Rise In Diastolic Blood Pressure Research Articles

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 > 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<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.

Sex Differences in Blood Pressure Response to Dietary Salt in Aged Rats

Background: The impact of dietary salt intake on blood pressure (BP) and its variability is critical for understanding cardiovascular risks, yet there is a scarcity of data exploring these effects across different sexes, particularly in the context of aging. Methods: This study examined the effects of varying salt diets on BP among aged female and male Sprague-Dawley rats (22-24 months). Subjects were administered either a control (0.4% NaCl), low (0.1% NaCl), or moderate-high (1% NaCl) salt diet for 12 weeks. BP levels and variability were measured at baseline, 2, 4, 8, and 12 weeks after dietary onset. Results: Preliminary findings revealed that, from the eighth week following dietary initiation, aged male rats exhibited a pronounced elevation in systolic BP when exposed to all types of diets, in contrast to aged female rats consuming low-salt diets. Additionally, aged male rats presented with a marked rise in diastolic BP upon consumption of both control and high-salt diets relative to female rats across all diets from the eighth week onward. Although systolic BP variability did not differ significantly between sexes, there were marked sex-specific differences in diastolic BP variability. Conclusions: The study identified sex-specific responses in BP and its variability to dietary salt intake in aged rats, with male rats showing heightened sensitivity. These findings underscore the importance of considering sex as a biological variable in dietary and cardiovascular health research. This research was funded by the START-UP FUNDING OF HANGZHOU NORMAL UNIVERSITY, grant number 4255C50221204123 (Dr. Fen Sun). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Effect of α-blockers on Handgrip Test Response of Diastolic Blood Pressure in Hypertensive, Benign Hypertrophy of Prostate Patients in a Therapeutics Clinic, Kolkata: A Cross-sectional Study.

The isometric handgrip (IHG) test is commonly used to detect sympathetic autonomic dysfunction. Tamsulosin, approved for the management of symptomatic benign prostatic hyperplasia (BPH), acts as an antagonist for α1-adrenergic receptors (α1-AR), whereas prazosin, an α1 receptor blocker, being less selective than tamsulosin, is used as an antihypertensive agent clinically. Our objective was to investigate if there is a distinction in blood pressure (BP) increase during IHG exercise between individuals with essential hypertension taking tamsulosin compared to those taking prazosin. A cross-sectional observational study was performed on 50 subjects receiving tablet prazosin and 47 subjects receiving tamsulosin, who were asked to undergo an IHG test. Pre- and posttest BP was recorded for both the groups, and the difference in diastolic BP (DBP) (delta DBP) was compared between the groups and to their respective baseline values. Post-IHG test, mean DBP was found to be 93.98 ± 9.13 mm Hg in the prazosin group and 101.00 ± 12.05 mm Hg in the tamsulosin group, respectively. The change of delta DBP in the tamsulosin group was significant, but the prazosin group showed an insignificant rise in DBP. Prazosin, being less selective than tamsulosin in terms of α1 receptor antagonism, showed suppression of BP during IHG. Tamsulosin demonstrates high selectivity for prostatic receptors while showing minimal affinity for vascular receptors. As a result, its impact on BP is expected to be minimal.

Change in telomere length and cardiovascular risk factors in testicular cancer survivors

BackgroundTesticular cancer (TC) survivors cured with chemotherapy (CT) are prone to develop cardiovascular diseases, as part of an accelerated aging phenotype. A mechanism contributing to these events can be telomere shortening. Patients and MethodsIn a prospective cohort of patients with disseminated TC who received cisplatin-based CT, mean absolute leukocyte telomere length (TL) was measured before and 1 year after start of treatment. Cardiovascular risk factors, including development of the metabolic syndrome and hypogonadism, were assessed before and up to 5 years after CT. ResultsFor the whole group (n = 55), TL did not change 1 year after CT (5.7 (2.2–13.4) vs. 5.8 kb (1.6–19.2), P = 0.335). At baseline, patients with a BMI >30 kg/m2 (n = 12) had shorter TL (4.9 (2.2–13.4) vs. 6.3 kb (3.1–12.9), P = 0.045), while no age-dependent differences were measured. Patients with TL shortening after 1 year (n = 7) showed a significant increase in diastolic blood pressure (P = 0.007) and triglycerides (P = 0.003), compared to those with unchanged TL. There was no association between telomere shortening after 1 year or short TL at baseline (n = 7+11) and development of metabolic syndrome (25% vs. 21%; P = 0.777), or hypogonadism (38% vs. 17%; P = 0.120) after 5 years. ConclusionsA small subset of TC patients treated with cisplatin-based CT showed telomere shortening 1 year after treatment. This shortening was associated to a rise in diastolic blood pressure and triglycerides, but not to newly developed metabolic syndrome and hypogonadism after 5 years.

Four-year longitudinal associations of physical activity, waist circumference, and blood pressure in UK adolescents.

This study assessed the specific influence of physical activity (PA) and waist circumference (WC) on the 4-year growth trajectory of blood pressure in UK high-school students. Four-year longitudinal monitoring of 1501 adolescents was conducted as part of the EoEHHS. Measurements were taken in Grades (G)7, 9, and 11. Systolic (SBP) and diastolic blood pressure (DBP) increased over the 4-year period (SBP G7 114.6 ± 8.9 mmHg, G9 118.1 ± 9.7 mmHg, G11 122.8 ± 7.8 mmHg; DBP G7 66.7 ± 6.6 mmHg, G9 68.0 ± 6.4 mmHg, G11 70.0 ± 5.2 mmHg). Baseline WC predicted baseline and growth in SBP, but the strongest contribution to SBP came from changes in WC (β = 0.084, p = 0.002). Baseline PAQ-A score (β = -0.822, p = 0.020) and changes in PAQ-A score (β = -0.650, p = 0.019) were associated with smaller increases in DBP over the 4-year measurement period. Baseline and change in WC predicted the growth trajectory of SBP, while baseline and change in PA predicted the growth trajectory of DBP. PA and WC have a prognostic value in predicting changes in blood pressure in adolescents. Increasing PA during adolescence could slow the rise in DBP over time. This is meaningful for future hypertension and CVD risk reduction into adulthood. Hypertension in adolescents is a growing health problem that is often overlooked. Baseline and changes in waist circumference over a 4-year period predicted development of systolic blood pressure, while baseline and changes in physical activity predicted development of diastolic blood pressure. Physical activity and waist circumference have a prognostic value in predicting changes in blood pressure in adolescents and could be valuable in planning programmes to prevent hypertension in similar communities and reduce the risk of future adult hypertension.

Phenylephrine and Ephedrine for Prevention of Hypotension in Women during Lower Segment Caesarean Section under Spinal Anaesthesia: A Randomised Clinical Study

Introduction: Hypotension is the most common serious adverse event associated with Spinal Anaesthesia (SA) and is associated with nausea and vomiting leading to pulmonary aspiration, respiratory depression and cardiac arrest. Phenylephrine (PE) and Ephedrine (EP) are vasopressors commonly used for prevention of hypotension associated with SA. Aim: To compare the efficacy and safety of PE and EP in prevention of hypotension induced by SA in women during Lower Segment Caesarean Section (LSCS) surgery. Materials and Methods: The present randomised clinical study was conducted on 60 women, between 18-36 years of age and a Heart Rate (HR) of 60-100 per minute randomised to receive either 100 mcg Intravenous (i.v.) bolus of PE, or 12 mg i.v. of EP during intrathecal block. Women having intraoperative hypotension were injected additional doses of vasopressor. Cardiovascular parameters were recorded at baseline (before block) and then at 1, 5, 10, 15, 30, 40 and 60 minutes. Further, safety was also assessed based on hypotension events and adverse events reported during immediate postoperative period. Data analysis was done using IBM SPSS 17 and a p-value <0.05 was considered statistically significant. Results: The mean age of the study participants in PE and EP group was 26.67±5.40 and 26.23±4.59 years, respectively. Significant differences were observed between PE and EP groups for change in Systolic Blood Pressure (SBP) after 1, 10, 30, 40 and 60 minutes. Overall, there was a slight fall in SBP with PE, whereas, with EP there was a slight rise in SBP. Also, the Diastolic Blood Pressure (DBP) was maintained with EP throughout the 60 minute period, whereas with PE there was an initial rise in DBP followed by a slight fall in DBP. The Mean Arterial Pressure (MAP) was well maintained with PE throughout, whereas with EP there was a fall in MAP after 15 minutes. However, these changes were not clinically significant. The Pulse Rate (PR) was lower with PE compared to EP group at time points of 1, 5, 15 and 20 minutes. The mean respiratory rates and blood oxygen saturation were similar with PE and EP administration (p>0.05). A total of 13 (43.3%) patients in the PE group and 14 (46%) in the EP group had adverse events excluding hypotensive patients. Conclusion: According to the findings of the present study, the i.v. bolus of 100 mcg PE and 12 mg EP administered immediately after SA are equally effective in prevention of maternal hypotension and do not cause any significant cardiovascular and respiratory effects.

Change in telomere length and cardiovascular risk in testicular cancer survivors.

12079 Background: Testicular cancer (TC) survivors cured with chemotherapy (CT) are prone to develop cardiovascular events, as part of an early aging phenotype. Telomere shortening could be a mechanism contributing to these events and their risk factors. Methods: In a prospectively followed cohort of patients with disseminated TC who received cisplatin containing CT (Lubberts et al., Eur J Cancer 2016), mean absolute leukocyte telomere length (TL) was measured using qPCR before and one year after start of cisplatin containing CT. Cardiovascular risk factors, including development of the metabolic syndrome (according to the NCEP ATP III definition) and hypogonadism (LH >10 U/L or testosterone < 10 nmol/L or use of testosterone suppletion), were assessed before and up to 5 years after CT. Shortening of TL was defined as a decrease of >33% after one year compared to baseline; short TL was defined as <5 kilobase (kb) pair (=P25). Data are presented as median (range). For comparisons, a Mann-Whitney U or Chi-Square test was applied. Results: 55 out of 73 patients of the initial cohort were evaluable for this analysis. CT regimens consisted of 3xBEP (n=41), 4x BEP (n=11), 4xEP (n=3). At baseline, patients with a BMI > 30 kg/m2 (n=12) had a shorter TL (4.9 (2.2-13.4) vs. 6.3 kb (3.1-12.9), p=.045); there was no difference in age. For the whole group, TL did not change one year after CT compared to baseline (5.7 (2.2-13.4) vs. 5.8 kb (1.6-19.2), p=.335). Patients with TL shortening after 1 year (n=7) showed a significant increase in diastolic blood pressure (p=.007) and triglycerides (p=.003), compared to those with unchanged TL (table). TL shortening after 1 year or short TL at baseline (n=7+11) are not significant predictors for newly developed metabolic syndrome (25 vs. 21%; p=.777), nor hypogonadism (38 vs. 17%; p=.120) after 5 years, compared to the others. Conclusions: A small subset of TC patients treated with cisplatin containing CT showed shortening of TL 1 year after treatment. This shortening is associated with a rise in diastolic blood pressure and triglycerides. Short or shortening of telomeres are not predictive for development of the metabolic syndrome or hypogonadism. [Table: see text]

AN ANALYTICAL CROSS SECTIONAL STUDY ON CARDIAC AUTONOMIC FUNCTIONS IN HYPO-THYROID PATIENTS

Background: Primary Hypothyroidism is a chronic endocrine disorder of thyroid gland with multifarious etiology 1 having a prevalence of 5 to 15% in India. The prevailing literature reports an increased risk of cardiovascular morbidity in hypothyroid patients and proposes derangements in the autonomic nervous system as an antecedent causative event. The present study was designed to explore these undermined autonomic nervous system derangements posing a risk of subsequent development of cardiovascular problems in hypothyroid patients. Aim and Objective: The objective of the current study was to explore and compare the cardiovascular autonomic functions in hypothyroid patients with age and sex-matched healthy controls. Materials and Methods: The present study was conducted in the Upgraded Department of Physiology, Sawai Man Singh Medical College and Attached Hospitals, Jaipur, enrolling 30 hypothyroid patients of both gender, recruited from the Department of Endocrinology and 30 age & gender-matched healthy controls recruited amongst the attendants and family members accompanying the hypothyroid patients. Prior approval and consent were obtained from the institutional ethics committee and research review board before commencement of the study. For assessing the autonomic functions, parasympathetic function tests namely E:I ratio, 30:15 ratio (lying to standing ratio), and valsalva ratio were resorted to, whereas, tests like blood pressure (BP) response to standing and sustained handgrip were used for the assessment of sympathetic functions. Results: When the subjects were tested for assessment of the sympathetic function, rise in diastolic BP during isometric handgrip exercise came out to be signicantly lower in hypothyroid patients (P < 0.05) in comparison to controls. Similarly, the fall in systolic BP on immediate standing was higher in the hypothyroid group (P < 0.05). On assessing the subjects for parasympathetic functions, E: I ratio (Expiration: Inspiration), 30:15 ratio and Valsalva ratio were found to be signicantly decreased (P < 0.05) in hypothyroid patients in comparison to healthy controls. Conclusion: The deranged autonomic function tests in hypothyroid patients suggest an underlying cardiovascular autonomic dysfunction putting hypothyroid patients at a greater risk of cardiovascular diseases later in life. Due to these prognostic implications, the present study recommends regular and periodic assessment of autonomic functions in hypothyroid patients.

Evaluation of Sympathetic and Parasympathetic Tone and Reactivity in Adolescents with Specific Learning Disorder (Dyslexia).

To evaluate the autonomic function in specific learning disorder (SLD) and comorbid SLD attention-deficit hyperactivity disorder (SLD-ADHD). A cross-sectional study was conducted in a tertiary care hospital with 20 adolescent subjects each of confirmed SLD, SLD-ADHD, and healthy control (mean age 15.32 y). Heart-rate variability and autonomic-function tests were carried out using standard protocols. Heart-rate variability parameters, viz., mean RR interval, number of RR intervals which differ by ≥ 50ms (NN50), percentage NN50, standard deviation of differences between adjacent RR intervals, root square of mean of the sum of the squares of differences between adjacent RR intervals, coefficient of variance and absolute power of high-frequency band (HF) recorded apparently lower levels in SLD and SLD-ADHD as compared to healthy control indicating lower parasympathetic tone. Whereas, higher absolute power of low- frequency band (LF) in SLD and SLD-ADHD than healthy control indicated enhanced sympathetic activity. Higher LF/HF and lower SD1/SD2 ratios in SLD and SLD-ADHD than healthy control indicated higher sympathetic tone over parasympathetic tone. Values of autonomic-function tests such as E:I ratio, change in heart rate during deep-breathing test, 30:15 ratio, and Valsalva ratio showed a decrease in SLD and SLD-ADHD as compared to healthy control implying reduction in parasympathetic reactivity. Increased values for rise in diastolic blood pressure in the isometric handgrip test and cold pressor test recorded in SLD as compared to healthy control, revealed the increased sympathetic reactivity. Overall, results of heart-rate variability and autonomic-function tests imply dysregulation of sympathetic and parasympathetic activities with sympathetic dominance in SLD and SLD-ADHD.

Biomarkers and Prevalence of Cardiometabolic Syndrome Among People Living With HIV/AIDS, Addis Ababa, Ethiopia: A Hospital-Based Study.

Background:While the fast extension of combination antiretroviral therapy (cART) has resulted in significant increases in life expectancy, disorders such as cardiometabolic syndrome (CMetS), which have received less attention, are becoming a major concern in HIV/AIDS patients (PLWHA).Objectives:The purpose of this research was to identify biomarkers and determine the prevalence of CMetS in PLWHA using the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) tools.Methods:Between January 2019 and February 2021, a hospital-based study of HIV-infected patients (n = 288) was conducted. The data were analyzed using binary logistic regression. To control the effect of confounders, independent variables with a P-value of <.20 in the bivariate logistic regression were incorporated into multivariate logistic regression. Statistical significance was defined as a 95% confidence interval and a P-value of less than .05.Results:The risk of CMetS increased twofold as age increased each year (P = .009), 1.2 times as the age at which cART began increased (P = .015), and 6 times with 1 or more co-morbidities (P = .028), according to the NCEP tool. Furthermore, significant NCEP-CMetS correlations were produced by a rise in diastolic blood pressure (P < .001) and cART duration (P = .006). Male gender was 99.9% less likely to be related to CMetS using the IDF tool, and the risk of CMetS increased fourfold with each unit increase in waist circumference (P < .001). Triglycerides and blood type “A” have been found to have substantial relationships with CMetS using both techniques.Conclusion:According to the study, CMetS was found to be common in PLWHA. Age, time on cART, age when cART started, gender, co-morbidities, waist circumference, and diastolic blood pressure were all revealed to be significant predictors of CMetS. Triglycerides and blood type “A” were the only biomarkers found to be significant with CMetS using both the NCEP and IDF tools.

High carbohydrate high fat diet causes arterial hypertension and histological changes in the aortic wall in aged rats: The involvement of connective tissue growth factors and fibronectin

BackgroundAge and diabetes are risk factors for arterial hypertension. However, the relationship between age, connective tissue growth factors, vascular aging and arterial hypertension while on a the high-carbohydrate high-fat diet (HCHFD) remains poorly understood. PurposeTo estimate the relationship between humoral factors, the morphological changes of aorta and impaired blood pressure regulation under the influence of age and a HCHFD. MethodsA study was carried out in male Wistar rats, which were divided into the following groups: 1st (n = 15) - naive young rats; 2nd (n = 15) – young rats, exposed to HCHFD; 3rd (n = 14) – naive old rats; 4th (n = 12) - old rats exposed to HCHFD. The age of old rats was 540 days, and young rats 150 days at the end of the diet. HCHFD contained proteins 16%, fats 21%, carbohydrates 46%, including 17% fructose, 0.125% cholesterol, 90 days. Blood pressure and body weight were measured weekly, carbohydrate metabolism, histological signs of changes in the aorta, serum transforming growth factor-β (TGF-β), connective tissue growth factor (CTGF), fibronectin, and endothelin-1 levels were determined one week after the onset of diet. ResultsThe severity of arterial hypertension and its histological signs in the aortic wall was found to be most pronounced in elderly rats kept on a HCHFD. In young rats kept on a HCHFD, arterial hypertension was transient. An increase in systolic blood pressure has a positive correlation with the degree of obesity, serum fibronectin, and endothelin-1 content, and impaired carbohydrate metabolism. The rise in diastolic blood pressure has a positive correlation with the serum CTGF, endothelin-1, fibronectin levels and aortic wall thickness, and impaired carbohydrate metabolism. A rise in the serum concentration of fibronectin was also associated with increased endothelin-1, TGFβ and CTGF serum levels. ConclusionThis study indicated that an increase in blood pressure in old rats with a high-carbohydrate high-fat diet is due to a disturbance of a structure of the vascular wall, the release of fibronectin, which can occur under the influence of carbohydrate metabolism disorders, endothelin-1, TGFβ and CTGF.

Acute responses of airway oxidative stress, inflammation, and hemodynamic markers to ambient PM2.5 and their trace metal contents among healthy adolescences: A panel study in highly polluted versus low polluted regions

Particulate air pollutants are known contributors to global cardiorespiratory mortality through several pathways. We examined the effects of varied exposure to PM2.5 and trace metals on biological markers of airway inflammation, oxidative stress, and hemodynamic function of young individuals living in two different exposure settings.We enrolled and followed a panel of 97 healthy nonsmoking participants aged 15–18 years living in a highly polluted metropolitan city of Tabriz (TBZ) and a much less polluted semi-urban town of Hadishahr (HDS). For five consecutive months, the subjects were examined by a physician, and fractional exhaled nitric oxide levels (FENO) were measured. Samples of exhaled breath condensation (EBC) were obtained for measuring interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), and total nitric oxide (NOx). We measured daily outdoor PM2.5 mass concentration in a fixed station in each location for all this period. The PM-metal content was analyzed by ICP-MS. The linear mixed-effects regression models were applied for data analysis.The averages of PM2.5 mass and total metals in TBZ were nearly two and four times higher than in HDS, respectively. In TBZ, an increased IQR of PM2.5 mass during 0–5 days was -correlated with a significant rise in diastolic blood pressure, heart rate, TNF-α, FENO, and NOx and reduction of IL-6. Moreover, exposure to low PM2.5 concentration is significantly -correlated with an elevation in diastolic blood pressure in HDS. We also observed that exposure to metal constituents in the highly polluted region is correlated with increased TNF-α and IL-6 with 131.80% (95% CI: 56.01, 244.39) and 47.51% (95% CI: 33.01, 62.05) per IQR of Hg, respectively.This study suggests that exposure to ambient PM2.5 and their metal contents in highly polluted areas may incite significant changes in airway inflammation, oxidative stress, and hemodynamic parameters in healthy subjects.

No Effect of Skin Lymphangiogenesis on Blood Pressure in Mouse Models of Salt‐Sensitive Hypertension

The pathogenesis of hypertension is not well understood, but high sodium intake has been associated with blood pressure (BP) rise. Studies have indicated that sodium can be stored in skin without commensurate water accumulation, and macrophages may secrete VEGF-C that can stimulate lymphangiogenesis, thereby acting as a buffer against increased BP. Here we aimed to explore the role of dermal lymphatics in BP and sodium homeostasis. Our hypothesis was that mice with reduced dermal lymphatic vessels were more prone to develop salt-sensitive hypertension, and that mice with hyperplastic vessels were protected against this outcome. Mice with either absent (K14-VEGFR3-Ig), hypoplastic (Chy) or hyperplastic (K14-VEGF-C) dermal lymphatic vessels and littermate controls were given high salt diet (HSD) (4% NaCl in the chow and 1% saline to drink), DOCA-salt diet (16mg/week 11-deoxycorticosterone acetate - 50mg/21 days slow release tablet subcutaneously and 1% saline to drink) or nitric oxide (NO) blocker diet (L-NAME 0.5mg/ml in drinking water for 3 weeks, followed by one week washout and thereafter 2 weeks HSD). BP was measured by telemetric recording, and tissue sodium content by ion chromatography. In contrast to previous studies, HSD did not induce an increase in BP or sodium storage in any of the mouse strains investigated. DOCA-salt, on the other hand, induced an increase in mean arterial pressure (MAP) in Chy of 13.4 ± 7.1 (SD) mm Hg (n=4), not different from a corresponding pressure in WT control of 14.7 ± 6.4 mm Hg, n=5. In K14-VEGFR3-Ig mice, DOCA raised the MAP 24 ± 12.1 mm Hg (n=6), not different from the corresponding WT control (22.8 ± 8.3 mm Hg, n=7). DOCA induced salt storage in skin and muscle, but to the same extent in mice with dysfunctional lymphatic vessels and WT controls. L-NAME diet tended to give a higher diastolic pressure in mice lacking dermal lymphatic vessels compared with WT control as suggested by the rise in diastolic BP of 11.6 ± 10.8 (SD) mm Hg (n=9) and 1.9 ± 2.4 (SD) mm Hg (n=6) (p<0.05, One-way ANOVA), respectively, without a concomitant increase in sodium content in skin or muscle in any of the strains. Our results indicate that there is no association between dermal lymphangiogenesis, sodium accumulation and blood pressure response. The response seen in NO-blocker diet in mice lacking dermal lymphatic vessels was salt storage independent. This suggests that dermal lymphatic vessels are not involved in salt storage or blood pressure regulation in these mouse models of salt-sensitive hypertension.

Postural changes in blood pressure among patients with diabetes attending a referral hospital in southwestern Uganda: a cross-sectional study

BackgroundOrthostatic hypotension (OH) and orthostatic hypertension (OHT) are often unrecognized in clinical care for diabetic individuals, yet they are associated with increased risk for adverse cardiovascular outcomes. We aimed to determine the prevalence of the abnormal orthostatic blood pressure (BP) responses, and associated factors among diabetic individuals in ambulatory care for diabetes in southwestern Uganda.MethodsWe conducted a cross-sectional study among diabetic individuals aged 18–65 years at Mbarara Regional Referral Hospital, southwestern Uganda from November 2018 to April 2019. We obtained demographic and clinical data including a detailed medical history, and glycemic profile. BP measurements were taken in supine position and within 3 min of standing. We defined OH in participants with either ≥ 20 mmHg drop in systolic BP (SBP) or ≥ 10 mmHg drop in diastolic BP (DBP) after assuming an upright position. OHT was defined in participants with either a ≥ 20 mmHg rise in SBP, or ≥ 10 mmHg rise in DBP after assuming an upright position. Multivariate logistic regression was used to identify factors associated with OH and OHT.ResultsWe enrolled 299 participants, with a mean age of 50 years (SD ± 9.8), and mean HbA1c of 9.7% (SD ± 2.6); 70% were female. Of the 299 participants, 52 (17.4%; 95% CI 13.3–22.2%) met the definition of OH and 43 (14.4%; 95% CI 10.6–18.9%) were classified as having OHT. In multivariable models, factors associated with diabetic OH were older age (OR = 2.40 for 51–65 years vs 18–50 years, 95% CI 1.02–5.67, P = 0.046), diabetic retinopathy (OR = 2.51; 95% CI 1.14–5.53, P = 0.022), higher resting SBP ≥ 140 mmHg (OR = 3.14; 95% CI 1.31–8.7.56, P = 0.011), and history of palpitations (OR = 2.31; 95% CI 1.08–4.92, P = 0.031). Self-report of palpitations (OR = 3.14; 95% CI 1.42–6.95, P = 0.005), and higher resting SBP ≥ 140 mmHg (OR = 22.01; 95% CI 1.10–4.42, P = 0.043) were associated with OHT.ConclusionOH and OHT are common among diabetic individuals in ambulatory diabetes care in southwestern Uganda. Orthostatic BP measurements should be considered as part of routine physical examination to improve detection of OH and OHT, especially among older diabetics with complications of the disease. Future studies to assess the health and prognostic implications of OH and OHT among diabetics in the region are warranted.

Comparison of autonomic function tests and high-sensitivity C-reactivity protein in overweight patients of polycystic ovarian syndrome and overweight controls

Objectives: Both polycystic ovarian syndrome (PCOS) and high body mass index (BMI) are associated with autonomic dysfunction. Most of the patients of PCOS have high BMI. Hence, BMI is likely to be a factor contributing to the autonomic dysfunction in PCOS. High-sensitivity C-reactive protein (hs-CRP) is a marker of inflammation and a predictor of future cardiovascular risk. PCOS patients have low-grade chronic inflammatory state. Coexistence of PCOS and obesity causes more increase in CRP, thereby further increasing the risk of cardiovascular morbidity. We have performed autonomic function tests and estimated hs-CRP in overweight patients of PCOS and compared our findings with the control group consisting of overweight normal subjects. Our aim is to find out whether the cardioautonomic and inflammatory changes seen in PCOS are due to the presence of increased weight or do the presence of increased weight add to the severity of these changes seen in PCOS. Materials and Methods: Cases consisted of 44 overweight patients of PCOS and controls included 44 healthy overweight subjects, all in the age group of 18–45 years. Autonomic function test consisted of three sympathetic and three parasympathetic reactivity tests. The following tests were done for parasympathetic reactivity: (a) Deep breathing test – expiration:inspiration ratio (E:I) was calculated. (b) Valsalva maneuver-Valsalva ratio was calculated. (c) Heart rate changes from lying to standing (LST) - 30:15 ratio was calculated. For assessing sympathetic reactivity, the following tests were used: (a) Isometric handgrip test – the difference between resting diastolic blood pressure (DBP) reading and the reading before release of hand grip is noted. (b) Cold pressor test (CPT) – The rise in DBP over the baseline DBP was noted. (c) Systolic BP (SBP) change in LST – the maximum fall in SBP was recorded. Measurement of serum hs-CRP was done using enzyme-linked immunosorbent assay. Results: We found that in the overweight PCOS group, there was a significant decrease in both sympathetic and parasympathetic reactivity than the overweight control group (p=0.000 for Valsalva ratio, 0.027 for 30:15 ratio, and 0.0005 for CPT). The difference between hs-CRP in controls and PCOS was also significant (P = 0.039). Conclusion: In our study, we concluded that the pathological changes due to PCOS could be attributed directly to the extent of inflammation measured by hs-CRP levels. These changes were not directly related to BMI as proven by comparing with controls (overweight non-PCOS subjects).

The gender-related peculiarities of the effects of telmisartan-based combined antihypertensive therapy on the dynamics of 24-hours profile of blood pressure

Objective — to evaluate the gender-related peculiarities of the effects of telmisartan-based combined antihypertensive therapy on the dynamics of 24-hours profile of blood pressure in patients with arterial hypertension depending on gender.Materials and methods. The study included 50 patients with arterial hypertension (AH), who received antihypertensive therapy and had uncontrolled arterial pressure as per the results of 24-hours ambulatory BP monitoring (DABPM). Among them were 23 men, average age (60.1 ± 2.7) years and 27 women, average age (64.4 ± 2.2) years. DABPM was performed to all patients before treatment and after 12 weeks of therapy. Prior to the study enrolment, all patients received combined antihypertensive therapy. After DABPM completion, the renin-angiotensin system (RAS) blocker used before enrolment was replaced by telmisartan in a dose of 40 — 80 mg.Results. It has been established that the average daily level of systolic blood pressure (SBP) after 12 weeks of therapy decreased significantly in men by 4.4 mm Hg and in women by 6.3 mm Hg. The average daily level of diastolic blood pressure (DBP) decreased in men by 7.1 mm Hg, in women — by 6.7 mm Hg. A decrease in the maximum SBP in the morning by 22.8 mm Hg in men and 23.4 mm Hg in women was determined. The maximal DBP in the morning decreased in men by 14.9 mm Hg, in women — by 19.1 mm Hg. The morning SBP index in men decreased by 41.5 %, in women — by 41.8 %, the morning DBP index — by 44.0 % and 33.7 %, respectively.Conclusions. After 12 weeks of telmisartan therapy, there was a significant decrease in mean daily SBP and DBP in men and women. Significant decrease in SBP and DBP in the active period was determined only in men, and decrease in SBP and DBP in the passive period was more pronounced in women. The positive effects of telmisartan therapy have been revealed in both men and women in terms of significant reduction of the maximal morning SBP and DBP, more than 40 % decrease of the morning SBP and DBP indices and the value of the morning SBP and DBP rise.

Diabetic Cardiovascular Autonomic Neuropathy, the Handgrip Test and Ambulatory Blood Pressure Monitoring Parameters: Are There Any Diagnostic Implications?

Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes mellitus. Cardiovascular reflex tests (CARTs) are the gold standard in the diagnosis of CAN, but the handgrip test is no longer recommended to be performed. Previously, the inverse association between the presence of hypertension and handgrip test abnormality was demonstrated and hypertension as major cause for excessive diastolic blood pressure rise during handgrip testing in diabetic individuals proposed. The aim of the present study is to describe more precisely the association between handgrip test and hypertension by performing ambulatory blood pressure monitoring (ABPM) among diabetic patients. A more comprehensive evaluation of the relationship between cardiovascular autonomic function, hypertension and the handgrip test was targeted using heart rate variability (HRV) analysis. Our study involved 163 patients with diabetes. Cardiovascular autonomic neuropathy was assessed by the CARTs and sustained handgrip test was performed. All patients underwent ABPM and HRV analysis well. CAN was diagnosed in 69 patients. Significant associations were found between the diastolic blood pressure increase in response to handgrip exercise and the 24-h (rho = 0.245, p = 0.003), daytime (rho = 0.230, p = 0.005) and night-time (rho = 0.230, p = 0.006) mean systolic and 24-h diastolic (rho = 0.176, p = 0.034) blood pressure values, systolic blood pressure load (rho = 0.252, p = 0.003) and systolic (rho = 0.236, p = 0.005) and diastolic (rho = 0.165, p = 0.047) hyperbaric impacts. Higher values of ambulatory blood pressure monitoring parameters are associated with greater increases in diastolic blood pressure during isometric handgrip exercise. Diastolic blood pressure elevations during the handgrip test are also correlated, in order to diminished heart rate variability parameters attributable to parasympathetic dysfunction highlighting the pivotal role of sympathetic overactivity in evolving handgrip test results. Our study provides further evidence on the inverse association between handgrip test abnormality and hypertension in diabetic patients.

Comparison of perioperative pulse rate, systolic blood pressure, diastolic blood pressure of intubating LMA and I-gel

Background: The most common and important being the deleterious haemodynamic consequences in response to laryngoscopy and intubation due to reflex sympathoadrenal stimulation.Objectives: to compare perioperative hemodynamic stability (pulse rate, systolic blood pressure, diastolic blood pressure) of these two devices. Study design: Randomised controlled prospective study. Participants: 80. Sampling: Systematic Random Sampling. Study period: from October 2016 to October 2018. Results: When hemodynamic variables are compared between two groups,statistically significant rise in heart rate from baseline value in group G upto 5 minutes and at removal than I-lma. Blood pressure variations in both groups were compared and they shown, statistically significant rise in systolic blood pressure from baseline value in group G upto 5 minutes and at removal than I-lma. Statistically significant rise in diastolic blood pressure in group G upto 3 minutes and at removal than I-lma group. Statistically significant rise in mean arterial blood pressure in group G upto 3 minutes and at removal than I-lma group.Conclusion: It was concluded that I-LMA causes significantly less hemodynamic perturbations than I-gel at various time intervals.

Abstract 488: Investigation of the Impact of Germ Line Variation in the K Channel Kcnj5 on the Renin-angiotensin Axis and Aldosterone Release in Human Subjects (linked)

Introduction: Somatic mutations in the KCNJ5 potassium channel are found in significant number of patients with primary aldosteronism (PA). In a previous study, a rare non-synonymous E&gt;Q (E282Q) single nucleotide polymorphism (SNP) rs7102584 in the KCNJ5 channel was identified and an in vitro study confirmed its functionality. This study tested the hypothesis that this germline SNP would affect release of aldosterone and raise blood pressure (BP) under salt-loaded conditions. Methods: Healthy volunteers (30 Group A = SNP heterozygous carriers and 30 Group B = homozygous wild type, mean age: 59±11) were recruited through the UK BioResource, with equal gender distribution in the two groups (40% males, 60% females). Investigators were blinded to the genotype of each recruit. Volunteers were on a low salt diet (≤6 g/d) for a week, and then exposed to high oral salt intake (&gt;9 g/d) for a week. Clinic BP, 24hour ambulatory blood pressure measurements (ABPM), 24hour urine electrolytes, renal biochemistry, renin, aldosterone and renin aldosterone ratio (ARR), were measured before and after high salt exposure. Data were analysed using repeated measures ANOVA and adjusted for age. Results: Following salt loading, the mean day average systolic blood pressure (SBP) and diastolic blood pressure (DBP) rise on ABPM was 2.5 ± 1 mm Hg and 0.7± 0.7 mm Hg. Similarly, night-time average SBP and DBP rise was 2.2 ±1.2 mm Hg and 1.6 ± 0.9 mm Hg respectively. The ARR fell by a mean of 5.0 ±1.7 pmol/mU. There were no significant differences between carriers of the E/Q KCNJ5 variant and wild-type subjects in BP values and biochemical parameters at baseline or under salt-loading. Conclusions: This is the first study we are aware of, that has attempted in vivo translation of this KCNJ5 germline variant. The germline variation does not seem to drive hyperaldosteronism in vivo, although we cannot exclude this in the rare subjects who are homozygous for the variation (mean allele frequency approximately &lt;1 in 1000).

Uric acid as a biomarker for pregnancy induced hypertension

Background: Pregnancy induced hypertension is the most common complication of pregnancy. It affects 5-7% of pregnant women. Pregnancy induced hypertension is characterized by vasospasm which is associated with platelet aggregation and reduced uteroplacental flow. In addition to these, altered renal function tests can also worsens the condition. This influences the maternal as well as fetal outcome. Aims: To prevent the complications of pregnancy induced hypertension and for proper management of these cases present study was conducted. Materials and Methods: The present study was conducted in 300 subjects grouped into 120 cases of normal pregnancy, 150 cases of pregnancy induced hypertensives, 30 cases of eclamptics and serum uric acid level was measured in these. Results and Discussion: elevated level of serum uric acid was seen with increase in gestation period and rise in diastolic blood pressure. The p- value was estimated by student t-test in different groups and was found to be< 0> Conclusion: Hence Serum Uric acid is the significant and reliable indicator for pregnancy induced hypertension to prevent the fetal and maternal mortality and morbidity. Keywords: Eclampsia, Gestational hypertension, Hyperuricemia, Pre-eclampsia, Pregnancy induced hypertension(PIH).