortic flow velocities. End-tidal PCO2 was recorded using a Nonin Lifesense device. In 46 (9%) patients, CO and CBF changes were in the normal range for HCs, and in 488 (91%) an abnormal CO and CBF reduction was found. In patients with abnormal CO and CBF reductions, the slope of the regression line of CO versus CBF reduction was almost 1. The multiple regression analysis of the latter group showed that the CO reduction for the most part predicted the CBF reduction, with a limited role for the PETCO2 reduction. Two different patient groups with a normal HR and BP response during the tilt were identified: those with a CO and CBF in the normal range for HCs and those with an abnormal CO and CBF reduction during the tilt (91% of patients). In the latter group of patients, an almost 1:1 relationship between the CO and CBF reduction suggests the absence of compensatory vasodilation in the cerebral vasculature. This might indicate endothelial dysfunction in most ME/CFS patients and may have clinical and therapeutic implications.

Unveiling relationships of human instinctive behaviors and blood pressure in Chinese adults: A network analysis.

Human behaviors and blood pressure (BP) are closely intertwined, affecting health. However, few studies have demonstrated their complex relationships. Using network analysis, we aimed to untangle the intricate and potential causal relationships between BP and human instinctive behaviors, identifying potential action points for hypertension prevention and control. Cohort study. This study is based on two-wave data from 11,277 Chinese adults in the China Multi-Ethnic Cohort (CMEC) and an independent validation cohort of 21,947 adults from the Chinese Cohort of Working Adults (CCWA). We conducted a cross-sectional network analysis to estimate the interrelationships between measured BP and self-reported physical activity (PA), diet, and sleep. The centrality of each variable within the network was estimated using strength centrality index. Additionally, we performed a longitudinal network analysis to infer the potential causal relationships between BP and human instinctive behaviors in participants with normal or above-normal BP. The network models suggested that BP exhibited negative associations with the dietary score (edge weight: -0.09) and sleep duration (-0.05). Non-sedentary behavior and dietary score were the most central variables, strongly connecting BP and other lifestyles. Higher BP predicted a poorer dietary score (β=-0.21) in participants with above-normal BP. The effect of BP on dietary score was replicated in the validation cohort and validated by linear regression analysis. Non-sedentary behaviors and dietary behaviors may be the potential action points in promoting healthy behaviors and contributing to BP management. It is essential to manage individuals' BP status, non-sedentary behaviors, and dietary behaviors to disrupt malignant cycles.

Effects of pre-pregnancy body mass index on cardiometabolic biomarkers in pregnant emirati women

BackgroundTo study effect of pregnancy on obese women’s maternal cardiometabolic biomarkers as a signature for maternal morbidity and complications.MethodsThis cross-sectional cohort study involved pregnant Emirati women who had regular menstrual cycles and had normal blood pressure. Pre-pregnancy body mass index was calculated using height and weight measurements recorded within three months before current pregnancy. Average systolic and diastolic blood pressure measurements were calculated from each visit. Blood samples were collected randomly once and following cardiometabolic biomarkers were measured.ResultsWe enrolled 178 pregnant women, with a mean age ± standard deviation of cohort was 29.9 ± 4.97 years and Pre-pregnancy body mass index 28.11 ± 6.58 kg/m2. None of blood pressure measurements or biomarkers serum concentrations were statistically different across Pre-pregnancy body mass index groups except for soluble intercellular cytoadhesive molecule-1levels which were the highest in underweight women. Pregnant women with pre-gestational obesity had higher systolic and diastolic blood pressure levels compared to women with normal or overweight. All variables were statistically significantly different by trimesters except systolic blood pressure, random blood glucose, lipoprotein-A, and high-sensitivity C-Reactive Protein. After adjusting, in a multivariate linear regression model, for maternal age, trimester of pregnancy, education level, parity and smoking, none of biomarkers or blood pressure were found to be significantly associated with Pre-pregnancy body mass index. In a multivariate linear regression model adjusting for maternal age, Pre-pregnancy body mass index, education level, parity and smoking, gamma-glutamyl transferase, total cholesterol, high density lipoprotein, low-density lipoprotein, triglycerides, apolipoprotein A & B, interleukin-6, tumor necrosis factor-alpha and insulin-like growth factor-1 concentrations remained significantly associated with advancing trimester of pregnancy. There was a significant interaction between Pre-pregnancy body mass index and trimester of pregnancy for serum gamma-glutamyl transferase and soluble intercellular cytoadhesive molecule-1concentration.ConclusionThis study emphasizes how pregnancy has a significant impact on cardiometabolic markers in obese women, indicating both hyperlipidemic status of pregnancy and diabetogenic tendency in obese patients who are not diabetics. These findings may suggest that pregnancy in obese patients increases risk of developing metabolic syndrome in future, therefore more attention is recommended of pregnant obese women and further study of establishing specific cardiometabolic biomarkers screening program.