Normotensive Group Research Articles

Altered expression of nutrient transporters in syncytiotrophoblast membranes in preeclampsia placentae

IntroductionExpression of nutrient transporters in the placenta affects fetal growth. This study reports the protein expression of nutrient transporters in the syncytial membranes [microvillous membrane (MVM) and basal membrane (BM)] of normotensive control and preeclampsia placentae. MethodsPlacentae were collected from fourteen normotensive control women and fourteen women with preeclampsia. The syncytiotrophoblast MVM and BM membranes were isolated. The protein expression of glucose transporter (GLUT1), vitamin B12 transporter (CD320) and fatty acid transporters (FATP2, FATP4) was assessed in both the membranes. ResultsComparison between membranes demonstrates similar CD320 protein expression in normotensive group whereas, in preeclampsia placentae it was higher in the BM as compared to MVM (p < 0.05). FATP2&4 protein expression was higher in the BM as compared to their respective MVM fraction in both the groups (p < 0.01 for both).Comparison between groups demonstrates higher GLUT1 expression in the MVM (p < 0.05) and BM (p < 0.05) whereas lower CD320 expression in the MVM (p < 0.05) of preeclampsia placentae as compared to their respective membranes in normotensive control. Furthermore, GLUT1 protein expression was positively associated and CD320 protein expression was negatively associated with maternal body mass index (BMI) (p < 0.05 for both). No difference was observed in the FATP2&4 protein expression. However, FATP4 protein expression was negatively associated with maternal blood pressure (p < 0.05 for MVM; p = 0.060 for BM) and birth weight (p < 0.05 for both membranes). DiscussionThe current study for the first time demonstrates differential expression of various transporters in the syncytiotrophoblast membranes of the preeclampsia placentae which may influence fetal growth.

Perbedaan Kejadian Penurunan Fungsi Kognitif pada Individu Normotensi dan Hipertensi dari Populasi Pesisir di Kecamatan Pemenang Kabupaten Lombok Utara

Hypertension occurs due to vasoconstriction and impaired vasodilation which causes increased vascular resistance. Hypertension is the risk factor of Cognitive impairment decreased cognitive function through the mechanism of vascular damage and toxicity. Cognitive function is a complex function in the human brain including aspects of memory, language, attention, visuospatial, and orientation. Cognitive impairment is also influenced by age, gender, physical activity, health factors, and education. The purpose of this study was to measure the effect of blood pressure on cognitive impairment in coastal populations in the working area of the Pemenang Health Center, North Lombok Regency. The research method used a cross sectional approach. The sampling method was purposive sampling. Measurement of cognitive function status using the Clock Drawing Test (CDT) questionnaire. Univariate data analysis to determine the frequency distribution of BMI research variables and the characteristics of respondents based on age, gender, educational, and occupation. Test the hypothesis using the Chi-Square test, with a probability value (p) &lt;0.05. The total number of respondents were 188, in the hypertension group was 88 (47%) and the normotensive group was 100 (53%) respondents. The age of the dominant respondent is in the range of 36-45 years, namely 96 (51.1%). As many as 158 (84%) of respondents experienced cognitive impairment and 82 (43.6%) of them had hypertension. There was a significant difference in the incidence of cognitive impairment in the hypertension and normotensive groups (p=0.001). There was a difference in the frequency of cognitive impairment in normotensive and hypertensive respondents in coastal populations in the working area of the Pemenang Health Center, North Lombok Regency.

Anxiety disorders and depression are associated with resistant hypertension.

Anxiety and depression can adversely affect the prognosis following cardiovascular diseases (CVDs) and may be associated with resistance to hypertension (HT) treatment. A better understanding of the complex biological substratum of resistant HT complicated by depression and anxiety is crucial for designing future primary care strategies. To evaluate the relationship between anxiety and depression and resistant HT, which will help to look at resistant HT from a broader perspective and aid the development of new strategies for diagnosis and treatment. We used a stratified random sampling method to select HT patients aged 18 and older in primary care setting. A total of 300 consecutive patients with persistent HT who were diagnosed with essential HT and uncontrolled blood pressure (BP) despite antihypertensive therapy were prospectively included in the study. Anxiety and depression were investigated, and scoring was evaluated using the Hospital Anxiety and Depression Scale (HADS). The study included 108 controlled and 91 uncontrolled HT patients. The HADS scales were higher in the controlled HT group compared to the uncontrolled HT group (6 (0-18) compared to 9 (0-20), p = 0.001; 5 (0-17) compared to 7 (0-16), p < 0.001, respectively). Body mass index (BMI) and C-reactive protein (CRP) were also significantly higher in the uncontrolled HT patients compared to the normotensive group. Anxiety was associated with a 2.18 times increased risk of HT and a 1.99 times increased risk of depression. Thus, anxiety and depression predicted resistant HT in both univariate and multivariate analyses. During the treatment of HT, efforts should be made to improve the psychological and social functions of the patients beyond the primary therapy for control of the disease. As such, we hope to draw attention to the importance of psychological factors, especially anxiety and depression, in any field of medicine related to managing resistant HT.

Association between Arterial Hypertension and Laboratory Markers, Body Composition, Obstructive Sleep Apnea and Autonomic Parameters in Obese Patients.

Systemic arterial hypertension (SAH) is a multifactorial disease, highly prevalent and associated with health risks. The purpose of this study was to investigate the association between SAH and laboratory, anthropometric, heart rate variability (HRV), and obstructive sleep apnea markers and, secondarily, to analyze the sensitivity and specificity of the variables that are independent factors in the association. Cross-sectional study with 95 obese patients treated at an obesity referral clinic in Salvador, BA, Brazil. SAH data were obtained from electronic medical records. The sample was stratified in the Normotensive Group (NG) and the Hypertensive Group (HG), and laboratory markers, body composition, polysomnography, and HRV were measured to evaluate the association of SAH with the predictor variables. For the analysis, p<0.05 was adopted. The average age of the NG was 36.3 ± 10.1 and HG 40.4 ± 10.6 years; 73.7% were women in the NG and 57.9% in HG; 82.4% in HG had insulin resistance. In the multivarious logistics regression model with adjustments in age, sex, height, and oxyhemoglobin saturation, SAH was inversely associated with fasting plasma glucose mg/dL (odds ratio [OR] = 0.96; 95% confidence interval [CI] = 0.92-0.99) and visceral fat area (VFA) cm2(OR = 0.98; 95% CI = 0.97-0.99). The area under the VFA curve was 0.728; CI 95% (0.620-0.836); fasting plasma glucose 0.693;CI 95% (0.582-0.804). Lower VFA and fasting plasma glucose concentrations were inversely associated with SAH. In addition, fasting plasma glucose and VFA showed a high sensitivity for SAH screening.

Association of Hypertensive Disorders of Pregnancy with variations in Serum Sodium and Potassium Concentration

Objective: To study the variation in Serum Sodium and Potassium concentration in Pre-eclampsia and Normotensive pregnant ladies.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of the Study: Combined Military Hospital, Kharian District Gujrat Pakistan, from Jun 2020 to Jan 2021.&#x0D; Methodology: The study population Comprosed of 80 pre-eclamptic and 80 normotensive pregnant women recruited consecutively at their first, third trimester, and prenatal visits. Serum Sodium and Potassium were analysed using Ericson Photometer.&#x0D; Results: When the two Groups were compared, in the Normotensive Group, the mean Sodium concentration of 132±4.490 mEq/dl was significantly less than the Pre-eclampsia Group of 139.1±3.909 mEq/dl. On the contrary, mean Serum Potassium concentration was significantly less in Pre-eclampsia 3.54±0.511 mmol/L compared to the Normotensive Group to 4.0±0.513 mmol/L.&#x0D; Conclusion: High levels of Sodium and low level of Potassium were observed in the Pre-eclampsia Group. There may be a causal relationship between electrolyte fluctuations and Pre-eclampsia.Keywords: Electrolytes, Hypertension, Potassium, Pre-eclampsia, Sodium.

Diffusion-Weighted MRI of the Fetal Brain in Fetal Growth Restriction With Maternal Preeclampsia or Gestational Hypertension.

The fetal neurodevelopmental microstructural alterations of intrauterine exposure to preeclampsia (PE) or gestational hypertension (GH) remain unknown. To evaluate the differences in diffusion-weighted imaging (DWI) of the fetal brain between normotensive pregnancies and PE/GH pregnancies, with a focus on PE/GH pregnancies with fetal growth restriction (FGR). Retrospective matched case-control study. 40 singleton pregnancies with PE/GH complicated by FGR, and 3 paired control groups (PE/GH without FGR, normotensive FGR, normotensive pregnancies) (28-38 gestational weeks). DWI with single-shot echo-planar imaging at 1.5 Tesla. The apparent diffusion coefficient (ADC) values were calculated in the centrum semi-ovale (CSO), parietal white matter (PWM), frontal white matter (FWM), occipital white matter (OWM), temporal white matter (TWM), basal ganglia, thalamus (THAL), pons, and cerebellar hemisphere. Student t test or Wilcoxon matched test was used to reveal the difference of ADC values among the investigated brain regions. A correlation between gestational age (GA) and ADC values was determined by linear regression analysis. Compared with fetuses in PE/GH without FGR and those with normotensive pregnancies, fetuses in the PE/GH with FGR group had significantly lower average ADC measurements of supratentorial regions (1.65 ± 0.09 vs. 1.71 ± 0.10 10-3 mm2 /sec; vs. 1.73 ± 0.11 10-3 mm2 /sec, respectively). Regions of significantly decreased ADC values in the fetal brain included CSO, FWM, PWM, OWM, TWM and THAL in cases of PE/GH with FGR. ADC values from supratentorial regions in PE/GH pregnancies were not significantly correlated with GA (P = 0.12, 0.26); however, this trend was statistically significant in the normotensive groups. ADC values may indicate fetal brain developmental alterations in PE/GH with FGR fetuses but more microscopic and morphological studies are necessary to provide additional evidence to offer a different interpretation of this trend in fetal brain. 4 TECHNICAL EFFICACY STAGE: 3.

Preterm birth and small for gestational age potentiate the association between maternal hypertensive pregnancy and childhood autism spectrum disorder

Children of mothers with hypertensive disorders of pregnancy (HDP) have high rates of preterm-birth (gestational age < 37 weeks) and small-for-gestational-age (SGA), both of which are risk factors of autism spectrum disorder (ASD). This study tested the multiple-hit hypothesis that preterm-birth and SGA in the neonatal period might potentiate the antenatal impact of HDP to increase childhood ASD hazards, and HDP might not be a major contributor. The propensity-score-matched cohort enrolled 18,131 mother–child pairs with HDP and 90,655 normotensive controls between 2004 and 2011. Children with siblings born to the same mothers were excluded for analysis to reduce the potential familial-genetic influence. HDP were classified into chronic-hypertension, gestational-hypertension, preeclampsia, and preeclampsia-with-chronic-hypertension. Using the normotensive group as the reference, the associations between HDP subgroups and the cumulative ASD risks were assessed with hazard ratios, and the effects of preterm-birth and SGA on the associations were examined. The HDP group had a higher cumulative rate of ASD (1.5%) than the normotensive group (1.2%). Preterm-birth and SGA exerted moderating effects to aggravate ASD hazards in children exposed to chronic-hypertension or gestational-hypertension. None of HDP types significantly contributed to ASD after adjustments. In conclusion, antenatal HDP exposure might predispose to ASD outcome through susceptibility to the impact of preterm-birth and SGA.

Normotensive state during acute phase of hypertensive intracerebral hemorrhage.

Hypertensive hemorrhage is a leading cause of intracerebral haemorrhage (ICH), although some of these patients may not present with high blood pressure (BP) at the time of ICH. This retrospective study included patients with history of hypertension presenting with ICH. Patients with systolic BP recording of more than 140 mmHg were included in hypertension group (group I). Patients whose BP rose to hypertension range after fluid correction were included in group II and patients with BP <140 mmHg on consecutive 1-week BP recordings were included in group III. Clinical features including volume of ICH of all the three groups were noted. Outcome in the form of mortality was analyzed. Chi-square test was used for categorical variables and independent t-test for continuous variables. P < 0.05 was considered significant. Ninety-two ICH patients with history of hypertension were included in the study. Of them, 20 patients (22%) presented with BP <140 mmHg systolic at the time of ICH. After fluid correction, it rose to hypertensive range in 9 (10%) but remained normal in 11 patients (12%) during consecutive recordings for 1-week post-admission. On comparing normotensive and hypertensive groups, significant difference was seen in survival and volume of ICH. There is a subset of hypertensive patients who may present with normal BP recording during acute ICH. The BP rises subsequently with the correction of hypovolemia in some. The volume of hemorrhage in normotensives is relatively small but whether this translates into better prognosis needs further studies.

EXPRESSION OF MICRO-RNA 221 AND 223 IN ISCHEMIC STROKE DUE HYPERTENSIVE EMERGENCY

Objective: Hypertensive crisis can account for damage on target organs characterizing hypertensive emergencies (HE). Ischemic Stroke (IS) is among these injuries. Expression of microRNAs (miRNAs) is considered the possible factors related to HE. This study evaluated the association of expression of miRNAs 221 and 223 in patients suffering ischemic stroke due to HE. Design and method: Thirty and four patients with IS due to hypertensive emergency (IS-HE), 33 individuals with IS without HE (IS), 31 controlled hypertensive (CHT) and 33 normotensive (NT) individuals were studied. The expression of miRNAs 221 and 223 was performed by RT-q PCR (real-time quantitative polymerase chain reaction). Results: Systolic and diastolic blood pressure were significantly higher in the IS-HE compared to IS, CHT and NT groups (162/99 mmHg vs 140/87, 128/69 and 129/82 mmHg, respectively; p &lt;0.05). The miRNA-221 expression was higher in the IS-HE group compared to the IS, CHT and NT groups (4.23 vs 2.44, 1.35 and 1.05, respectively; p&lt;0.0001). There was overexpression of miR-223 in the IS-HE and IS groups compared to CHT and NT groups (1.56 and 1.73 vs 0.13 and 0.66; p &lt; 0.001). Conclusions: This study provides evidence of the miRNAs participation in the pathophysiology of ischemic stroke due hypertensive emergency, thus assuring that the increased expression of miR-221 and miR-223 determines a greater chance of the individual presenting IS due HE. The miRNAs 221 and 223 are related to endothelial damage; thus, their overexpression shows the participation of endothelial dysfunction in cases of acute blood pressure elevation. FAPESP 2016/08203-6.

PREDICTIVE FACTORS OF MASKED HYPERTENSION IN TYPE 2 DIABETES

Objective: - Primary objective: to identify masked hypertension predictive risk factors in normotensive type 2 diabetic patients in clinical measurement. Design and method: This was a case-control study. We performed 24-hour ambulatory BP in 358 type 2 diabetic patients normotensive in clinical measurement. We compared both Masked Hypertension and Normotensive groups according to clinical/laboratory parameters and target organ damage, and identify MH predictor risk factors among diabetic population Results: The percentage of participants with masked hypertension was 30,7%, in 54,5% of the cases, it is a noctural hypertension. 38,2% of the masked hypertension patients has normal high blood pressure in routine office measurement, 53,63 % of our MH are obese, 64,5% had metabolic syndrome as classified by NCEP/ATP III. Predictors of masked hypertension are: Normal high blood pressure in consultation, the presence of left ventricular hypertrophy and a microalbuminuria. In this hypertensive masked population, target organs achievement is frequent: 6,8% have peripheral arterial disease, 64,8% have left ventricular hypertrophy, 48% have microalbuminuria, 72,9% have intima-media thickness &gt; 0,9 and 56,3% have arterial stiffness evidence by a PWV&gt; 10 m/sec. Conclusions: Predictive factors assessment for masked hypertension helps to better assess cardiovascular risk in normotensive type 2 diabetic patients in routine practice.

LEGACY OF ARTERIAL HYPERTENSION OF WOMEN WITH A PAST HISTORY OF PREECLAMPSIA

Objective: Preeclampsia increases the longterm risk of cardiovascular disease. Some of the women affected by this condition remain hypertensive after delivery. Hypertensive phenotypes can be detected with ambulatory BP monitoring (ABPM). This study aimed to determine the prevalence of hypertension using ABPM and office measurements. Design and method: We conducted a cross- sectional study which included women who delivered between January 2015 and June 2021 and were diagnosed and followed up for preeclampsia in three major obstetrical and gynaecologic units in Yaounde. We excluded from the study all women who had a history of chronic hypertension or a known Cardiopathy. Sociodemographic data and past history were recorded, a physical exam,ecg, an ultrasound and ABPM was performed to all participants. Results: 101 participants were included. The mean age was 30.56 years. 40.6% of women had hypertension (sustained hypertension, with sometime masked hypertension) with ABPM. Sustained hypertension was most common (26.7%), followed by masked hypertension (11.9%) and white-coat hypertension (2%). With office BP measurement, only 28.7% of women would have been diagnosed hypertensive. 29.8% of women had a disadvantageous dipping pattern. Among those that develop chronic hypertension, 18.8% had LVH at electrocardiography, 7.9% had both LVH and an abnormal left ventricular geometry on ultrasound while in normotensive women 1.9% had LVH at Ecg with 1% having both LVH and abnormal geometry at ultrasound. 20.8% of these women were obese during the follow up compared to 11.9% in the normotensive group. We had 26 patients (25,74%) with severe office hypertension and 32,3% were obeses. The fundus was normal in the majority of cases and we had no signs of neurological deficits or impaired cognition. Renal function was always normal or subnormal. Finally, we had two cases of heart failure. Conclusions: Many women affected by preeclampsia remain hypertensive after delivery. Masked hypertension and white-coat hypertension are risk factors for future cardiovascular disease and can only be diagnosed with ABPM. It is important to provide adequate follow-up for these women in order to intervene on the factors leading to this outcome.

ELEVATED PLATELET REACTIVITY IN PATIENTS WITH UNCONTROLLED HYPERTENSION: THE EFFECT OF CHA2DS2-VASC SCORE

Objective: Hypertension is associated with vascular and endothelial dysfunction that may result in a greater propensity for reactive platelets to cause thrombosis. Purpose: The aim of this study was to evaluate multiple platelet activation pathways in hypertensive patients with different level of blood pressure control and cardiovascular risk factors. Design and method: Thirty nine uncontrolled (office SBP &gt; 140 mmHg and ambulatory daytime SBP &gt;135 mmHg, 27 males, aged 58 ± 9 years) and 32 well controlled (office SBP &lt; 140 mmHg and ambulatory daytime SBP &lt; 135 mmHg, 21 males, aged 58 ± 8 years) essential hypertensive patients were included in the study. Twenty four healthy individuals (12 males, aged 53 ± 10 years) were served as control group. Blood samples were obtained before and 48 hours after the procedure and platelet aggregation was tested in platelet rich plasma after activation with arachidonic acid (AA), adenosine diphosphate ADP), collagen (Col), epinephrine (Epi) and ristocetin (Risto), by using AggRAM Platelet Aggregation Analyzer. Results: Hypertensive patients showed elevated platelet reactivity in all platelet activation pathways compared to normotensive group (AA: 88.8 ± 6.8% versus 79.5 ± 7.3%, ADP: 86.8±9.1% versus 71.5±7.7%, Col: 86.5 ± 5.7% versus 73.9 ± 6.7%, Epi: 92.6±5.4% versus 80.5 ± 5.7%, Risto: 93.8 ± 6.8% versus 79.9 ± 6.3%, p &lt;0.05 for all). Col, Epi and Risto platelet activation pathway showed a statistically significant increase in patients with uncontrolled hypertension compared to the group with well controlled hypertension (AA: 88.8 ± 6.1% versus 89.1 ± 4.1%, ADP: 89.8 ± 4.1% versus 87.5±4.7%, Col: 87.5±4.7% versus 81.9 ± 6.7%, Epi: 93.6 ± 4.4% versus 80.1 ± 5.7%, Risto: 94.8 ± 3.8% versus 80.9 ± 4.3%,). Notably, strong correlations were found between the Col platelet pathway activation and Risto platelet pathway activation and CHA2DS2-VASc score (r = 0.57, p &lt;0.001 and r = 0.61, p &lt;0.001, respectively) in hypertensive patients. Conclusions: Patients with uncontrolled hypertension showed elevated platelet reactivity. Patients with high CHA2DS2-VASc even without atrial fibrillation carry also a higher risk of thrombosis as indicated by the increased platelet aggregation under certain pathways of activation.

Prediction of Hypotension During Neuraxial Anesthesia in Patients with Pregnancy-Induced Hypertension Through Subclavian Vein Collapsibility Index

Objective: To explore and evaluate the predictive value of subclavian vein collapsibility index (SCV-CI) on hypotension during neuraxial anesthesia in patients with pregnancy-induced hypertension (PIH). Methods: Pregnant women with PIH who underwent elective cesarean section in our hospital from January to July 2021 were selected as the research subjects. Patients who experienced hypotension during anesthesia were included into the hypotension group, whereas patients who had a normal blood pressure during anesthesia were included in the normotensive group. The SCV-CI was then calculated for three respiratory cycles, the average value was taken as the base value, and the patient was monitored for another 20 minutes. The blood pressure, heart rate, blood oxygen saturation, and SCV-CI of the patients were measured, and the incidence of maternal nausea and vomiting and cord blood gas were recorded. Then, a correlation analysis was conducted on the relationship between subclavian vein collapsibility index and hypotension. A receiver operating characteristic curve was drawn to seek the threshold value of subclavian vein collapsibility index for post-anesthesia hypotension. Results: There was no significant difference in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) between the two groups before anesthesia (P &gt; 0.05). After anesthesia, the above indexes (SBP, 103.25 ± 12.48 mmHg; DBP, 58.94 ± 7.46 mmHg; and HR, 52.96 ± 6.48 beats/min) were significantly lower than those of the normal blood pressure group, and the difference was statistically significant (P &lt; 0.05). In comparison, the SCV-CI in the hypotension group was 35.82 ± 4.93% greater than that in the normal blood pressure group (23.85 ± 5.27%), and the incidence of nausea and vomiting in the hypotension group (40.0%) was significantly higher than that in the normotensive group (10.53%), and the difference was statistically significant (P &lt; 0.05). The area under the curve of SCV-CI prediction against hypotension in patients with PIH under neuraxial anesthesia was 0.825 (95% CI: 0.762–0.893, P &lt; 0.001), the cut-off value was 25.68%, the predictive sensitivity was 92.68%, and the specificity was 81.24%. Conclusion: SCV-CI has a good predictive value for the occurrence of hypotension in patients with PIH during neuraxial anesthesia.

Analysis of the prevalence and related factors of primary hypertension among adolescents and children in the Taicang area

ObjectiveTo investigate the prevalence of hypertension in adolescents and children in the Taicang area and analyse related factors to provide a theoretical basis for the prevention and control of hypertension in this region.MethodsA total of 1,000 students who were visited and surveyed in primary schools in the Taicang area in 2021 were selected for statistical testing using a cluster random sampling method, and a survey was conducted on their dietary habits. dietary habits, such as the consumption of meals that included protein-rich animal products, beans and dairy products, vegetables and fruits, salty foods and fried food, was taken into consideration, along with physical fitness indices, waist-to-height ratio and waist circumference.ResultsOf the 1,000 adolescents and children surveyed, 222 were classified into the hypertensive group and 778 into the normotensive group. There were 138 boys (a prevalence rate of 6.3%) and 84 girls (a prevalence rate of 4.1%) in the hypertensive group. The physical fitness indices of the hypertensive group were significantly higher than those of the normotensive group. Concerning dietary structure, the frequency of cereal intake between the two groups was comparable, while the hypertensive group’s intake of vegetables, fruits, beans and dairy products was significantly lower than that of the normotensive group. Finally, a logistic multivariate regression analysis of related factors was carried out, and it was concluded that waist-to-height ratio, waist circumference and salty and fried food intake were positively correlated with the prevalence of hypertension.ConclusionThe prevalence of hypertension among adolescents and children in the Taicang area is high. Body weight and dietary structure can be used as reference indicators for the prevalence of hypertension in this age group.

Role of Internal Jugular Vein Collapsibility Index in Predicting Post-spinal Hypotension in Pregnant Women Undergoing Cesarean Section: A Prospective Observational Study.

Introduction Post-spinal hypotension (PSH) frequently occurs in women undergoing cesarean section. In recent studies, Ultrasound-guided measurements of the internal jugular vein (IJV) have been reported to predict fluid responsiveness. We planned to evaluate the correlation between the internal jugular vein collapsibility index (IJVCI) and PSH in cesarean section patients. Methods Ninety-one parturients who underwent elective lower segment cesarean section with a singleton pregnancy were recruited. Preoperatively, patients were placed in a supine position with a 15-degree left lateral tilt. Maximum (at the end of expiration) and minimum (at the end of inspiration) IJV diameters (mm) and IJVCI were assessed using M-mode imaging during spontaneous and deep breathing. Spinal anaesthesia was performed at the L3-4 or L4-5 level. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, respiratory rate, and SpO2 were recorded from baseline till the delivery of the baby. Results Among 91 patients, 40 (45.5%) patients had at least one episode of hypotension. Demographic variables and baseline vitals were comparable between the hypotensive and normotensive groups (p>0.05). In spontaneous and deep breathing, IJV diameter at the end-expiration (IJVdmax), end-inspiration (IJVdmin), and IJVCI amongst both hypotensive and non-hypotensive pregnant women were statistically similar. Receiver Operating Characteristic (ROC) curve analysis showed that during spontaneous breathing, using a cut-off point of 29.5%, IJVCI had a sensitivity and specificity of 70% and 23%, respectively, for predicting PSH; whereas during deep breathing, IJVCI had a sensitivity and specificity of 77% and 27%, respectively, for predicting the same using a cut-off value of 37.5%. Conclusion We conclude that internal jugular vein parameters such as maximum diameter, minimum diameter, and IJVCI during spontaneous and deep breathing cannot be used as reliable predictors of post-spinal hypotension in pregnant patients undergoing elective cesarean section.

Gestational Hypertension and Human Breast Milk Composition in Correlation with the Assessment of Fetal Growth-A Pilot Study.

1 in 10 pregnant women is diagnosed with gestational hypertension. Increasing evidence suggests that preeclampsia, gestational diabetes and gestational hypertension may affect human breast milk's lactogenesis and percentage composition. We aimed to examine whether there is any significant influence of gestational hypertension on the composition of macronutrients in human breast milk and to assess its correlation with fetal growth. A total of 72 breastfeeding women (34 diagnosed with gestational hypertension and 38 normotensive women during pregnancy) were recruited to the study at the Division of Neonatology, Medical University of Gdańsk, between June and December 2022. Milk samples were collected between the 3rd and 6th day of lactogenesis. Samples were analyzed using the Miris HMA™ Human Milk Analyzer (Upsala, Sweden), which evaluates the milk composition's energy, fat, carbohydrate and protein quantity. In addition, we assessed the children's anthropometric measurements (birth weight, body length and head circumference at birth). We used logistic regression to estimate the adjusted odds ratio and 95% confidence interval. The mean (±standard deviation) macronutrient composition per 10 mL of milk in the GH group was 2.5 g (±0.9) of fat, 1.7 g (±0.3) of true protein, 7.7 g (±0.3) of carbohydrates and 63.2 g (±8.1) of energy, in the normotensive women group 1.0 g (±0.9) of fat, 1.7 g (±0.3) of true protein, 7.3 g (±0.4) of carbohydrates and 57.9 g (±8.6) of energy content, respectively. The fat composition was higher in the PIH group by a mean of 0.6 g (p < 0.005). Gestational hypertension had a positive, significant correlation with birth weight (p < 0.013) and the mother's pre-pregnancy weight (p < 0.005). In conclusion, we found significant differences between milk composition in postpartum women with gestational hypertension compared to healthy, normotensive women. Human milk from women with gestational hypertension was found to contain a higher composition of fat, carbohydrates and energy in comparison to healthy women. Our aim is to further evaluate this correlation, as well as to assess the growth rate of newborns in order to determine the need for individualized formulas for women with pregnancy-induced hypertension, those with poor lactogenesis and those who cannot or choose not to breastfeed.

The Effects of Hypotensive Anaesthesia on Reducing Intraoperative Blood Loss, Duration of Operation and Quality of Surgical Field During Orthognathic Surgery in a Tertiary Care Hospital

Background: Hypotensive anaesthesia is a method of reducing the blood pressure of a patient at some point of surgical treatment to reduce the quantity of blood loss. This is the most frequently used approach in microvascular surgery however it can be used in a wide range of surgeries. The efficacy of hypotensive anaesthesia is decreasing intraoperative blood loss, lowering operation time and enhancing the quality of surgery. Objectives: The aim of the study is to assess the effects of hypotensive anaesthesia on reducing intraoperative blood loss, duration of operation and quality of surgical field during orthognathic surgery in a tertiary care hospital. Methods: The study was carried out in the Anaesthesiology Department of Dhaka Dental College and Hospital, Dhaka, Bangladesh from July 2021 to December 2022. A prospective, randomized clinical research with 72 individuals was conducted. They were assigned at randomization to either a normotensive or a hypotensive anaesthesia group. Results: The mean blood loss for surgeries carried out under normotensive anaesthesia was 276.66±57.50 ml, whereas the mean blood loss for surgeries carried out under hypotensive anaesthesia was 162.50±37.25 ml. In the normotensive and hypotensive groups, the mean duration of operation was 195.83±60.44 minutes and 195±58.05 minutes respectively. Conclusions: Reducing intraoperative blood loss is really a benefit of hypotensive anaesthesia. As a standard method for orthognathic surgery, hypotensive anaesthesia can be justified for less blood loss and enhancing the quality of surgical field.

Placental transcriptome analysis of hypertensive pregnancies identifies distinct gene expression profiles of preeclampsia superimposed on chronic hypertension

BackgroundThe pathogenesis of preeclampsia superimposed on chronic hypertension (SI) is poorly understood relative to preeclampsia (PreE) occurring in pregnant people without chronic hypertension. Placental transcriptomes in pregnancies complicated by PreE and SI have not been previously compared.MethodsWe identified pregnant people in the University of Michigan Biorepository for Understanding Maternal and Pediatric Health with hypertensive disorders affecting singleton, euploid gestations (N = 36) along with non-hypertensive control subjects (N = 12). Subjects were grouped as: (1) normotensive (N = 12), (2) chronic hypertensive (N = 13), (3) preterm PreE with severe features (N = 5), (4) term PreE with severe features (N = 11), (5) preterm SI (N = 3), or (6) term SI (N = 4). Bulk RNA sequencing of paraffin-embedded placental tissue was performed. The primary analysis assessed differential gene expression relative to normotensive and chronic hypertensive placentas, where Wald adjusted P values < 0.05 were considered significant. Unsupervised clustering analyses and correlation analyses were performed between conditions of interest, and a gene ontology was constructed.ResultsComparing samples from pregnant people with hypertensive diseases to non-hypertensive controls, there were 2290 differentially expressed genes. The log2-fold changes in genes differentially expressed in chronic hypertension correlated better with term (R = 0.59) and preterm (R = 0.63) PreE with severe features than with term (R = 0.21) and preterm (R = 0.22) SI. A relatively poor correlation was observed between preterm SI and preterm PreE with severe features (0.20) as well as term SI and term PreE with severe features (0.31). The majority of significant genes were downregulated in term and preterm SI versus normotensive controls (92.1%, N = 128). Conversely, most term and preterm PreE with severe features genes were upregulated compared to the normotensive group (91.8%, N = 97). Many of the upregulated genes in PreE with the lowest adjusted P values are known markers of abnormal placentation (e.g., PAAPA, KISS1, CLIC3), while the downregulated genes with the greatest adjusted P values in SI have fewer known pregnancy-specific functions.ConclusionsWe identified unique placental transcriptional profiles in clinically relevant subgroups of individuals with hypertension in pregnancy. Preeclampsia superimposed on chronic hypertension was molecularly distinct from preeclampsia in individuals without chronic hypertension, and chronic hypertension without preeclampsia, suggesting that preeclampsia superimposed on hypertension may represent a distinct entity.

Hypertensive Disorders of Pregnancy and the Risk of Developing Hypertension Outside of Pregnancy Based on Updated Hypertension Guidelines [ID: 1377015

INTRODUCTION: The purpose of this study is to determine whether hypertensive disorders of pregnancy (HDP) affect the development of chronic hypertension (HTN) within 5 years postdelivery based on updated guidelines by the American Heart Association (AHA). METHODS: This IRB-approved study evaluated women who delivered at one hospital from 2014 to 2016. Participants were determined to be normotensive or with HDP. Inclusion criteria for the HDP group was diagnosis of gestational HTN or preeclampsia at 20 weeks of gestation or greater. Exclusion criteria were previous diagnosis of HTN and age over 40. Women were followed up to 5 years postdelivery to assess development of chronic HTN, defined by the 2017 AHA guidelines as systolic greater than 130 mm Hg or diastolic greater than 80 mm Hg. RESULTS: Sixty-four participants (30.9%) developed chronic HTN within 5 years of delivery. Of these participants, 6.25% were from the normotensive pregnancy group, while 84.4% were from the preeclampsia with severe features group, with adjusted odds ratio of 11.38 (CI 4.67–22.46). Compared to the 5-year normotensive group, the 5-year chronic HTN group was associated with higher maternal body mass index (BMI) (P=.0146), preterm delivery (P=.0231), and neonatal intensive care unit (NICU) admission (P=.04). CONCLUSION: The rate of chronic HTN development 5 years postdelivery was significantly higher in participants with HDP, notably preeclampsia with severe features. Participants with development of chronic HTN had increased BMI during pregnancy, preterm delivery, and NICU admission rates as compared to participants with 5-year normotensive pressures. Awareness of the prevalence and risk factors for development of chronic hypertension provides areas of focus for future investigations.

Altered autonomic control or coronary artery blood flow by the aortic body chemoreceptors in conscious normotensive and hypertensive sheep

Peripheral arterial chemoreceptors monitor the chemical composition of the blood. While, the carotid bodies located at the bifurcation of the common carotid arteries have been extensively studied. The physiological role of the aortic bodies located in the walls of the aortic arch remains relatively under-studied, and its role in hypertension is unexplored.We hypothesized that activation of the aortic bodies would increase coronary blood flow in the normotensive state and that the parasympathetic nerves to the heart would mediate this.Experiments were conducted in conscious and anesthetized ewes instrumented to record arterial pressure, coronary blood flow, and cardiac output. Two groups of animals were studied, one made hypertensive using a 2 kidney one-clip model (HTN. n=6) and a sham-clipped normotensive group (Con. n=6). Unilateral renal clipping increased resting mean arterial pressure (Con: 84±5 vs HTN 115±6 mmHg). The aortic body chemoreceptors were stimulated by a bolus infusion of potassium cyanide (KCN; 10-30 μg/kg) into the left ventricle.Activation of the aortic bodies in the normotensive and hypertensive animals resulted in a significant increase in coronary blood flow ( P&lt;0.05, 2-way ANOVA, interaction effect), which was not different between groups. In normotensive sheep, the aortic body chemoreflex-mediated coronary vasodilation was attenuated by atropine infusion. Interestingly, the coronary vasodilation in hypertensive animals was not altered by the blockade of muscarinic receptors but was attenuated after propranolol infusion ( P&lt;0.05, interaction effect). Bilateral vagotomy is not possible in conscious animals; under anesthesia, the coronary blood flow response to aortic body stimulation was significantly attenuated in normotensive sheep. Neither atropine nor propranolol affected the aortic body chemoreflex meditated changes in either group's blood pressure, heart rate, or cardiac output. This data suggests that the aortic bodies play an important role in modulating coronary blood flow and that their effector mechanism is altered in hypertension. Many patients with hypertension are on beta-blockers. Our finding indicates that the aortic bodies modulate coronary blood flow via a beta-adrenergic mechanism in hypertension, which may have important implications for regulating coronary blood flow during exertion in hypertensive patients. Work is supported by the Health Research Council (HRC) of New Zealand. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.