Rapid Blood Pressure Research Articles

Evaluation of blood pressure trajectories and outcome in critically ill children with initial hypertension on admission to Paediatric Intensive Care

ObjectiveHypertension on paediatric intensive care (PICU) is associated with adverse outcomes. Management is complex; hypertension often represents a physiological adaptive response and exposure to hypertension could lead to altered pressure-flow autoregulation. International treatment consensus is to avoid rapid blood pressure (BP) reduction. Our aim was to examine if the rate and magnitude of BP reduction in hypertensive patients was correlated with harm. Patients and methodsWe performed a single centre, retrospective, observational study in a quaternary PICU analysing the first 24 h post admission high resolution BP profiles of children with admission BP above the 95th centile. Individual BP profiles were analysed regarding both time spent and magnitude below a threshold; 75% of the admission BP in the first 24 h. Outcomes were organ support-free days at day 28, change in serum creatinine and PICU mortality. Main findingsOf 3069 admissions in a 36-month period (2016–2018), 21.7% had initial hypertension on admission to PICU. A total of 3,259,111 BP measurements (99.4% invasive) were available. Pre-existing hypertension was documented in 4.9% of patients. Both time spent and magnitude below threshold BP was poorly correlated with duration of required organ support and risk of death after adjusting for PIM score, pre-existing hypertension and raised intracranial pressure. We did find an association with a rise in serum creatinine on both uni- and multivariable analysis. ConclusionsThe risk of harm due to early and significant reduction of raised blood pressure in critically ill children appears to be limited.

Blood Pressure Trajectory and Its Influencing Factors in Chinese Adults: A Cohort Study with Long-Term Follow-Up.

BackgroundFew studies have been reported on the factors affecting the trajectory of blood pressure in Chinese adults. This study aimed to identify the pattern of blood pressure trajectories and analyze the factors affecting different trajectories.Material/MethodsA total of 749 participants were included in this study from the China Health and Nutrition Survey (CHNS) database, collected between 1989 and 2006, and were followed up until 2015. A group-based trajectory model was used to identify similar development trajectories of blood pressure levels. Univariate and multivariate logistic regression analysis was used to explore the influencing factors of blood pressure trajectories.ResultsThree systolic (SBP) and diastolic blood pressure (DBP) trajectory groups were identified: Group 1, “low initial blood pressure and slight rise” (SBP, n=267, 35.65%); Group 2, “low initial blood pressure and moderate rise” (SBP, n=375, 50.07%); and Group 3, “high initial blood pressure and high rise” (SBP, n=107, 14.29%). In the SBP trajectory groups, age ≥40 years, male sex, body mass index (BMI) ≥24 kg/m2, and the eastern region of China were associated with a rapid rise and high baseline blood pressure (P<0.01). In terms of DBP trajectory, male sex, BMI ≥24 kg/m2, and the eastern region of China were also related to the rapid rise and high baseline blood pressure, while age may not affect rise rate (P<0.01).ConclusionsDifferent blood pressure trajectories and related influencing factors may provide information for targeted interventions, especially for people with high initial blood pressure and high rise.

Agreement of High-Definition Oscillometry (HDO) and Invasive Blood Pressure Measurements at a Metatarsal Artery in Isoflurane-Anaesthetised Horses.

Simple SummaryIn equine anaesthesia, valid and reliable blood pressure monitoring is crucial for adequate blood pressure management. Various non-invasive blood pressure monitors have been studied with varying results. High-definition oscillometry (HDO) promises greater accuracy than conventional oscillometric devices. With the cuff placed at the tail, the monitor gives satisfactory readings in normotensive anaesthetised horses, while for measuring low and high blood pressure, reliability was inadequate. To date, high-definition oscillometry has not been evaluated at the easily accessible equine metatarsal area. Therefore, the objective of this study was to assess agreement between HDO and invasive blood pressure, both obtained at a metatarsal artery at different blood pressure ranges in anaesthetised horses. Additionally, compliance with the American College of Veterinary Internal Medicine consensus guidelines was assessed. Agreement of HDO and invasive blood pressure was acceptable for mean arterial blood pressure during normotension only. During hypotension and hypertension, measurements were not valid. The monitor failed to meet most of the consensus validation criteria. Consequently, invasive blood pressure measurement remains preferable in haemodynamically unstable patients.High-definition oscillometry (HDO) over the metatarsal artery (MA) in anaesthetised horses has not yet been evaluated. This study aimed to assess agreement between HDO and invasive blood pressure (IBP) at the metatarsal artery, and to evaluate compliance with the American College of Veterinary Internal Medicine (ACVIM) consensus guidelines. In this experimental study, 11 horses underwent general anaesthesia for an unrelated, terminal surgical trial. Instrumentation included an IBP catheter in one and an HDO cuff placed over the contralateral MA, as well as thermodilution catheters. Systolic arterial pressure (SAP), mean arterial pressure (MAP), diastolic arterial pressure (DAP), and cardiac output were measured simultaneously. Normotension (MAP 61–119 mmHg) was maintained during the surgical study. Subsequently, hypotension (MAP ≤ 60 mmHg) and hypertension (MAP ≥ 120 mmHg) were induced pharmacologically. For MAP, the agreement between HDO and IBP was acceptable during normotension, while during hypotension and hypertension, IBP was overestimated and underestimated by HDO, respectively. The monitor failed to meet most ACVIM validation criteria. Consequently, if haemodynamic compromise or rapid blood pressure changes are anticipated, IBP remains preferable.

A non-invasive blood pressure prediction method based on pulse wave feature fusion

To study the non-invasive blood pressure prediction based on pulse wave feature fusion to achieve rapid blood pressure (BP) measurement and improve the measurement accuracy, which provides a new method for the non-invasive blood pressure measurement by wearable devices. From the pulse signals, 82 dimensional features were extracted, including time domain features extracted by the feature point method, ratio features of pulse wave amplitude and pulse-taking pressure fusion, and pulse wave velocity (PWV) features. Feature fusion is performed by feature importance analysis to reduce the dimensionality, and the fused features are used to build blood prediction models based on gradient boosting decision tree (GBDT) regression algorithm. The correlation coefficients between the predicted and actual values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 0.93 and 0.92, respectively, which had high correlation, and the mean absolute errors between the predicted and actual values of SBP and DBP were 3.75 mmHg and 3.10 mmHg, respectively, with standard deviations of 5.46 mmHg and 3.93 mmHg, all of which met the overall performance requirements of the association for the advancement of medical instrumentation (AAMI) and British hypertension society (BHS) International electronic blood pressure monitor. This blood pressure prediction model can be better used in the non-invasive blood pressure measurement of wearable devices, which is more convenient and has higher prediction accuracy compared with mercury sphygmomanometer.

Assessment of Myocardial Function During Blood Pressure Manipulations Using Feature Tracking Cardiovascular Magnetic Resonance.

Background: Coronary autoregulation is a feedback system, which maintains near-constant myocardial blood flow over a range of mean arterial pressure (MAP). Yet in emergency or peri-operative situations, hypotensive or hypertensive episodes may quickly arise. It is not yet established how rapid blood pressure changes outside of the autoregulation zone (ARZ) impact left (LV) and right ventricular (RV) function. Using cardiovascular magnetic resonance (CMR) imaging, measurements of myocardial tissue oxygenation and ventricular systolic and diastolic function can comprehensively assess the heart throughout a range of changing blood pressures.Design and methods: In 10 anesthetized swine, MAP was varied in steps of 10–15 mmHg from 29 to 196 mmHg using phenylephrine and urapidil inside a 3-Tesla MRI scanner. At each MAP level, oxygenation-sensitive (OS) cine images along with arterial and coronary sinus blood gas samples were obtained and blood flow was measured from a surgically implanted flow probe on the left anterior descending coronary artery. Using CMR feature tracking-software, LV and RV circumferential systolic and diastolic strain parameters were measured from the myocardial oxygenation cines.Results: LV and RV peak strain are compromised both below the lower limit (LV: Δ1.2 ± 0.4%, RV: Δ4.4 ± 1.2%, p < 0.001) and above the upper limit (LV: Δ2.1 ± 0.4, RV: Δ5.4 ± 1.4, p < 0.001) of the ARZ in comparison to a baseline of 70 mmHg. LV strain demonstrates a non-linear relationship with invasive and non-invasive measures of oxygenation. Specifically for the LV at hypotensive levels below the ARZ, systolic dysfunction is related to myocardial deoxygenation (β = −0.216, p = 0.036) in OS-CMR and both systolic and diastolic dysfunction are linked to reduced coronary blood flow (peak strain: β = −0.028, p = 0.047, early diastolic strain rate: β = 0.026, p = 0.002). These relationships were not observed at hypertensive levels.Conclusion: In an animal model, biventricular function is compromised outside the coronary autoregulatory zone. Dysfunction at pressures below the lower limit is likely caused by insufficient blood flow and tissue deoxygenation. Conversely, hypertension-induced systolic and diastolic dysfunction points to high afterload as a cause. These findings from an experimental model are translatable to the clinical peri-operative environment in which myocardial deformation may have the potential to guide blood pressure management, in particular at varying individual autoregulation thresholds.

Comparison of premade clevidipine and pharmacy-prepared nicardipine in time to goal systolic blood pressure in acute cerebrovascular accident.

To compare pharmacy-prepared nicardipine and premade clevidipine with regard to time to goal systolic blood pressure (SBP) in acute cerebrovascular accident (CVA). A retrospective, observational study was conducted comparing patients with acute CVA who received nicardipine or clevidipine. The primary objective was time to goal SBP. Secondary objectives included time from order to administration, time from administration to goal SBP, percentage of SBP readings below goal, total volume administered, hospital and intensive care unit lengths of stay, inpatient mortality and adverse events. Seventy-one patients were included in the study, 37 in the nicardipine group and 34 in the clevidipine group. A significant difference was found in mean time to goal SBP (150.9 minutes in the nicardipine group vs 69.3 minutes in the clevidipine group, P < 0.01). Time from order to administration was 80.1 minutes in the nicardipine group and 35.2 minutes in the clevidipine group (P < 0.01). Mean time from administration to goal SBP was 70.9 minutes in the nicardipine group and 42.3 minutes in the clevidipine group (P = 0.02). There was no difference between groups in percentage of SBP readings below goal, total volume administered, length of stay, or inpatient mortality. Adverse events occurred in 13 (35.1%) of the nicardipine-treated patients and 17 (50%) of the clevidipine-treated patients (P = 0.42). Compared to use of pharmacy-prepared nicardipine, use of premade clevidipine was associated with a shorter time to goal SBP in patients with acute CVA. There were no significant between-group differences in safety outcomes. Premade clevidipine should be considered over pharmacy-prepared nicardipine when rapid blood pressure lowering is warranted in acute CVA.

Acute induction of psoriasis-like skin inflammation disturbes vascular tone and provokes a rapid blood pressure response in mice

Abstract Background Psoriasis is the most common chronic skin disease worldwide. Furthermore, it is an independent cardiovascular risk factor. Several genetic and inducible murine models reproduce specific aspects of the human disease. In mice genetically overexpressing IL-17A in keratinocytes or dendritic cells, we coulod show both aspects of the disease: cutaneous hallmarks and the vascular phenotype. The most popular inducible model consists of topical application of Imiquimod (IMQ), a Toll-like receptor 7/8 agonist. In this model, cardiovascular aspects have not been studied yet. Therefore, we examined vascular and hemodynamic effects in this most popular murine psoriasis model. Methods C57BL/6J mice were treated with 5% IMQ or sham cream. During treatment, we measured bodyweight, skin thickness and skin water loss. After 10 days, aortic relaxation studies were performed. For assessment of vascular inflammation, inflammatory cell infiltration into the aortic tissue was investigated by flow cytometric analysis. To record physical activity, blood pressure and heart rate, carotid catheters were implanted two weeks before treatment with IMQ. Blood pressure and heart rate were continuously recorded by receiver platforms. Results IMQ treatment resulted in severe skin inflammation and induced a skin barrier defect resulting in a 7-fold increase of transcutaneous water loss (from 11±6 ml/m2h to 77±30 ml/m2h). Physical activity decreased more than 50% after d1 of treatment and normalized at d7. Telemetric recording revealed a reflex tachycardia at 1d of IMQ-application (from 492±21 bpm to 524±20 bpm) followed by a significant reduction of heart rate for the next two days (456±18bpm). Systolic blood pressure showed a similar trend: after a fast increase (from 120±13 mmHg to 127±18 mmHg), blood pressure dropped below baseline at d2/3 with a subsequent recovery. We could display a highly significant positive correlation between blood pressure and heart rate during the treatment (R=0.6; p≤0.0001). Aortas from animals after 10d of IMQ-treatment showed an increased infiltration of CD45+ and CD11b+ inflammatory cells but no change of responsiveness to endothelium dependent and independent vasodilators in organ chamber studies. Conclusion Skin treatment with IMQ had severe implications on the hemodynamic system: After an initial peak of heart rate and blood pressure, mice showed significantly lower values for two days with a subsequent full recovery. Moreover, bodyweight and physical activity were significantly altered during treatment. Our data indicate that skin inflammation and inflammatory skin barrier disruption by IMQ forces a compensatory whole-body response. 10 days of IMQ-treatment resulted in vascular inflammation without mediating vascular dysfunction. In summary, we could reveal that IMQ-induced psoriasis, as the most popular murine psoriasis model worldwide, has extensive effects on the cardiovascular system. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Boehringer Ingelheim Foundation “Novel and neglected cardiovascular risk factors: molecular mechanisms and therapeutic implications”German Federal Ministry for Education and Research (BMBF EDU-V24)

Oral Nifedipine versus Intravenous Labetalol for Acute Blood Pressure Control in Severe Hypertension of Pregnancy: A Study at Faridpur Medical College Hospital

The first line antihypertensive treatment for severe hypertension of pregnancy includes labetalol, hydralazine, or nifedipine. Rapid but safe blood pressure control allows the definitive treatment, the delivery of baby to be carried out with minimal delay and good maternal and fetal outcomes. This non-randomized clinical trial was performed in Faridpur Medical College Hospital to compare the effectiveness and tolerability of oral nifedipine and intravenous labetalol in the acute control of severe hypertension of pregnancy. Total 50 admitted pregnant women with a viable fetus (&gt;_ 24 weeks of gestation) having severe hypertension were allocated into two groups, Group A: 25 patients receiving oral nifedipine (10 mg), Group B: 25 patients receiving injectable labetalol (with incremental doses: 20, 40, 80mg). Up to 5 doses were tried for each drug at 15 minutes interval until target blood pressure (&lt;_150/100 mmHg) was achieved. Baseline characteristics like mean age, mean weight, heart rate, systolic and diastolic pressures were similar in both labetalol and nifedipine groups. The average time required to achieve target blood pressure was 30.33 ± 10.44 minutes for labetalol and 25.63 ± 10.12 minutes for nifedipine (p=0.9129). Feto-maternal outcomes and adverse drug related effects were similar among the two groups. Both intravenous labetalol and oral nifedipine were found to be equally effective and well tolerated. Nifedipine may be preferable as it is a simple, flat dose schedule and an oral regimen. Faridpur Med. Coll. J. 2021;16(1):25-29

Hypertensive emergency and hypertensive urgency management in the emergency department

Hypertension (HT) is a serious public health problem with an increasing prevalence all over the world. It is a significant cause of mortality and morbidity due to the complications it causes in the short and long term. The majority of applications to emergency departments are due to HT. Hypertensive crisis is defined as systolic blood pressure ≥ 180 mmHg and/or diastolic blood pressure ≥ 120 mmHg. It is evaluated under two separate headings according to the presence of target organ damage (TOD) accompanying these values. If TOD accompanies, it is defined as hypertensive emergency; if TOD is not present, it is defined as hypertensive urgency. Whether or not there is end-organ damage is the most important key point in the management of treatment. In hypertensive emergencies, treatment should be rapid to prevent target organ damage. For this purpose, emergency intravenous treatment should be applied, and the patient should be followed up under intensive care conditions for close hemodynamic follow-up. It has been shown that rapid blood pressure reduction in hypertensive urgency does not contribute to mortality and morbidity in the short term. In fact, it is not recommended because it is known that sudden lowering of blood pressure may cause hypoperfusion. For this purpose, oral antihypertensives are administered for treatment in hypertensive urgency and it is aimed to reach the target blood pressure values within days.

Impact of Uncontrolled Hypertension at 3Months After Intracerebral Hemorrhage.

BackgroundSurvivors of intracerebral hemorrhage (ICH) are at high risk for recurrent stroke, which is associated with blood pressure control. Because most recurrent stroke events occur within 12 to 18 months of the index ICH, rapid blood pressure control is likely to be crucial. We investigated the frequency and prognostic impact of uncontrolled short‐term hypertension after ICH.Methods and ResultsWe analyzed data from Massachusetts General Hospital (n=1305) and the University of Hong Kong (n=523). We classified hypertension as controlled, undertreated, or treatment resistant at 3 months after ICH and determined the following: (1) the risk factors for uncontrolled hypertension and (2) whether hypertension control at 3 months is associated with stroke recurrence and mortality. We followed 1828 survivors of ICH for a median of 46.2 months. Only 9 of 234 (4%) recurrent strokes occurred before 3 months after ICH. At 3 months, 713 participants (39%) had controlled hypertension, 755 (41%) had undertreated hypertension, and 360 (20%) had treatment‐resistant hypertension. Black, Hispanic, and Asian race/ethnicity and higher blood pressure at time of ICH increased the risk of uncontrolled hypertension at 3 months (all P<0.05). Uncontrolled hypertension at 3 months was associated with recurrent stroke and mortality during long‐term follow‐up (all P<0.05).ConclusionsAmong survivors of ICH, >60% had uncontrolled hypertension at 3 months, with undertreatment accounting for the majority of cases. The 3‐month blood pressure measurements were associated with higher recurrent stroke risk and mortality. Black, Hispanic, and Asian survivors of ICH and those presenting with severe acute hypertensive response were at highest risk for uncontrolled hypertension.

Multilevel Evaluation of Rapid Weight Loss in Wrestling and Taekwondo

The practice of strategies for rapid weight loss (RWL) involve diverse factors, such as individual expectations, social interactions, structural elements, etc., conforming to a “culture” of RWL, which must be evaluated and understood in a broad sense. Based on the need of a comprehensive evaluation of the use of RWL in practitioners of combat sports, an ad hoc questionnaire designed for this study, which includes the types and detailed descriptions of RWL strategies, that athletes currently use, the prevalence and frequency of use, the physiological and psychological consequences, the perception of the effect of RWL on their own performance and finally, the individuals who influence the adoption of this practice. One hundred and sixty combat athletes from wrestling and taekwondo disciplines, from Mexico, filled out this questionnaire. Data collected for their statistical analyses. Results revealed a RWL strategies prevalence of 96% across the participants. Our results revealed that 57% of those athletes using RWL lose more than 5% of their body mass. Across the athletes, the most commonly used RWL strategies and with higher intensity were increased exercise and training with plastic or thick clothes. The greater the relative weight loss, the greater the presence of physiological symptoms in athletes, such as rapid breathing and blood pressure. Athletes also mentioned mood states such as tiredness, sadness, confusion, fatigue and vigor, these last two positive and negative mood states are associated with the relative weight loss, respectively. Finally, the people who most influenced the adoption of RWL strategies were the coaches, parents and nutritionists. In conclusion, the questionnaire prepared for this study allowed us to obtain valuable information about the several factors, and their interactions, involved in the practice of RWL in combat athletes. This type of practice could increase health risks and decrease their performance. Therefore, here we state the importance of a comprehensive evaluation of RWL strategies that allows the development of psycho-educational and social-based interventions and programs for the promotion of proper weight maintenance, and prevention against RWL strategies, involving the individuals who influence the adoption of these practices and supporting it with the help of communication technologies.

Cardiovascular fingolimod effects on rapid baroreceptor unloading are counterbalanced by baroreflex resetting

Background and purposeInitial cardiovascular fingolimod effects might compromise baroreflex responses to rapid blood pressure (BP) changes during common Valsalva-like maneuvers. This study evaluated cardiovascular responses to Valsalva maneuver (VM)-induced baroreceptor unloading and loading upon fingolimod initiation.Patients and methodsTwenty-one patients with relapsing-remitting multiple sclerosis performed VMs before and 0.5, 1, 2, 3, 4, 5, and 6 hours after fingolimod initiation. We recorded heart rate (HR) as RR intervals (RRI), systolic and diastolic BP (BPsys, BPdia) during VM phase 1, VM phase 2 early, VM phase 2 late, and VM phase 4. Using linear regression analysis between decreasing BPsys and RRI values during VM phase 2 early, we determined baroreflex gain (BRG) reflecting vagal withdrawal and sympathetic activation upon baroreceptor unloading. To assess cardiovagal activation upon baroreceptor loading, we calculated Valsalva ratios (VR) between maximal and minimal RRIs after strain release. Analysis of variance or Friedman tests with post hoc analysis compared corresponding parameters at the eight time points (significance: p < 0.05).ResultsRRIs at VM phase 1, VM phase 2 early, and VM phase 2 late were higher after than before fingolimod initiation, and maximal after 4 hours. Fingolimod did not affect the longest RRIs upon strain release, but after 3, 5, and 6 hours lowered the highest BPsys values during overshoot and all BPdia values, and thus reduced VRs. BRG was slightly higher after 3 and 5 hours, and significantly higher after 4 hours than before fingolimod initiation.ConclusionsVR-decreases 3–6 hours after fingolimod initiation are physiologic results of fingolimod-associated attenuations of BP and HR increases at the end of strain and do not suggest impaired cardiovagal activation upon baroreceptor loading. Stable and at the time of HR nadir significantly increased BRGs indicate improved responses to baroreceptor unloading. Thus, cardiovascular fingolimod effects do not impair autonomic responses to sudden baroreceptor loading or unloading but seem to be mitigated by baroreflex resetting.

759. Where can we find active TB? Case finding at community sites and alcohol based venues (ABVs) in rural South Africa

BackgroundCommunity-based intensive case finding (CBICF) is an effective strategy for infectious disease case detection, particularly for hard-to-reach populations. Alcohol use is increasingly recognized as a risk factor for tuberculosis. We report on the association of alcohol use with tuberculosis case detection as part of a CBICF in a rural resource limited setting.MethodsIn rural KwaZuluNatal, South Africa, community health workers stationed outside ABVs, community centers, and public events conducted health education and voluntary confidential screening in a mobile clinic. A WHO endorsed TB symptom screen (with sputum collection for GeneXpert if ≥1 symptom), HIV rapid test, random glucose (elevated >7mmol/L), and blood pressure (elevated >140 or >90mmHg) were offered. Community members with positive results were referred to their primary care clinic. Alcohol Use Disorder Identification Test (AUDIT) was used to identify hazardous drinking (score ≥8for men, ≥6for women). Here we report on TB screening results only.ResultsAmong 1438 participants, 91.2% were screened at ABV, 72.3% were male, median age was 30 (IQR 22-46), 25.9% were employed, 92.0% had electricity but only 29.4% had running water. Among those screened at all sites, 43.1% reported hazardous alcohol use, 39.3% tobacco use, and 13.9% cannabis use. Overall, 5 people with active TB were identified representing a number needed to screen of 288 to identify one case of TB. Bivariate analysis showed TB cases were more likely to be associated with older age (p=0.03), cigarette use (p=0.06), and hazardous alcohol use (p=0.01). Among only men who were screened, older age (p=0.01) and hazardous alcohol use (p=0.04) were associated with active TB disease. The mean AUDIT score among TB cases was 13.8 (SD 4.09) compared to non-TB cases 6.8 (SD 7.5) (p=0.04).ConclusionCBICF is a useful way to detect people with active TB, especially for hard-to-reach rural populations. Focusing screening efforts among those at ABVs is high yield and can be a useful adjunctive strategy for TB case finding efforts. These findings highlight a need for comprehensive substance abuse services to assist those at high risk for TB acquisition.Disclosures All Authors: No reported disclosures

Treatment With Angiotensin II Is Associated With Rapid Blood Pressure Response and Vasopressor Sparing in Patients With Vasoplegia After Cardiac Surgery: A Post-Hoc Analysis of Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) Study

The present study investigated outcomes in patients with vasoplegia after cardiac surgery treated with angiotensin II plus standard-of-care vasopressors. Vasoplegia is a common complication in cardiac surgery with cardiopulmonary bypass and is associated with significant morbidity and mortality. Approximately 250,000 cardiac surgeries with cardiopulmonary bypass are performed in the United States annually, with vasoplegia occurring in 20%to-27% of patients. Post-hoc analysis of the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) study. Multicenter, multinational study. Sixteen patients with vasoplegia after cardiac surgery with cardiopulmonary bypass were enrolled. Angiotensin II plus standard-of-care vasopressors (n = 9) compared with placebo plus standard-of-care vasopressors (n = 7). The primary endpoint was mean arterial pressure response (mean arterial pressure ≥75 mmHg or an increase from baseline of ≥10 mmHg at hour 3 without an increase in the dose of standard-of-care vasopressors). Vasopressor sparing and safety also were assessed. Mean arterial pressure response was achieved in 8 (88.9%) patients in the angiotensin II group compared with 0 (0%) patients in the placebo group (p = 0.0021). At hour 12, the median standard-of-care vasopressor dose had decreased from baseline by 76.5% in the angiotensin II group compared with an increase of 7.8% in the placebo group (p = 0.0013). No venous or arterial thrombotic events were reported. Patients with vasoplegia after cardiac surgery with cardiopulmonary bypass rapidly responded to angiotensin II, permitting significant vasopressor sparing.

Advances in Therapeutic Approaches for Spontaneous Intracerebral Hemorrhage.

Spontaneous intracerebral hemorrhage (ICH) results in high rates of morbidity and mortality, with intraventricular hemorrhage (IVH) being associated with even worse outcomes. Therapeutic interventions in acute ICH have continued to emerge with focus on arresting hemorrhage expansion, clot volume reduction of both intraventricular and parenchymal hematomas, and targeting perihematomal edema and inflammation. Large randomized controlled trials addressing the effectiveness of rapid blood pressure lowering, hemostatic therapy with platelet transfusion, and other clotting complexes and hematoma volume reduction using minimally invasive techniques have impacted clinical guidelines. We review the recent evolution in the management of acute spontaneous ICH, discussing which interventions have been shown to be safe and which may potentially improve outcomes.

Obesity, Hypertension, and Bariatric Surgery.

Obesity increases the risk of hypertension. However, blood pressure decreases before any significant loss of body weight after bariatric surgery. We review the mechanisms of the temporal dissociation between blood pressure and body weight after bariatric surgery. Restrictive and bypass bariatric surgery lower blood pressure and plasma leptin levels within days of the procedure in both hypertensive and normotensive morbidly obese patients. Rapidly decreasing plasma leptin levels and minimal loss of body weight point to reduced sympathetic nervous system activity as the underlying mechanism of rapid blood pressure decline after bariatric surgery. After the early rapid decline, blood pressure does not decrease further in patients who, while still obese, experience a steady loss of body weight for the subsequent 12months. The divergent effects of bariatric surgery on blood pressure and body weight query the role of excess body weight in the pathobiology of the obesity phenotype of hypertension. The decrease in blood pressure after bariatric surgery is moderate and independent of body weight. The lack of temporal relationship between blood pressure reduction and loss of body weight for 12 months after sleeve gastrectomy questions the nature of the mechanisms underlying obesity-associated hypertension.

Early Initiation of Oral Antihypertensives Reduces Intensive Care Unit Stay and Hospital Cost for Patients with Hypertensive Intracerebral Hemorrhage

Intravenous nicardipine infusion is effective for rapid blood pressure control. However, its use requires hemodynamic monitoring in the intensive care unit (ICU) and is associated with high hospital cost. This study aimed to examine the effect of early versus late initiation of oral antihypertensives on ICU length of stay (LOS) and cost of hospitalization in patients with hypertensive intracerebral hemorrhage (ICH). This is a single-center retrospective study of patients with hypertensive ICH treated with nicardipine infusion from January 1, 2013, to December 31, 2017. Patients were dichotomized into study and control groups, based on receiving oral antihypertensives within 24h versus after 24h of emergency department arrival. Baseline characteristics, duration of nicardipine infusion, LOS in the ICU and hospital, functional outcome at discharge, and hospital cost were compared between the two groups using univariate and multivariate analysis. A total of 90 patients in the study group and 76 in the control group were identified. There was no significant difference in demographics, past medical history, and initial SBP between the two groups. After adjusting for confounding factors with multivariate regression models, early initiation of oral antihypertensives was associated with significant reductions in duration of nicardipine infusion (55.5 ± 60.1 vs 121.6 ± 141.3h, p <0.005), nicardipine cost ($14,207 vs $29,299, p < 0.01), ICU LOS (2 vs 5days, p < 0.005), and cost of hospitalization ($24,564 vs $47,366, p < 0.01). There was no significant difference in adversary renal events, favorable outcomes, and mortality between the two groups. Early initiation of oral antihypertensives is safe and may have a significant financial impact on patients with hypertensive ICH.

Comparison of the effects of early pelvic floor muscle rehabilitation on postpartum pelvic floor rehabilitation and sexual function in different delivery methods

Objective To observe the effect of early pelvic floor muscle rehabilitation on postpartum pelvic floor rehabilitation and sexual function in different delivery methods. Methods Ninety-three parturient women who admitted to the Department of Obstetrics and Gynecology in Taizhou Hospital from January 2018 to December 2018 were divided into cesarean section group (53 cases) and vaginal delivery group (40 cases) according to the mode of delivery.Early pelvic floor muscle rehabilitation was performed in both two groups.Maternal pelvic floor rehabilitation was assessed by pelvic floor muscle pressure and muscle fiber contraction, and maternal sexual function was assessed by sexual function status score. Results Before treatment, the sustained systolic blood pressure of type Ⅰ muscle fibers[(28.14±3.03)cmH2O vs.(27.66±3.14)cmH2O], the duration of type Ⅰ muscle fibers[(9.54±1.04)s vs.(9.66±1.00)s], the rapid systolic blood pressure of type Ⅱ muscle fibers[(48.14±3.03)cmH2O vs.(47.66±3.14)cmH2O], and the contraction of type Ⅱ muscle fibers[(2.54±1.04) vs.(2.66±1.00)] had no statistically significant differences between the two groups (t=0.401, 0.312, 2.401, 0.324, all P>0.05). After treatment, the sustained systolic blood pressure of type Ⅰ muscle fibers, duration of type Ⅰ muscle fibers, rapid systolic blood pressure of type Ⅱ muscle fibers, and the contraction of type Ⅱ muscle fibers had statistically significant differences between the two groups (t=10.642, 10.214, 10.672, 10.254, all P 0.05). After intervention, both two indicators were elevated, and the differences were statistically significant compared with before treatment (t=12.093, 14.152, all P 0.05). Conclusion Early pelvic floor rehabilitation is beneficial to the recovery of pelvic floor and sexual function. Key words: Pelvic floor; Hospitals, convalescent; Cesarean section; Natural childbirth

Rapid blood pressure increase after renal denervation in anaesthetized rats: interaction of oxidative stress and neuronal nitric oxide synthase.

We showed previously that in anaesthetized rats acute noninvasive renal denervation (DNX) induced an increase in arterial blood pressure (MABP), unlike the usual hypotensive effect. Here we aimed to establish the background of such unusual response, especially the role of oxidative stress as suggested by an earlier study. The contribution of oxidative stress was explored by studying the effects on DNX-induced MABP increase of pretreatment with 4-hydroxy-3-methoxyacetophenone (apocynin, APO), a powerful antioxidant and antihypertensive agent, and N(omega)-propyl-L-arginine (L-NPA), a blocker of neuronal nitric oxide synthase (nNOS). In anaesthetized Wistar rats maintained on standard (STD) or high-salt (HS) diet sequential right- and left-side DNX was performed. MABP responses were examined without pretreatment and after APO (20 mg/day on two preceding days) and L-NPA (1 mg/kg/h throughout experiment), given alone or combined. In untreated rats, bilateral DNX increased MABP by 6% on STD and 15% on HS diet (P < 0.01 or less); the difference between MABP responses was highly significant (P = 0.002). In STD rats APO or APO + L-NPA treatment failed to alter post-DNX MABP increases whereas L-NPA alone reversed the response and a significant 7% decrease occurred. In HS rats APO and L-NPA given alone reversed the MABP response and significant decreases of 14% (P = 0.001) and 8% (P = 0.01), were seen. Surprisingly, with L-NPA + APO pretreatment only abolishment (not reversal) of post-DNX pressure increase occurred. The results suggest that both systemic, intrarenal and brain oxidative stress, and excessive nNOS activity, mostly in the brain, determine the unexpected post-DNX pressure increase.

Biodegradable Therapeutic Microneedle Patch for Rapid Antihypertensive Treatment.

A hypertensive emergency causes severe cardiovascular diseases accompanied by acute target organ damage, requiring rapid and smooth blood pressure (BP) reduction. Current medicines for treating hypertensive emergencies, such as sodium nitroprusside (SNP), require careful dose control to avoid side effects (e.g., cyanide poisoning). The clinical administration of SNP using intravenous injection or drip further restrict its usage for first aid or self-aid in emergencies. Here, we developed an antihypertensive microneedle (aH-MN) technique to transdermally deliver SNP in combination with sodium thiosulfate (ST) as a cyanide antidote in a painless way. Dissolvable microneedles loaded with SNP and ST were fabricated via the centrifugation casting method, where the SNPs were stably packaged in microneedles and would be immediately released into the systemic circulation via subcutaneous capillaries when aH-MNs penetrated the skin. The antihypertensive effects were demonstrated on spontaneously hypertensive rat models. Rapid and potent BP reduction was achieved via aH-MN treatment, fulfilling clinical BP-control requirements for hypertensive emergencies. The side effects including skin irritation and target organ damage of aH-MN therapies were evaluated; the combinative delivery of ST effectively suppressed these side effects induced by the consecutive intake of SNP. This study introduces an efficient and patient-friendly antihypertensive therapy with a favorable side-effect profile, particularly a controllable and self-administrable approach to treat hypertensive emergencies.