Small Increase In Blood Pressure Research Articles

Abstract P101: The Association Between Residing in a Food Desert and Hypertension in Victims of Sudden Death

Introduction: Sudden deaths, defined as unexpected deaths not attributable to suicide, trauma or cancer account for over 10% of deaths in adults aged 18-64 years. More evidence is needed to understand how socioeconomic factors interplay with physiological processes such as hypertension to contribute to sudden death. We hypothesized that residing in a food desert would be associated with hypertension and poor blood pressure (BP) control in people who died of sudden death. Methods: We screened Emergency Medical Services (EMS) records from 2013 to 2015 in Wake County, NC, which includes the capital city of Raleigh and >1 million residents, and adjudicated 399 sudden death victims using a standardized protocol. We collected medical history and BP measures from health records and linked geocoded patient addresses to census-tract data from the USDA’s Food Access Research Atlas. Of these, 350 victims had address data available, and of these 196 had blood pressures available. Residing in a food desert was defined as living in a low income and low access area, which is defined as no access to grocery stores within 1 mile in urban areas and 10 miles in rural areas. The ten most recent systolic BP measures prior to death were used to calculate average BP. We calculated unadjusted differences in mean BP by residence in a food desert. We also calculated unadjusted odds ratios (ORs) comparing the probability of having a hypertension diagnosis and of having controlled BP (systolic BP <130 mmHg) by residence in a food desert. Results: We examined 350 sudden decedents who were 33% Black (116 of 350), 64% White (224 of 350), 31% women (109 of 350), and a median age of 55. Of these, seventy-nine (23%) resided in a food desert, and these were more likely to have diabetes mellitus (38.0% vs. 26.6%), (30 of 79 and 72 of 271 respectively). Sudden decedents who resided in a food desert had higher systolic BP with a mean of 140 mmHg compared with 134 mmHg for those who did not reside in a food desert (mean difference 6.15, CI 6.012-6.298). Of those residing in a food desert, 60.8% (48 of 79) had a medical diagnosis of hypertension, and 33.3% (14 of 48) had controlled BP. There was no association between residing in a food desert and a diagnosis of hypertension (OR 1.04, 95% CI 0.62-1.74) or controlled BP (OR 1.73, 95% CI 0.85-3.54). Conclusion: Almost a quarter of sudden decedents resided in a food desert at the time of death. In this case group, residing in a food desert was associated with a small BP increase but not with diagnosed hypertension or controlled BP. Large population studies are necessary to investigate the risk of sudden death and poor blood pressure control associated with residing in a food desert.

Brief early life angiotensin-converting enzyme inhibition attenuates the diuretic response to saline loading in sheep with solitary functioning kidney.

A solitary functioning kidney (SFK) from birth predisposes to hypertension and kidney dysfunction, and this may be associated with impaired fluid and sodium homeostasis. Brief and early angiotensin converting enzyme inhibition (ACEi) in a sheep model of SFK delays onset of kidney dysfunction. We hypothesized that modulation of the renin angiotensin system via brief postnatal ACEi in SFK would reprogram renal sodium and water handling. Here, blood pressure (BP), kidney haemodynamics and kidney excretory function were examined in response to an isotonic saline load (0.13 ml/kg/min; 180 minutes) at 20 months of age in SFK (fetal unilateral nephrectomy at 100 days gestation; term 150 days), sham and SFK+ACEi sheep (ACEi in SFK 4-8 weeks of age). Basal BP was higher in SFK than sham ( 13 mm Hg), and similar between SFK and SFK+ACEi groups. Saline loading caused a small increase in BP ( 3-4 mm Hg) the first two hours in SFK and sham sheep but not SFK+ACEi sheep. Glomerular filtration rate did not change in response to saline loading. Total sodium excretion was similar between groups. Total urine excretion was similar between SFK and sham animals but was 40% less in SFK+ACEi animals compared to SFK animals. In conclusion, this study indicates that water homeostasis in response to a physiological challenge is attenuated at 20 months of age by brief early life ACEi in SFK. Further studies are required to determine if ACEi in early life in children with SFK could compromise fluid homeostasis later in life.

Abstract P225: Dahl Salt-sensitive And Salt-resistant Rats Exhibit Highly Disparate Blood Pressure Responses To Lifetime High Fat Diet Feeding

In an effort to understand obesity associated hypertension, we and others are using Dahl salt-sensitive (SS) rats fed a high fat diet as an experimental model. One reason for choosing this rat strain is that it is well-known that SS rats exhibit accelerated hypertension development not just in response to high salt intake but to numerous other stimuli as well, when compared to Dahl salt resistant (SR) rats. However, it is not known whether this general dichotomous sensitivity to hypertension development in SS and SR rats also extends to the impact of high fat feeding. Therefore, in the present study we tested the hypothesis that high fat feeding would cause a smaller increase in blood pressure in SR rats versus SS rats in both females and males (n=8 each). To explore possible strain differences in the mechanisms known to contribute to obesity associated hypertension, we also compared the activity of the renin angiotensin and sympathetic nervous systems in SS and SR rats. Rats were fed a high fat diet (60% kcal fat) from weaning. Blood pressure was measured by telemetry starting at 12 weeks of age. At 12 weeks, mean arterial pressures (MAP, mmHg) were 109±8 and 158±6 in male SR and SS rats, and 108±1 and 150±5 in female SR and SS rats, respectively. By 18 weeks MAP were 109±7 and 175±4 in male SR and SS rats, and 108±1 and 180±4 in female SR and SS rats, respectively. In males, plasma renin was lower, and aldosterone the same, in SS rats than SR rats. However, SS rats showed larger falls in blood pressure during week-long ACE inhibitor treatment and to acute sympathoinhibition with hexamethonium than did SR rats. In females, plasma renin and aldosterone both were higher in SS rats than SR rats. Female SS rats also showed larger falls in blood pressure to chronic ACE inhibition and acute ganglion blockade than did SR rats. These results confirm that both male and female SR rats are highly resistant to obesity associated hypertension, and that less robust activation by high fat diet of the renin angiotensin and sympathetic nervous systems may be a causative factor.

Organization of treatment and health resort rehabilitation of elderly and long-living patients with cardiovascular diseases in hospital for war veterans

The Russian Federation belongs to the countries with very high cardiovascular risk. Data on risk factors for death in people of old age and long-livers are not well understood. Objective. To summarize the experience of organizing treatment and inpatient rehabilitation of elderly patients and long-livers with cardiovascular diseases, to assess their cardiovascular risk factors. Methods. The study involved 50 patients, aged from 77 to 97 years (average age – 86.6 ± 4.9 years), who underwent treatment and rehabilitation for cardiovascular diseases. 32 (64 %) people corresponded to old age, and 18 (36 %) people over the age of 90 years were long-livers. There were 36 (72 %) women and 14 (28 %) men. Results. All 50 patients had arterial hypertension. Angina pectoris was diagnosed in 49 (98 %) patients. One myocardial infarction was suffered by 4 (8 %) people, two – 3 (6 %). 7 (14 %) people had a stroke, and another (2 %) suffered from the disease twice. Atrial fibrillation was diagnosed in 8 (16 %) patients, diabetes mellitus – in 11 (22 %). Сarotid arteries stenoses were found in 23 (95.8 %) patients, in 5 of them up to 50–55 %, including one occlusion. All patients were discharged with improvement after complex therapy in accordance with guidelines. Conclusions. A system for the rehabilitation of elderly patients and long-livers with cardiovascular diseases has been developed. Patients of older age groups have very high cardiovascular risk and prevalence of cardiovascular risk factors. Relatively small increases in blood pressure, the degree of arterial stenosis of a less hemodynamically significant level, and the use of combined therapy for cardiovascular diseases are factors that make it possible to survive until the age of long-livers.

Organization of treatment and health resort rehabilitation of elderly and long-living patients with cardiovascular diseases in hospital for war veterans

The Russian Federation belongs to the countries with very high cardiovascular risk. Data on risk factors for death in people of old age and long-livers are not well understood.Objective. To summarize the experience of organizing treatment and inpatient rehabilitation of elderly patients and long-livers with cardiovascular diseases, to assess their cardiovascular risk factors.Methods. The study involved 50 patients, aged from 77 to 97 years (average age – 86.6 ± 4.9 years), who underwent treatment and rehabilitation for cardiovascular diseases. 32 (64 %) people corresponded to old age, and 18 (36 %) people over the age of 90 years were long-livers. There were 36 (72 %) women and 14 (28 %) men.Results. All 50 patients had arterial hypertension. Angina pectoris was diagnosed in 49 (98 %) patients. One myocardial infarction was suffered by 4 (8 %) people, two – 3 (6 %). 7 (14 %) people had a stroke, and another (2 %) suffered from the disease twice. Atrial fibrillation was diagnosed in 8 (16 %) patients, diabetes mellitus – in 11 (22 %). Сarotid arteries stenoses were found in 23 (95.8 %) patients, in 5 of them up to 50–55 %, including one occlusion. All patients were discharged with improvement after complex therapy in accordance with guidelines.Conclusions. A system for the rehabilitation of elderly patients and long-livers with cardiovascular diseases has been developed. Patients of older age groups have very high cardiovascular risk and prevalence of cardiovascular risk factors. Relatively small increases in blood pressure, the degree of arterial stenosis of a less hemodynamically significant level, and the use of combined therapy for cardiovascular diseases are factors that make it possible to survive until the age of long-livers.

Knockout of Macula Densa Neuronal Nitric Oxide Synthase Increases Blood Pressure in db/db Mice.

[Figure: see text].

Acute Hemodynamic Responses to Three Types of Hamstrings Stretching in Senior Athletes.

Although stretching is recommended for fitness and health, there is little research on the effects of different stretching routines on hemodynamic responses of senior adults. It is not clear whether stretching can be considered an aerobic exercise stimulus or may be contraindicated for the elderly. The purpose of this study was to compare the effect of three stretching techniques; contract/relax proprioceptive neuromuscular facilitation (PNF), passive straight-leg raise (SLR), and static sit-and-reach (SR) on heart rate (HR) and blood pressure (BP) in senior athletes (119 participants: 65.6 ± 7.6 yrs.). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and HR measurements were taken at baseline (after 5-minutes in a supine position), 45 and 90-seconds, during the stretch, and 2-minutes after stretching. Within each stretching group, (SLR, PNF, and SR) DBP, MAP and HR at pre-test and 2-min post-stretch were lower than at 45-s and 90-s during the stretch. SLR induced smaller increases in DBP and MAP than PNF and SR, whereas PNF elicited lower HR responses than SR. In conclusion, trained senior adult athletes experienced small to moderate magnitude increases of hemodynamic responses with SLR, SR and PNF stretching, which recovered to baseline values within 2-min after stretching. Furthermore, the passive SLR induced smaller increases in BP than PNF and SR, while PNF elicited lower HR responses than SR. These increases in hemodynamic responses (HR and BP) were not of a magnitude to be clinically significant, provide an aerobic exercise stimulus or warrant concerns for most senior athletes.

Empagliflozin Downregulates Renal NHE3 Activity and NaPi‐2 Expression and Reduces Blood Pressure in Hypertensive Rats

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, also known as gliflozins, can lower blood pressure (BP) and reduce cardiovascular mortality in hypertensive patients with type 2 diabetes. However, the molecular mechanisms underlying the antihypertensive effects of the SGLT2 inhibitors have not been elucidated. This study tested the hypothesis that empagliflozin, an SGLT2 inhibitor, reduces BP of nondiabetic hypertensive rats and that this effect may be associated with altered expression and/or covalent modification of apical sodium transporters in the renal proximal tubule. To this end, spontaneously hypertensive rats (SHR) and normotensive Wistar rats (12-14 weeks of age) were treated for 2 weeks with empagliflozin 10 mg/kg/day or vehicle (water) orally. BP was measured non-invasively (tail-cuff plethysmography) and invasively (arterial catheterization). Proximal tubule Na+/H+ exchanger isoform 3 (NHE3) activity was assessed by in vivo stationary microperfusion. NHE3 phosphorylated at serine 552 (pNHE3-552), total NHE3 and Na+-dependent phosphate cotransporter type II (NaPi-2) expression in the renal cortex were evaluated by immunoblotting. We found that vehicle-treated SHR exhibited a small increase in BP (9±2 mmHg), whereas empagliflozin reduced BP of hypertensive rats (-10±2 mmHg). No changes in BP were observed in Wistar rats. The in vivo stationary microperfusion analyses showed that empagliflozin inhibited the activity of NHE3 in both hypertensive and normotensive rats. Inhibition of NHE3 activity by empagliflozin was not accompanied by differences in the levels of pNHE3-552 or total NHE3 expression in the renal cortex. On the other hand, NaPi-2 expression was upregulated in the renal cortex of vehicle-treated SHR (226±18 vs. 100±5% in vehicle-treated Wistar rats, p< 0.0001), and treatment with empagliflozin significantly reduced it (163±11 vs. 226±18%, p< 0.01). Renal cortical NaPi-2 abundance was not affected by empagliflozin in normotensive rats. These findings demonstrate empagliflozin lowers blood pressure in nondiabetic hypertensive rats. Moreover, it shows that SGLT2 inhibition may reduce proximal tubule sodium reabsorption via inhibition of NHE3 and downregulation of NaPi-2. Future studies are necessary to evaluate the impact of SGLT2 inhibitors in the distal nephron and its association with the antihypertensive effects of the gliflozins.

Effects of Chewing Gum on Nitric Oxide Metabolism, Markers of Cardiovascular Health and Neurocognitive Performance after a Nitrate-Rich Meal

Objectives Cardiovascular and neurocognitive responses to chewing gum have been reported, but the mechanisms are not well understood. Chewing gum after a nitrate-rich meal may upregulate the reduction of oral nitrate to nitrite and increase nitric oxide (NO), a molecule important to cardiovascular and neurocognitive health. We aimed to explore effects of chewing gum after a nitrate-rich meal on nitrate metabolism (through the enterosalivary nitrate-nitrite-NO pathway), endothelial function, blood pressure (BP), neurocognitive performance, mood and anxiety. Methods Twenty healthy men (n = 6) and women (n = 14) with a mean age of 48 years (range: 23–69) were recruited to a randomized controlled cross-over trial. After consumption of a nitrate-rich meal (180 mg of nitrate), we assessed the acute effects of chewing gum, compared to no gum chewing, on (i) salivary nitrate, nitrite and the nitrate reductase ratio (100 x [nitrite]/([nitrate] + [nitrite]); (ii) plasma nitrite, S-nitrosothiols and other nitroso species (RXNO); (iii) endothelial function (measured by flow mediated dilatation); (iv) BP; (v) neurocognitive performance; (vi) mood; and (vii) anxiety. Results Consumption of the nitrate-rich meal resulted in a significant increase in markers of nitrate metabolism. A significantly higher peak flow mediated dilatation was observed with chewing compared to no chewing (baseline adjusted mean difference: 1.10%, 95% CI: 0.06, 2.14; p = 0.038) after the nitrate-rich meal. A significant small increase in systolic BP, diastolic BP and heart rate were observed with chewing compared to no chewing after the nitrate-rich meal. The study did not observe increased oral reduction of nitrate to nitrite and NO, or improvements in neurocognitive performance, mood or anxiety with chewing compared to no chewing. Conclusion Chewing gum after a nitrate-rich meal resulted in an acute improvement in endothelial function and a small increase in BP but did not result in acute effects on neurocognitive function, mood or anxiety.

Abstract P136: Effects Of Sex Hormones On The Hemodynamic And Sympathetic Responses To Centrally Administered Tumor Necrosis Factor-α In Rats

Inflammation plays an important role in the pathophysiology of cardiovascular dysfunction and neurohumoral excitation in heart failure and hypertension. Growing evidence has demonstrated significant sex differences in the inflammatory response and immune processes, with estrogen exerting an anti-inflammatory effects and testosterone potentially having pro-inflammatory influence. We previously reported that central administration of tumor necrosis factor-α (TNF-α) elicited different effects on blood pressure (BP), heart rate (HR) and renal sympathetic nerve activity (RSNA) in male and female rats. Whether the sex steroids estrogen and testosterone contribute to the observed differences in TNF-α-induced hemodynamic and sympathetic responses remains unknown. We hypothesized that estrogen protects against TNF-α-induced sympathetic excitation and pressor responses while testosterone enhances these excitatory outcomes in response to TNF-α. Female or male Sprague Dawley rats (10-12 weeks) anesthetized with ketamine plus xylazine underwent bilateral ovariectomy or castration, respectively, 2 weeks prior to study. Sham-operated (Sham) female or male animals served as controls. TNF-α (100 ng) was administered intracerebroventricularly (ICV). BP (mmHg), HR (bpm) and RSNA (% change) were recorded in urethane anesthetized rats. In ovariectomized female rats (n=6), ICV TNF-α induced significantly (*p&lt;0.05 vs. Sham) larger increases in BP (19.3 ± 1.4* vs. 12.8 ± 1.2 ), HR (76.3 ± 4.8* vs. 51.5 ± 4.3) and RSNA (104.8 ± 6.9* vs. 72.4 ± 5.1), compared with Sham-female rats, that began within 20-30 mins and peaked at 90-120 mins after ICV injection. In castrated male rats (n=6), ICV TNF-α-elicited significantly smaller increases in BP (15.2 ± 1.3* vs. 21.8 ± 1.6), HR (57.7 ± 4.2* vs. 82.6 ± 4.1) and RSNA (72.6 ± 4.3* vs. 110.3 ± 4.7), compared with Sham-male animals. These data indicate a distinct role of sex hormones estrogen and testosterone in central inflammation-driven cardiovascular and sympathetic activation and suggest a protective effect of estrogen and a harmful effect of testosterone in the development of hypertension and heart failure.

Lifelong high‐altitude hypoxia induces arterial baroreflex adaptations: new insights and future directions

Lifelong high‐altitude hypoxia induces arterial baroreflex adaptations: new insights and future directions

Long-term risk for kidney donors with hypertension at donation - a retrospective cohort study.

In the general population, small increases in blood pressure are associated with increased mortality. In kidney donors this association is less certain. We therefore assessed long-term overall and cardiovascular mortality in donors who were hypertensive at the time of donation compared with normotensive donors. Hypertension was defined as blood pressure >140/90mmHg or use of antihypertensive drugs. Adequate records available in 2131 donors revealed that 140 were hypertensive and 1991 were normotensive. Multivariable regression analyses were performed for overall and cardiovascular mortality. Hypertensive donors were significantly older (mean 57.7 vs. 46.9years), more were males (44.3% vs. 41.5%), had higher body mass index (26.4 vs. 24.7) and lower estimated glomerular filtration rate (91.8 vs. 101.2ml/min/1.73m2 ). After a median observation time of 20.8years (interquartile range 11) 71 hypertensive donors had died and 26 of the deaths were cardiovascular. Multivariable analysis did not suggest a generalizable association between hypertension and long-term overall mortality [hazard ratio (HR) 1.1, 95% confidence interval (CI) 0.9-1.5, P=0.34] or cardiovascular mortality (HR 1.1, 95% CI 0.7-1.8, P=0.55). These data may support the use of older healthy kidney donors with hypertension at donation.

Elevated blood pressure and household solid fuel use in premenopausal women: Analysis of 12 Demographic and Health Surveys (DHS) from 10 countries

BackgroundApproximately three billion people are exposed to household air pollution (HAP) from solid fuel cookstoves. Studies from single settings have linked HAP with elevated blood pressure (BP), but no evidence exists from multi-country analyses. ObjectivesUsing nationally representative and internationally comparable data, we examined the association between solid fuel use and BP in 77,605 largely premenopausal women (aged 15–49) from ten resource-poor countries. MethodsWe obtained data on systolic and diastolic BP, self-reported primary cooking fuel, health and socio-demographic characteristics from 12 Demographic and Health Surveys conducted in Albania, Armenia, Azerbaijan, Bangladesh, Benin, Ghana, Kyrgyzstan, Lesotho, Namibia, and Peru. We estimated associations between history of fuel use [solid fuel (coal or biomass) versus clean fuel (electricity or gas)] with systolic and diastolic BP and hypertension using a meta-analytical approach. ResultsOverall, the country-level mean systolic and diastolic BP were 117 (range: 111–127) and 74 (71–83) mmHg, respectively. The country-level mean age of the women was 30.8 years (range: 28.4–32.9). The prevalence of solid fuel use was 46.0% (range: 4.1–95.8). In adjusted, pooled analyses, primary use of solid fuel was associated with 0.58mmHg higher systolic BP (95% CI: 0.23, 0.93) as compared to primary use of clean fuel. The pooled estimates for diastolic BP and pulse pressure were also positive, but the confidence intervals contained zero. The pooled odds of hypertension was [OR = 1.07 (95% CI: 0.99, 1.16)], an effect that was driven by rural participants for whom solid fuel use was associated with a 16% greater odds of hypertension [OR = 1.16 (95% CI: 1.01, 1.35)]. ConclusionsCooking with solid fuels was associated with small increases in BP and odds of hypertension. Use of cleaner fuels like gas or electricity may reduce cardiovascular risk in developing countries, particularly among rural residents.

Trials and Tribulations of CETP Inhibitors.

The development of CETP (cholesteryl ester transfer protein) inhibitors has had a long and difficult course with 3 compounds failing in phase III clinical trials. Finally, the REVEAL (Randomized Evaluation of the Effects of Anacetrapib through Lipid modification) trial has shown that the CETP inhibitor anacetrapib decreased coronary heart disease when added to statin therapy. Although the result is different to earlier studies, this is likely related to the size and duration of the trial. The benefit of anacetrapib seems to be largely explained by lowering of non-HDL-C (high-density lipoprotein cholesterol), rather than increases in HDL-C. Although the magnitude of benefit for coronary heart disease appeared to be moderate, in part this may have reflected aspects of the trial design. Anacetrapib treatment was associated with a small increase in blood pressure, but was devoid of major side effects and was also associated with a small reduction in diabetes mellitus. Treatment with CETP inhibitors, either alone or in combination with statins, could provide another option for patients with coronary disease who require further reduction in LDL (low-density lipoprotein) and non-HDL-C.

P24: DUAL EFFECT OF PHENYLEPHRINE TO IMPROVE CORONARY PERFUSION DURING ANAPHYLAXIS MANAGEMENT

Adrenaline, the drug of choice in anaphylaxis may produce side effects like tachycardia resulting in impaired coronary perfusion in the setting of severe hypotension. In this situation, Phenylephrine was used to improve coronary perfusion by Increasing coronary flow time from reflex bradycardia and an increase in coronary perfusion pressure resulting from an overall increase in systemic blood pressure. We describe a situation where at the end of an elective high anterior resection for colovesical fistula, immediately after administering reversal agents (Neostigmine and glycopyrrolate), there was severe hypotension with systolic blood pressure of 40m mmHg unresponsive to Ephedrine and Metaraminol. Adrenaline boluses resulted in tachycardia with marked ST segment elevation and slight increase in blood pressure. Intravenous Phenylephrine 100 mcg bolus was given and repeated twice over a period of 15 minutes which reduced the heart rate from 130 to 100 beats/minute as well as increased the blood pressure with ST segment returning to baseline. ANZAAG guidelines were followed to maximise management and team efficiency during and after the crisis and resulted in an uneventful recovery. A 10 fold increase in serum Tryptase confirmed anaphylaxis. Anaphylaxis to reversal agents (Neostigmine and Glycopyrrolate) is rare1 and in this situation it was complicated by ECG evidence of tachycardia induced ST segment elevation after administration of 2 doses of 100 mcg increments of adrenaline with only small increase in blood pressure. Phenylephrine improved the myocardial perfusion and blood pressure. We recommend that Phenylephrine should be considered in the presence of Adrenaline induced tachycardia to improve myocardial perfusion during anaphylaxis management. 1. McNicholas JJ, Harban FM. Anaphylaxis caused by neostigmine. Anaesthesia 2000; 55: 1039.

Evaluation of double-lumen endotracheal tube extubation force by extraction angle: a prospective randomized clinical trial

Study ObjectiveGentle and noninvasive double-lumen tracheal tube (DLT) extubation is important for both airway and circulatory management, especially after lung resection. We performed a prospective randomized clinical trial comparing DLT extubation force based on 2 different extraction angles. DesignRandomized clinical trial. SettingOperating room. PatientsSixty adult patients scheduled for elective surgery under general anesthesia using DLT with ASA physical status 1 to 3. InterventionsSixty patients who underwent lung resection with a DLT were randomly assigned to extraction angles of 60° (30 patients) and 90° (30 patients) relative to the ground. MeasurementsExtubation forces and changes in vital signs were compared between groups. Results were analysed with the Mann-Whitney U test, non-paired t test, and χ2 test. P<.05 was considered significant. Main ResultsLess extraction force was needed at 60° compared to 90° (90°, 13.9±2.3 N; 60°; 7.1±2.1 N; P<.001). The rate of increase in systolic and diastolic blood pressure (post-extubation/pre-extubation) was significantly smaller at 60° than at 90° (systolic blood pressure, P<.001; diastolic blood pressure, P=.002). ConclusionsOur findings suggest that DLT extubation at 60° requires less force than at 90° and was accompanied by a smaller increase in blood pressure. Thus, extraction at 60° may be less invasive and beneficial for patients undergoing DLT extubation.

Hypertensive Crisis: The Causative Effects of Nonsteroidal Anti- Inflammatory Drugs

62-year-old female presents with hypertensive urgency while taking daily NSAIDs. This case demonstrates the effect of NSAIDs on BP, an often over-looked etiology of secondary hypertension. The detrimental effects of NSAIDs upon blood pressure have been well documented. The report reiterates and reviews the severity of the problem. We will review the existing literature and discuss the importance of small increases in blood pressure. This paper has not been submitted elsewhere, is not under review, or published previously and all of the authorship are aware of and approve the manuscript being submitted to this journal.

Endoplasmic reticulum stress in the brain subfornical organ contributes to sex differences in angiotensin-dependent hypertension in rats.

Endoplasmic reticulum (ER) stress in the brain subfornical organ (SFO), a key cardiovascular regulatory centre, has been implicated in angiotensin (ANG) II-induced hypertension in males; however, the contribution of ER stress to ANG II-induced hypertension in females is unknown. Female hormones have been shown to prevent ER stress in the periphery. We tested the hypothesis that females are less susceptible to ANG II-induced SFO ER stress than males, leading to sex differences in hypertension. Male, intact and ovariectomized (OVX) female rats received a continuous 2-week subcutaneous infusion of ANG II or saline. Additional male, intact and OVX female rats received intracerebroventricular (ICV) injection of ER stress inducer tunicamycin. ANG II, but not saline, increased blood pressure (BP) in both males and females, but intact females exhibited smaller increase in BP and less depressor response to ganglionic blockade compared with males or OVX females. Molecular studies revealed that ANG II elevated expression of ER stress biomarkers and Fra-like activity in the SFO in both males and females; however, elevations in these parameters were less in intact females than in males or OVX females. Moreover, ICV tunicamycin induced smaller elevation in BP and less increase in expression of ER stress biomarkers in the SFO in intact females compared with males or OVX females. The results suggest that differences in ANG II-induced brain ER stress between males and females contribute to sex differences in ANG II-mediated hypertension and that oestrogen protects females against ANG II-induced brain ER stress.

Cyclooxygenase-1 inhibition attenuates angiotensin II-salt hypertension and neurogenic pressor activity in the rat

Cyclooxygenase (COX)-derived prostanoids contribute to angiotensin II (ANG II) hypertension (HTN). However, the specific mechanisms by which prostanoids act are unclear. ANG II-induced HTN is caused partly by increased sympathetic nervous system activity, especially in a setting of high dietary salt intake. This study tested the hypothesis that COX-derived prostanoids cause ANG II-salt sympathoexcitation and HTN. Experiments were conducted in conscious rats. Infusion of ANG II (150 ng·kg(-1)·min(-1) sc) caused a marked HTN in rats on 2% salt diet, but a much smaller increase in blood pressure in rats on 0.4% salt diet. The nonselective COX inhibitor ketoprofen (2 mg/kg sc) given throughout the ANG-II infusion period attenuated HTN development in rats on 2% NaCl diet, but not in rats on 0.4% NaCl diet. The acute depressor response to ganglion blockade was used to assess neurogenic pressor activity in rats on 2% NaCl diet. Ketoprofen-treated rats showed a smaller fall in arterial pressure in response to ganglion blockade during ANG-II infusion than did nontreated controls. In additional experiments, ketoprofen-treated rats exhibited smaller increases in plasma norepinephrine levels and whole body norepinephrine spillover than we previously reported in ANG II-salt HTN. Finally, the effects of the selective COX-1 inhibitor SC560 (10 mg·kg(-1)·day(-1) ip) and the selective COX-2 inhibitor nimesulide (10 mg·kg(-1)·day(-1) ip) were investigated. Treatment with SC560 but not nimesulide significantly reduced blood pressure and the depressor response to ganglion blockade in ANG II-salt HTN rats. The results suggest that COX-1 products are critical for sympathoexcitation and the full development of ANG II-salt HTN in rats.

The Green Heart Initiative

The Green Heart Initiative