Diastolic Blood Pressure Recordings Research Articles

Mean arterial pressure, fitness, and executive function in middle age and older adults.

Previous literature suggests that higher fitness is related to better executive function in older adulthood, but the mechanisms underlying this association are poorly understood. While many studies have focused on these associations in older adulthood, recent evidence suggests the importance of cardiorespiratory fitness (CRF) and long-term blood pressure control on cognitive functioning. The purpose of the current study was to examine whether mean arterial pressure (MAP) mediated the association between CRF and executive function in middle age and older adults. Participants were adults (age 40+) without any self-reported psychiatric and neurological disorders or cognitive impairment from the Nathan Kline Institute Rockland Sample (N=224, M age=56). CRF was defined by V̇O2max estimated via a bike test, neuropsychological testing was used to examine executive functioning, and MAP was calculated from systolic and diastolic blood pressure recordings. Mediation models were analyzed controlling for age, sex, and education. Results indicated that higher CRF was associated with better inhibition (B=-0.0048, t=-2.16, p=0.03) and there was a significant indirect effect of greater CRF on better inhibition through lower MAP (B=-0.0011; CI [-0.0026, -0.0002]). There were additional significant indirect effects of greater CRF and better fluency (B=0.0028; CI [.0009, 0.0053]) and planning (B=0.0037; CI [.0014, 0.0074]) through lower MAP. This suggests that MAP may be an underlaying physiological mechanism by which CRF influences executive function in mid- and older adulthood.

VALIDATION OF THE VITA-D1 NONINVASIVE CONTINUOUS BLOOD PRESSURE MONITOR WITH PHOTOPLETHYSMOGRAPHY-ONLY TECHNOLOGY FOR SELF-MEASUREMENT AND CLINIC USE

Objective: Hypertension is still a prevalent health burden without adequate population awareness. As a diagnostic footstone and prognostic indicator, it is of great importance to precisely measure blood pressure (BP). The referenced methods to date for BP measurements are based on inflated cuff. However, stress may contribute to unanticipated BP increasements. Hence, conventional methods limit the efficiency of BP management. A promising BP measuring device with no cuff inflation is clinic practical. Yet, no robust devices with beat-to-beat photoplethysmography (PPG)-only technique have been validated. Design and method: Participants were recruited among out- and inpatients at the Department of Hypertension and Vascular Disease, from May 2019 to November 2019. Exclusive criteria mainly included age below 25 years old, pregnancy, arrythmia and poor quality Korotkoff sounds. Before initiation, an entrance BP measurement based on calibrated mercury sphygmomanometer was needed for each participant for test device calibration. The validation procedure was prospectively conducted following the European Society of Hypertension International Protocol (ESH-IP) revision 2010 in adults. Results: A total of 48 participants were screened and final 33 were enrolled (10 females, mean age 52.1 ± 11.3 years). 99 pairs of comparisons were obtained from 33 enrollees. The number of measurements within a difference range of up to 5 mmHg were 80 for systolic blood pressure (SBP) and 94 for diastolic blood pressure (DBP). All of the 99 SBP and DBP recordings were in a difference range of up to 15 mmHg. Mean observer-test device differences were −1.1 ± 4.2 mmHg for SBP and −1.3 ± 3.0 mmHg for DBP. Meanwhile, 28 and 32 enrollees had at least 2 out of 3 device-observers differences no more than 5 mmHg for SBP and DBP, respectively. Conclusions: The VITA-D1 passed the validation criteria according to the ESH-IP revision 2010 and may be recommended for clinical or self BP monitoring. Being innovative for its cuffless and user-friendly design, VITA-D1 is a promising device for reliable, convenient, and comfortable BP measurements.

Vascular Inflammation and Cardiovascular Burden in Metastatic Breast Cancer Female Patients Receiving Hormonal Treatment and CDK 4/6 Inhibitors or Everolimus

Background: Chemotherapy regimens for breast cancer treatment can promote vascular dysfunction and lead to high cardiovascular risk.Purpose: To investigate the cardiovascular burden and vascular inflammation in metastatic breast cancer patients receiving CDK 4/6 inhibitors or everolimus in addition to standard hormonal treatment.Methods: 22 consecutive female patients with metastatic breast cancer were enrolled. Relative wall thickness (RWT) and left ventricle mass (LVM) measurements by transthoracic echocardiography were obtained followed by 24-h ambulatory blood pressure monitoring, and 18F-fluorodeoxyglucose positron-emission tomography/computed tomography imaging. Uptake of the radiotracer in the aortic wall was estimated as tissue-to-background ratio (TBR). Each patient was assessed for the aforementioned parameters before the initiation and after 6 months of treatment.Results: At follow up, patients assigned to CDK 4/6 treatment demonstrated increased 24-h systolic blood pressure (SBP) (p = 0.004), daytime SBP (p = 0.004) and night time SBP (p = 0.012) (Group effect). The 24-h mean arterial pressure measurements were also higher in CDK 4/6 population, in comparison to everolimus that displayed firm values (Group effect- p = 0.035, Interaction effect-p = 0.023). Additionally, 24 h diastolic blood pressure recordings in CDK 4/6 therapy were higher opposed to everolimus that remained consistent (Interaction effect- p = 0.010). In CDK 4/6 group, TBR aorta also increased significantly, whereas TBR values in everolimus remained stable (Interaction effect-p = 0.049). Both therapeutic regimens displayed statistically significant damaging effect to RWT and LVM.Conclusion: CDK 4/6 inhibitors and hormonal treatment can lead to increased vascular inflammation, and higher blood pressure compared to the combination of everolimus and hormonal treatment. Moreover, both treatment strategies promoted left ventricle remodeling.

Vascular inflammation and cardiovascular burden in metastatic breast cancer female patients receiving hormonal treatment and CDK 4/6 inhibitors or everolimus

Abstract Background Chemotherapy regimens for breast cancer treatment can promote vascular dysfunction and lead to high cardiovascular risk. Purpose The aim of this study was to investigate the cardiovascular burden and vascular inflammation in metastatic breast cancer patients receiving either CDK 4/6 inhibitors and hormonal treatment or standard everolimus and hormonal treatment. Methods 22 consecutive female patients with metastatic breast cancer that expressed estrogen and /or progesteron receptor and were HER2-negative were enrolled. Patients with active infection, chronic autoimmune disease and history of chemotherapy for the metastatic disease and/or adjuvant chemotherapy during the past 3 years were excluded. All subjects received hormonal treatment and of those, 10 received everolimus and 12 received therapy with CDK 4/6 inhibitors. The two groups were matched for age, history of hypertension, diabetes, dyslipidemia, smoking and all were free of major cardiovascular events for the past 6 months. Regional wall thickness (RWT) and left ventricle mass (LVM) measurements by transthoracic echocardiographic study were obtained followed by 24 hour ambulatory blood pressure monitoring, and 18F-fluorodeoxyglucose positron-emission tomography/computed tomography imaging. Radiotracer uptake in the aortic wall (ascending, arch, descending, abdominal), was quantified as tissue-to-background ratio (TBR).Each patient was assessed for the aforementioned parameters before the initiation and after 6 months of treatment. Results At follow up, patients assigned to CDK4/6 treatment demonstrated increased measurements of 24 hour systolic blood pressure (SBP) (p=0.004), daytime SBP(p=0.004) and night time SBP (p=0.012) (Group effect). The 24 hour mean arterial pressure measurements were also higher in CDK 4/6 population, in comparison to everolimus that displayed firm values. (Group effect- p=0.035, Interaction effect-p=0.023).Additionally, 24 hour diastolic blood pressure recordings in CDK 4/6 therapy were higher opposed to everolimus that remained consistent (Interaction effect- p=0.010). In CDK 4/6 group, TBR aorta measurements also increased significantly, whereas TBR values in everolimus remained stable. (Interaction effect-p=0.049). Both therapeutic regimens displayed statistically significant damaging effect with regards to the following variables: Night-time SBP (p=0.032), RWT (p<0.001), and LVM (p<0.001). Conclusion Chemotherapy with novel CDK 4/6 inhibitors and hormonal treatment can lead to increased vascular inflammation, and higher blood pressure values compared to the combination of everolimus and hormonal treatment in female patients with HR-positive HER2-negative metastatic breast cancer. Moreover, both treatment strategies promote remodelling of the left ventricle by means of increased RWT and mass. Further research and longitudinal studies in this field are required to validate the above findings. Funding Acknowledgement Type of funding source: None

2-Chloroprocaine and Bupivacaine for lower abdomen and lower limb surgeries under spinal anesthesia: Effects on Haemodynamics

Systemic absorption of local anesthetics produces effects on the cardiovascular and central nervous systems. At blood concentrations achieved with normal therapeutic doses, changes in cardiac conduction, excitability, refractoriness, contractility, and peripheral vascular resistance are minimal. However, toxic blood concentrations depress cardiac conduction and excitability, which may lead to atrioventricular block and ultimately to cardiac arrest. In addition, with toxic blood concentrations myocardial contractility may be depressed and peripheral vasodilation may occur, leading to decreased cardiac output and arterial blood pressure. Patients aged between 18 to 60 years of either gender, belonging to ASA Grade I and II, for elective lower limb and lower abdominal surgeries under spinal anaesthesia. In this present study, diastolic blood pressure recordings were not statistically significant between the two groups observed at different time intervals.

Impact of Simulated Hyperventilation and Periodic Breathing on Sympatho-Vagal Balance and Hemodynamics in Patients with and without Heart Failure

Background: The effects of hyperventilation and hyperventilation in the context of periodic breathing (PB) on sympatho-vagal balance (SVB) and hemodynamics in conditions of decreased cardiac output and feedback resetting, such as heart failure (HF) or pulmonary arterial hypertension (PAH), are not completely understood. Objectives: To investigate the effects of voluntary hyperventilation and simulated PB on hemodynamics and SVB in healthy subjects, in patients with systolic HF and reduced or mid-range ejection fraction (HFrEF and HFmrEF) and in patients with PAH. Methods: Study participants (n = 20 per group) underwent non-invasive recording of diastolic blood pressure, heart rate variability (HRV), baroreceptor-reflex sensitivity (BRS), total peripheral resistance index (TPRI) and cardiac index (CI). All measurements were performed at baseline, during voluntary hyperventilation and during simulated PB with different length of the hyperventilation phase. Results: In healthy subjects, voluntary hyperventilation led to a 50% decrease in the mean BRS slope and a 29% increase in CI compared to baseline values (p < 0.01 and p < 0.05). Simulated PB did not alter TPRI or CI and showed heterogeneous effects on BRS, but analysis of dPBV revealed decreased sympathetic drive in healthy volunteers depending on PB cycle length (p < 0.05). In HF patients, hyperventilation did not affect BRS and TPRI but increased the CI by 10% (p < 0.05). In HF patients, simulated PB left all of these parameters unaffected. In PAH patients, voluntary hyperventilation led to a 15% decrease in the high-frequency component of HRV (p < 0.05) and a 5% increase in CI (p < 0.05). Simulated PB exerted neutral effects on both SVB and hemodynamic parameters. Conclusions: Voluntary hyperventilation was associated with sympathetic predominance and CI increase in healthy volunteers, but only with minor hemodynamic and SVB effects in patients with HF and PAH. Simulated PB had positive effects on SVB in healthy volunteers but neutral effects on SVB and hemodynamics in patients with HF or PAH.

Relation of Blood Pressure to Severity of Pericardial Effusion

Subacute tamponade is a challenging diagnosis requiring careful consideration of both clinical and imaging data. We aimed at exploring the association of initial blood pressure with markers of pericardial effusion severity in patients with moderate and large pericardial effusion. We conducted a retrospective, single-center study in 102 well-phenotyped patients with moderate and large pericardial effusion. The presenting systolic and diastolic blood pressure recordings were divided into tertiles to examine the association between the blood pressure and the different established markers of pericardial effusion severity. On presentation, 42% of patients had systolic blood pressure exceeding 130 mmHg, and only 5% of patients had systolic blood pressure <90 mmHg. Patients in the lowest blood pressure tertiles did not differ significantly from patients in the upper tertiles in terms of clinical, etiologic, or echocardiographic characteristics. Although patients who underwent pericardial drainage had higher presenting heart rates, no significant differences were seen in the blood pressure recordings, either systolic or diastolic (mean 125 mmHg vs 130 mmHg, p = 0.36 and 76 vs 75 mmHg, p = 0.82, respectively). In conclusion, systolic and diastolic blood pressure recordings upon initial presentation do not demonstrate a significant association with markers of effusion severity or the need for drainage in patients with moderate and large pericardial effusion.

Timing is everything: Anticipatory stress dynamics among cortisol and blood pressure reactivity and recovery in healthy adults

Psychological states of anticipation modulate biological stress responsivity. While researchers generally investigate how subjective distress corresponds to the magnitude of stress reactivity, physiological recovery after acute stressors must also be considered when investigating disease vulnerabilities. This study assessed whether anticipatory stress would correspond to stress reactivity and recovery of salivary cortisol and blood pressure levels in response to a well-validated psychosocial stressor. Thirty participants (63% female; mean ± SEM age 45.4 ± 2.12 years) were exposed to the Trier Social Stress Test (TSST) consisting of a public speech and mental arithmetic. Ten salivary cortisol samples and systolic and diastolic blood pressure recordings were collected at time points spanning 50 min before and up to 50 min after stress exposure. These data were transformed into parameters representing stress reactivity (area under the curve) and stress recovery (percent change). The Primary Appraisal Secondary Appraisal scale assessed anticipatory stress before exposure to the TSST. Our results revealed that increased anticipatory stress predicted increased stress reactivity for cortisol (p = 0.009) but not blood pressure. For stress recovery, increased anticipatory stress predicted greater decrements of cortisol concentration (p = 0.015) and blood pressure (p = 0.039), even when controlling for total systemic “output” by incorporating baseline activity. This efficient shutdown of stress responses would have otherwise been ignored by solely investigating reactive increases. These findings underscore the importance of measuring multiple dynamic parameters such as recovery when investigating physiological stress response patterns as a function of psychosocial factors.

Role of proteinuria in defining pre‐eclampsia: Clinical outcomes for women and babies

1. The presence of proteinuria is not essential to the diagnosis of pre-eclampsia under many diagnostic consensus statements. The aim of the present study was to assess maternal and perinatal outcomes after proteinuric pre-eclampsia compared with other non-proteinuric disease presentations. 2. An individual patient data review (n = 670) was undertaken for 2003-2006 at a tertiary referral centre in Sydney (NSW, Australia). Women were diagnosed in accordance with the Australasian Society for the Study of Hypertension in Pregnancy Consensus Statement. Data were analysed with the Chi-squared test, t-tests and non-parametric tests. Statistical significance was set at P < 0.05. 3. The proteinuric cohort had higher systolic and diastolic blood pressure recordings than the non-proteinuric cohort (160/102 and 149/94 mmHg, respectively; P < 0.001), and were also administered magnesium sulphate more frequently (44 vs 22%, respectively; P < 0.001), delivered at earlier gestation (37 vs 38 weeks, respectively; P < 0.001), required operative delivery more frequently (63 vs 48%, respectively; P < 0.001) and received more antihypertensive medications during the antenatal period (72 vs 57%, respectively; P < 0.001). Acute renal failure and acute pulmonary oedema were rare. Four cases of eclampsia all occurred in non-proteinuric women. The perinatal mortality rate was lower for the offspring of women with proteinuric pre-eclampsia compared with offspring of non-proteinuric women (13/1000 and 31/1000, respectively; P = 0.006). 4. The results of the present study indicate that the presence of proteinuria denotes a group of women who have higher antenatal blood pressure, who deliver at earlier gestation and require operative delivery more commonly, although it is not an indicator of other markers of maternal morbidity or perinatal mortality.

Comparison of agreement between different measures of blood pressure in normotensive females

The aim of this study was to determine whether there are differences between nurse-taken blood pressure (BP), physician-taken BP, and automated device. BP was measured in 163 normotensive females. In a center for family planning and mother–child health, measurements were taken by a male physician and by a nurse and by using a validated automatic device. The difference between the systolic and diastolic BP recordings at the three measurement modalities was statistically significant ( p < .001). BPs taken by the physician were markedly higher than the measurements taken by the nurse and the automated device. The results from this study show that systolic and diastolic BP taken using an automated device in normotensive females are significantly lower than the readings obtained by the physician and are almost identical to those taken by the nurse. Physicians should therefore not make any decisions based on BP measured manually during a first encounter and should rely on BP reported by well-trained observers or by validated automatic devices.

ABPM vs. office blood pressure to define blood pressure control in treated hypertensive paediatric renal transplant recipients

While 24-h ambulatory blood pressure monitoring (ABPM) is an established tool for monitoring antihypertensive therapy in adults, data in children are scarce. We retrospectively analysed whether office blood pressure (BP) is reliable for the diagnosis of BP control in 26 treated hypertensive paediatric renal transplants. Controlled office BP was defined as the mean of three replicate systolic and diastolic BP recordings less than or equal to the 95th age-, sex- and height-matched percentile on the three-outpatient visits closest to ABPM. Controlled ABPM was defined as systolic and diastolic daytime BP < or =95th distribution adjusted height- and sex-related percentile of the adapted ABPM reference. Eight recipients (30%) with controlled office BP were in fact categorized as having non-controlled BP by ABPM criteria. Overall, when office BP and ABPM were compared using the Bland and Altman method, the 95% limits of agreement between office and daytime values ranged from -12.6 to 34.1 mmHg for systolic and -23.9 to 31.7 mmHg for diastolic BP, and the mean difference was 10.7 and 3.9 mmHg respectively. Office readings miss a substantial number of recipients who are hypertensive by ABPM criteria. Undertreatment of hypertension could be avoided if ABPM is applied as an adjunct to office readings.

Effect of Sibutramine on Weight Management and Metabolic Control in Type 2 Diabetes

The aim of this study was to provide a comprehensive meta-analysis of randomized controlled clinical studies on the effects of sibutramine on weight loss and glycemic control in obese subjects with type 2 diabetes. Controlled clinical trials assessing the effect sizes of sibutramine on weight loss effects on glycemia in obese subjects with type 2 diabetes were identified and reviewed using the Cochrane Library, Medline, EMBASE, and a manual search. Eight placebo-controlled, double-blind, randomized trials of sibutramine were included. After sibutramine treatment, the decrease in body weight and waist circumference was significantly greater than in the placebo group. Fasting blood glucose and HbA(1c) significantly decreased after sibutramine treatment. Treatment benefits were seen in plasma triglycerides and HDL, without significant variations in serum total and LDL cholesterol. No differences in systolic blood pressure between the sibutramine and the placebo groups were seen, while recording of diastolic blood pressure and heart rate showed that sibutramine produced a small increase relative to placebo. A pharmacological approach in a weight management program for patients with type 2 diabetes may be helpful in glycemic control and in the management of other risk factors. Sibutramine may help improve glucose control because it is conducive to weight loss. The reviewed data on the effect of sibutramine further enforce the recommendations that weight management may be the most important therapeutic task for most obese subjects with type 2 diabetes.

Knowledge of blood pressure measurement among a teaching hospital staff in a developing nation.

Hypertension is a common and potentially serious disease and accurate measurement of blood pressure (BP) is important for its diagnosis and management. The aim of this study was to assess the knowledge of hospital staff on the basic principles of BP measurement. Consultants, junior doctors and nurses in a large teaching hospital in southern Saudi Arabia were requested to answer a questionnaire about the most important aspects pertaining to BP measurement. The overall response rate was about 70%. There was a wide diversity of responses reflecting a poor knowledge of some of the basic techniques of BP measurement. This included inconsistencies regarding the knowledge of cuff size, recording of diastolic BP, position of the arm and rate for deflating the cuff. Overall, 60% of the respondents had insufficient knowledge. Inaccurate BP measurement can seriously affect the diagnosis and management of the patient with this common disease. Hospital staff need to improve their knowledge about BP measurement, and teaching programmes about BP measurement should be developed as part of continuing education.