Significant Decrease In Systolic Blood Pressure Research Articles

WORK-BASED ISOMETRIC EXERCISES EFFECT ON BLOOD PRESSURE: THE EEFIT STUDY

Objective: To evaluate the effect of two workplace isometric exercise interventions on blood pressure in hypertensive adults. Design and method: A randomized controlled multicenter clinical trial conducted in hypertensive (>130 mmHg systolic blood pressure (SBP)) 35 to 65 years old in work places in Colombia. Participants were assigned to either of two interventions: isometric handgrip dynamometer training at 30% of maximum strength (HGD) or wall squat (WS), or to a control group following standard recommendations. The interventions were performed at the participant’s workplace and consisted of 4 sets of 2 minutes of sustained isometric contraction with 2 minutes’ rest between sets, 3 times per week for 12 weeks. SBP and diastolic blood pressure (DBP) were measured using an automatic device (Omron) with a standardized protocol before and after the 12-week intervention. Results: Pre and post measurements were completed by 105 hypertensive participants: mean age of 45 years (SD 9.5), 63.8% of which were men. In the HGD group (n = 38) there were significant decreases in SBP [Pre: 141 mmHg (SD 7.8), Post: 127 mmHg (SD 9.1) (p < 0.001)], and in DBP [Pre: 87 mmHg (SD 5.8), Post: 82 mmHg (SD 9.5) (p < 0.001)]. There were also significant decreases in the WS-group (n = 35) in SBP [Pre: 139 mmHg (SD 7.5), Post: 126 mmHg (SD 12.4) (p < 0.001)], and in DBP [Pre: 86 mmHg (SD 5.2), Post 82 mmHg (SD 8.1) (p < 0.001)]. In the control group (n = 32), there were no significant changes in either in SBP [Pre: 140 mmHg (SD 8.4), Post: 137 mmHg (SD 12.9)], or DBP [Pre: 86 mmHg (SD 5.0), Post: 85 mmHg (SD 8.0) (p = 0.71)]. Conclusions: Both workplace isometric training interventions resulted in significant and clinically relevant reductions in blood pressure in subjects with high blood pressure. The combination of effectiveness, modest time commitment (42 minutes per week) and ease with which the interventions can be implemented in the workplace setting makes them both attractive and practical options with minimal barriers for participation. Furthermore, WS can be performed without any equipment.

Body mass index change in relation to longitudinal systolic blood pressure: An age- and sex-matched and repeated measures study

Background and aimsThe positive association between mean systolic blood pressure (SBP) and body mass index (BMI) diminished or reversed over the past four decades. The primary aim of this study was to evaluate effects of BMI change on longitudinal SBP. Methods and resultsA total of 3638 participants who had annual health examination from 2015 to 2019 were included and matched by age and sex according to BMI levels. BMI and SBP were measured annually and their association were assessed by a linear mixed-effects regression model. The normal weight participants had a sustained weight gain as well as SBP increase during the study period (all Ptrend <0.001). The obese participants had a sustained weight loss but SBP did not decrease simultaneously. If BMI change was considered, the obese participants with BMI loss had a significant decrease of SBP during the study period (Ptrend = 0.0012). Mixed-effects models showed that weight gain was more influential on longitudinal SBP in the normal weight participants and weight loss was in the obese participants. The obese group with BMI loss had a decrease of SBP by 5.01 mmHg (95% confidence interval: 2.56 mmHg, 7.46 mmHg) compared to their counterparts with BMI maintenance from 2015 to 2019. ConclusionsThe effect of weight change on longitudinal SBP was varied among BMI groups. With the increase of baseline BMI level, the positive effect of weight loss on SBP became greater and the negative effect of weight gain on SBP were attenuated.

Hemodynamic and ventilatory changes in pediatric patients with special needs: A comparative clinical study.

Very limited data are available on the hemodynamic and ventilatory changes during sedation and general anesthesia using bispectral index (BIS) monitoring in intellectually disabled children. The purpose was to determine the hemodynamic and ventilatory changes after propofol and sevoflurane administration in children with special needs (CSN) versus healthy children (HC) during dental treatment. Forty pediatric patients needing dental treatment were allocated into two groups: children without systemic disease (healthy children [HC]) and mentally disabled children (children with special needs [CSN]). Sevoflurane in oxygen (100% oxygen, 5 l/min) and continuous propofol infusion (target-controlled infusion [TCI], 2 µg/ml) were used as sedative agents, and 2% lidocaine with 1:80,000 adrenaline was used as local anesthesia in both groups. Heart rate (HR), oxygen saturation (SaO2), respiratory rate (RR), exhaled carbon dioxide (CO2), blood pressure (BP) and bispectral monitoring (BIS) values were recorded during the entire dental treatment procedure. A statistically significant decrease in systolic BP, diastolic BP and RR was observed, with no significant differences between the healthy and disabled groups. In contrast, the HR and BIS values were lower in the CSN group than in the healthy patients (p ≤ 0.05). Patients with special needs had lower HR and BIS values than healthy patients, while BP, SaO2 and exhaled CO2 showed similar results in both groups. Key words:Bispectral index, hemodynamic changes, ventilatory changes, pediatric patients, special needs.

Features of the clinical course of arterial hypertension in patients with gene polymorphism under the influence of antihypertensive medicines

Arterial hypertension is a very heterogeneous disease, therefore the influence of environmental factors along with genetic factors leads to various options for the development and course of arterial hypertension. The aim of the study – to find out the effect of fixed combinations of antihypertensive drugs on the features of the clinical course of arterial hypertension in patients with gene polymorphism. We examined 86 patients. The patients were divided into 2 groups: group 1 consisted of 43 people who received a fixed combination of valsartan and amlodipine, group 2 included 43 patients who received a fixed combination of olmesartan and amlodipine. In patients of group 1, a significant decrease in average daily systolic blood pressure (SBP) in carriers of the AC genotype of the AGTR1 gene was established by 7.0% (p&lt;0.01), as well as SBP and DBP (diastolic blood pressure) in carriers of the CC genotype by 11.3 % and 9.8% (p&lt;0.01) respectively. Carriers of the TT, TC, and CC genotypes of the eNOS gene had a significant decrease in SBP by 7.8%, 8.3%, and 13.6% (p&lt;0.01), respectively, and DBP was significantly different from the indicator before treatment in carriers of the CC genotype and decreased by 11.0% (p&lt;0.02). In patients of group 2, a significant decrease in SBP in carriers of the AC genotype of the AGTR1 gene was established by 8.2 % and in DBP in carriers of the CC genotype by 11.2% (p&lt;0.01). Carriers of TT, TC and CC genotypes of the eNOS gene had a probable decrease in the level of average daily SBP by 8.3%, 9.7% and 16.5%, respectively, compared to the level before treatment (p&lt;0.01). In carriers of the CC genotype of the eNOS gene, BP decreased by 13.2% (p&lt;0.01). It has been proven that the use of fixed combinations of valsartan with amlodipine and olmesartan with amlodipine in terms of its effect on the clinical course and the level of SBP and DBP in patients with arterial hypertension with a gene polymorphism is almost the same and is most pronounced in carriers of the CC genotype of the AGTR1 and eNOS genes. Keywords: valsartan, olmesartan, amlodipine.

Effect of Banaba (Lagerstroemia speciosa) on Metabolic Syndrome, Insulin Sensitivity, and Insulin Secretion.

To evaluate the effect of Banaba (Lagerstroemia speciosa) on metabolic syndrome (MetS), insulin sensitivity, and insulin secretion. A randomized, double-blind, placebo-controlled clinical trial was carried out in 24 patients with diagnosis of MetS according to the International Diabetes Federation criteria. Body weight, waist circumference, and blood pressure were evaluated. Fasting plasma glucose (FPG) and insulin concentrations were measured every 30 min during 2 h after a 75-g dextrose load. Lipid profile was determined before and after the pharmacological intervention. Twelve patients received Banaba (500 mg) twice a day, before breakfast and dinner for 12 weeks. The remaining 12 patients received placebo at the same dosage. Body mass index, area under the curve (AUC) of glucose and insulin, insulin sensitivity, total insulin secretion, and the first phase of insulin secretion were calculated. After Banaba administration, there were significant decreases in systolic blood pressure (SBP) (121.5 ± 12.9 vs. 116.3 ± 9.8 mmHg, P = .050), FPG (5.9 ± 0.4 vs. 5.7 ± 0.4 mmol/L, P = .034), triglycerides (TG) (2.3 ± 0.4 vs. 1.7 ± 0.5 mmol/L, P = .021), very low-density lipoprotein (VLDL) (0.5 ± 0.1 vs. 0.3 ± 0.1 mmol/L, P = .021), AUC of insulin (50,675 ± 14,309 vs. 37,983 ± 19,298 mmol/L, P = .017), and insulinogenic index (0.4 ± 0.2 vs. 0.3 ± 0.2, P = .047). Eight patients (67%) of the Banaba group showed remission of MetS. In the placebo group, there was a downward trend toward statistical significance in the Stumvoll index (910.3 ± 514.1 vs. 651.0 ± 405.2, P = .062). Banaba administration leads to remission of MetS and a significant decrease in SBP, FPG, TG, VLDL, AUC of insulin, and total insulin secretion. Clinical Trial Registration number: NCT02767869.

Effects of transcranial direct current stimulation associated with an aerobic exercise bout on blood pressure and autonomic modulation of hypertensive patients: A pilot randomized clinical trial.

The objective of this article was to evaluate the effects of an aerobic exercise bout associated with a single session of anodal transcranial direct current stimulation (tDCS) over the left temporal lobe on blood pressure (BP) and heart rate variability (HRV) in hypertensive people. After met the inclusion criteria, twenty hypertensive people were randomized to active-tDCS or sham-tDCS group. Initially, they provided their sociodemographic data, a blood sample, and went through an evaluation of the cardiorespiratory performance. Then, a single session of tDCS with an intensity of 2mA over the left lobe during 20min was carried out. After tDCS, it was performed a session of moderate-intensity aerobic exercise during 40min. BP during 24h and HRV measurements were performed before (baseline) and after the intervention. Systolic BP during sleep time decreased in the active-tDCS group (p=0.008). Diastolic BP showed a significant decrease 3h after the intervention in the active-tDCS group (p=0.01). An intragroup comparison showed a significant decrease in systolic BP 3h after intervention only for the active-tDCS group (p=0.04). Besides, there was a trend toward a difference in wake for diastolic BP for active-tDCS (p=0.07). Lastly, there were no changes in the HRV for both groups. It is suggested that anodal tDCS associated with moderate-intensity aerobic exercise can decrease systolic and diastolic BP of hypertensive people during sleep time and 3h after the intervention.

The Role of Social Context in Physiological and Psychological Restoration in a Forest: Case Study of a Guided Forest Therapy Program in Taiwan.

Existing studies have demonstrated the restorative benefits of being in forests. However, most studies have designed participants to engage individually in forest walking and viewing, which neglects the social aspect of conversation. Researchers suggested that social context should be studied in order to have a better understanding how forests foster human health. To this end, we examined the role of social context using three types of forest therapy programs: a guided program, a self-guided program, and a walk alone program. A between-subject, pretest–posttest field experimental design was employed to evaluate restorative effects by measuring the physiological responses and mood states incurred in different forest therapy programs. Our findings showed, that the walk alone group exhibited a significant systolic blood pressure decrease and a significant increase in sympathetic nervous activity; the self-guided group showed a significant increase in heart rate values and significant decreases in systolic blood pressure and diastolic blood pressure; and the guided group revealed a significant decrease in systolic blood pressure. Further, the three forest therapy programs had positive effects on improving mood states, except a nonsignificant vigor–activity increase in the walk alone group. The three programs did not exhibit significant differences in changes of restorative benefits in physiological and psychological measures except for a significant difference in changes in sympathetic nervous activity between the walk alone group and guided group. The results showed the restorative benefits of forest therapy are apparent regardless of the program type. The management team should continue promoting forest therapy for public health by providing different types of forest therapy programs and experiences.

Fixed combination of ramipril and indapamide in patients with hypertension and non-alcoholic fatty liver disease: focus on the large arteries

Objective.To assess the effect of antihypertensive therapy with ramipril and indapamide on the elasticity of the vascular wall of the large arteries in relation to insulin resistance and chronic low-intensity inflammation in patients with hypertension (HTN) and non-alcoholic fatty liver disease (NAFLD).Design and methods.An open prospective controlled study was conducted: 30 patients with HTN stage I–II in combination with NAFLD (Fatty Liver Index (FLI) &gt; 60) at the age of 45–65 years were included. Washout period was scheduled 5–7 days before the baseline examination, followed by the prescription of one of the fixed combinations of ramipril (2,5/5 mg/day) and indapamide (0,625/1,25 mg), depending on the required dosage (Konsilar-D 24 VERTEX AO, Russia) and were given recommendations on lifestyle changes and weight loss. A clinical examination was carried out, indicators of daily blood pressure (BP) monitoring and central aortic pressure (CAP), pulse wave velocity (PWV), lipid and carbohydrate metabolism, chronic low-intensity inflammation and the severity of insulin resistance before and after treatment were analyzed.Results.After 24-week therapy with a fixed combination of ramipril and indapamide at an average dosage of 4,04 ± 1,24 and 1,01 ± 0,31 mg, respectively, 100% of patients with HTN and NAFLD achieved target BP levels. According to 24-hour BP monitoring data, a significant decrease in systolic BP (SBP) and diastolic BP (DBP) was observed, both in the daytime (Δ12 mm Hg, р = 0,0001; Δ5,5 mm Hg, р = 0,0019, respectively), and at night (Δ13,5 mm Hg, р = 0,0006; Δ5,5 mm Hg, р = 0,0054, respectively). In addition, there was a significant decrease in CAP in the daytime (SBPao p = 0,0011, DBPao p = 0,0022) and night hours (SBPao p = 0,0015, DBPao p = 0,00124), and a statistically significant decrease in augmentation index (day p = 0,0460, night p = 0,0182). When evaluating clinical data and bioimpedance measurements, a decrease in waist circumference (p = 0,0000), hip circumference (p = 0,0001), the proportion of subcutaneous (p = 0,0134) and visceral (p = 0,0019) fat was found, which may indicate a decrease in the severity of visceral obesity. Also, during treatment, there is a decrease in the severity of insulin resistance (and the concentration of tumor necrosis factor alpha (TNF-α) (p &lt; 0,0001) and CRP (p = 0,0002) in blood plasma. Finally, fixed combination of ramipril and indapamide led to a significant decrease in vascular stiffness (p = 0,0166) and a decrease in the proportion of patients with PWV paradoxical test (p = 0,0320). Correlation analysis showed that increased stiffness of the large arteries in patients with HTN and NAFLD is closely related to insulin resistance and lipid metabolism. At the same time, after 24-week therapy by a fixed combination of ramipril and indapamide, a decrease in the vascular stiffness in patients with HTN and NAFLD significantly correlated with the TNF-α concentration.Conclusions.A 24-week therapy by the fixed combination of ramipril and indapamide iin patients with HTN and NAFLD is associated with the persistent decrease in BP and CAP, both during the day and at night. There was a decrease in the vascular rigidity in muscular arteries. The treatment and recommendations for changing the lifestyle are associated with the decrease in the severity of abdominal obesity and insulin resistance, as well as the decrease in the severity of low-intensity systemic inflammation in patients with HTN and NAFLD, and a significant correlation was established between a decrease in TNF-α and an increase in the vascular elasticity of muscle and elastic type arteries.

Ficus asperifolia Miq‐enriched biscuit diet protects against L‐NAME induced hyperlipidemia and hypertension in rats

AbstractDietary sources of functional foods and nutraceutical have shown strong potentials in the management of hypertension and its complications. Sandpaper leaves, Ficus asperifolia Miq (FA), particularly found in Africa has a rich folkloric history in the management of diabetes and hypertension. This study produced biscuits supplemented with blends of FA at 2.5% and 5% fed to Nw (G)‐nitro‐l‐arginine‐methyl‐ester (L‐NAME, 40 mg/kg/day) induced‐hypertensive rats for 14 days followed by the assessment of blood pressure, lipid profile, and atherogenic index in hypertensive rats. The phenolic constituents of FA blends were analyzed using high‐performance liquid chromatography diode‐anode (HPLC‐DAD). Thereafter, the mean arterial blood pressure (MABP) and systolic blood pressure (SBP) was measured using the tail‐cuff method after which the heart and lungs of rats were collected, weighed, and the antioxidant status and lipid cholesterol profile were assessed. We realized that recorded phenolic constituents in extracts of FA was at a high level and FA enriched biscuit‐diet caused a significant decrease in SBP and MABP in L‐NAME‐induced hypertensive rats, body weight, atherogenic index and cholesterol profile in treated rats. However, FA enriched biscuit resulted in increased activities of catalase (CAT), superoxide dismutase (SOD), and glutathione‐S‐transferase (GST) antioxidant enzymes in the heart and lungs of hypertensive rats. This study revealed that FA enriched biscuit‐diet does not only have antihypertensive and antioxidant potential in L‐NAME‐induced hypertensive rats but also plays a protective role in the management of hyperlipidemia.

HIGH-SALT DIET CAUSES DROP IN BLOOD PRESSURE DURING DEVELOPMENT OF ONE-KIDNEY ONE-CLIP RENOVASCULAR HYPERTENSION IN FEMALE RATS

Objective: The aim of this research was to study high-salt diet (HSD) impact on development of renovascular hypertension (RH) in male and female Wistar rats. Design and method: Male and female Wistar rats were divided into three groups. The RH/CTRL group had a standard diet (0.25% NaCl). The RH/HSD group gets HSD (4% of NaCl). The RH/DC group had HSD during the first 4 weeks of experiment only. After two-week diet adaptation period Goldblatt's one-kidney one-clip surgery was conducted for all groups of the animals. The RH dynamics was monitored for the next 5 weeks. Blood and urine samples were taken on the 1st, 4th and 7th weeks. Results: There was no diet impact on systolic blood pressure (SBP) before the surgery. In male rats after the surgery an accelerated blood pressure elevation in RH/HSD and RH/DC groups was observed on the 3rd week (mean ± SEM: RH/CTRL 151 ± 4 mm Hg; RH/DC 169 ± 10, p = 0.08; RH/HSD 176 ± 8, p &lt; 0.05). Diet change in RH/DC group resulted in prevention of further elevation of SBP. The SBP in RH/DC group was lower than in RH/HSD group by the 7th week of the experiment (RH/HSD 188 ± 9 mm Hg; RH/CTRL 179 ± 6, p = 0.50; RH/DC 167 ± 5, p &lt; 0.05). In female rats an acceleration of SBP elevation in RH/HSD and RH/DC groups was lower than that in male groups (RH/CTRL 159 ± 7 mm Hg; RH/DC 173 ± 7; RH/HSD 174 ± 6). The significant decrease of SBP was in RH/HSD and RH/DC groups on the 5th week (RH/HSD -29 ± 3; RH/DC -29 ± 10 mm Hg, p &lt; 0.05). It was followed by the further elevation of blood pressure in RH/HSD group, but not in RH/DC group. SBP was lower in RH/DC group than in RH/HSD and RH/CTRL groups on the 7th week of the experiment (RH/HSD 175 ± 7 mm Hg; RH/CTRL 170 ± 9; RH/DC 141 ± 4). Creatinine clearance in male rats rises on the 4th week and decreases on the 7th week. In female there was a contrary dynamics. Conclusions: The influence of HSD on development of RH differs between male and female rats. In female rats HSD leads to a significant decrease of blood pressure during the third week of RH development.

THE INFLUENCE OF LIRAGLUTIDE ON THE LEVEL OF BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION AGAINST THE BACKGROUND OF OBESITY AND TYPE 2 DIABETES MELLITUS

Objective: To assess the effect of liraglutide (L) on the level of blood pressure (BP) in patients with arterial hypertension (AH) and obesity against the background of type 2 diabetes mellitus (T2DM). Design and method: A total of 55 patients with stage II AH and concomitant non-severe T2DM were examined (fasting plasma glucose &lt;12 mmol/L, glycosylated hemoglobin (HbA1c) - 8.75 ± 1.4%, disease duration 6.4 ± 1.8 years, mean age 51.4 ± 2.7, BMI 35.2 ± 2.6 kg/m2, mean BP 165/103 ± 3.4/2.2 mm Hg). Patients were distributed into 2 groups: the comparison group consisted of 22 patients who received metformin 850 mg 2/day, lisinopril 10 mg 1/day and amlodipine 10 mg 1/day. Patients of the main group (L-group, n = 23), received liraglutide 1.8 mg in addition to similar therapy. Results: 6 months after the initiation of therapy, the following results were obtained: HbA1C in the L group was 6.35 ± 0.5%, and in the comparison group - 7.78 ± 0.45% (p &lt; 0.05). BMI in the L-group was 30.28 ± 1.1 kg/m2, and in the comparison group - 32.5 ± 1.2 kg/m2. Systolic blood pressure (SBP) in the L-group was 132 ± 8.23 mm Hg., and in the comparison group - 143.5 ± 10.15 mm Hg., p &lt; 0.05 of difference between groups. The diastolic blood pressure (DBP) in the L- group was 84.5 ± 3.7 mm Hg, and in the comparison group - 89 ± 5.5 mm Hg, significant differences were not identified. Conclusions: A significant decrease in SBP during treatment with liraglutide in patients with hypertension against the background of obesity and type 2 diabetes can be due to both significant loss of body weight and an improvement of metabolic control. The obtained data suggest that liraglutide has a potential to reduce cardiovascular risk in hypertensive patients with obesity and diabetes.

Comparison of haemodynamic response to laryngoscopy and endotracheal intubation following induction of general anaesthesia with propofol or etomidate

Aims and Objectives: Propofol and etomidate are most frequently used intravenous induction agents, with very similar onset of action and duration of action, few advantages over each other and few unwanted effects. Recent studies and reintroduction of etomidate has paved way for its routine use in haemodynamically unstable patients. Materials and Methods: One hundred patients belonging to American Society of Anaesthesiologists (ASA) class I and II, aged between 18 to 60 years scheduled to undergo elective surgical procedure under general anaesthesia were selected. All the patients received tablet diazepam 0.2 mg/kg as premedication and fentanyl 2 mcg/kg body weight before induction. Patients were be randomly allocated to group P ((n = 50), who received propofol 2 mg/kg or group E (n = 50) who received, Etomidate 0.3 mg/kg as induction agent for general anaesthesia. Endotracheal intubation was facilitated by vecuronium 0.1mg/kg body weight. Heart rate (HR), Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) were recorded at basal, after fentanyl, 1, 3, 5 and 10 min following induction. Results: There was no significant change in the heart rate at and after the induction, intubation in either group P or group E. There was significant decrease in SBP, DBP and MAP in group P following induction, whereas there was less decrease in Group E. There was increase in the SBP, DBP and MAP after intubation in both the groups, but in group P it did not increase above the basal and remained below the basal levels at 5 and 10 minutes following intubation. Conclusion: Etomidate provides stable haemodynamics at induction of general anaesthesia. But it does not attenuate the haemodynamic response to laryngoscopy and intubation. Propofol causes significant hypotension at induction and attenuates the pressor response to laryngoscopy and intubation. Keywords: Propofol, Etomidate, Haemodynamic, Laryngoscopy, Blood pressure.

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.

Abstract 15205: MANP: A Novel ANP Analog for Hypertension Associated With Obesity and Metabolic Syndrome

Introduction: Atrial natriuretic peptide (ANP) plays an important role in blood pressure (BP) regulation via the second messenger cGMP. ANP also induces lipolysis by increasing plasma levels of non-esterified fatty acids (NEFA). MANP is a new Mayo Clinic designed ANP analog consisting of the native ANP with a novel 12-amino-acid C-terminus extension. In experimental models, MANP is more potent than ANP in reducing BP and inducing natriuresis. These actions are mediated by the activation of the pGC-A receptor and generation of cGMP. To date, the BP pressure lowering, cGMP generating and lipolytic actions of MANP remain unexplored along with its safety and tolerability in subjects with hypertension (HTN) associated with metabolic disease. Hypothesis: In subjects with HTN, obesity and metabolic syndrome (MS), MANP administration is safe, well tolerated, activates cGMP and exerts BP lowering and lipolytic properties. Methods: Double-blind, placebo-control clinical trial in 22 subjects (17 receiving MANP) with HTN, obesity and MS involving a single subcutaneous (SQ) injection of MANP (2.5 μg/Kg) or placebo. Subjects were monitored and cardiovascular, cGMP and metabolic parameters were collected during 24 hours after the injection. Results: In all subjects, MANP was safe and well-tolerated with no serious adverse side effects. MANP increased mean cGMP plasma levels after 30 minutes (delta: 4.8 ± 2.0 pmol/mL, p=0.02) and 1 hour (delta: 2.9 ±1.3 pmol/mL, p=0.03) when compared to baseline. Six hours after MANP injection systolic BP decreased by 5.7 ± 2.9 mmHg (p=0.06) whereas subjects receiving placebo had no decrease in blood pressure values compared to baseline. During fasting period, one hour after the administration of MANP, NEFA plasma levels increased by 108.2 ± 37.4 μM (p=0.01). Conclusions: In subjects with HTN, obesity and MS, SQ MANP is safe, well tolerated and activates the pGC-A receptor as measured by a significant increase in the second messenger cGMP. Subjects receiving MANP showed a borderline significant decrease in systolic BP and a significant increase in NEFA circulating levels supporting anti-hypertensive and lipolytic properties. Our findings support MANP as a potential novel therapy for HTN associated with metabolic disease.

EFFICACY OF NITROGLYCERINE INFUSION VERSUS SUBLINGUAL NIFEDIPINE IN SEVERE PRE-ECLAMPSIA

Background: Pre-eclampsia is a pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation. The incidence of preeclampsia is estimated to range between 2.5 and 5%. An accurate estimate, as well as its global burden, is difficult to obtain, due to lack of data from several countries and standardization of diagnostic criteria. Objective: To compare between the uses of continuous i.v. administration of nitroglycerine versus sublingual nifedipine in the management of women with severe pre-eclampsia who were being managed with controlled plasma volume expansion and MgSO4 loading and maintenance doses. Patients and Methods: Patients were taken from Sayed Galal Hospital. This study was carried out on 100 women with severe pre-eclampsia who were being managed with controlled plasma volume expansion and MgSO4 loading and maintenance doses. Those women were randomly assigned into two equal groups: Nitroglycerine or nifedipine. Both groups were compared as regard maternal adverse effects of vasodilator therapy, mean arterial pressure changes within one hour after vasodilator therapy, post therapy changes in fetal cardiotocography (CTG) and for feto-maternal complications including gestational age of termination of pregnancy, time of maternal intensive care unit (ICU) stay and the need of neonatal ICU. Results: Statistical analysis of the magnitude and time course of maternal hypotensive responses after initiation of the vasodilator therapy showed that, in nitroglycerine group, a statistically significant decrease in both systolic blood pressure (SBP) and diastolic blood pressure (DBP) started just 5 min. after the initiation of nitroglycerine infusion, while in nifedipine group, the significant decrease in SBP and DBP started 15 min. after oral nifedipine. The SBP and DBP measurements in nitroglycerine group were significantly lower than those in nifedipine group. The feto-maternal safety margin observed was similar in the two study groups. Conclusion: IV infusion of nitroglycerine was effective, safe and alternative therapy for severe pre-eclampsia.

The acute and chronic effects of high-intensity exercise in hypoxia on blood pressure and post-exercise hypotension: A randomized cross-over trial.

Background:Acute exercise leads to an immediate drop in blood pressure (BP), also called post-exercise hypotension (PEH). Exercise in hypoxia is related to additional vasodilation, potentially contributing to more profound PEH. Therefore, we investigated the impact of hypoxia versus normoxia on the magnitude of PEH. Second, we examined whether these changes in PEH relate to the BP-lowering effects of 12-week exercise training under hypoxia.Methods:In this prospective study, 21 healthy individuals (age 22.2 ± 3.0 years, 14 male) performed a 45-minute high-intensity running exercise on 2 different days in a random order, under hypoxia (fraction of inspired oxygen 14.5%) and normoxia (fraction of inspired oxygen 20.9%). BP was examined pre-exercise (t = 0) and at t = 15, t = 30, t = 45, and t = 60 minutes post-exercise. Afterward, subjects took part in a 12-week hypoxic running exercise training program. Resting BP was measured before and after the 12-week training program.Results:Acute exercise induced a significant decrease in systolic BP (systolic blood pressure [SBP], P = .001), but not in diastolic BP (diastolic blood pressure [DBP], P = .113). No significant differences were observed in post-exercise BP between hypoxic and normoxic conditions (SBP, P = .324 and DBP, P = .204). Post-exercise changes in SBP, DBP, and mean arterial pressure significantly correlated to the 12-week exercise training-induced changes in SBP (r = 0.557, P = .001), DBP (r = 0.615, P < .001), and mean arterial pressure (r = 0.458, P = .011).Conclusion:Our findings show that hypoxia does not alter the magnitude of PEH in healthy individuals, whilst PEH relates to the BP-lowering effects of exercise. These data highlight the strong link between acute and chronic changes in BP.

Study of Antihypertensive Activity of Anvillea radiata in L-Name-Induced Hypertensive Rats and HPLC-ESI-MS Analysis.

This study aimed to evaluate the effect of the aqueous extract of Anvillea radiate (A. radiata) aerial parts (AEAR) on arterial blood pressure in normotensive and hypertensive rats. The effect of the acute and sub-chronic administration of AEAR on the following blood pressure parameters: systolic blood pressure (SBP), mean blood pressure (MBP), diastolic blood pressure (DBP), and heart rate (HR) was evaluated in normotensive and L-NAME induced hypertensive rats. In the second experiment, the vasorelaxant effect of AEAR was assessed in isolated aortic rings from rats with functional endothelium pre-contracted with epinephrine (EP) or KCl, and six antagonists/ inhibitors were used to explore the mechanisms of action involved in the vasorelaxant effect. In order to determine the phytochemical contents of Anvillea radiata, HPLC-ESI-MS analysis was conducted. Daily oral administration of AEAR (100 mg/kg) provoked a significant decrease in SBP, MBP, and DBP without affecting HR in hypertensive rats. In addition, AEAR (0.08-0.64 mg/ml) revealed a vasorelaxant effect in thoracic aortic rings pre-contracted by EP (10 μM) or KCl (80 mM). This effect was reduced in the presence of Nifedipine, L-Name or Methylene blue. The polyphenolic compounds of AEAR were determined. This study revealed that AEAR possesses a potent antihypertensive activity and its vasorelaxant activity seems to be mediated through Ca2+ channels, direct nitric oxide (NO), and NO/cGMP pathways. Chlorogenic acid and caffeic acid identified in A. radiata could be at least partially responsible for the antihypertensive activity of this extract.

Effect of ertugliflozin on glycemic levels, blood pressure and body weight of patients with type 2 diabetes mellitus: a systematic review and meta-analysis.

To conduct a meta-analysis to evaluate the effect of ertugliflozin on long-term hemoglobin A1c (HbA1c), body weight and blood pressure (BP). Online databases available were searched from their inception to February 2020. Randomized controlled trials (RCTs) comparing ertugliflozin to either placebo or an active control drug were included. Data on four efficacy outcomes were extracted, namely: HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP) and body weight. Continuous outcomes were pooled using a random-effects model and presented as weighted mean differences (WMDs) and corresponding 95% CIs. Additionally, a subgroup analysis was done to compare two doses of ertugliflozin (5mg and 15mg). A sensitivity analysis was also performed by eliminating studies using active drugs as controls. From a total of 123 search results, eight studies were included. Compared to the control group, ertugliflozin was associated with a significant decrease in SBP (WMD: -3.64mmHg, 95% CI [-4.39,-2.90]; p < 0.001; I2= 0%) and DBP (WMD: -1.13mmHg, 95% CI [-1.67,-0.60], p < 0.001; I2= 0%). Similarly, significant reductions in body weight (WMD: -2.35kg, 95% CI [-2.94,-1.77]; p < 0.001; I2= 0%) as well as HbA1c (WMD: -0.41%, 95% CI [-0.62,-0.20]; p < 0.001; I2= 0%) were seen with ertugliflozin. Subgroup analysis demonstrated no significant difference in efficacy between the two doses in any of the four outcomes. Ertugliflozin results in significant reductions in HbA1c, body weight, SBP and DBP, when compared to control. Subgroup analyses suggest that these effects are not dose-dependent.

A systematic review and meta-analysis on effect of spinal mobilization and manipulation on cardiovascular responses.

Background:Spinal pain or misalignment is a very common disorder affecting a significant number of populations resulting in substantial disability and economic burden. Various manual therapeutic techniques such as spinal manipulations and mobilizations can be used to treat and manage pain and movement dysfunctions such as spinal mal-alignments and associated complications. These manual therapeutic techniques can affect the cardiovascular parameters.Objective:The objective of this systematic review and meta-analysis is to assess the effect of spinal manipulation and mobilization on cardiovascular parameters.Methods:We conducted a systematic review and meta-analysis to assess the effects of spinal mobilization and manipulation on cardiovascular responses. Mean changes in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Heart Rate (HR) were primary outcome measures. RevMan 5.3 software was used for the meta-analyses. Quality of the included studies was assessed by PEDro Rating scale. Risk of bias was assessed by Cochrane collaboration tool of risk of bias.Results:Results of meta-analysis showed that there was statistically significant decrease in SBP (, 95% , 0.08; ) with moderate heterogeneity (, ) in experimental group as compared to control group. There was statistically non-significant decrease in DBP (, 95% , 0.69; ) with high heterogeneity (, ), Change HR was statistically non-significant (, 95% , 3.11; ) with moderate heterogeneity (, ). Exclusion of short duration studies in sensitivity analysis revealed a statistically significant change in DBP (, 95% , ; ). However, the result was statistically non-significant for HR after sensitivity analysis.Conclusion:Spinal manipulations and mobilizations may result in significant decrease of systolic as well as diastolic Blood Pressure.

The Effects of Synthesized Semicarbazone Copper Complex on Blood Pressure in Normotensive and L-NAME Induced Hypertensive Rats

Hypertension has been for decades a major contributor to overall mortality and morbidity worldwide. This study was aimed towards evaluating changes in blood pressure in normotensive and L-NAME hypertensive induced rats subjected to treatment with a synthesized semicarbazone copper complex (CSCZ)**. CSCZ was synthesized from the reaction between di-2-pyridylketone semicarbazone (dpksc) and CuCl2.2H2O in refluxing ethanol and characterized from its spectroscopic and elemental analyses. The infrared and electronic absorption spectra are in accord with the proposed formulation of the complex. Animals were rendered hypertensive by oral administrations of Nω-nitro-L-arginine methyl ester (L-NAME) daily (dose 40 mg/kg body weight) for 5 weeks. Oral daily dosages (20 mg/kg body weight) of CSCZ was administered to the animals. A significant decrease in systolic blood pressure (SBP) at 132.91 ± 7.62 was observed in the L-NAME/CSCZ treated group (LCZ) when compared to the L-NAME group at 161.00 ± 5.34 while no significant changes were observed in heart rate (HR) and pulse pressure (PP). Treatment with CSCZ also seemingly normalised and prevented the development of L-NAME induced hypertension in the rats. A significant decrease in SBP and PP was also seen in the normotensive group treated with CSCZ at 91 ± 2.11 and 21.67 ± 1.43 respectively when compared to the control group at 130.63 ± 2.98 and 44.10 ± 5.15 respectively. These findings reveal the blood pressure lowering effects of CSCZ in normotensive rats and its ability to prevent L-NAME induced hypertension.