Rise In Blood Pressure Research Articles

Low molecular weight heparins promote migration and invasion of trophoblast cells through regulating the PI3K/AKT signaling pathway.

Pregnant women confront a high risk of mortality due to preeclampsia (PE), which also results in severe challenges for newborns. Due to their efficient properties and minimal side effects, low molecular weight heparins (LMWHs) are extensively utilized by optimizing their molecular size. Nevertheless, there have been no reports regarding the alleviating effect of LMWHs on PE and the molecular mechanism underlying it. To examine the therapeutic impact of LMWHs on PE, we initially created a PE rat model and assessed the advantages of LMWHs on PE through Western blot, immunofluorescence, TUNEL, 24-h proteinuria determination, and other techniques. Furthermore, we examined the in vitro molecular mechanism of LMWHs therapy on PE using CCK-8, Transwell, Flow cytometry, Wound healing assay, and other techniques. LMWHs, when used in vivo, reduced the rise in blood pressure and 24-h proteinuria in rat models of PE. Additionally, they prevented trophoblast cell apoptosis in these rat models. In vitro, LMWHs demonstrated a significant ability to enhance the migration and invasion of HTR-8 and JEG-3 cells. Mechanistically, LMWHs mitigate the development of PE by activating the PI3K/AKT signaling pathway. According to our findings, the activation of the PI3K/AKT signaling pathway by LMWHs appears to provide relief for PE. Therefore, we have compelling evidence supporting the use of LMWHs as an efficient treatment for PE.

Leisure sedentary time and elevated blood pressure: evidence from the statutory retirement policy.

The relationship between sedentary behaviors and elevated blood pressure remains inconclusive, and the socioeconomic mechanisms underlying the linkage are rarely discussed. Since retirement is often associated with behavioral changes that impact health, this study aims to provide evidence on changes in leisure sedentary time after the statutory retirement age on elevated blood pressure, along with the socioeconomic mechanisms. We utilized data from five waves (2004-2015) of the China Health and Nutrition Survey (CHNS), focusing on males aged 55-65 employed in the formal sector. Leisure sedentary time, the independent variable, was measured based on self-reported data, while diastolic (DBP) and systolic (SBP) blood pressure were the dependent variables. Using statutory retirement policy as an exogenous variation, we employed a continuous difference-in-differences (DID) framework and a propensity score matching difference-in-differences (PSM-DID) approach to examine the relationship between changes in leisure sedentary time after the statutory retirement age and elevated blood pressure. The analysis was conducted using ordinary least squares (OLS). To address potential endogeneity, we applied the instrumental variable (IV) method via two-stage least squares (2SLS). Our findings indicate an increase in diastolic blood pressure after statutory retirement, attributed to increased leisure sedentary time. However, there was no significant increase in systolic blood pressure. Moreover, physical activity did not appear to offset this rise in blood pressure, while higher educational attainment and having family members employed in the medical field helped mitigate its negative effects. This study highlights the potential adverse impact of increased leisure sedentary time on diastolic blood pressure among middle-aged men in the formal sector, while also exploring the socioeconomic factors that may alleviate these effects. These results provide a foundation for public health initiatives aimed at addressing the rising prevalence of sedentary behavior and its association with blood pressure issues.

Association between late pregnancy prehypertension and adverse outcomes among newborns of women delivered at a tertiary hospital in Eastern Uganda: a prospective cohort study

BackgroundPrehypertension during pregnancy is currently not considered as a high-risk pregnancy state in existing guidelines despite recent research correlating it with higher rates of morbidity and mortality in both the mother and the fetus. Studies on prehypertension have not been conducted in Africa despite high rates of poor neonatal outcomes.AimsThe study aimed to determine the association between late pregnancy prehypertension and adverse outcomes in newborns of women with late pregnancy prehypertension at Jinja Regional Referral Hospital.Methods and materialsBetween September 2022 and January 2023, a hospital-based prospective cohort study including 300 pregnant women was conducted. Participants were divided according to third-trimester blood pressure, as determined by the JNC-8 criteria. Following hospital admission for labor and delivery, 150 normotensive women and 150 prehypertensive women were identified and followed until delivery, and their neonates were followed until death or hospital discharge. A p value of ≤ 0.05 was the threshold for statistical significance when comparing the groups using the relative risk, X2, and Mantel-Haenszel adjustment.ResultsComposite adverse neonatal outcomes were more common in prehypertensive women compared to normotensive women (48.67% versus 32.67%), particularly Small-for-Gestation Age (SGA), stillbirth, and composite adverse neonatal outcomes had significantly higher likelihood, with aRRs of 1.63 (95% CI 1.10–2.42, p = 0.037), 9.0 (95% CI 1.15–70.16, p = 0.010), and 1.55 (95% CI 1.16–2.08, p < 0.001), respectively. By a linear model, birthweight decreased by 45.1 g for every 10 mmHg rise in systolic blood pressure (p = 0.041, Pearson correlation of -0.118).Conclusion and recommendationsPrehypertension in late pregnancy increased risks for adverse neonatal outcomes, thus a need to potentially lower pregnancy hypertension cut-off levels possibly through adopting the ACC/AHA blood pressure definitions for pregnant women.

Effect of endothelin-1 on the blood pressure response to acute hypoxia and hyperoxia in healthy young men.

Endothelin-1 (ET-1) and its receptors are linked to increases in sensitivity of the chemoreceptors to hypoxic stress and the development of hypertension in preclinical models. We hypothesized ET receptor antagonism would lower resting blood pressure (BP) as well as the acute BP response to chemoreflex stress. Twenty-four men (31 ± 5 years, 26 ± 3 kg/m2) completed two study visits (control, bosentan). On each visit, BP was assessed under three conditions: (1) normoxia (FiO2 0.21), (2) chemoreflex excitation via hypoxia (FiO2 0.05-0.21), (3) chemoreflex inhibition via hyperoxia (FiO2 1.00). Bosentan increased plasma ET-1 (0.94 ± 0.90 to 1.27 ± 0.62 pg/mL, p = 0.004), supporting receptor blockade. Resting diastolic (73 ± 5 to 69 ± 7 mmHg, p = 0.007) and mean (93 ± 7 to 88 ± 7 mmHg, p = 0.005) BP were reduced following bosentan compared to control with no change in systolic BP (p = 0.507). The mean BP response to both acute hypoxia (-0.48 ± 0.38 to -0.25 ± 0.31 mmHg/%, p = 0.004) and hyperoxia (area under the curve -93 ± 108 to -27 ± 66 AU, p = 0.018) were attenuated following bosentan. Acute ET receptor inhibition attenuates the rise in BP during chemoreflex excitation as well as the fall in BP during chemoreflex inhibition in healthy young men. These data support a role for ET-1 in control of resting BP, possibly through a chemoreceptor-mediated mechanism.

Abstract P378: Impaired Diurnal Control of Blood Pressure and Sodium Excretion in Aged Hypertensive Male Sprague Dawley Rats

Hypothesis: The diurnal rhythmicity of blood pressure (BP) and sodium excretion is important to blood pressure regulation and is strongly influenced by the circadian clock genes. We hypothesized that the diurnal control of BP and natriuresis is impaired in aged male Sprague Dawley (SD) rats and may be associated with altered kidney expression of circadian clock gene proteins. Methods: Radiotelemetry (to record mean arterial BP (MAP)) and metabolic balance (to assess sodium excretion) was conducted in 3-month-old (3M) and 16-month-old (16M) male SD rats. On a separate day, 3M and 16M rats received an acute 900 μEq NaCl load by oral gavage at ZT0 and sodium excretion was assessed. Total renal cortex expression of Per1 and Bmal1 was assessed by immunoblotting (N=4-6/group ± SD). Results: 16M rats exhibit significantly increased MAP and 24-h sodium retention vs. 3M rats [MAP (mmHg) 3M 102±4 vs. 16M 127±5, P&lt;0.05; 24h Na retention (mEq/24h) 3M 0.3±0.1 vs. 16M 0.8±0.2, P&lt;0.05). 16M rats exhibit an attenuation of the circadian MAP pattern compared to 3M rats. Aged rats have a significant decrease in the blood pressure rise during the dark (active) vs. 3M rats (Dark phase increase in MAP (mmHg) 3M +13.6±2.1 vs. 16M +4.8±1.9, P&lt;0.05). 3M rats exhibit a classical diurnal pattern of 24-h sodium excretion with increased natriuresis during the dark (active) phase – a response that is attenuated in 16M rats that exhibit a significant reduction in the increase in natriuresis in the dark phase (Light phase UNaV (μEq/12h) 3M 380±48 vs. 16M 410±36, Dark phase natriuresis 3M 620±31 vs 16M 502±27, P&lt;0.05). 16M rats had an impaired natriuretic response to an acute oral NaCl load in the first 12h post-gavage (UNaV 12h (μEq/12h) 3M 681±42 vs. 16M 243±39, P&lt;0.05). In 16M old rats there was no change in renal Per1 and decreased renal Bmal1 protein (Bmal1 fold change 16M vs. 3M, 0.65±0.7, P&lt;0.05). Conclusions: We observed impaired circadian control of blood pressure and renal sodium excretion in aged male SD rats. These changes in renal sodium handling may reflect endogenous decreases in renal Bmal1 levels with age and contribute to the observed hypertensive phenotype in aged rats.

Abstract P341: Orthostatic Hypertension Does Not Alter the Effect of Intensive Blood Pressure Treatment on Cardiovascular Disease and All-Cause Mortality: An Individual-Level Meta-analysis

Background: Orthostatic hypertension (OHTN) is common among adults with hypertension (HTN) and associated with cardiovascular disease (CVD). It is unclear whether HTN treatment reduces CVD outcomes similarly in adults with OHTN as adults without OHTN. Methods: We performed an individual-level meta-analysis, updating a previous systematic review of MEDLINE, EMBASE, and CENTRAL databases through November 13, 2023, which included randomized trials of blood pressure (BP) pharmacologic treatment (more intensive BP goal or active agent) on CVD or death. CVD events were adjudicated and included fatal and nonfatal coronary heart disease, stroke, and congestive heart failure. OHTN was defined as a rise in systolic BP ≥20 mmHg and/or diastolic BP ≥10 mmHg after changing positions from sitting to standing. Effects were examined overall and by trial type (BP goal or active agent), using Cox proportional hazard models adjusted for age and sex. Results: Of the 9 trials included, there were 29,235 participants followed for median of 4 years (mean age 69.5±10.9 years; 48.3% female; 21.0% with OHTN at baseline). Baseline OHTN was not associated with a higher risk of CVD or death (HR 1.03; 95% CI: 0.95, 1.13). More intensive BP treatment or active therapy lowered risk of CVD or death among those with OHTN at baseline (HR 0.80; 95% CI: 0.69, 0.93) and without OHTN at baseline (HR 0.81; 95% CI: 0.75, 0.87) with no difference between strata ( P -interaction 0.95) ( Figure ). Conclusion: While baseline OHTN was common among adults with HTN, it was not associated with CVD or death and did not alter the protective effect of more intensive treatment. More intensive treatment is an effective approach to prevent CVD events among adults with OHTN.

Abstract 40: Sodium-mediated Blood Pressure Increase in Chronic Kidney Disease and Diabetic Kidney Disease Patients Coincides With Vasodysfunction.

Background: Chronic kidney disease (CKD) and diabetic kidney disease (DKD) patients are advised to limit salt intake, because of its detrimental effects on blood pressure (BP) and albuminuria. The salt-sensitive BP response in these patients may be attributed to impaired renal ability to excrete sodium (Na+) resulting in fluid overload and/or vasodysfunction. To define which factor relates to BP sensitivity in both CKD and DKD, we studied the Na+-mediated BP response in these patients as compared to healthy volunteers (HV). Methods: In this randomized crossover study, CKD patients (KDIGO stage G2/3A, proteinuria &gt;0.5 g/d), Type 2 DKD patients (KDIGO stage G2/3A, proteinuria 0.2 - 0.5 g/d) and HV followed a 7-day low sodium diet (LSD, &lt;50mmol/d) and high sodium diet (HSD, &gt;200mmol/d), respectively. After each diet, assessment of the hemodynamic profile included daytime BP (Mobil-O-Graph) and cardiac output (CO) measurements (using NexfinTM), by which SVR was calculated accordingly. Extracellular fluid volume (ECV) change was assessed with multi-frequency body impedance spectroscopy (Fresenius). Results: We included 20 CKD (mean age 48 yrs, median (IQR) proteinuria 0.7 (0.6-1.6) g/d, mean (SD) eGFR 60.7 (16.3) ml/min/1.73m2) and 8 DKD patients (age 68 yrs, proteinuria 0.3 (0.2-0.4) g/d, eGFR 59.0 (15.9) ml/min/1.73m2), and 16 HV (age 41 yrs). Dietary salt intervention was successful with mean difference in urine Na+ excretion of 185, 168, and 209 mmol/day in CKD, DKD and HV respectively. After HSD, mean (SD) systolic BP change was 9.3 mmHg (8.9; p&lt;0.001) in CKD and 13.8 mmHg (10.4; p&lt;0.01) in DKD, while systolic BP change (3.1 mmHg (6)) in HV was not significant. After HSD, we observed significant ECV expansion in all groups without differences between groups (CKD 1.6 L, DKD 1.6 L, HV 1.4 L, p=0.27), while no effects on CO were observed. After HSD, the mean (SD) SVR in CKD increased with 125.7 dyn*sec*cm-5 (247.9, p=0.04) and in DKD with 125.5 dyn*sec*cm-5 (142.6, p=0.04), while in HC a non-significant decline of -109.2 dyn*sec*cm-5 was observed (358.2, p=0.24). Conclusion: The Na+-mediated BP rise in both CKD and DKD coincides with an increase in SVR. The absence of differences in ECV and CO between the three groups indicates that salt sensitivity in both CKD and DKD is not completely based on fluid overload but might be due to an inability to induce vasodilation.

An observational study to compare the efficacy of intravenous dexmedetomidine versus intravenous esmolol for attenuation of pressor response during laryngoscopy and endotracheal intubation

Laryngoscopy and endotracheal intubation during general anaesthesia is an invasive stimulus associated with release of circulating catecholamine leading to hemodynamic and cardiovascular responses resulting in tachycardia, hypertension and arrhythmias. Many prophylactic drugs have been used to decrease cardiovascular response to laryngoscopy &amp; intubation. Aim of this study is to compare effectiveness of Dexmedetomidine 1μg/kg and Esmolol 1 mg/kg intravenously in attenuating cardiovascular response during laryngoscopy and intubation during general anaesthesia.This randomised double blinded prospective study was conducted on 50 patients, of either gender between age group 18-60 years and American Society of Anaesthesiology (ASA) classification I &amp; II, undergoing various surgeries under General anaesthesia requiring intubation. Patients were randomly divided into 2 groups of 25 patients each. Group D patients received intravenously Inj. Dexmedetomidine 1 mcg/kg as an infusion in 100ml Normal Saline over 20 minutes before induction of general anaesthesia. Group E patients received intravenously Inj. Esmolol 1 mg/kg diluted with normal saline to volume of 10ml given just before induction of general anaesthesia.Hemodynamic parameters such as Heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded at baseline, after study drug administration, after induction, at laryngoscopy and intubation and 1, 3, 5 and 7 min after Endotracheal intubation.: Comparison of two groups reveals that dexmedetomidine shows less rise in heart rate (P-0.0003) and mean arterial pressure (P-0.0106) at the laryngoscopy and intubation. It also shows less rise in systolic and diastolic blood pressure after induction and after intubation (P&amp;#60; 0.05) than Esmolol. This study suggests that Dexmedetomidine 1µg/kg was more effective in attenuating the stress response to laryngoscopy and intubation as compared to Esmolol 1mg/kg.

Management Strategies for Hypertensive Crisis: A Systematic Review.

A hypertensive crisis is defined as a sudden and significant rise in blood pressure. The blood pressure reading is 180/120 mmHg or higher. A hypertensive crisis is a medical emergency. It can lead to a heart attack, stroke, or other life-threatening medical problems. Investigating the management of the hypertensive crisis was the goal of this study. English-language articles were collected from 2010 to 2024 demonstrating the management of the hypertensive crisis. Overall, there were 15 articles. Surveys and analyses of national databases were the most widely used methods (n=15). The scientific studies documented (1) all investigative studies or reports that included a hypertensive crisis diagnosis, (2) data integrity and reproducibility, and (3) management studies.Other studies show that acute severe hypertension in the hospital is associated with high rates of mortality and morbidity, particularly with new or worsening end-organ damage. The problem is linked to poor medical adherence, but alarmingly low follow-up rates are likely to contribute to a high recurrence rate. The treatment of acute severe hypertension varies according to the hospital unit (medical ward or intensive care unit), medication, and blood pressure targets or thresholds. Because of a lack of evidence-based guidance, arbitrary blood pressure control targets are used, or blood pressure targets are crudely extrapolated from guidelines intended primarily for outpatient management. Patients with acute aortic dissection need to be administered intravenous esmolol within 5 to 10 minutes in order to lower their blood pressure right away. The goal is to maintain a systolic reading of less than 120 mm Hg. Vasodilators such as nitroglycerin or nitroprusside may be administered if the blood pressure persists following beta blocking. Intravenous administration of clevidipine, nicardipine, or phentolamine is required; the initial dose is 5 mg, with subsequent doses given every 10 minutes as necessary to achieve the desired reduction in blood pressure.

Haemodynamic Responses Following Lidocaine Infusion on Hypertensive Patient Undergoing Laparoscopic Cholecystectomy

Many pharmacological methods have been evaluated to attenuate the adverse haemodynamic responses resulting from airway manipulation and pneumoperitoneum. Intravenous lidocaine infusion is one of them; bolus dose of intravenous lidocaine is used to reduce haemodynamic changes resulting from intubation and extubation reflex whereas intraoperative infusion of lidocaine has been used for post-operative analgesia in laparoscopic cholecystectomy. This randomized controlled trial was conducted to observe the effectiveness of lidocaine infusion in obtundation of haemodynamic responses on hypertensive patient undergoing laparoscopic cholecystectomy. A total number of 80 patients were enrolled in this study. Patients were allocated into two groups by computer generated random chart according to a 1:1 ratio. The patients of group A were given general anaesthesia with placebo normal saline infusion and the patients of group B were given general anaesthesia with lidocaine infusion (1.5mg/kg). Mean differences of blood pressure (SBP &amp; MAP) and heart rate at different time periods from baseline were compared between two groups. The demographic profiles were almost similar between the groups (p&gt;0.05). In comparison between two groups, heart rate, systolic blood pressure and mean arterial pressure rise from baseline value was more in normal saline group (group A) than lidocaine test group (group B) during peri-intubation, pneumoperitoneum and peri-extubation period. Statistical difference was significant between two groups (p&lt;0.05) in different haemodynamic parameters. Adverse events such as tachycardia premature ventricular contraction (PVC) and hypertension were observed much more in group A, which was higher than that of group B. We observed that administration of lidocaine infusion attenuates haemodynamic responses of hypertensive patient during laparoscopic cholecystectomy. CBMJ 2024 July: vol. 13 no. 02 P: 148-157

Perioperative infusion of magnesium sulfate versus dexmedetomidine on the hemodynamic responses in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial

Background: Laparoscopic cholecystectomy is associated with less post-operative pain, shorter hospitalization, and a faster functional recovery as compared to the open procedure. However, like any other surgery, a stress response is induced. Anesthesia interventions such as direct laryngoscopy, tracheal intubation, and extubation involve severe sympathetic stimulation. Magnesium can block the release of catecholamines from both the adrenal gland and adrenergic nerve terminals by inhibiting of activation of membrane Ca²⁺-ATPase and Na⁺-K⁺-ATPase. Aims and Objectives: Both magnesium sulfate and dexmedetomidine decrease the release of catecholamines and attenuate pressor responses to anesthesia and surgery. Materials and Methods: Eighty-four ASA I/II patients were randomly allocated to two groups. Group D received dexmedetomidine 1 μg/kg followed by 0.4 μg/kg/h and Group M received 2 g MgSO₄ followed by 15 mg/kg/h. hemodynamic variables were recorded as T0 (after loading dose of study drug), just before (T1) and 1, 2, and 3 min after ProSeal laryngeal mask airway (PLMA) insertion (T2 [i] [ii] [iii]), before and after peritoneal insufflation (T3 and T4), before and after table tilt (T5 and T6), after resuming flat position (T7), peritoneal deflation (T8), PLMA removal (T9), and on post-anesthesia care unit admission (T10). Data were collected and analyzed using SPSS 17 statistical software. Results: The demographic profile was comparable. After the study drug administration, there was a fall in mean arterial pressure (MAP) in both groups (Group D &gt; Group M) and no pressor response to PLMA insertion. At peritoneal insufflation, the MAP increase was significantly more in Group M at T6, T7, and T8 (31.9%, 27.9%, and 35.6% above baseline, respectively). Although there was a fall in systolic blood pressure (SBP) from the baseline throughout the procedure in both groups, SBP was significantly higher at most times in Group M as compared to Group D (P&lt;0.05). In both groups, there was a similar rise in diastolic blood pressure after peritoneal insufflation. The mean heart rate was significantly lower in Group D at all time points. Conclusion: Dexmedetomidine seemed to be superior to MgSO₄ for ameliorating hemodynamic responses in patients undergoing laparoscopic cholecystectomy.

Morin Prevents Non-Alcoholic Hepatic Steatosis in Obese Rats by Targeting the Peroxisome Proliferator-Activated Receptor Alpha (PPARα).

Obesity has become a widespread issue globally. Morin, a flavonoid with traditional use in managing hyperglycemia and hyperlipidemia, has demonstrated antioxidant and anti-inflammatory properties in experimental studies. This research aims to explore the anti-obesity potential of morin in rats subjected to a high-fat diet (HFD) and investigate whether its effects are mediated through PPARα regulation. Young adult male Wistar albino rats were divided into four groups (n = 8/group): normal, morin (50 mg/kg/BWT, oral), HFD, and HFD + morin (50 mg/kg/BWT, oral). Treatments were administered daily for 17 consecutive weeks. Morin mitigated the elevation in glucose levels and decreased fasting glucose and insulin levels, along with the HOMA-IR index, in HFD-fed rats. Furthermore, morin reduced calorie intake, final body weights, and the masses of subcutaneous, epididymal, peritoneal, and mesenteric fat in these rats. It also attenuated the rise in systolic blood pressure in HFD-fed rats and decreased serum levels of triglycerides, cholesterol, free fatty acids, LDL-c, and leptin, while increasing levels of HDL-c and adiponectin in both normal and HFD-fed rats. Moreover, morin restored normal liver structure and reduced fat vacuole accumulation in HFD-fed rats. Notably, it upregulated mRNA levels of PPARα in the livers and white adipose tissue of both normal and HFD-fed rats. These findings suggest the potential use of morin to enhance fatty acid oxidation in white adipose tissue and mitigate obesity, warranting further clinical investigation into its therapeutic applications.

May Measurement Month 2021: an analysis of blood pressure screening results from Poland.

May Measurement Month 2021 (MMM21) is the fourth edition of the global initiative in Poland initiated by the International Society of Hypertension (ISH) and aimed at raising awareness of hypertension and the need for blood pressure (BP) screening. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in 132 sites - between May and September 2021. Blood pressure was measured in 1699 subjects (mean age: 40.8 ± 17.0 years; 68.8% females). After multiple imputation, the age and sex standardized systolic and diastolic BP was 126.6/78.7 mmHg for the entire group, 133.8/81.9 mmHg in individuals on antihypertensive medication, and 125.4/78.6 mmHg in those not taking antihypertensive drugs. The proportion of subjects with high BP (≥140/90 mmHg) were: 30.9% for the entire group, 40.4% in subjects taking antihypertensive drugs, and 17.9% in those not taking antihypertensive drugs. Of all participants, 33.9% were in the age range of 18-29 years and we observed higher BP levels and more frequent BP elevation in males in this age group. These data provide unique insights into the hypertension rates during the COVID-19 pandemic. Due to the associated restrictions, only limited data could be obtained for older adults. Interestingly, among young Polish participants, the rate of hypertension and the level of BP were higher in males compared to females, suggestive perhaps of a higher susceptibility of males to experience a rise in BP during specific circumstances associated with a pandemic.

Excessive Blood Pressure Rise and Cardiovascular Remodeling in Marathon Runners.

Exercise-induced hypertension (EIH) is thought to be associated with increased cardiovascular (CV) risks. However, no previous studies have investigated the effects of EIH on CV systems in marathon runners without CV risk factors using both 24-hr ambulatory blood pressure (BP) monitoring and exercise stress echocardiography (ESE). This study firstly described differences in CV adaptations according to EIH assessed by both exams. Marathon runners between 35 and 64 years of age without CV risk factors were eligible. All the participants underwent both 24-hr ambulatory BP monitoring and ESE. EIH was defined as a maximal exercise systolic BP≥210 mmHg. The EIH group (n=19) had shorter training history and higher exercise intensity compared to the non-EIH group (n=23). The average systolic BP was higher in the EIH group than in the non-EIH group. Left cardiac chamber size and left ventricular mass (LVM) were also higher in the EIH group compared to the non-EIH group. Maximal BP during ESE was positively correlated with both parameters. Exaggerated BP response during exercise needs to be monitored for pre-emptive measurements before it results in progressive cardiovascular maladaptation.

A Comparative Study Between Intravenous Esmolol and Oral Clonidine in Attenuating Hyperdynamic Cardiovascular Response to Laryngoscopy and Endotracheal Intubation.

Background In today's era of anesthesia, balanced anesthesia is the main basis of patient care and pain management. Of all the medications given during general anesthesia, premedication, induction agents, and muscle relaxants play a major role in keeping the hemodynamics properly under control. When laryngoscopy is performed to intubate, a pain stimulus will be generated, leading to a rise in blood pressure and heart rate. This stimulus can be avoided without any complications if appropriate premedication is given to the patient at the appropriate dosage. In this research, we compare the influence of injection esmolol and oral clonidine during the time of induction as premedications to suppress the hemodynamic response. Material and methods In a prospective randomized controlled trial, 90 patients were divided into three groups: Group E (esmolol) received 2 mg/kg IV esmolol diluted in 0.9% NS two minutes pre-anesthesia; Group C (clonidine) received oral clonidine 4 mcg/kg 90 minutes pre-anesthesia; and Group P (placebo) received IV normal saline and oral water. Blood pressure, heart rate, and mean arterial pressure were measured at baseline and seven subsequent time points. Results The study compared systolic blood pressure (SBP), mean arterial pressure (MAP), and diastolic blood pressure (DBP) changes over seven minutes in three groups, clonidine (Group C), placebo (Group P), and esmolol (Group E). At one minute, Group E showed a consistent MAP decrease from 95.21 mmHg to 85.92 mmHg, while Group C and Group P exhibited fluctuating trends. DBP decreased across all groups, with Group P ending highest (77.7 mmHg) and Group C lowest (66.8 mmHg). Group E's SBP decreased steadily from 126.2 mmHg to 118.0 mmHg, Group C decreased from 128 mmHg to 116.1 mmHg, and Group P showed more erratic fluctuations in SBP, DBP, and MAP. Conclusion These findings suggest that intravenous esmolol shows a good hemodynamic response having superior control over heart rate and getting the pressure under control quickly without major drop compared with the clonidine and placebo groups.

Environmental Cadmium Exposure Induces an Increase in Systolic Blood Pressure by Its Effect on GFR

Chronic exposure to the nephrotoxic metal pollutant, cadmium (Cd), has been associated with hypertension, but the mechanism by which it raises blood pressure is not understood. We hypothesize that exposure to Cd reduces the glomerular filtration rate (GFR), which in turn causes a rise in blood pressure. Data were collected from 447 Thai subjects with a mean age of 51.1 years, of which 48.8% had hypertension, 15.4% had diabetes, and 6.9% had an estimated GFR (eGFR) below 60 mL/min/1.73 m2 (low eGFR). More than half (58.8%) and 23.9% had moderate and severe tubular proteinuria, respectively. The mean blood and urinary Cd concentrations were 2.75 and 4.23 µg/L, respectively. Doubling of body burden of Cd increased the prevalence odds ratios (POR) for low eGFR and severe tubular proteinuria 41% and 48%, respectively. The POR for hypertension rose twofold in those with blood Cd levels of 0.61–1.69 µg/L or urinary Cd excretion levels ≥ 0.98 µg/g creatinine. In the hypertensive group, the eGFR was inversely associated with age (β = −0.517), the Cd excretion rate (β = −0.177), and diabetes (β = −0.175). By mediation analysis, an increase in SBP was attributable totally to the effect of Cd on GFR. Thus, blood pressure appeared to rise as GFR fell. This finding is consistent with the well-known role of the kidney in long-term blood pressure regulation, and explains a universally high prevalence of hypertension among patients with low eGFR.

Gstp1 negatively regulates blood pressure in hypertensive rat via promoting APLNR ubiquitination degradation mediated by Nedd4.

Hypertension is a leading risk factor for disease burden worldwide. Vascular contraction and remodeling contribute to the development of hypertension. Glutathione S-transferase P1 (Gstp1) plays several critical roles in both normal and neoplastic cells. In this study, we investigated the effect of Gstp1 on hypertension as well as on vascular smooth muscle cell (VSMC) contraction and phenotypic switching. We identified the higher level of Gstp1 in arteries and VSMCs from hypertensive rats compared with normotensive rats for the first time. We then developed Adeno-associated virus 9 (AAV9) mediated Gstp1 down-regulation and overexpression in rats and measured rat blood pressure by using the tail-cuff and the carotid catheter method. We found that the blood pressure of spontaneously hypertensive rats (SHR) rose significantly with Gstp1 down-regulation and reduced apparently after Gstp1 overexpression. Similar results were obtained from the observations of 2-kidney-1-clip renovascular (2K1C) hypertensive rats. Gstp1 did not influence blood pressure of normotensive Wistar-Kyoto (WKY) rats and Sprague-Dawley (SD) rats. Further in vitro study indicated that Gstp1 knockdown in SHR-VSMCs promoted cell proliferation, migration, dedifferentiation and contraction, while Gstp1 overexpression showed opposite effects. Results from bioinformatic analysis showed that the Apelin/APLNR system was involved in the effect of Gstp1 on SHR-VSMCs. The rise in blood pressure of SHR induced by Gstp1 knockdown could be reversed by APLNR antagonist F13A. We further found that Gstp1 enhanced the association between APLNR and Nedd4 E3 ubiquitin ligases to induce APLNR ubiquitination degradation. Thus, in the present study, we discovered a novel anti-hypertensive role of Gstp1 in hypertensive rats and provided the experimental basis for designing an effective anti-hypertensive therapeutic strategy.

Comparison of intravenous bolus phenylephrine, ephedrine and mephentermine for maintenance of arterial blood pressure during spinal anaesthesia in caesarean section

Background: Subarachnoid block, although being highly efficient, often has limitation such as hypotension which can result in adverse maternal and fetal outcome, continues to be a matter of concern to the Anesthesiologist. The study was to compare the effect of phenylephrine, ephedrine and mephentermine, for maintenance of arterial pressure during spinal anaesthesia for caesarean section. Methodology: A prospective randomized double blinded study involving 90 patients with hypotension after subarachnoid block under spinal anesthesia was conducted, dividing them into three groups: P (Phenylephrine) 100 mcg, E (Ephedrine) 6 mg, and M (Mephentermine) 6 mg. Patients were compared based on age, weight, height, hemodynamic parameters, complications, and neonatal APGAR scores. Results: On inter-group comparison rise in systolic, diastolic and mean arterial blood pressure at 1,2,4 and 6min after drug administration were significantly high in phenylephrine group (p &lt;0.01) compared to ephedrine and mephentermine group. Thereafter the differences narrowed off. Heart rate was raised during episodes of hypotension. The mean heart rate was decreased significantly (p&lt;0.05) in phenylephrine group compared to other two groups. The neonatal APGAR score were &gt;/= 7 in the three groups at the 1st and 5th min. Conclusion: The study found that phenylephrine, ephedrine, and mephentermine effectively maintained arterial blood pressure in intravenous bolus form during subarachnoid block for caesarean section. Phenylephrine, a fast-acting, short-lived normotensive drug, significantly reduced heart rate compared to ephedrine and mephentermine, but did not cause significant adverse effects on mother and fetus. Keywords: hypotension; ephedrine; mephentermine; phenylephrine; subarachnoid block

Effects of General Anesthesia on Noninvasively Measured Central and Peripheral Blood Pressure: A Prospective, Observational-based Cross-over Study

Abstract Background: Blood pressure (BP) monitoring is the basic hemodynamic parameter necessary to monitor the hemodynamic changes occurring under general anesthesia (GA) to maintain adequate perfusion to major organs such as the heart, brain, and kidneys. Physicians heavily rely upon peripheral hemodynamic measurements despite availability of devices suitable for measurement of central blood pressure through non-invasive manner paving a gap in the literature concerning the effects of GA on central pressure. Aims and Objective: In this comparative cross-over study, authors have aimed to find out the degree of changes in central and peripheral BP after the introduction of GA among adult patients of different age groups scheduled for routine surgical procedures with an objective to maintain vital functions more precisely – considering the fact that vital organ perfusions (heart, brain etc.,) depend more on the required values of CBP than that of PBP. Material &amp; Methods: Following approval from IEC, sixty adult patients with ASA physical status 1 or 2 undergoing routine surgical procedures under general anesthesia were enrolled in this prospective cross-over study where each patient was case as well control for measurement and comparison of his/her central and peripheral blood pressure. Patients, being divided into three groups as per age range - 20-40 years (Group A), 40-60 years (Group B), and 60-80 years (Group C) had their normal Riva Rocci BP cuff (Space Lab Inc. USA) placed in one arm for peripheral BP measurement and special Riva Rocci (Uscom Ltd., Australia).) BP cuff for on another arm for Central BP measurement. After patient’s arrival into operation theatre, baseline hemodynamic parameters were taken followed by sequential measurements of CBP and PBP with an interval of 2 minutes till 30-40 mins of operation. There were alternative measurements of these pressures with recording of data from either of the devices as mentioned for further comparison and analysis. Results: From baseline values, it was found that all the three groups were comparable in respect of age, height, weight, PBP and CBP. When measured pressure of all groups combined, that there was a fall in both Central and Peripheral SBP as well as DBP after giving intravenous induction agent (propofol) and rise in both central and peripheral SBP and DBP after laryngoscopy and intubation. Degree of systolic blood pressure change in both peripheral &amp; central that is fall of BP in 3rd reading &amp; rise of BP in 5th reading was greatest in group C, followed by group B, then group A [p - 0.005]. While comparing three subgroups, the baseline Augmentation Index (AI) was highest in group C and lowest in group A. Following the administration of general anesthesia (GA), the change in Augmentation Index (ΔAI), was most pronounced in the third reading corresponding to the time after the administration of the induction agent. Conclusion: Measurement of CBP through peripheral placement of cuff is a unique feasible method to detect real changes of circulation with actual pressure in vital organs. Thus, the study suggests that central blood pressure measurements can provide a more accurate reflection of hemodynamic changes during general anesthesia, especially in older individuals or those with different cardiovascular conditions allowing better vital management of body circulation.

Therapeutic Effect of Alpha Lipoic Acid in a Rat Preclinical Model of Preeclampsia: Focus on Maternal Signs, Fetal Growth and Placental Function.

Chronic hypertension is a major risk factor for preeclampsia (PE), associated with significant maternal and neonatal morbidity. We previously demonstrated that pregnant stroke-prone spontaneously hypertensive rats (SHRSP) display a spontaneous PE-like phenotype with distinct placental, fetal, and maternal features. Here, we hypothesized that supplementation with alpha lipoic acid (ALA), a potent antioxidant, during early pregnancy could ameliorate the PE phenotype in this model. To test this hypothesis, timed pregnancies were established using 10 to 12-week-old SHRSP females (n = 19-16/group), which were assigned to two treatment groups: ALA (injected intraperitoneally with 25 mg/kg body weight ALA on gestation day (GD1, GD8, and GD12) or control, receiving saline following the same protocol. Our analysis of maternal signs showed that ALA prevented the pregnancy-dependent maternal blood pressure rise (GD14 blood pressure control 169.3 ± 19.4 mmHg vs. 146.1 ± 13.4 mmHg, p = 0.0001) and ameliorated renal function, as noted by the increased creatinine clearance and improved glomerular histology in treated dams. Treatment also improved the fetal growth restriction (FGR) phenotype, leading to increased fetal weights (ALA 2.19 ± 0.5 g vs. control 1.98 ± 0.3 g, p = 0.0074) and decreased cephalization indexes, indicating a more symmetric fetal growth pattern. This was associated with improved placental efficiency, decreased oxidative stress marker expression on GD14, and serum soluble fms-like tyrosine kinase 1 (sFlt1) levels on GD20. In conclusion, ALA supplementation mitigated maternal signs and improved placental function and fetal growth in SHRSP pregnancies, emerging as a promising therapy in pregnancies at high risk for PE.