Presence Of Blood Pressure Research Articles

The Global Burden of Resistant Hypertension and Potential Treatment Options.

Resistant hypertension (RH) is defined as systolic blood pressure (SBP) or diastolic blood pressure (DBP) that remains .140 mmHg or .90 mmHg, respectively, despite an appropriate lifestyle and the use of optimal or maximally tolerated doses of a three-drug combination, including a diuretic. This definition encompasses the category of controlled RH, defined as the presence of blood pressure (BP) effectively controlled by four or more antihypertensive agents, as well as refractory hypertension, referred to as uncontrolled BP despite five or more drugs of different classes, including a diuretic. To confirm RH presence, various causes of pseudo-resistant hypertension (such as improper BP measurement techniques and poor medication adherence) and secondary hypertension must be ruled out. Inadequate BP control should be confirmed by out-of-office BP measurement. RH affects about 5% of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Once RH presence is confirmed, patient evaluation includes identification of contributing factors such as lifestyle issues or interfering drugs/substances and assessment of hypertension-mediated organ damage. Management of RH comprises lifestyle interventions and optimisation of current medication therapy. Additional drugs should be introduced sequentially if BP remains uncontrolled and renal denervation can be considered as an additional treatment option. However, achieving optimal BP control remains challenging in this setting. This review aims to provide an overview of RH, including its epidemiology, pathophysiology, diagnostic work-up, as well as the latest therapeutic developments.

Optimization of pharmacotherapy of gestational hypertension

Annotation. Hypertension in pregnant women disimprove the placental function, impairs fetal development and has an adverse effect on the condition of a woman. Usually dopegyt is used to treat gestational hypertension. However, it reduces the microcirculation of blood in the placenta, causing or increasing pre-existing placental dysfunction. Therefore, the aim of the research is to optimize the method of gestational hypertension pharmacotherapy in pregnant women with a set of infusion drugs including pentoxifylline, arginine hydrochloride with levocarnitine and reosorbilact to prevent fetoplacental dysfunction and perinatal pathology in this case. We examined 73 pregnant women, among whom we distinguished 3 groups: first group (n = 30) - pregnant women with GH, who, along with the basic therapy with dopegyt received a complex of infusion solutions (pentoxifylline, a solution containing arginine hydrochloride and levocarnitine, drug reosorbilact); second group (n=20) - patients with gestational hypertension who received only basic therapy with dopegyt; control group (n=23) - women with physiological pregnancy. Studies of the clinical effectiveness of the proposed treatment were evaluated by cases of prevention of perinatal pathology (intrauterine growth restriction of the fetus (IUGR), premature birth, etc.) and the results of clinical, laboratory and instrumental research methods. Criteria for inclusion in the study were: the presence of blood pressure ≥150/100 mm Hg, dopegyt, gestational age from 28 to 36 weeks, singleton pregnancy. Examination of pregnant women was performed using standard clinical, laboratory and instrumental (Doppler ultrasounds) research methods. The analysis of the obtained data was performed using the program “STATISTICA 5.5”. Established that in patients who received our treatment regimen, there was a significant reduction in the development of placental dysfunction (OR 0.30, 95 % CI [0.12-0.74], p=0.009), fetal IUGR (OR 0.33, 95 % CI [0.12-0.96], p=0.042), acute fetal distress (OR 0.25, 95 % CI [0.075-0.83], p=0.02), weakness of childbirth (OR 0,19, 95 % CI [0.04-0.82], p=0.03), reducing the risk of perinatal CNS damage (OR 0.22, 95 % CI [0.05-0.99], p=0.049 ) and reducing the risk of cephalohematoma (OR 0.25, 95 % CI [0.075-0.83], p=0.024).

Production of antihypertensive and antidiabetic peptide fractions from quinoa (Chenopodium quinoa Willd.) by electrodialysis with ultrafiltration membranes

Processing bioactive peptides from natural sources using electrodialysis with ultrafiltration membranes (EDUF) have gained attention since it can fractionate in terms of their charge and molecular weight. Quinoa is a pseudo-cereal highlighted by its high protein content, amino acid profile and adapting growing conditions. The present work aimed at the production of quinoa peptides through fractionation using EDUF and to test the fractions according to antihypertensive and antidiabetic activity. Experimental data showed the production of peptides ranging between 0.4 and 1.5 kDa. Cationic (CQPF) (3.01 %), anionic (AQPF) (1.18 %) and the electrically neutral fraction quinoa protein hydrolysate (QPH)-EDUF (∼95 %) were obtained. In-vitro studies showed the highest glucose uptake modulation in L6 cell skeletal myoblasts in presence of QPH-EDUF and AQPF (17 % and 11 %) indicating potential antidiabetic activity. The antihypertensive effect studied in-vivo in spontaneously hypertensive rats (SHR), showed a decrease in systolic blood pressure in presence of the fractionated peptides, being 100 mg/kg a dose comparable to Captopril (positive control). These results contribute to the current knowledge of bioactive peptides from quinoa by reporting the relevance of EDUF as tool to produce selected peptide fractions. Nevertheless, further characterization is needed towards peptide sequencing, their respective role in the metabolism and scaling-up production using EDUF.

Abstract WP120: Can Early Transcranial Doppler Ultrasound Predict Early Neurological Deterioration And Risk Of Hemorrhagic Transformation After Endovascular Treatment?

Background: Recent advances in endovascular therapy (EVT) have led to a significant improvement in functional outcomes of patients with stroke. However, early neurological deterioration (END) after EVT has still remained a concerning issue. Reasons for END include reocclusion, hyperperfusion after recanalization, and hemorrhagic transformation. The current study was designed to assess the feasibility of early transcranial Doppler (TCD) after EVT, to identify association between TCD findings and END. Methods: This is a pilot study to assess the feasibility of TCD prior and early (within 60 minutes) after EVT. For all selected arteries, we measured peak systolic velocity, end diastolic velocity, mean flow velocity and pulsatility index. Patients were followed for three months after the intervention and disability was measured using modified Rankin scale (mRS). We examined the possible association between active leptomeningeal collateral flow after EVT and END. Results: Between October 16, 2020, and March 28, 2021, we recruited 20 acute ischemic stroke patients with large vessel occlusion who underwent EVT. Five patients were excluded because of a poor temporal window; two had an unsuccessful intervention. Four patients had END and all of them had active leptomeningeal flow with elevated blood pressure after EVT. In cases without END, we did not observe any flow diversion or active leptomeningeal collateral after EVT.In those without significant post-stroke disability (mRS<2), we did not observe any active leptomeningeal flow or flow diversion with blood pressure of ≤ 155/85. Most patients with post-stroke disability (mRS ≥ 2) had either flow diversion or active leptomeningeal flow in the presence of blood pressure ≥ 170/93. Hyperemia was associated with hemorrhagic transformation, particularly in the presence of elevated blood pressure. All cases with symptomatic hemorrhagic transformation had hyperemia. Conclusion: TCD is a feasible approach early after EVT. It has clinical implications in identifying those with END and risk for sICH. Early TCD after EVT may provide personalized BP management based on individualized cerebral flow and the presence of active collateral flow after EVT. Studies with larger sample size are warranted.

Association between comorbidities and blood pressure trajectories in patients with hypertension

Abstract Background Our knowledge of how to better manage elevated blood pressure in presence of comorbidities is limited; in part due to exclusion or underrepresentation of multimorbid patients from major clinical trials. Purpose To investigate the burden and types of comorbidities in patients with hypertension, to assess how such comorbidities and other variables affect blood pressure levels over time. Methods The study was conducted using linked electronic health records from the UK Clinical Practice Research Datalink study from its inception on 1 January 1985 to 30 September 2015. Using linked electronic health records, we compared systolic blood pressure levels among 295,487 patients with diagnosed hypertension by type and numbers of major comorbidities from at least 5 years before to up to 10 years after hypertension diagnosis. We used a multiple landmark cohort design in order to investigate associations prospectively with time-updated information that takes advantage of the dynamic nature of electronic health records. Results Time-updated multivariable linear regression analyses showed that the presence of more comorbidities was independently associated with lower blood pressure during follow-up. This negative association was not specific to particular types of comorbidities; although associations were stronger in those with pre-existing cardiovascular disease. Tracking patients backwards to years prior to hypertension diagnosis revealed that the association between comorbidities and blood pressure were even more pronounced in years before hypertension diagnosis. Despite substantial declines in blood pressure in the first year after diagnosis, subsequent changes were modest, with no evidence of a more rapid decline in those with more or specific types of comorbidities. Conclusions Blood pressure levels at which patients were diagnosed with hypertension varied substantially and were lower when patients had more comorbidities. This early selection bias was a key determinant of long-term differences in blood pressure by comorbidity status and provides an additional explanation for the lower blood pressure in multimorbid patients. Mean SBP (mmHg) over time Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): National Institute for Health Research Oxford Biomedical Research Centre, Rhodes Trust and Clarendon Fund

C-reactive protein, interleukin-6 and pre-eclampsia: large-scale evidence from the GenPE case-control study

Multiple small studies have suggested that women with pre-eclampsia present elevated levels of C-reactive protein (CRP) and interleukin-6 (IL-6). However, little is known regarding the source of this CRP and IL-6 increase. Therefore, the aim of this study was to evaluate the relationship between CRP and IL-6 levels with pre-eclampsia considering different confounding factors. Using data from a large Colombian case-control study (3,590 cases of pre-eclampsia and 4,564 normotensive controls), CRP and IL-6 levels were measured in 914 cases and 1297 controls. The association between maternal serum levels of CRP and IL-6 with pre-eclampsia risk was evaluated using adjusted logistic regression models. Pre-eclampsia was defined as presence of blood pressure ≥140/90 mmHg and proteinuria ≥300mg/24 h (or ≥1 + dipstick). There was no evidence of association between high levels of CRP and IL-6 with pre-eclampsia after adjusting for the following factors: maternal and gestational age, ethnicity, place and year of recruitment, multiple-pregnancy, socio-economic position, smoking, and presence of infections during pregnancy. The adjusted OR for 1SD increase in log-CRP and log-IL-6 was 0.96 (95%CI 0.85, 1.08) and 1.09 (95%CI 0.97, 1.22), respectively. Although previous reports have suggested an association between high CRP and IL-6 levels with pre-eclampsia, sample size may lack the sufficient power to draw robust conclusions, and this association is likely to be explained by unaccounted biases. Our results, the largest case-control study reported up to date, demonstrate that there is not a causal association between elevated levels of CRP and IL-6 and the presence of pre-eclampsia.

New Hybrid Hetero-Structure (Zr7O9F10/ZrB2) Ultraviolet (UV) Photo-Catalyst synthesized by Hydrothermal Method

Hypertension is defined as the presence of blood pressure within 140/90 mm Hg. High blood pressure can be seen at any age from infancy. Hypertension, primary (primary, idiopathic, basic) and secondary (secondary) is divided into two. Cases of hypertension (approximately 95%. Five percent of cases are secondary hypertension, most of which are renal.

New Hybrid Hetero-Structure (Zr7O9F10/ZrB2) Ultraviolet (UV) Photo-Catalyst synthesized by Hydrothermal Method

Hypertension is defined as the presence of blood pressure within 140/90 mm Hg. High blood pressure can be seen at any age from infancy. Hypertension, primary (primary, idiopathic, basic) and secondary (secondary) is divided into two. Cases of hypertension (approximately 95%. Five percent of cases are secondary hypertension, most of which are renal.

Interpretations Outcomes of Assays Fulfilling on Knockdown Cells and in Vivo

Hypertension is defined as the presence of blood pressure within 140/90 mm Hg. High blood pressure can be seen at any age from infancy. Hypertension, primary (primary, idiopathic, basic) and secondary (secondary) is divided into two. Cases of hypertension (approximately 95%. Five percent of cases are secondary hypertension, most of which are renal.

A Sensıtıve and Sımple Spectrofluorımetric Method for Analysıs Antı-Hypertensıve Drugs in Pharmaceutıcal Preparatıons

Hypertension is defined as the presence of blood pressure within 140/90 mm Hg. High blood pressure can be seen at any age from infancy. Hypertension, primary (primary, idiopathic, basic) and secondary (secondary) is divided into two. Cases of hypertension (approximately 95%. Five percent of cases are secondary hypertension, most of which are renal.

Heart rate in patients with or without hypertension: A retrospective study

Introduction: Heart rate (HR) is correlated with peripheral and central blood pressure (BP), which may be a determinant in the development of hypertension (HTN). The objective of this study was to assess the HR in patients with and without HTN and identify the determinants of HR in patients with HTN.Materials and Methods: In a retrospective analysis of patient data at a single center from central India, HR was Clinic records, with the presence assessed using an electronic pulse recorder as well as using the traditional method of counting radial pulse. A patient with HTN was identified by the presence of BP ≥140/90 mmHg or by their taking antihypertensive medications. HR was compared between patients with and without HTN. Factors associated with HR in patients with HTN were assessed.Results: In a total of 1020 patients' data included in the study, 81.5% had HTN and 18.5% were nonhypertensive. The mean HR was significantly higher in patients with HTN than in controls (78.0 ± 13.0 vs. 75.7 ± 10.3 beats per min [bpm], P = 0.033). Furthermore, the proportion of patients with HR ≥≥80 bpm was significantly higher in patients with HTN (43.9% vs. 24.4%, P = 0.017). In patients with HTN, the mean HR was significantly higher in those who had diabetes (P = 0.002). A significantly higher percentage of patients who had HR 80 bpm or more were females (P = 0.015), had diabetes (P = 0.002) and uncontrolled BP (P = 0.036), and were receiving thiazide diuretics (P = 0.001).Conclusion: HR is significantly higher in patients with HTN than nonhypertensive controls in the central Indian population. Prospective studies are necessary to assess the impact of various factors on HR and also the role of HR in the development of incident HTN and adverse cardiovascular outcomes in patients with HTN.

Predictive value of Lipocalin 2 and hyperuricemia on maternal and fetal outcome in pre-eclampsia

Background: Pre-eclampsia is a complex hypertensive syndrome that originates in early pregnancy and leads to considerable maternal and fetal morbidity and mortality. Lipocalin 2 is low in healthy human tissue but increased in pathological conditions following endothelial cell injury. Women with pre-eclampsia showed elevated uric acid level in the maternal blood.Objective: To assess the predictive value of Lipcalin 2 and hyperuricemia on the severity of pre-eclampsia and on maternal and fetal outcome.Patients and Methods: Sixty women enrolled in the present study were forty affected by preeclampsia and 20 women with uncomplicated pregnancies formed the control group. All women included in the study were subjected to; complete history taking; clinical and blood pressure evaluation; measurements of biochemical parameters and evaluation of maternal and fetal well-being.Results: Thirty-two of hypertensive women were mild pre-eclampsia having blood pressure ≥140/90mmHg but less than 160/110mmHg. Eight cases were severe pre-eclampsia with the presence of blood pressure ≥160/110 mmHg. All hypertensive women showed statistically significant increased biochemical parameters compared to control p<0.001. Lipocalin 2 and serum uric acid levels in the studied group showed a positive correlation with various biochemical parameters and hyperuricaemia showed a good relation with the pathogenesis of the maternal and fetal manifestations.Conclusion: Lipocalin 2 could be used as a sensitive indicator of severity of preeclampsia. On the other hand hyperuricaemia showed a good relationship with fetal outcome in hypertensive disorder of pregnancy, identifying those fetuses that are likely to have Intra Uterine Growth Retardation and high perinatal mortality.

A comparative analysis of body fat percentage and incidence of essential hypertension and type-2 diabetes mellitus in a vegetarian and non-vegetarian population

Background: Obesity is identified as a complex multifactorial disorder and a notable growing global problem. Body fat percentage (BFP) is more reliable method as compared to BMI for assessing the risk of developing disease. Essential hypertension and Type-2 diabetes mellitus are both associated with adiposity. Aims & Objective: In this study, we planned to observe the association, if any, of raised BFP levels in strict-vegetarians and comparatively analyzed with non-vegetarians in context to the indicated diseases. Materials and Methods: After getting approval from ethical review committee of the Aga Khan University for this Random, Cross sectional and population based study, 563 subjects were selected randomly (males 295, females 268, strict-vegetarians n= 324 (58.0%), non-vegetarian n=235 (42.0%) in 2012 from Tharparker, Pakistan. We recorded demographic and anthropometric data, presence of blood pressure, type-2 diabetes mellitus and co-morbidities. Analysis of BFP was carried out by Deurenberg formula. Level of BFP >20 in males and > 25 in females was taken as raised/abnormal. Data was analyzed descriptively and categorically by using SPSS-21 for comparative analysis of prevalence of the essential hypertension (EHTN) and Type-2 Diabetes Mellitus (T2DM). Comparative analysis of association of raised levels of BFP was carried out in context to EHTN and T2DM in vegetarian and non-vegetarian population. A p-Value of < 0.05 was considered significant. Results: Vegetarian subjects, n= 324 (58.0%), showed minimum age as 15 years; maximum 82 (mean 39.6, Std. Deviation 16.6). Non-vegetarian subjects, n= 235 (42.0%), had minimum age 10 years; maximum 76 years (mean 33.7, Std. Deviation 15.5). More male subjects had raised BFP (270 = 94.7%) than females (129 = 49%), p-Value 0.000. Despite positive association of raised BFP levels with EHTN and T2DM, the comparative analysis of association of raised BFP levels among the vegetarian and non-vegetarian cohort in relation to both EHTN and T2DM showed non-significant p-Values (0.105 and 0.347 respectively). Conclusion: Raised body fat percentage in the strict-vegetarian and non-vegetarian cohorts showed a non-significant association to produce essential hypertension and type-2 diabetes mellitus. Findings point to some other risk factors which could be responsible to produce the disease in the studied cohorts. Doing exercise and reducing caloric intake is strongly advised as the best measure to maintain a normal phenotype.

Prospective Relationship of Low Cardiovascular Risk Factor Profile at Younger Ages to Ankle‐Brachial Index: 39‐Year Follow‐Up—The Chicago Healthy Aging Study

BackgroundData are sparse regarding the long-term association of favorable levels of all major cardiovascular disease risk factors (RFs) (ie, low risk [LR]) with ankle-brachial index (ABI).Methods and ResultsIn 2007–2010, the Chicago Healthy Aging Study reexamined a subset of participants aged 65 to 84 years from the Chicago Heart Association Detection Project in Industry cohort (baseline examination, 1967–1973). RF groups were defined as LR (untreated blood pressure ≤120/≤80 mm Hg, untreated serum cholesterol <200 mg/dL, body mass index <25 kg/m2, not smoking, no diabetes) or as 0 RFs, 1 RF, or 2+ RFs based on the presence of blood pressure ≥140/≥90 mm Hg or receiving treatment, serum cholesterol ≥240 mg/dL or receiving treatment, body mass index ≥30 kg/m2, smoking, or diabetes. ABI at follow-up was categorized as indicating PAD present (≤0.90), as borderline PAD (0.91 to 0.99), or as normal (1.00 to 1.40). We included 1346 participants with ABI ≤1.40. After multivariable adjustment, the presence of fewer baseline RFs was associated with a lower likelihood of PAD at 39-year follow-up (P for trend is <0.001). Odds ratios (95% CIs) for PAD in persons with LR, 0 RFs, or 1 RF compared with those with 2+ RFs were 0.14 (0.05 to 0.44), 0.28 (0.13 to 0.59), and 0.33 (0.16 to 0.65), respectively; findings were similar for borderline PAD (P for trend is 0.005). The association was mainly due to baseline smoking status, cholesterol, and diabetes. Remaining free of adverse RFs or improving RF status over time was also associated with PAD.ConclusionsLR profile in younger adulthood (ages 25 to 45) is associated with the lowest prevalence of PAD and borderline PAD 39 years later.

Fine-mapping and comprehensive transcript analysis reveals nonsynonymous variants within a novel 1.17 Mb blood pressure QTL region on rat chromosome 10

The presence of blood pressure (BP) quantitative trait loci (QTL) on rat chromosome 10 has been clearly demonstrated by linkage analysis and substitution mapping. Using congenic strains containing the LEW rat chromosomal segments on the Dahl salt-sensitive (S) rat background, further iterations of congenic substrains were constructed and characterized to fine-map a chromosome 10 region (QTL1) linked to blood pressure. Comparison of seven congenic substrains refined QTL1 to a 1.17 Mb segment flanked by D10Mco88 and D10Mco89, which are located at 71,513,116 and 72,684,774 bp, respectively. The newly defined QTL1, containing 18 genes, is captured in its entirety within a single congenic substrain. A thorough transcript analysis revealed that 3 of these 18 genes, Ccl5, Ddx52, and RGD1559577, had nonsynonymous allelic variations between the S rat and the LEW rat. None of the detected transcripts within the newly defined QTL1 are implicated directly in BP control in humans or model organisms. Therefore, the present work defines a novel blood pressure QTL with three potential quantitative trait nucleotides.

Bioactive Calcium Phosphate Material for Dental Endodontic Treatment. Root Apical Deposition.

An injectable bone substitute (IBS) made of a suspension of Calcium phosphate ceramic was used to filled dental root canal after removing of canal pulp. The aim of this study was to verify the ability of calcium phosphate ceramic suspension to fill the apical zone of teeth ex vivo (n=40) and in vivo in a sheep model (n=8). The results showed that injection is possible with a good level of BCP granules at the end of the root dental canal with extracted tooth. In vivo, the presence of blood pressure due to the pulpectomy is a negative parameter to allow a good filling. The scanning electron microscopy revealed mineral formation at the apex level with mineral tissue conduction between the BCP granules but only one tooth showed a good apical filling with a good sealing. The sealing of the apex seems to depend of the amount of BCP granules. Other experiments with other animal models closer to a Human model have to be performed before human trials.

Ambulatory blood pressures and autonomic nervous function in normoalbuminuric type I diabetic patients.

In insulin-dependent diabetes mellitus (IDDM) patients with normal urinary albumin excretion (UAE) controversy exists about the presence of blood pressure (BP) elevation and an attenuation of BP decline during sleep. These issues were studied in 60 IDDM patients and 55 healthy control subjects with 24 h ambulatory blood pressure monitoring. In addition, in the IDDM patients two cardiovascular reflex tests were performed to study autonomic nervous function. 55 IDDM patients had 4.4/3.1 mm Hg higher 24 h systolic/diastolic pressures when compared with 55 healthy matched controls (P = 0.005/0.009). The diastolic BP decline during sleep was significantly attenuated in IDDM patients compared to healthy volunteers (18.9 vs 22.2%, P = 0.01). The maximum/minimum (max/min) ratio of the RR' interval of the lying to standing test (lower values indicating (incipient) parasympathetic dysfunction) was positively related to the decline of the diastolic BP during sleep in the diabetic patients. This relationship did not persist after adjusting for decline of heart rate during sleep. IDDM patients with normal UAE, compared with healthy control subjects, have higher BPs during both the waking and sleeping periods and a decreased diastolic BP decline during sleep. In these patients both the diastolic BP decline and the heart rate decline during sleep were related to the max/min ratio. These findings are consistent with the hypothesis that attenuation of diastolic BP decline during sleep is at least partly due to (incipient) damage to the parasympathetic nervous system, which, through a blunted heart rate decline, leads to a decreased decline of cardiac output during sleep.

Prehospital cardiac arrest treated by urban first-responders: Profile of patient response and prediction of outcome by ventricular fibrillation waveform

To determine the speed and characteristics of patient response to urban first-responder defibrillation and to determine whether amplitude of ventricular fibrillation (VF) can predict outcome in these patients. All adult patients in prehospital VF treated by fire department first-responders (265). A prospective observational study occurring between February 1, 1989, and January 1, 1991. Patients were defibrillated according to advanced cardiac life support and first-responder protocols. ECG and time data were recorded digitally. Sixty-five percent of patients converted from VF to a more stable rhythm at least once during first-responder monitoring. Fifty-four percent of converted patients refibrillated at least once, and 42% of all stable conversions occurred after at least one episode of refibrillation. Seventy percent of all refibrillations occurred less than six minutes after the defibrillator was turned on, and 23% occurred after more than ten minutes. The proportion of stable conversions decreased from 30% on first conversion to 2% on fourth conversion. With each successive conversion the interval to refibrillation grew shorter, and development of a pulse or blood pressure became less likely. Presence of blood pressure or pulse after conversion had a sensitivity for hospital discharge of 54% and a specificity of 98%. Maximum VF amplitude before countershock was highly predictive of postshock rhythm, stable conversion in the field, time interval before refibrillation, inpatient admission, and hospital discharge. VF amplitude was unrelated to response interval or interval to defibrillation but was positively related to bystander CPR. Logistic regression identified VF amplitude as the most important predictor of hospital discharge; traditional variables such as response interval and bystander CPR were not predictive once amplitude had been accounted for. Changes in VF amplitude during the course of resuscitation efforts were frequent and also predictive of outcome. Patients in VF who were treated by early countershock refibrillated much more frequently than previously reported. Refibrillations occur both early and late. Initial VF maximum amplitude is strongly predictive of outcome. Future reports of VF cardiac arrest should control for this previously neglected variable. Increased amplitude of VF during repeated refibrillation episodes is associated with increased hospital discharge, so future studies of advanced cardiac life support interventions should explore changes in VF amplitude as an outcome variable.