Percentage Of Systolic Blood Pressure Research Articles

Dexmedetomidine vs. Propofol: Haemodynamic Changes in Conscious Sedation in Arthroscopic Shoulder Surgery in the Beach Chair Position: A Randomized Control Trial

Background: Interscalene brachial plexus block (ISB) combined with conscious sedation is a viable alternative to general anaesthesia for arthroscopic shoulder surgery in the beach chair position. The purpose of the trial was to compare the haemodynamic instability and safety of Dexmedetomidine vs Propofol for conscious sedation in arthroscopic shoulder surgery in the beach chair position. Method: A single-blinded prospective randomized trial was conducted in 56 patients randomly allocated into Dexmedetomidine and Propofol groups for conscious sedation following ISB placement. The primary outcome was to measure intraoperative haemodynamic variations (systolic blood pressure, mean arterial pressure, heart rate) in the two groups maintaining adequate conscious sedation during arthroscopic shoulder surgery in the beach chair position. Results: In the dexmedetomidine group a significantly higher percentage of systolic blood pressure (21.86 𝑣𝑠 10.81%, p = 0.001, 𝑑 = 1.05) and a higher percentage heart rate (18.52 vs 9.02%, p = 0.002, 𝑑 = .98) drop from baseline measurements was noted. A large (d ≥ 0.8) Cohen’s effect size suggested the high practical significance of the finding. Perioperative hypotensive (f=19, p<0.001) and bradycardic (f=21, p=0.003) episodes were significantly more frequent in the dexmedetomidine group. The propofol group had a greater incidence of airway complications requiring intervention (f=6 vs f=0, p=.023). Conclusion: Dexmedetomidine leads to significant blood pressure and heart rate reductions from baseline values in the beach chair position providing controlled hypotension and has minimal airway complications in patients undergoing arthroscopic shoulder surgery in the beach chair position under ISB and conscious sedation compared to Propofol.

Effect of Preoperative Antianxiety Medications on Blood Pressure and Blood Loss in Total Knee Arthroplasty: A Case-Control Study.

The increasing number of canceled operations in patients undergoing total knee arthroplasty (TKA) due to high blood pressure readings has put a considerable burden on surgeons. In this study, we aim to assess the effect of giving antianxiety drugs preoperatively on maintaining blood pressure (BP) and blood loss for patients undergoing TKA surgery. This retrospective case-control study included patients who underwent total knee arthroplasty and divided them into two main groups: those who had taken a 3 mg bromazepam oral tablet at the night preoperatively and the control group. The blood pressure of patients was then measured preoperatively (baseline), in the morning of surgery, in the operating room before anesthesia, and during the surgery. The percentage of measured BP was calculated by dividing the measured BP by the baseline, then multiplying by 100. 301 patients were included in our study: 137 received bromazepam and 164 as a control group. The ratio of systolic BP (SBP) in the morning of surgery to the baseline (percentage of morning SBP) decreased significantly in the bromazepam group compared with the controls. The ratio of SBP, in the operating room before anesthesia (percentage of preanesthesia SBP) also decreased significantly in the bromazepam group. However, the percentage of SBP in the middle of surgery did not change significantly. In addition, there was a significant difference change from the baseline in diastolic BP and mean arterial BP between the two groups in the morning of surgery, inside the theatre, and in the middle of the operation. The bromazepam group also showed a significant decrease in blood loss. Preoperative oral antianxiety drugs (bromazepam) helps in controlling hemodynamic changes associated with anxiety, including maintaining BP in well-controlled hypertensive and healthy patients undergoing TKA, and it plays a role in decreasing the total blood loss.

Nutrition Indicators, Dyslipidemia and Arterial Pressure in the Pediatric Population Located in Low and High Marginalisation Zones in Mexico

Aim of the study. The objective of this investigation is to evaluate nutritional indicators, lipidic profile, and blood pressure in the pediatric population that live in low and high marginalisation zones in Mexico. Methods. In a cross-sectional analytical study, students 6 to 18 years old in low and high marginalisation areas of Mexico were selected. Participants were asked to take surveys related to anthropometrics, biochemical, arterial pressure, and evaluation of healthy nutrition index. Results. Less than 1% of the participants had a “healthy nutrition” for both areas. The joint prevalence of overweight and obesity was 40%. The combined prevalence of elevated systolic and diastolic blood pressure was almost 40%, a huge percentage of systolic blood pressure (32%) was observed as well. Half of the population had high levels of triglycerides. Marginalisation was inversely associated with systolic and diastolic blood pressure and positively associated with HDL-C. The population has a low consumption of fruits and vegetables together with high consumption of beverages containing sugar and sweets. It is evident in all the indicators that a significant percentage of subjects exceed the clinical cut-off values related to risk regardless of marginalisation level. Conclusions. It is necessary to insist on educational intervention to create a conscience in observing healthy nutrition at an early age and to preserve these healthy habits during adolescence. The inclusión of the measurement of clinical indicators like arterial pressure and the evaluation of biochemical indicators that assess cardiovascular risks in the public policies of pediatric health is necessary.

Study on the correlation between ambulatory blood pressure and left atrial diameter in patients with treated and controlled office hypertension

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients suffered from different kinds of target organ damage even after years of standardized treatment in clinic. Purpose To explore the relationship between ABPM and LAD in patients with treated essential hypertension. Methods The study enrolled 347 patients with controlled blood pressure evaluated by clinical standard in the Department of Hypertension from January 2015 to May 2020. The T test was used to compare general data, Cardiac ultrasoundwere used to compare the differences between the two groups. Spearman correlation was used to analyze the correlation between ABPM and heart rate variability and target organ damage.Logistic regression analysis was used to figure out the independent risk factor for LAD abnormity. Results (1)LAD normal group: 153 people; the LAD abnormal group: 194 people. Compared with the LAD normal group, the proportion of males, age,body mass index, duration of hypertension,fasting blood glucose, and glycosylated hemoglobin and the proportion of patients with controlled ABPM were significantly higher in the LAD abnormal group(P < 0.05). The average LAD in abnormal group was significantly lower than the LAD normal group (P < 0.05). RAS inhibitor(ACEI or ARB)usage rate of LAD normal group is significantly higher than LAD abnormal group(P < 0.05). On the contrary the usage rate of diuretic of the LAD normal group is lower than of the LAD abnormal group. (2)Spearman correlation analysis between the average blood pressure of each time period of ABPM and LAD found that LAD are positively correlated with the systolic blood pressure for the whole day（r = 0.141, p = 0.00）, the day time （r = 0.118, p = 0.02）or nocturnal（r = 0.178,=0.001）. However there is a negative correlation between LAD and the percentage of systolic blood pressure drops at night（r = 0.149,=0.005. (3)Through Logistic regression analysis, it was found that BMI(OR: 1.22, 95% CI: 1.125-1.324, P < 0.001),nocturnal average systolic blood pressure(OR: 1.02, 95% CI: 1.003-1.038, P = 0.019）, duration of hypertension (OR: 1.043, 95% CI: 1.01-1.078, P = 0.01;)and diuretic usage (OR: 0.298, 95% CI: 0.138-0.644, P = 0.002)are independent risk factors for LAD .(4) For LAD abnormity, the risk factors mentioned above were identified when the area under the LAD abnormity ROC curve exceeded 80.4 % (P = 0.11, 95% CI: 1.125-1.324, P < 0.001). Conclusion 1. Hypertension patients whose office blood pressure reached the standard but with uncontrolled ABPM have significantly suffered form a higher LAD enlargement than those met the standard both in clinic and ABPM. The uncontrolled ABPM is an independent risk factor for LAD. 2. In the 24-hour blood pressure, uncontrolled of SBP by time of day is positively correlated with LAD. 3. Hypertensive patients whose blood pressure in the office reach the standard should actively perform ABPM and adjust the treatment plan according to the circadian blood pressure rhythm.

Plasma catestatin importance and correlation in patients with dipper and non-dipper hypertension patients

Catestatin (CST) is a metabolite of chromogranin A, a soluble protein in catecholamine storage vesicles acting as a feedback inhibitor of catecholamine secretion. This study aims to investigate the correlation of catestatin with dipper and non-dipper status in hypertensive patients. Hypertensive (n=355) and healthy subjects (n=129) were randomly selected at an outpatient clinic. Blood pressure and heart rate were measured according to relevant guidelines. Plasma catestatin level, plasma glucose, lipid levels were measured. An ambulatory blood pressure monitor was performed to determine the dipping patterns in hypertensive subjects. Univariate and multivariate analyses were conducted to assess factors affecting catestatin levels. Left ventricular mass was higher among hypertensives compared with healthy controls (178±47 g versus 213±52 g in healthy controls and hypertensives, p<0.05), but there was no significant difference between the two hypertensive groups 205±43 g versus 228±77 g in dippers versus non-dippers, p=0.54). Average systolic blood pressure (SBP) and the percentage of systolic blood pressure dipping were statistically significantly negative correlated with CST (r=-0.316, p<0.05 for systolic dipping%, r=-0.283, p<0.05 for ASBP). In multivariate analysis for the prediction of catestatin levels, systolic dipping % and mean SBP were found to be independent predictors of plasma catestatin level. Plasma catestatin levels were lower among hypertensives compared to healthy controls and modest inverse correlations between catestatin and dipping percentage of systolic blood pressure and also between catestatin and average systolic blood pressure were noted. In hypertensive subjects, lower plasma catestatin levels may alert clinicians to the non-dipping status of the blood pressure.

Abstract 13411: Vasodilatory Capacity With Regadenoson Myocardial Perfusion Imaging In Patients With End Stage Liver Disease

Introduction: The sensitivity and specificity of myocardial perfusion imaging in end stage liver disease (ESLD) patients ranges between 35-37% and 63-88%, respectively. Despite high levels of endogenous catecholamines and angiotensin, ESLD induced arterial vasodilation may exhaust the vasodilatory capacity of common pharmacologic stress agents. Reduced heart rate (HR) response to vasodilator stress test has been associated with increased major adverse cardiac events (MACE) in pre-transplant end stage renal disease patients but there is limited data in ESLD. We hypothesize that the hemodynamic response, measured as a change in HR and systolic blood pressure (SBP), during regadenoson stress test will be more robust when associated with low level exercise. Method: Forty-five subjects with ESLD referred for pre-transplant risk stratification were assigned to 1 of 3 groups: regadenoson alone or associated with low level treadmill or bicycle maneuver. Regadenoson was injected 2 minutes after low level exercise in the treadmill and bicycle groups. Myocardial perfusion images and hemodynamic changes were performed and interpreted as part of the standard clinical protocol. Results: There were 21 subjects in the regadenoson alone group, 10 in the low level treadmill group, and 14 in the bicycle maneuver group. There were no perfusion abnormalities in any of the groups and LVEF were greater than 50%. There was a statistically significant difference in HR response between the 3 groups (p = 0.015), but not in percentage SBP change between the 3 groups (p = 0.4). Pairwise comparison of regadenoson alone vs. low level treadmill percentage HR change showed statistical significance (p = 0.011). There was no MACE at 6-month follow-up. Conclusions: Low level exercise achieved a higher HR response than the other groups with a similar SBP response. The increased HR response may represent a more physiologic assessment of the true vasodilatory capacity remaining in ESLD patients.

Early blood pressure assessment after acute myocardial infarction: Insights using digital health technology

ObjectiveThere is rising interest in digital health in preventive cardiology, particularly for blood pressure (BP) management. In a digital health study of early BP assessment following acute myocardial infarction (AMI), we sought to examine feasibility and the (1) proportion of post-AMI patients with controlled BP and hypotension, and (2) association between prior cardiovascular disease (CVD) and BP post-AMI. MethodsIn this substudy of the parent Myocardial infarction, COmbined-device, Recovery Enhancement (MiCORE) study, type 1 AMI patients were enrolled between October 2017 and April 2019. Participants self-monitored their BP through 30 days after hospital discharge using an FDA-approved wireless BP monitor connected with a smartphone application. Linear mixed-effects models assessed the association between prior CVD and BP trajectory post-discharge, adjusting for antihypertensive medications and a propensity score inclusive of CVD risk factors. ResultsSixty-eight AMI patients (mean age 58 ​± ​10 years, 75% male, 68% white race, 68% history of hypertension, 24% prior CVD) provided 2638 measurements over 30 days. The percentage of BP control <130/80 ​mmHg was 59.6% (95% CI: 54.3–64.9%) and <140/90 ​mmHg was 83.7% (95% CI: 80.3–87.2%). The percentage of systolic BP ​<90 ​mmHg was 1.1% (95% CI: 0.17–2.0%) and the percentage of diastolic BP ​<60 ​mmHg was 3.9% (95% CI: 2.6–5.2%). Prior CVD was associated with 12.2 ​mmHg higher mean daily systolic BP during admission (95% CI: 3.5–20.9 ​mmHg), which persisted over follow-up. There was no association between prior CVD and diastolic BP. ConclusionThe digital health program was feasible and ~40% of post-AMI patients who engaged in it had uncontrolled BP according to recent guideline cutpoints, while hypotension occurred rarely. The gap in BP control was especially large in patients in whom AMI represented recurrent CVD. These data suggest an opportunity for more aggressive secondary prevention early after MI as care models integrate digital health.

Determining the Prevalence of Primary Aldosteronism in Patients With New-Onset Type 2 Diabetes and Hypertension

Despite a high prevalence of hypertension in diabetes and close relationship between primary aldosteronism (PA) and glucose metabolism, few study concerns the prevalence of PA in diabetes with hypertension. This study aimed to detect the prevalence of PA in patients with new-onset type 2 diabetes (T2D) and hypertension and to explore the association between PA and diabetes. A total of 256 outpatients with new-onset T2D and hypertension were screened for PA. Plasma aldosterone concentration (PAC), plasma renin activity (PRA) were measured. Patients with an aldosterone renin activity ratio (ARR) ≥ 30 ng/dL/ng/mL/h and PAC ≥ 15 ng/dL underwent confirmatory captopril challenge test (CCT) for PA. The diagnostic criteria for PA were, after CCT, (1) PAC decreased < 30%, (2) ARR maintained ≥ 30 ng/dL/ng/mL/h, and (3) PAC was ≥ 11 ng/dL. Of 256 consecutive patients, 99 (39%) were positive for the screening test, and 49 (19%) were diagnosed with PA. Compared with those in groups A (screening test -) and B (screening test +, CCT -), patients in group C (diagnosed with PA) had a higher percentage of systolic blood pressure of ≥ 160 mmHg, less family history of hypertension, and lower serum potassium. Patients in group B and C had higher PAC and ARR levels, but lower PRA than those in group A. Homeostatic model assessment for insulin resistance (HOMA-IR) was positively associated with PAC level among the diabetic patients. The prevalence of PA in new-onset T2D patients with hypertension is at least 19%. Higher aldosterone may be related with insulin resistance in patients with diabetes.

Visceral fat, cardiometabolic risk factors, and nocturnal blood pressure fall in young adults with primary hypertension.

The aims of this study were to assess associations of body fat levels and distribution with metabolic profiles and 24-hour blood pressure in young adults with primary hypertension. Visceral fat (VF) was estimated using dual-energy X-ray absorptiometry. VF was highly significantly associated with a high frequency of overweight/obesity, impaired fasting glucose, increased levels of triglycerides and LDL-cholesterol, and lowered level of HDL-cholesterol. The value of systolic blood pressure (SBP) nocturnal fall was similar between patients receiving RAAS inhibitors, beta-blockers, and calcium channel blockers. In multiple regression, the VF/weight ratio after adjusting for age, gender, total fat, and chronotherapeutic drug delivery was associated with the percentage SBP nocturnal fall (β=-.3108; 95% CI: -0.5923; -0.0980; P=.013). In males, excess VF increased the odds by 2.3 times for non-dipping blood pressure. Our results suggest that in young adult hypertensives, the VF/weight ratio might be associated with non-dipping blood pressure.

SINGLE AND MULTIPLE ISCHEMIC BRAIN MICROLESIONS AFTER CAROTID ARTERY STENTING

Aim. To identify most probable cardiovascular predictors of periprocedural ischemic brain microlesions after carotid artery stenting (CAS) accounting its presumable pathogenesis. Material and methods. 84 patients with carotid artery stenosis undergoing CAS in a specialized medical center were examined. Diffusion-weighted imaging (DWI) magnetic resonance imaging was performed in all patients before and after intervention. Results. Among selected patients aged 40 to 83 years (mean age of 60.6Ѓ}3.9 years, male 80.95%) 39 (46.4%) patients had new ischemic brain microlesions after CAS, differently located. Among all patients (n=84) microlesion count correlated with age (γ=0.243; p<0.01), preprocedural hemoglobin level (γ=-0.278; p<0.01), systolic blood pressure (SBP) level before CAS (γ=0.190; p<0.05) and diastolic blood pressure (DBP) level 1 hour after CAS (γ=-0.201; p<0.05). In patients with microlesions their count (n=39) correlated with SBP and DBP levels 15 min after CAS (γ=-0.370; p<0.01 and γ=-0.369; p<0.01, respectively), percentage of SBP and DBP levels decrease during CAS (γ=0.404; p<0.01 and γ=0.458; p<0.001, respectively), SBP level 24 h after CAS (γ=-0.272; p<0.05) and body mass index (γ=-0.260; p<0.05). Patients with multiple microlesions (n=25) differed from patients without lesions (n=45) older age (67.0 [64.0; 77.0] vs 64.0 [60.0; 70.0], p<0.05), lower preprocedural hemoglobin level (130.9Ѓ}14.5 vs 139.5Ѓ}13.6, p<0.01), lower percentage of smokers (32.0% vs 57.8%, p<0.05), previous ipsilateral stroke (36.0% vs 13.3%, p<0.05) and persistent periprocedural arterial hypotension (12.0% vs 2.2%, p<0.05). These patients with multiple microlesions had more significant DBP level decrease (17.0 [10.0; 25.0] vs 6.5 [1.3; 11.8], p<0.05) compared with patients with single lesions (n=14). In the group of patients with single brain microlesion, unstable (71.4% vs 40.0%, p<0.05) and calcified (64.3% vs 28.0%, p<0.05) atherosclerotic plaques were seen more often compared with patients with multiple lesions. Patients with single brain microlesion differed from patients without lesions greater frequency of calcified atherosclerotic plaques (64.3% vs 31.1%, p<0.05), usage of proximal embolic protection devices (21.4% vs 0.0% p<0.01) and predilatation (35.7% vs 13.3%, p<0.05), perioperative neurological symptoms (21.4% vs 4.4%, p<0.05, and higher SBP levels during 24 h after CAS (mean values 137-122 mm Hg vs 120-112 mm Hg, p<0.05). Conclusion. Single microlesion is associated with unstable or calcified plaques and CAS technical complexities. Multiple microlesions may be associated with periprocedural hemodynamic instability and cerebral hypoperfusion risk factors.

OS 18-01 CORRELATION BETWEEN COGNITIVE DECLINE AND BLOOD PRESSURE IN ELDERLY PATIENTS WITH CONTROLLED HYPERTENSION.

Objective: The objective of this study was to assess cognitive performance in older adults treated and controlled for blood pressure (BP) when compared to untreated normotensive subjects, and to determine whether blood pressure still correlates with poorer cognitive performances. Design and Method: Forty-eight older adults aged between 65 and 85 years were recruited in the community and divided into two groups: normotensive (n = 26) and controlled hypertensive (n = 22). Each participant underwent a neuropsychological assessment that targeted memory, attention, language and executive functions. Ambulatory blood pressure monitoring (24 hours) as well as a blood test (Na+, K+, Ca2+, blood creatinine, glucose, triglycerides, thyroid function) were performed. One-way ANOVAs were conducted on each neuropsychological measure with group (normotensive vs. hypertensive) as a between-subject factor. Pearson correlations were also performed to examine the relationship between blood pressure parameters and cognitive performance. Results: Results from ANOVAs revealed a significant difference between groups on response times in the switching condition of the Colour-Word Interference Test (CWIT), with controlled hypertensive patients performing worse than their normotensive counterparts. The analysis also demonstrated significant positive correlations (p < 0.05) between the percentage of systolic blood pressure (SBP) day values over 135 mmHg (% SBP day > 135 mmHg), and a number of conditions like, the switching cost from CWIT, and the Trail making Test Part B (TMTB). The switching conditions (e.g., TMTB), as well as the switching cost (difference in the reaction time between repetitive, and switching tasks), both assess cognitive flexibility, which is an executive function that relies heavily on prefrontal lobe integrity. Incidentally, these mechanisms have been reported as good predictors of cognitive decline and dementia in older adults. Conclusions: There is a strong correlation between the % SBP day > 135 mmHg, and poor executive functioning, reinforcing the hypothesis that the BP threshold should be decreased to protect the brain of hypertensive subjects.

Study Of Sex Differences In Systolic Blood Pressure And Exercise In Non- Athletic Adults

Background & Objectives: The aim of the present study was to study the sex d ifferences in Systolic Blood Pressure (SBP) responses to Exercise in healthy, non- athletic adu lt's. SBP during exercise have been found to predic t hypertension, coronary heart disease and cardiovascular disease (CVD). Materials & Methods: One hundred normal, healthy, non-smoking subjects (50 Male & 50 Female) of Dr. PSIMS& RF are selected based on healthy life style, Body mass index, rest ing blood pressure & resting heart rate. Results: Age, BMI and pre-exercise heart rate showed no significant differences between genders. During the exercise test, males showed extremely si gnificant % rise in SBP & HR than females. % HR decline in 1st min and 3rd min has got extremely statistical significance between males and females. Systolic blood pressure recovery ratio shows extremely significant increase from 1st min to 3rd min in males. The % HR decline in the 3rd min showed extremely significant increase in males when compared to females. SBP responses during and after maximal exercis e were estimated using percentage SBP rise (%SBP rise) and SBP ratio in 3 minutes of recovery relative to 1 minute (SBP R2). Males showed a significantly higher %SBP rise (34.75± 6.32; p<0.00 1) and lower SBPR2 (0.90± 0.04; p<0.001) in comparison to females. Conclusion: Exercise SBP testing provide an important clue to i dentify the subjects at risk for developing hyperte nsion

The Ability of Anesthesia Providers to Visually Estimate Systolic Pressure Variability Using the “Eyeball” Technique

Systemic arterial respiratory variation has been shown to be a reliable predictor of changes in cardiac output after fluid administration. Arterial respiratory variation is often estimated from visual examination of the arterial waveform tracing. Our goal in this study was to assess the ability of anesthesia providers to visually estimate systolic pressure variation (SPV) as a percentage of systolic blood pressure (SPV). Fifty anesthesia providers were recruited and asked to visually examine 10 recorded arterial waveform tracings (played in real time), to estimate SPV, and to state whether or not a fluid bolus was indicated. After completion of the examination, the participants were shown the original tracings, the true value for SPV, and their estimate. The percentage of incorrect physician decisions to administer or not administer additional fluid was analyzed using a binomial proportion confidence interval. Clinical utility was also assessed using clinical significance analysis. Limits of agreement were analyzed using the nonparametric approach recommended by Bland and Altman. The mean bias was +1.2%. The nonparametric limits of agreement were -5.1 and 7.5%, and contained 82% of values. Actual physician decisions were incorrect 4.4% of the time (95% confidence interval [CI] 2.8% to 6.6%). On the basis of the clinical significance analysis, only 1% of treatments based on the visual estimation would have been incorrect. Visual estimates of respiratory variation are within clinically reasonable limits 82% of the time and lead to erroneous management decisions in 4.4% of measurements.

Comparison of Acetate‐Free Citrate Hemodialysis and Bicarbonate Hemodialysis Regarding the Effect of Intra‐Dialysis Hypotension and Post‐Dialysis Malaise

Compared with acetate dialysate, bicarbonate dialysate has shown beneficial effects in reducing the morbidity associated with dialysis, but a small amount of acetate in bicarbonate dialysate may evoke hypotension or malaise. Acetate-free citrate hemodialysis (AFHD) may avoid these problems. In 44 hemodialysis patients bicarbonate hemodialysis (BHD) was conducted for three months, followed by a switch to AFHD for three months, and a further switch to bicarbonate hemodialysis (ReBHD). In BHD, AFHD and ReBHD, intra-dialysis hypotension and post-dialysis malaise were determined (hypotension: intra-dialysis systolic blood pressure (SBP) was expressed as a percentage of SBP at the start of hemodialysis, malaise was assessed by a self-reported 0 to 3 scale, 0: absence of malaise, 3: unbearable malaise). Compared with BHD, AFHD patients complained of less malaise but the intra-dialysis blood pressure change did not differ significantly (malaise: BHD 0.73 ± 0.76 vs. AFHD 0.32 ± 0.47, P < 0.0001, end hemodialysis SBP: BHD 93.6 ± 8.9 vs. AFHD 93.8 ± 10.1, P = NS). After switching to ReBHD from AFHD, the malaise score increased (AFHD 0.32 ± 0.47 vs. ReBHD 0.77 ± 0.89, P < 0.0001) and the intra-dialysis blood pressure dropped markedly (end hemodialysis SBP: AFHD 93.8 ± 10.1 vs. ReBHD 87.3 ± 10.5, P < 0.0001). Malaise was very severe in five patients who could not continue ReBHD. After ten days under ReBHD, ReBHD was changed to AFHD again in all patients. Although the exact mechanisms are not known, AFHD may be preferable to BHD to prevent hemodialysis-induced hypotension and malaise.

Dysregulation of glucose, insulin, triglyceride, blood pressure, and oxidative stress after an oral glucose tolerance test in men with abdominal obesity

Postprandial metabolic dysregulation plays a role in the development of atherosclerosis. Visceral fat accumulation is an important component of various metabolic disorders including glucose intolerance, dyslipidemia, and hypertension, which correlate with atherosclerotic cardiovascular disease. The aim of the present study was to compare the postprandial response of various metabolic parameters, blood pressure, adiponectin, and oxidative stress to 75-g oral glucose tolerance test (OGTT) in men with (n = 23) and without (n = 7) abdominal obesity based on waist circumference (WC) cutoff value of 85 cm (based on the Japanese criteria for the metabolic syndrome). The cross-sectional prospective study included 30 male subjects who were on no medications and newly diagnosed with mild hypertension and/or dyslipidemia. The percentage change in each parameter ([each parameter at 120 minutes after an OGTT − that before an OGTT]/that before an OGTT × 100) was calculated. The percentage systolic blood pressure, percentage diastolic blood pressure, and percentage triglyceride were −6.3% ± 3.5%, −9.4% ± 3.0%, and −10.2% ± 2.1%, respectively, in the WC less than 85 group (vs baseline: P = .10, P < .01, and P < .001) and 2.0% ± 1.7%, 0.9% ± 2.4%, and 2.8% ± 3.3%, respectively, in the WC at least 85 group (vs WC <85 group: P < .05, each). However, there were no significant differences in percentage total cholesterol and percentage high-density lipoprotein cholesterol between the 2 groups. The percentage thiobarbituric acid–reacting substances tended to be lower in the WC less than 85 group (vs baseline: P = .07), but not in the WC at least 85 group, albeit statistically insignificant (WC <85 vs ≥85 group: P = .057). The maximum carotid intima-media thickness was larger in the WC at least 85 group than the WC less than 85 group ( P < .05). Evaluation of postprandial changes in obesity-related parameters may be important in preventing atherosclerotic diseases.

Prevalence of ambulatory hypotension in elderly patients with CKD stages 3 and 4

Recent understanding of the incidence of chronic kidney disease (CKD) has led us to the introduction of national blood pressure (BP) targets aimed at reducing the incidence of end-stage renal failure. The target clinic BP is <140/90 mmHg and <130/80 in patients with significant proteinuria according to UK NICE guidelines. However, the relationship between clinic BP and ambulatory hypotension has not been studied. We prospectively collected data regarding cardiovascular risk factors, clinic and 24-h ambulatory blood pressure monitoring (24-h ABPM) in 98 treated patients with CKD stages 3 and 4. The mean percentage of systolic blood pressure (SBP) recordings <100 mmHg was 21.2 +/- 16.2% and of diastolic blood pressure (DBP) recordings <60 mmHg was 19.8 +/- 16.9%. The patients were divided into two groups above and below the median age. The older group had a higher percentage of cardiovascular disease than younger patients (57.1 versus 34.7, P = 0.03) and a lower percentage of primary renal disease (18.4 versus 55.1, P < 0.01). Clinic SBP was higher in the older group (158.4 +/- 20.1 versus 147.2 +/- 17.8 mmHg, P < 0.01) but 24-h ABPM SBP was not different (117.3 +/- 14.7 versus 121.0 +/- 12.8 mmHg, P = 0.19). DBP was lower in the older group for both clinic BP (80.3 +/- 10.2 versus 85.5 +/- 12.3 mmHg, P = 0.03) and 24-h ABPM (69.1 +/- 8.2 versus 76.7 +/- 8.8 mmHg, P = <0.01). There were a higher percentage of systolic (SBP <100 mmHg) and diastolic (DBP<60 mmHg) hypotensive episodes in the older group (21.3 +/- 18.9 versus 13.2 +/- 13.6% P = 0.02 and 21.6 +/- 17.9 versus 8.1 +/- 13.3%, P < 0.01, respectively). Hypotension was common among treated CKD patients and despite similar clinic SBP, older CKD patients had lower 24-h ABPM DBP and more frequent systolic and diastolic hypotensive episodes. Further research is underway into how this relates to antihypertensive therapy and future outcomes.

Influence of age on blood pressure recovery after maximal effort ergometer exercise in non-athletic adult males

This study investigated whether age influences blood pressure recovery after maximal exercise in adult males. Forty healthy, non-athletic adult males (20 young, aged 22 +/- 3.46 years and 20 older, aged 48 +/- 6.91 years) participated in the study. Subjects performed a maximal-effort ergometer exercise test. Peak oxygen uptake (VO2max) was measured during the exercise protocol; heart rate (HR) and blood pressure (BP) were measured before exercise, during exercise (at 2-min intervals), and at the first minute of post-exercise recovery and subsequently at 2-min intervals until the recovery of BP. Results indicated that young adults had lower systolic blood pressure (SBP) recovery ratio (P < 0.05), lower SBP recovery time (P < 0.001), higher SBP% decline in 1, and 3 min (P < 0.001), and higher DBP% decline in 1, and 3 min (P < 0.05, <0.001) than the older adults, thus indicating faster BP recovery in young than older adults. A bivariate correlation test, revealed significant associations (P < 0.001, <0.01) between age and BP recovery parameters: percentage SBP decline in 1 and 3 min (27 and 39%), percentage DBP decline in 1 and 3 min (14 and 26%), third minute SBP ratio (22%), and SBP recovery time (72%). After controlling for factors affecting BP recovery such as resting SBP, percentage HR decline, VO2max and delta SBP, the observed correlations reduced in SBP recovery time (29%; P < 0.002) but disappeared (P > 0.01) in the other BP recovery parameters. These data indicate the need to take into account, factors affecting BP recovery when interpreting the effect of age on BP responses after exercise in future investigations.

Weight loss reduces plasma endothelin-1 concentration in obese men.

Obesity is associated with endothelial dysfunction that may contribute to the development of diabetes, hypertension, and atherosclerosis. Endothelin-1 (ET-1), which is produced mostly by vascular endothelial cells, has potent vasoconstrictor and proliferative activity in vascular smooth muscle cells and, therefore, has been implicated in regulation of vascular tonus and the progression of atherosclerosis, suggesting that ET-1 may be important in endothelial dysfunction. We studied whether diet-induced weight loss (i.e., lifestyle modification) affects plasma ET-1 concentration in obese individuals. We measured plasma ET-1 concentration in seven obese men (age: 48 +/- 4 years old, body mass index: 27.7 +/- 0.5 kg/m2) before and after a 3-month, diet-induced weight reduction program (i.e., lifestyle modification program). Caloric restriction reduced body weight from 78 +/- 3 to 68 +/- 2 kg (P < 0.001) and resulted in 12.1 +/- 1.2% reduction in body mass index (24.3 +/- 0.3 kg/m(2), P < 0.0001). After the weight reduction program, systolic and diastolic blood pressure significantly decreased (128 +/- 7 vs. 115 +/- 4 mm Hg, P < 0.05 and 88 +/- 4 vs. 77 +/- 2 mm Hg, P < 0.01, respectively). The plasma level of ET-1 significantly decreased after the program (5.1 +/- 0.4 vs. 4.0 +/- 0.3 pg/ml, P < 0.05). The percentage systolic blood pressure reduction and percentage plasma ET-1 concentration reduction was in a linear relationship (r = 0.86, P < 0.05). Furthermore, the relationship between percentage weight reduction and percentage plasma ET-1 concentration reduction was linear (r = 0.87, P < 0.05). We conclude that weight loss by low-calorie diet (i.e., lifestyle modification) reduces plasma ET-1 concentration in obese individuals. This reduction may contribute to the improvement of obesity-induced endothelial dysfunction.

Effects of weight loss induced by gastric surgery on left ventricular mass and blood pressure in severe obese patients

To assess the effects of weight loss induced by bariatric surgery on left ventricular mass (LVM), 24-hour blood pressure profile, and metabolic parameters in obese patients. Before and 6 months after a bariatric surgery for weight loss, echocardiography to assess the LVM and 24-hour ambulatory blood pressure monitoring (ABPM) were performed in 27 obese patients, 24 females / 3 males, body mass index (BMI) = 50,7 ± 6,1 Kg/ m2. Hemoglobin, serum albumin, glucose, lipid profile and liver enzymes levels were determined before and 6 months after surgery. BMI was significantly reduced from 50,7 ± 6,1 Kg/ m2 to 38,1 ± 3,3 Kg/ m2 (31,5% of the initial weight; p < 0.001). Left ventricular mass reduced from 201 ± 58,2 to 176 ± 60,6 g or 12,5 %; p < 0,01. Also the mean systolic blood pressure (SBP) (from 124 ± 10,2 to 113 ± 12,6 mmHg; p<0,001) and the mean diastolic blood pressure (DBP) (from 72,5 ± 7,7 to 68,9 ± 8,41mmHg; p< 0,03) were reduced. The percentage SBP fall during sleep did not change (-8.0±5.0 to -8.7±4.2%). There were no correlations between the changes in LVM and the changes in weight loss, SBP and DBP. Significant reductions were observed in blood glucose (from 96.8±26.3 to 78.1± 12.5 mg/dl; p<0,01), total- cholesterol (from 217.2±55.2 to 201.2± 55.0 mg/dl; p<0,01), and LDL-cholesterol (from 165.3±9 8.0 to 125.7± 46.5 mg/dl; p<0,02) but not in triglycerides levels (from 142.6± 99.7 to 124.2±80.2; p>0,05). HDL-cholesterol was significantly increased (from 42.8±8.3 to 50.6±12.7; p<0,01). Serum hemoglobin (13.2±1.7 vs 12.8±1.9 g/dl; p>0,05) and serum albumin (3.8± 0.3 vs 3.9± 0.3 g/dl; p>0,05) were not changed while alkaline phosphatase, but no other liver enzymes, increased significantly after surgery from144.0± 84.3 to 213 ± 57,9 g/dl; p=0,02.Concluding, bariatric surgery induced significant weight loss, decreases in LVM and 24h-ABPM, glucose, total-cholesterol and LDL-cholesterol levels and increases in HDL-cholesterol without changes in hemoglobin or albumin levels. The increase in alkaline phosphatase levels is probably caused by the higher lipolisis rate after surgery. The absence of correlations between weight loss or BP levels and LVM reduction suggests that other factors, possibly reductions in body fluid volume may account for LV changes.

Relationship Between Left Ventricular Mass and Noninvasive Monitoring of Blood Pressure

We studied the relationship between left ventricular mass index (LVMI) and blood pressure (BP) monitored during 24 hours in 35 normotensive and 58 hypertensive patients with no treatment for more than three months. We found a close correlation between LVMI and the average daytime systolic BP (r = 0.68). Other parameters derived from BP monitoring were also correlated with LVMI: daytime diastolic BP (0.54), nighttime systolic and diastolic BP (0.61 and 0.54), pulse pressure (0.58), the average of the five highest systolic and diastolic BP (0.57 both), and the percentage of systolic BP above 140 mm Hg (r = 0.64). However, in a stepwise multiple regression analysis only daytime systolic BP was independently correlated to LVMI. The standard deviation of systolic BP was not significantly correlated to LVMI. The same positive correlation between daytime systolic BP and LVMI was found in normotensive and hypertensive patients, males and females, and patients with and without left ventricular hypertrophy. So, at least regarding the prediction of the degree of left ventricular hypertrophy, the average systolic BP during daytime seems to be the only valuable parameter to look at in ambulatory BP monitorings of untreated hypertensive patients.