Significant Rise In Blood Pressure Research Articles

Physiological impact of a single cup of coffee on systemic blood pressure and heart rate – A randomized controlled trial

Background: Coffee is a prevalent beverage that is consumed on a global scale. This study was done to depict the immediate effects of caffeine on systemic blood pressure (BP) and heart rate (HR) in young healthy, normotensive individuals who consume coffee on an infrequent basis, using validated non-invasive techniques. The acute properties of caffeine have been the subject of numerous studies, and we’ll be exploring the latest findings on this topic. Thus, we think that it is more useful to ascertain if a typical cup of coffee can produce a significant rise in BP and HR. Aims and Objectives: This research aimed to examine the effect of a single cup of coffee on the HR and BP of young healthy adults. Materials and Methods: The study was conducted on 68 participants from 1st-year MBBS students enrolled in the study of those 4 were excluded as two males showed systemic BP of >140/80 and we have excluded two females to maintain an equal male and female ratio. In a randomized double-blind, placebo-controlled study, 64 healthy subjects were first divided into caffeine and placebo groups. One cup of coffee and a placebo drink were administered orally to 64 healthy, normotensive adults, and BP (systolic BP [SBP], diastolic BP [DBP]) and HR were observed. Results: Administration of caffeine shows increased systolic and DBP from 0 to 30 min after coffee intake was significantly higher in the caffeine group than in the placebo group. The mean SBP, DBP at 90 min in the caffeine group was compared to the mean SBP, DBP at 90 min in the placebo group. The mean difference in both was statistically significant with a P < 0.001. Conclusion: The present study concludes that the ingestion of a single cup of caffeinated coffee may elicit a significant increase in both systolic and DBP, as well as in HR, among young, healthy, and sporadic coffee consumers. Notably, such a rise in physiological parameters may interfere with the accuracy of BP measurements taken in the few hours following coffee intake, especially in individuals who consume coffee on an occasional basis.

Interventions required and outcome in pregnancy induced hypertension patients in Intensive Care Unit: An observational study

Hypertensive disorders of pregnancy, particularly preeclampsia, eclampsia remain one of the leading causes of maternal morbidity and mortality worldwide. We studied the association between the risk factors, interventions required, diagnosis and outcome in these patients admitted to the Intensive Care Unit (ICU).: We conducted a prospective, observational study after the Institutional Scientific and Ethics committee approval. The Institutional record was taken to identify 70 women with Pregnancy Induced Hypertension (PIH) admitted to ICU after meeting the inclusion and exclusion criteria. Socio-demographic details, indication and timing of ICU admission were noted. On ICU admission; baseline vitals, detailed history, duration of complications, therapeutic interventions, laboratory parameters and imaging were compiled. Maternal outcome was assessed in terms of interventions needed, complications encountered and mortality or discharge and follow up was done up to 6 weeks postpartum. Fetal outcome was assessed in terms of live births or Intrauterine fetal death (IUFD), Apgar score, term/preterm and followed up to 7 postnatal days.: It was observed that out of 70 women enrolled in our study, 48 women were diagnosed with preeclampsia, 54 belonged to the age group of 21-30 years, 61 were unregistered for antenatal checkup, 46 had term gestation, 52 were nulliparous and 64 underwent Lower segment caesarean section (LSCS). 60 of them had postpartum ICU admission, all of them had significant rise in blood pressure. Most common interventions were transfusion of blood products (n=30) and mechanical ventilation (n=6). HELLP syndrome was the most common complication (n=7). Maternal mortality was seen in 6 women. 35 neonates had low birth weight, 6 had intra uterine growth retardation (IUGR), 19 were preterm and Apgar score was significant at 5 minutes.: From our observations, it can be concluded that majority of the women were diagnosed with preeclampsia, were relatively of younger age group, nulliparous with no antenatal checkup, underwent LSCS and were admitted postpartum to ICU. Transfusion of blood products was the most common intervention & HELLP syndrome was most common complication. Maternal mortality was higher in women with preeclampsia although overall mortality was low. The incidence of low birth weight, IUGR and preterm neonates was more in eclamptic women. Neonatal mortality was more in preeclamptic women.

Development of a computational fluid dynamic model to investigate the hemodynamic impact of REBOA.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a lifesaving intervention for major truncal hemorrhage. Balloon-tipped arterial catheters are inserted via the femoral artery to create a temporary occlusion of the aorta, which minimizes the rate of internal bleeding until definitive surgery can be conducted. There is growing concern over the resultant hypoperfusion and potential damage to tissues and organs downstream of REBOA. To better understand the acute hemodynamic changes imposed by REBOA, we developed a three-dimensional computational fluid dynamic (CFD) model under normal, hemorrhage, and aortic occlusion conditions. The goal was to characterize the acute hemodynamic changes and identify regions within the aortic vascular tree susceptible to abnormal flow and shear stress. Methods: Hemodynamic data from established porcine hemorrhage models were used to build a CFD model. Swine underwent 20% controlled hemorrhage and were randomized to receive a full or partial aortic occlusion. Using CT scans, we generated a pig-specific aortic geometry and imposed physiologically relevant inlet flow and outlet pressure boundary conditions to match in vivo data. By assuming non-Newtonian fluid properties, pressure, velocity, and shear stresses were quantified over a cardiac cycle. Results: We observed a significant rise in blood pressure (∼147 mmHg) proximal to REBOA, which resulted in increased flow and shear stress within the ascending aorta. Specifically, we observed high levels of shear stress within the subclavian arteries (22.75 Pa). Alternatively, at the site of full REBOA, wall shear stress was low (0.04 ± 9.07E-4 Pa), but flow oscillations were high (oscillatory shear index of 0.31). Comparatively, partial REBOA elevated shear levels to 84.14 ± 19.50 Pa and reduced flow oscillations. Our numerical simulations were congruent within 5% of averaged porcine experimental data over a cardiac cycle. Conclusion: This CFD model is the first to our knowledge to quantify the acute hemodynamic changes imposed by REBOA. We identified areas of low shear stress near the site of occlusion and high shear stress in the subclavian arteries. Future studies are needed to determine the optimal design parameters of endovascular hemorrhage control devices that can minimize flow perturbations and areas of high shear.

Management of posterior reversible encephalopathy syndrome in a pediatric patient with a rare adrenocortical tumor after computed tomography-guided biopsy

The posterior reversible encephalopathy syndrome (PRES) in pediatric patients is rare but a treatable reversible condition. In the pediatric age group, most cases had been reported among patients with leukemia undergoing chemotherapy and rarely in patients with solid tumors. We report a 2-year-old male child with a large retroperitoneal mass arising from the right adrenal gland. The patient had a significant rise in blood pressure followed by seizures and altered sensorium after a computed tomography-guided biopsy from the tumour mass. The patient was managed meticulously considering it as a case of PRES by a multidisciplinary team of the intensive care unit. Later, the adrenal mass was evaluated and confirmed to be a pediatric adrenocortical tumor on biopsy report which is also a rare occurrence in the pediatrics age group.

Acute Effects of Vasopressin Arginine Infusion in Children with Congenital Heart Disease: Higher Blood Pressure Does Not Equal Improved Systemic Oxygen Delivery.

The use of vasopressin has been increased in recent years in children after congenital heart surgery. However, there is limited information regarding its effects on cardiac output, systemic oxygen delivery, and myocardial energetics. The purpose of this study is to characterize the effects of vasopressin infusions on hemodynamics and systemic oxygen delivery in children with congenital heart disease. A retrospective, single-center study of patients with congenital heart disease who received vasopressin infusions in a pediatric cardiac intensive care unit between January 2019 and May 2020. The measured values collected for study were systolic and diastolic blood pressure, heart rate, arterial oxygen saturation as determined by pulse oximetry, arterial pH, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, serum lactate, serum sodium, and renal and cerebral oximetry based on near-infrared spectroscopy. The calculated values for this study were the difference between arterial and NIRS oximetry, the reno-cerebral near-infrared spectroscopy gradient and the vasoinotrope score. A Wilcoxon signed-rank test was utilized to compare values of paired continuous variables before and after initiation of the vasopressin infusion. Correlations were assessed using Spearman correlation analyses and stepwise regressions were completed. A total of 26 vasopressin infusions among 20 unique patients were included in the final analyses. Of these 26 vasopressin infusions, 18 were in patients with biventricular circulation and 8 were in patients with functionally univentricular circulation. The median vasopressin infusion dose at initiation was 0.4 (0.1-1) milliunits/kg/min. For the entire cohort 2 h after the initiation of vasopressin, systolic blood pressure increased to 8.4mmHg, p < 0.01, but no significant correlation was found to markers of systemic oxygen delivery. Similar results were obtained when only those with biventricular circulation were considered. Those with functionally univentricular circulation were not found to have any statistically significant rise in blood pressure. Vasopressin infusions appear to statistically significantly increase systolic blood pressure in children with congenital heart disease who have a biventricular but not functionally univentricular circulation. Even when an increase in systolic blood pressure is present, systemic oxygen delivery did not improve.

Fasting plasma glucose, lipid ratios, and atherogenic coefficient are the risk factors for hypertension in chronic kidney disease patients on hemodialysis: A report from the Regional High Speciality Hospital of Peninsular Yucatan, Mexico

Chronic kidney disease (CKD) is associated with the development of cardivascular disease (CVD). CKD is one of the major public health problems in Mexico. Derived parameters of lipid profile, namely atherogenic index of plasma (AIP), atherogenic coefficient (AC), and Castelli risk index (CRI I and CRI II) are useful for predicting hypertension among CKD patients on hemodialysis that are not widely reported from Mexico. Objective of the present study was to find interrelationships among blood pressure, fasting plasma glucose (FPG), and derived parameters of lipid profile (AIP, AC, CRI-I, and CRI-II) among adult CKD patients on hemodialysis in a hospital in Yucatan, Mexico. Methods: An observational study was performed using the medical records (2016 and 2017) of 47 CKD patients on hemodialysis in the Regional High Speciality Hospital of Yucatan Peninsula (HRAEPY in Spanish acronym). Multiple linear regression models were developed to evaluate the use of FPG level and derived parameters of lipid profile (AC, CRI-I, and CRI-II) as risk factors predicting mean arterial pressure (MAP). Results showed remarkable prevalence of excess weight (55% overweight, 15% obesity) and hypertension (64%) in the sample. Correlation coeffcients and multiple linear regression models showed significant rise of blood pressure in association with elevated FPG level and derived lipid profile parameters. The results confirm the use of FPG, AC, CRI-I and CRI-II as the indicators for an early diagnosis of hypertension and related CVDs among CKD patients on hemodialysis.

Effect of Local Anaesthesia with and without Adrenaline on Blood Pressure, Pulse Rate and Oxygen Saturation - A Comparative Study

Introduction: Most of the minor oral surgical procedures are performed under local anaesthesia (LA). Vasoconstrictor present in LA decreases the rapid absorption of LA, decreases systemic toxicity, increases duration of LA and provides local hemostasis which favor clinicians for better work performance. But it is also known to increase heart rate (HR) and blood pressure (BP).&#x0D; Objective: To evaluate the effect of vasoconstrictor adrenaline 1:80,000 in 1.8 ml of 2% Lidocaine on systolic and diastolic blood pressure, pulse rate and oxygen saturation of normotensive patients.&#x0D; Methods: A prospective randomized study was conducted on 70 patients who were divided randomly into 2 parallel groups according to the LA received. Group 1 (G1): lidocaine 2% without adrenaline and Group 2 (G2): lidocaine 2% with adrenaline 1:80,000. Blood pressure, pulse rate and oxygen saturation were measured before and 10 minutes after LA administration for each patient.&#x0D; Results: Statistically significant rise in blood pressure and pulse rate was seen in group receiving LA with adrenaline (G2) 10 minutes after administration.&#x0D; Conclusion: Though adrenaline amount in 1.8ml causes significant rise of parameters assessed under the study, the rise is not clinically relevant for a normotensive, medically fit patient.

ЗНАЧИМОСТЬ УРОВНЯ ГИПОТЕРМИИ В НЕЙРОФИЗИОЛОГИЧЕСКИХ РЕАКЦИЯХ ОРГАНИЗМА ЧЕЛОВЕКА НА ЭКСПЕРИМЕНТАЛЬНОЕ ОБЩЕЕ ОХЛАЖДЕНИЕ

Effects of hypothermia on the character of changes in central hemodynamics, heart rate variability (HRV) and EEG were studied during an experimental whole-body cooling of 30 healthy male subjects at the age of 18–20 years. The subjects were divided into 2 equal groups by the median body temperature in the total sample (34.1 °С) during cooling. The experiment consisted of 3 steps: rest at +20 °С, 10-min exposure to -20 °С in a hypothermal chamber and rewarming at +20 °С. The parameters registered at each step included EEG, blood pressure (BP), heart rate (HR) and temperature in the external auditory meatus. In the cooling chamber, body temperature lowered reliably by 1.4–3.1 °С on the average. In both groups hypothermia reduced the index of regulatory systems strain, increased total HRV power and BP, and decreased HR. During rewarming all these parameters tended to return to baseline values. Subjects with a more distinct hypothermia (33.1 °С) displayed a weakened baroreflex reaction (slight HR reduction) accompanied by a stronger vascular reaction (significant BP rise). High baroreflex stability in the subjects with low-level hypothermia (35 °С) was evidenced by a significant HR decrease in response to the BP rise. Changes in the EEG amplitude and frequency patterns during cooling declared themselves by enhancement of the subcortex regulatory activity (reliable rise in the theta-activity). Also, the alpha-activity was increased in the subjects with high-level hypothermia and decreased in 73 % of the subjects with a low-level hypothermia which points to desynchronization of the main rhythm.

Changes of blood pressure following initiation of physical inactivity and after external addition of pulses to circulation

PurposeTo determine whether an innovative, motorized, wellness device that effortlessly produces physical activity (JD) can mitigate the hypertensive effects of prolonged sitting or lying down.MethodsTwenty-two normotensive and hypertensive adults of both genders gave informed consent to participate in a randomized controlled crossover study of a passive simulated jogging device (JD) in both supine and seated postures. Each study participant was monitored with a continuous non-invasive arterial pressure monitoring device (CNAP) over 60 min. The initial 10 min served as baseline for each posture. The subjects were randomized to begin with either JD or SHAM control for 30 min, and monitoring was continued for an additional 10 min in one posture; three days later posture and order of JD or SHAM were changed.ResultsIn both seated and supine postures, SHAM was associated with a significant rise in blood pressure (BP) which was observed within 5–10 min; it continued to rise or remain elevated for over a 40-min observation period. In contrast, JD produced a significant decrease in both systolic and diastolic blood pressure in both postures. During recovery in seated posture JD decreased systolic and diastolic BP by − 8.1 and − 7.6 mmHg, respectively. In supine posture, a similar decrease in BP occurred.ConclusionsThere is rapid onset of increase in systolic and diastolic BP with physical inactivity in both supine and seated postures. Administration of JD significantly decreased BP in both postures. Further studies are needed to assess long-term effectiveness.

Anesthetic management of thoracoscopic resection of lung lesions in small children.

Video-assisted thoracoscopic surgery has dramatically increased over the last decade because of both medical and cosmetic benefits. Anesthesia for video-assisted thoracoscopic surgery in small children is more challenging compared to adults due to the considerable problems posed by small airway dimensions and ventilation. The optimal technique for one-lung ventilation has yet to be established and the use of remifentanil infusion in this setting is not well described. This study investigated the use of extraluminal bronchial blocker placement for one-lung ventilation and the effect of infusion of remifentanil in infants and small children undergoing video-assisted thoracoscopic surgery. We retrospectively reviewed the technique of one-lung ventilation and the hemodynamic effects of remifentanil infusion in 31 small children during elective video-assisted thoracoscopic surgery for congenital lung lesions under anesthesia with sevoflurane or isoflurane, oxygen, and air. Patients' heart rate, blood pressure, and endtidal carbon dioxide at baseline (after induction of anesthesia), immediately after one-lung ventilation, during carbon dioxide insufflation, and at the end of one-lung ventilation were extracted from the database and analyzed. The use of vasopressors or dexmedetomidine was also recorded and analyzed. Extraluminal placement of a bronchial blocker alongside the tracheal tube was successfully performed in 90.3% of cases (28 patients) without any serious complications or arterial oxygen desaturation. There was no significant rise in blood pressure or heart rate even with the rise of endtidal carbon dioxide concentration during video-assisted thoracoscopic surgery. In 58% of patients (18 patients), phenylephrine was administered to maintain the blood pressure within 20% of the baseline value. There was no significant change in the heart rate of all patients at each time point. One-lung ventilation with an extraluminal parallel blocker was used effectively in this series of young children undergoing thoracoscopic excision of congenital pulmonary lesions. Remifentanil infusion attenuated surgical stress effectively in infants and small children undergoing video-assisted thoracoscopic surgery.

Comprehensive Ultrasound Assessment of the Craniocervical Circulation in Transient Global Amnesia.

Structural changes and metabolic stress have been reported on diffusion-weighted magnetic resonance imaging in the cornu ammonis 1 area of the hippocampus in patients with transient global amnesia (TGA), but a consensus on pathogenesis is still lacking. The aim of our study was to perform a comprehensive ultrasound analysis of the cerebrovascular circulation in our population of patients with TGA. One hundred patients with TGA and 50 age- and sex-matched control participants underwent ultrasound examinations of the cervicocranial circulation. The most significant risk factor for TGA was arterial hypertension (P < .01). There were no significant atherosclerotic lesions on the large arteries of the neck (mean internal carotid artery stenosis ± SD, 28.7% ± 11.7%) or on the large intracerebral arteries (good structural and hemodynamic status; P > .05). Rarely detected microembolic signals or a right-left cardiopulmonary shunt excluded an emboligenic mechanism of TGA (P > .05). The internal jugular vein valves were incompetent in 54% of patients with TGA, and this condition was associated with an increased risk of TGA (odds ratio, 4.16; 95% confidence interval, 1.91-9.04). The mean values of the breath holding index and pulsatility index, as parameters of small-vessel function, were within normal ranges and without differences between the TGA and control groups (P > .05). Our ultrasound examination did not detect significant structural atherosclerotic changes of cervicocranial arteries, and an emboligenic mechanism was excluded. Only a significant rise of blood pressure in TGA and significant valvular insufficiency of the internal jugular vein were established. New research should clarify whether these simultaneous functional circulatory changes have relevance for metabolic stress in the cornu ammonis of the hippocampus.

101 Effect of oxygen therapy in early neotnatal life on capillary microcirculation and blood pressure in low birth weight infants

BackgroundLow birth weight (LBW) is a risk factor for adult essential hypertension, diabetes mellitus, obesity and cardiovascular disease mortality in later life. Individuals with history of LBW have many abnormalities...

DOCA-Salt Hypertension: an Update.

Hypertension is a multifaceted disease that is involved in ∼40% of cardiovascular mortalities and is the result of both genetic and environmental factors. Because of its complexity, hypertension has been studied by using various models and approaches, each of which tends to focus on individual organs or tissues to isolate the most critical and treatable causes of hypertension and the related damage to end-organs. Animal models of hypertension have ranged from Goldblatt's kidney clip models in which the origin of the disease is clearly renal to animals that spontaneously develop hypertension either through targeted genetic manipulations, such as the TGR(mRen2)27, or selective breeding resulting in more enigmatic origins, as exemplified by the spontaneously hypertensive rat (SHR). These two genetically derived models simulate the less-common human primary hypertension in which research has been able to define a Mendelian linkage. Several models are more neurogenic or endocrine in nature and illustrate that crosstalk between the nervous system and hormones can cause a significant rise in blood pressure (BP). This review will examine one of these neurogenic models of hypertension, i.e., the deoxycorticosterone acetate (DOCA), reduced renal mass, and high-salt diet (DOCA-salt) rodent model, one of the most common experimental models used today. Although the DOCA-salt model is mainly believed to be neurogenic and has been shown to impact the central and peripheral nervous systems, it also significantly involves many other body organs.

Cardiovascular Response to Defecating Postures with and without Valsalva Maneuver in Healthy Individuals

Abstract Aims: To assess the cardiovascular response to defecating postures of bridging and sitting lean forward with and without Valsalva maneuver in healthy individuals. Study design: Prospective interventional cross-over study in healthy population. Study material: Stop watch, Rubber tube, Nostril clip, Pillow, Mercury Sphygmomanometer, Cardioscope (Model no.: Iris 50, Maestros company). Materials and methods: A total of 100 healthy individuals participated in the study. They maintained sitting lean forward and in bridging position for 5 minutes with and without Valsalva maneuver. Valsalva maneuver was performed at 40 mm Hg pressure for 15 seconds. Blood pressure and heart rate were recorded. Mean arterial pressure and rate pressure product were derived. Data analysis: The data was analyzed using Statistical Package for the Social Sciences v 16. Shapiro–Wilk test was used to test normality, and nonparametric Mann-Whitney test was used with p &lt; 0.05 as statistically significant. Results: Sitting in lean forward position showed statistical significant increase in heart rate (p &lt; 0.05) compared to bridging position with Valsalva maneuver. There was a significant rise in blood pressure with bridging as compared to sitting lean forward with Valsalva. There was no statistically significant difference in heart rate and blood pressure between sitting lean forward position and bridging position without Valsalva maneuver. Conclusion: Sitting lean forward position and bridging position increase hemodynamic load compared to relaxed sitting posture. With Valsalva maneuver sitting lean forward posture causes greater rise in heart rate compared to bridging position.

Salt Sensitivity Determined From Capillary Blood

Background/Aims: A significant rise of blood pressure in response to a given salt load is a weak indication of high salt sensitivity, supposed to foster the development of arterial hypertension and related diseases in later life. In search of an alternative method we recently developed the salt blood test (SBT), a new concept for quantifying salt sensitivity (SS). Based on this concept, namely that red blood cells (RBC) report on salt sensitivity, the SBT-mini was developed. Methods: The SBT-mini utilizes a droplet of capillary blood mixed with a ‘smart' Na⁺ cocktail. Red blood cells (RBC) of this mixture are allowed to sediment by gravity in a glass tube. SS is quantified by measuring RBC sedimentation rate. 90 healthy volunteers (39 males, 51 females; mean age: 23±0.5 years) were evaluated and ‘standard values' for males and females were derived. Results: Sodium buffer capacity of female blood is about 20 % smaller as compared to male blood due to the lower hematocrit of females. SS of an individual is related to the mean standard value (set to 100 %) of the respective male/female cohort. High SS (> 120 %) has been found in 31 % of males and 28 % of females. Conclusions: SS can be estimated derived from the individual RBC sodium buffer capacity as measured by the SBT-mini. About one third of a healthy test cohort exhibits a high sensitivity to salt. Reduction of sodium consumption to at least two grams per day (equals five grams of NaCl per day as suggested by the WHO) is recommended, particularly for individuals with high salt sensitivity.

Does levobupivacaine have a benefit over bupivacaine in our practice?

Background The well-known toxic effects of bupivacaine on central nervous system and cardiovascular system were a base for the development of new long-acting local anesthetics. Levobupivacaine is the pure S(-)-enantiomer of racemic bupivacaine. This study compares the efficacy of levobupivacaine as against bupivacaine by epidural clinical study and by different routes in animal study. Materials and methods Evaluation of the analgesic activities by the hot plate method was carried out in nine groups of mice. Each four groups were injected intraperitoneally with either levobupivacaine or bupivacaine. The control group received saline. The hemodynamic effects of levobupivacaine and bupivacaine were carried out on the isolated rabbit's heart and anesthetized cats for carotid blood pressure and ECG. Thirty patients undergoing limb surgery were randomized to receive 15 ml of 0.5% levobupivacaine or bupivacaine through epidural needle. Intraoperative blood pressure and heart rate were recorded. Onset time of sensory and motor block, time to T 10 sensory block, complete motor block, quality of analgesia, and times for two segment regressions were detected. Results Experimentally, the intensity and duration of analgesia produced by levobupivacaine was more than that of bupivacaine. Both drugs induced significant dose-dependent negative inotropic effect, but it was lesser in levobupivacaine than in bupivacaine. An amount of 2 mg/kg levobupivacaine produced a significant rise in blood pressure and 4 mg/kg significantly decreased it, whereas 1 and 2 mg/kg bupivacaine produced a significant decrease in blood pressure. The ECG pattern of levobupivacaine showed no abnormalities, but bupivacaine at a dose of 2 mg/kg produced significant bradycardia and ECG changes. Cardiac arrest and death of cats occurred when 4 mg/kg of bupivacaine was injected. Clinically, the onset time of sensory block, time to T 10 sensory block and time to complete motor block are lower with bupivacaine than with levobupivacaine. Conclusion We found, based on the current pharmacodynamics evidence from this experimental and clinical study, that levobupivacaine has good analgesic activity and less cardiodepressant effect, and it offers advantages over bupivacaine.

Change of the renal hydrogen sulfide system in salt-sensitive hypertensive rats

Objective To study the change of the renal endogenous hydrogen sulfide(H2S) pathway in the development of salt-sensitive hypertension in Dah1 rats. Methods Sixteen male Dah1 rats, in accordance with the random number table, were randomly divided into control group and high salt group fed with diet containing 80 g/kg NaCl.After 8 weeks, 24 h urine sodium, 24 h urinary protein, serum creatinine and serum urea were measured.The microstructural and ultrastructural changes in kidney were observed with light microscope and electronic microscope.The serum and kidney H2S contents were determined by using sulphur-sensitive electrode method.The mRNA levels of cystathionine β-synthase(CBS), cystathionine γ-lyase(CSE) and mercaptopyruvate sulfurtransferase(MPST) in renal tissue were determined by means of real-time polymerase chain reaction(RT-PCR). The protein expressions of CBS, CSE and MPST in renal tissue were detected by using Western blot. Results Compared with control group, high salt group rats had a significant rise in blood pressure, declined renal function, damaged renal structure, segmental glomerular sclerosis, small artery wall thickening, and occlusion of the lumen.Moreover, the endogenous H2S pathway in kidney of Dah1 rats with high salt diet was downregulated markedly, demonstrated by the decreased serum and kidney H2S content, the reduced renal CBS, CSE and MPST mRNA expressions and CBS protein expression of kidney tissue. Conclusion The endogenous H2S/CBS pathway is downregulated during the development of salt-sensitive hypertension in Dah1 rats. Key words: High salt; Hypertension; Dah1 salt-sensitive rat; Hydrogen sulfide

The aqueous calyx extract of Hibiscus sabdariffa may lower blood pressure and pulse rate by sympathetic nervous system‐dependent mechanism(s) (1170.11)

This study tested the hypothesis that the hypotensive effect of the aqueous calyx extract of Hibiscus sabdariffa (HS) may be sympathetically mediated. Following ethical approval and informed consent, the cold pressor test (CPT) was performed in 20 healthy subjects before and after the oral administration of 15mg/Kg HS. The blood pressure (BP) and pulse rate (PR) responses were measured digitally. Mean arterial pressure (MAP; taken as representative BP) was calculated. Experiments were performed in accordance with the Principles of the Declaration of Helsinki. Results are expressed as mean ±SEM. P&lt;0.05 was considered significant. CPT done in the absence of HS resulted in a significant rise in BP and PR (111.1 ± 2.1mmHg and 100.8 ± 2.0/min) from the basal values (97.9±1.9mmHg and 87.8±2.1/min; P&lt;0.0001 respectively). In the presence of HS however, these fell significantly (101.5±1.8mmHg and 92.4±2.0/min; P&lt;0.0001 respectively). These results suggest that the hypotensive effect of HS may be due to an attenuation of the discharge of the sympathetic nervous system.Grant Funding Source: Personal Funds

Cardiovascular risk assessment for the use of ADHD drugs in children

Drug therapy for ADHD (Attention Deficit Hyperactivity Disorder) has generally been regarded as safe. ECG screening of healthy children and adolescents before initiating this type of treatment appears to be usual in Norway, despite recommendations that ECGs should only be undertaken in individuals who are at risk. The purpose of this article is to clarify relevant guidelines for cardiovascular risk assessment for the use of ADHD drugs in children and adolescents, as well as to propose practical recommendations. The article is based on a literature search in PubMed completed on 1 October 2013, and on the author's own clinical experience and discretionary assessments. The use of CNS stimulants and atomoxetine is associated with a slight rise in blood pressure and pulse rate, as well as small changes in QT interval. A small percentage of patients (5-10%) experience a clinically significant rise in blood pressure and pulse rate. Sudden death does not appear to occur more frequently in children and adolescents taking ADHD drugs in therapeutic doses than in children and adolescents who do not use such drugs. There is little knowledge available on the long-term effects of ADHD drugs on the cardiovascular system of otherwise healthy individuals, or on the risk related to the use of ADHD drugs in children and adolescents with cardiac disease. The drugs are thought to increase the risk of sudden cardiac death in some arrhythmia syndromes. Our assessment is that caution should be exercised in the use of ADHD drugs in children with potentially dangerous cardiac arrhythmias. We recommend clinical examination and a thorough medical history review in order to identify individuals at risk before initiating drug therapy, and also suggest that it is not necessary for healthy children to be given an ECG examination before introducing ADHD drugs. In children with known cardiac disease, arrhythmia or risk factors for cardiac disease, ADHD treatment should be undertaken in consultation with a medical specialist with competence in pediatric cardiology.

Prevention and treatment of postpartum hypertension

Postpartum blood pressure (BP) is highest three to six days after birth when most women have been discharged home. A significant rise in BP may be dangerous (e.g., can lead to stroke), but there is little information about how to prevent or treat postpartum hypertension. To assess the relative benefits and risks of interventions to: (1) prevent postpartum hypertension, by assessing whether 'routine' postpartum medical therapy is better than placebo/no treatment; and (2) treat postpartum hypertension, by assessing whether (i) one antihypertensive therapy is better than placebo/no therapy for mild-moderate postpartum hypertension; and (ii) one antihypertensive agent offers advantages over another for mild-moderate or severe postpartum hypertension. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2013), bibliographies of retrieved papers, and personal files. For women with antenatal hypertension, trials comparing a medical intervention with placebo/no therapy. For women with postpartum hypertension, trials comparing one antihypertensive with either another or placebo/no therapy. We extracted the data independently and were not blinded to trial characteristics or outcomes. We contacted authors for missing data when possible. Nine trials are included. Four trials (358 women) compared furosemide, nifedipine capsules, or L-arginine with placebo/no therapy. For women with antenatal pre-eclampsia, postnatal furosemide is associated with a strong trend towards reduced use of antihypertensive therapy in hospital. For treatment of mild-moderate postpartum hypertension, three trials (189 women) compared timolol, oral hydralazine, or oral nifedipine with methyldopa. Use of additional antihypertensive therapy did not differ between groups (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.20 to 4.20; three trials), but the trials were not consistent in their effects. The drugs were well tolerated.For treatment of severe postpartum hypertension, two trials (120 women) compared intravenous hydralazine with either sublingual nifedipine or intravenous labetalol. There were no maternal deaths or hypotension. Use of additional antihypertensive therapy did not differ between groups (RR 0.58, 95% CI 0.04 to 9.07; two trials), but the trials were not consistent in their effects. For women with pre-eclampsia, postnatal furosemide may decrease the need for postnatal antihypertensive therapy in hospital, but more data are needed on substantive outcomes before this practice can be recommended. There are no reliable data to guide management of women who are hypertensive postpartum. Any antihypertensive agent used should be based on a clinician's familiarity with the drug. Future studies should include data on postpartum analgesics, severe maternal hypertension, breastfeeding, hospital length of stay, and maternal satisfaction with care.