Systolic Blood Pressure In Group Research Articles

Blood Pressure and Outcome After Mechanical Thrombectomy With Successful Revascularization.

Background and Purpose- Successful reperfusion can be achieved in more than two-thirds of patients treated with mechanical thrombectomy. Therefore, it is important to understand the effect of blood pressure (BP) on clinical outcomes after successful reperfusion. In this study, we investigated the relationship between BP on admission and during the first 24 hours after successful reperfusion with clinical outcomes. Methods- This was a multicenter study from 10 comprehensive stroke centers. To ensure homogeneity of the studied cohort, we included only patients with anterior circulation who achieved successful recanalization at the end of procedure. Clinical outcomes included 90-day modified Rankin Scale, symptomatic intracerebral hemorrhage (sICH), mortality, and hemicraniectomy. Results- A total of 1245 patients were included in the study. Mean age was 69±14 years, and 51% of patients were female. Forty-nine percent of patients had good functional outcome at 90-days, and 4.7% suffered sICH. Admission systolic BP (SBP), mean SBP, maximum SBP, SBP SD, and SBP range were associated with higher risk of sICH. In addition, patients in the higher mean SBP groups had higher rates of sICH. Similar results were found for hemicraniectomy. With respect to functional outcome, mean SBP, maximum SBP, and SBP range were inversely associated with the good outcome (modified Rankin Scale score, 0-2). However, the difference in SBP parameters between the poor and good outcome groups was modest. Conclusions- Higher BP within the first 24 hours after successful mechanical thrombectomy was associated with a higher likelihood of sICH, mortality, and requiring hemicraniectomy.

Associations between Blood Pressure Indices and Brachial\u2013ankle Pulse Wave Velocity in Treated Hypertensive Adults: results from the China Stroke Primary Prevention Trial (CSPPT)

Brachial–ankle pulse wave velocity (baPWV), as a marker of arterial stiffness, has been demonstrated to be associated with blood pressure (BP) and onset of hypertension. However, little information is available on the associations between baPWV and BP indices [systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), mean arterial pressure (MAP)] in treated hypertensive patients. We aimed to assess the associations between BP indices and baPWV. In this cross-sectional study, 14,598 hypertensive patients from China Stroke Primary Prevention Trial (CSPPT) at the exit visit of the trial were analyzed. Elevated baPWV was defined as ≥18.3 m/s. Multivariate linear and logistic regression analyses were performed to evaluate the associations of BP indices with baPWV and elevated baPWV. Moreover, the smooth curve fitting (penalized spline method) was conducted. Multivariate linear regression analyses showed that continuous SBP, DBP, PP and MAP were independently and positively associated with baPWV (β = 0.081, 0.084, 0.078 and 0.115, respectively, all P < 0.001). Compared with controlled SBP group (<140 mm Hg), uncontrolled SBP (≥140 mm Hg) was significantly associated with higher baPWV [β = 2.234, 95% confidence interval (CI): 2.137–2.332]. Similarly, compared with controlled DBP group (<90 mm Hg), uncontrolled DBP (≥90 mm Hg) was significantly associated with higher baPWV (β = 1.466, 95%CI: 1.341–1.590). Multiple logistic analyses also showed that SBP, DBP, PP and MAP were significantly and positively associated with elevated baPWV (OR = 1.056, 1.049, 1.052, and 1.075, respectively, all P < 0.001). The fully-adjusted smooth curve fitting presented a linear association between BP indices with baPWV. In conclusion, among treated hypertensive patients, SBP, DBP, PP and MAP levels were independently and positively associated with baPWV and elevated baPWV, suggesting that baPWV might be a way to predict uncontrolled BP.

Abstract NS4: Early and Continued Nursing Care Allows a Fast, Intensive, and Maintained BP Reduction in Patients With Acute Intracerebral Hemorrhage

Background and Purpose: Recent studies have highlighted the key influence of both time to achieve blood pressure (BP) control and the persistence of BP stable in the potential benefit of intensive BP reduction on attenuating intracerebral hemorrhage (ICH) expansion. We aimed to compare two different BP management protocols in acute ICH to determine the influence of stroke nursing practice in BP control over first 24h. Methods: Consecutive patients with spontaneous ICH &lt;6h and systolic BP (SBP) &gt;150 mmHg under an early (antihypertensive IV bolus by nursing attention at CT scan), intensive (SBP target &lt;140 mmHg), and maintained (antihypertensive continuous infusion after IV bolus) BP protocol within a 4-year period (2013-2017) were evaluated (Early-Intensive-Maintained SBP group). They were compared with a 1:1 matched prospectively collected historical control group (2009-2013) under a non-early (IV bolus by nursing attention at Stroke Unit), non-intensive (SBP target &lt;180 mmHg), and no-maintained (no continuous infusion after initial IV bolus) BP protocol. All patients underwent a bedside non-invasive BP monitoring at 15 min intervals over the first 24h. The time from BP lowering treatment initiation to achieve SBP target and the persistence of SBP bellow target at different time points was recorded in both groups. Results: One hundred and three Early-Intensive-Maintained SBP patients were matched with 103 controls. Mean age was 71.7±13.3 years, 134 (65%) were men, and median SBP was 177 (162-197) mmHg. Median time to SBP target achievement was lower in Early-Intensive-Maintained SBP patients as compared with control group (45 [30-60] vs. 90 [27-167.50] min, P=0.045 ). Early-Intensive-Maintained SBP patients maintained the SBP below the target more frequently than control group at different time points, including 60 min (40.8% vs. 36.9%, P &lt;0.001), 120 min (36.9% vs. 34%, P &lt;0.001), 18h (32% vs. 22.3%, P &lt;0.001), and 24h (33% vs. 4.9%, P &lt;0.001), respectively. Conclusions: The stroke nurse plays a key role in the management of BP in acute ICH patients. An early and continued nursing care allows a fast and maintained BP reduction in acute ICH patients under an intensive BP reduction protocol.

Comparative evaluation of anaesthetic efficacy and haemodynamic effects of a combination of isobaric bupivacaine with buprenorphine vs. isobaric levobupivacaine with buprenorphine for spinal anaesthesia - A double blinded randomised clinical trial.

Background and Aims:Bupivacaine is the most frequently used local anaesthetic for spinal anaesthesia, however, use of levobupivacaine in clinical practice has advanced recently. This study aimed to compare the anaesthetic potency and haemodynamic effects of intrathecal bupivacaine with buprenorphine versus levobupivacaine with buprenorphine in infraumbilical surgeries.Methods:This prospective randomised double blind study was conducted in seventy patients aged 18–65 years, American Society of Anesthesiologists grade I-II, scheduled for lower abdominal and lower limb surgery under spinal anaesthesia. The patients either received 0.5% isobaric racemic bupivacaine 3 ml with 2 μg/kg of buprenorphine (Group B) or 0.5% isobaric levobupivacaine 3 ml with 2 μg/kg of buprenorphine (Group L). The time for onset of sensory block between the two groups was the priomary end-point. Other measurements included haemodynamic variables, sensory and motor blockade characteristics, postoperative analgesia, and complications in the first 24 h.Results:There was no significant difference in the onset of sensory block between the two groups. Sensory and motor blockade characteristics were similar between the two groups. However, there was significant fall in the heart rate at 5 min in Group B compared to Group L. There was statistically significant fall in systolic blood pressure in group B compared to Group L from 5 min up to 60 min and fall in diastolic blood pressure from 10 min to 45 min.Conclusion:Our study showed that onset of sensory block is similar between isobaric levobupivacaine with buprenorphine 37 38 and isobaric bupivacaine with buprenorphine.

Prognostic value of pre-dialysis blood pressure and risk threshold on clinical outcomes in hemodialysis patients: The Q-Cohort Study.

The influence of pre-dialysis blood pressure (BP) on the prognosis of hemodialysis (HD) patients is still inconclusive.A total of 3436 HD patients were prospectively followed up for 4 years. The patients were divided into quintiles of pre-dialysis systolic BP (SBP) and diastolic BP (DBP) levels [mm Hg]: Quintile 1 (Q1), SBP <134, DBP <66; Q2, SBP 134 to 147, DBP 66 to 72; Q3, SBP 148 to 158, DBP 73 to 79; Q4, SBP 159 to 171, DBP 80 to 85; Q5, SBP ≥172, DBP ≥86. The association between the pre-dialysis BP and outcomes were examined using a Cox proportional hazards model.During a 4-year follow-up period, 564 (16.4%) patients died of any cause and 590 (17.2%) developed cardiovascular (CV) events. The lowest level of pre-dialysis SBP group (Q1) showed a significantly increased risk of all-cause mortality (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.40–2.39) and the highest group (Q5) significantly increased risk of CV events (HR 1.31, 95% CI 1.02–1.68) compared with the reference group (Q3), respectively. The highest level of pre-dialysis DBP group was significantly associated with increased risk for both all-cause mortality and CV events. Restricted cubic spline analysis for BP and outcomes suggested the optimal pre-dialysis BP value associated with the lowest risk of outcomes was SBP 152 mm Hg for all-cause mortality, SBP 143 mm Hg for CV events, and DBP 68 mm Hg for all-cause mortality.Our results suggested that pre-dialysis BP was independently associated with all-cause mortality and CV events among Japanese HD patients.

A3154 Effects of Lipid - lowering Therapy on Blood Pressure and Arteriosclerosis in Elderly Patients with Obese Hypertension

Objectives: To investigate the effect of lipid-lowering on therapeutic effect and arteriosclerosis in elderly patients with different types of obesity. Methods: According to the factorial design, the subjects were randomly divided into four groups: 89 cases (group A) with lipid-lowering and depressing abdominal obesity group, 75 cases (group B) with lipid-lowering and blood pressure non-abdominal obesity group, Eighty-seven obese patients (group C) and 71 non-obese obese patients (group D). Antihypertensive therapy to give candesartan, rosuvastatin, simple antihypertensive treatment given candesartan, placebo. Regular follow-up of 1 year. Results: ¢ÙAfter treatment, body mass index, waist circumference, triglyceride, total cholesterol, fasting blood glucose, alanine aminotransferase, ankle brachial index, and ankle-brachial index decreased significantly in abdominal obesity group and non-abdominal obesity group The decreasing degree of lipid-lowering and antihypertensive treatment group was better than that of pure antihypertensive treatment group, the difference was statistically significant (P < 0.05). ¢Ú There was significant difference in clinical curative effect among all groups (P < 0.05), the systolic blood pressure in group C was significantly different from that in group B and group D (P < 0.05), and the difference between group B and group A and group C was statistically Significance (P < 0.05). The diastoli Conclusion: The lipid-lowering effect of lipid-lowering therapy on elderly patients with obesity and hypertension is significant, which can significantly reduce obesity-related indicators such as blood pressure, blood lipids, blood glucose and other symptoms, and effectively improve the symptoms of atherosclerosis without obvious adverse reactions. For these patients, To achieve more effective treatment.

The Optimal Blood Pressure Target in Different Dialysis Populations

Hypertension is common and contributes to adverse outcomes in patients undergoing dialysis. However, the proper blood pressure (BP) target remains controversial and several factors make this difficult. This study aimed to investigate the adequate BP target in patients undergoing prevalent dialysis. Data were retrieved from the Clinical Research Center for End-Stage Renal Disease (2009–2014). 2,299 patients undergoing dialysis were evaluated. Patients were assigned into eight groups according to predialysis systolic blood pressure (SBP). The primary outcome was all-cause mortality. During the median follow-up of 4.5 years, a U-shape relation between SBP and mortality was found. The risk of mortality was increased in the SBP <110 and ≥170 mmHg groups. In subgroup analysis, the risk of mortality was similarly shown U-shape with SBP in subjects with no comorbidities, and no use of antihypertensive agents. However, only lowest SBP was a risk factor for mortality in patients with older, having diabetes or coronary artery disease, whereas highest SBP was an only risk factor in younger patients. In respect of dialysis characteristics, patients undergoing hemodialysis showed U-shape between SBP and mortality, while patients undergoing peritoneal dialysis did not. Among hemodialysis patients, patients with shorter dialysis vintage and less interdialytic weight gain showed U-shape association between SBP and mortality. This study showed that the lowest or highest SBP group had higher risk of mortality. Nevertheless, the optimal target BP should be applied according to individual condition of each patient.

Trajectory Groups of 24-Hour Systolic Blood Pressure After Acute Ischemic Stroke and Recurrent Vascular Events.

Background and Purpose- Blood pressure dynamics in patients with acute ischemic stroke may serve as an important modifiable and prognostic factor. Methods- A total of 8376 patients with acute ischemic stroke were studied from a prospective multicenter registry. Patients were eligible if they had been admitted within 24 hours of symptom onset and had ≥5 systolic blood pressure (SBP) measurements during the first 24 hours of hospitalization. SBP trajectory groups in the first 24 hours were identified using the TRAJ procedure in SAS software with delta-Bayesian Information Criterion and prespecified modeling parameters. Vascular events, including recurrent stroke, myocardial infarction, and death, were prospectively collected. The risk of having vascular events was calculated using the frailty model to adjust for clustering by hospital. Results- The group-based trajectory model classified patients with acute ischemic stroke into 5 SBP trajectory groups: low (22.3%), moderate (40.8%), rapidly stabilized (11.9%), acutely elevated (18.5%), and persistently high (6.4%) SBP. The risk of having vascular events was increased in the acutely elevated (hazard ratio, 1.28 [95% confidence interval, 1.12-1.47]) and the persistently high SBP groups (hazard ratio, 1.67 [95% confidence interval, 1.37-2.04]) but not in the rapidly stabilized group (hazard ratio, 1.13 [95% confidence interval, 0.95-1.34]), when compared with the moderate SBP group. Conclusions- SBP during the first 24 hours after acute ischemic stroke may be categorized into distinct trajectory groups, which differ in relation to stroke characteristics and frequency of subsequent recurrent vascular event risks. The findings may help to recognize potential candidates for future blood pressure control trials.

Interval Aerobic Exercise versus Cupping Therapy on Essential Hypertension in Women

Abstract Background: Exercise and cupping therapy has been suggested to be available treatment for hypertension. This study compares the effect of interval aerobic exercise versus cupping on essential hypertensive women.Aim of the Study: To determine the effect of interval aerobic exercise versus cupping therapy on Essential Hyper-tensive women.Subject and Methods: Thirty women had essential hyper-tension stage: 1 (140: 160mmHg systole-90-100mmHg dias-tole) were randomly assigned into two groups equal in number. Group (A) fifteen women received moderate intensity (aerobic interval) exercise (4 to 7) of modified 0-10 Borg scale, exercise session 15:20min, three times per week for a month. Group (B) fifteen women received cupping therapy session on six points in the neck and back 20min, one session at the beginning of a study month. Results: Significant reduction of systolic blood pressure at post-treatment in comparison to pre-treatment (p-value= 0.0001*). There was improvement of systolic blood pressure in group: A percent of change (improvement) was 13.79%. There was improvement of systolic blood pressure in Group B percent of change (improvement) was 11.5%, multiple pair wise comparison tests (post hoc tests) revealed that there was no significant difference of the mean values of the post test between both groups with (p=0.096). In spite of that there was no statistical significant difference between Group A and Group B, was clinical difference and high percent of improve-ment in favor to Group A. There was improvement of diastolic blood pressure in Group A and percent of change (improve-ment) was 11.96%. Multiple pair wise comparison tests (post hoc tests) revealed that there was significant reduction of diastolic blood pressure at post-treatment in compare to pre-treatment (p-value= 0.0001*) this mean there was improvement of diastolic blood pressure in Group B and percent of change (improvement) was 13.19%. In spite of there was no statistical significant difference between Group A and Group B, there was clinical difference and high percent of improvement in favor to Group B.Conclusion: It was concluded that participation in aerobic interval exercise or cupping therapy have positive effect on blood pressure in stage one essential hypertensive women and can be used as alternative treatment modalities.

Pulse Wave Analysis of HbA1C Categorized Prediabetes, Type 2 Diabetes and Normo-Glycemic Populations

Arterial stiffness is a significant risk factor for cardiovascular events and early detection is key for intervention and monitoring. This pathophysiological process is accelerated in type 2 diabetes (T2D), yet the onset of this condition has a limited body of research. PURPOSE: To evaluate (1) arterial stiffness properties via pulse wave analysis (PWA) across a 4-group spectrum, and (2) determine whether waist-to-height-ratio (WHtR), waist circumference (WC) or body mass index (BMI) serves as the best predictor of early changes in PWA pathophysiology. METHODS: PWA was measured in 52 participants across four groups separated by HbA1c values: 13 normo-glycemic (N, 4.0-5.1), 14 high normal (HN, 5.2-5.6), 10 prediabetes (PD, 5.7-6.4) and 13 with T2D (T2D, ≥ 6.5). Brachial, central and peripheral pressures, central and peripheral augmentation index (AIx) data were collected via Sphygmocor using validated methods after overnight caffeine abstinence and a minimum 4-hr fast. Group differences were evaluated via MANCOVAs. HbA1C, WHtR, WC and BMI data were assessed through regression to determine the best predictor. RESULTS: Significant differences were found between N to T2D and HN to T2D for brachial systolic blood pressure (SBP) [F(3,46)=2.743, p<.05], brachial diastolic blood pressure (DBP) [F(3,46)=3.329, p<.028] and brachial mean pressures (MP) [F(3,46)=4.321, p<.009]. Central DBP and MP differed between N to T2D, and HN to PD and T2D groups [DBP:F(3,44)=3.874, p<.015; MP:F(3,44)=3.303, p<.029]. Central pulse pressure (PP) and CAIx showed no differences between groups. Peripheral pressures significantly differed between N and both PD and T2D; HN and both PD and T2D groups for peripheral SBP [F(3,44)=3.007, p<.040], peripheral DBP [F(3,44)=4.316, p<.009] and peripheral MP [F(3,44)=3.487, p<.023], but not PP or PAIx. WHtR and WC were identified as the best predictors of CAIx after adjusting for age and height [R2=.800, F(5,45)=16.023, p<.0005; adj. R2=.640], while PAIx had no significant predictor. CONCLUSIONS: PWA may be effective for identifying differences in multiple brachial, central and peripheral pressure measures across a novel, pre-defined HbA1C spectrum; however, more research needs to be executed to validate these findings. WHtR and WC, but not BMI, effectively predicts CAIx.

Study to Measure the impact of Pharmacists and Pharmacy Services (STOMPP) on Medication Non-Adherence: Medication Adherence and Clinical Outcomes

Objective: To compare the impact of various pharmacy-based services on medication adherence and clinical outcomes.&#x0D; Design: Prospective, randomized control trial&#x0D; Setting: A local endocrinology group (clinic setting) and community pharmacies belonging to a regional integrated delivery network (IDN) in Toledo, OH&#x0D; Population: Subjects included within this study had type 2 diabetes, were prescribed a minimum of five medications, at least 18 years of age, having the ability to self-administer medications as prescribed, and be able to speak and understand English. Subjects were required to have Paramount health insurance, must be willing and able to provide informed consent, actively participate in the assigned MTM sessions, and have adequate transportation to attend the sessions at a participating pharmacy. &#x0D; Methods: Patients were recruited through flyers at practice sites, referrals from physicians and pharmacists, and direct mailers. Members of the research team would screen patients to assess their eligibility to participate in the study. Patients who fit the inclusion criteria were randomized into one of the following four different groups: Pill Bottle (PB), Blister Pack (BP), Pill Bottle + Medication Therapy Management (PB+MTM), and Adherence Pharmacy (BP+MTM). Patients enrolled in the BP groups had their medications synchronized. Patients in the AP group were given the option to have their medications delivered, if needed.&#x0D; Practice innovation: We partnered with a regional integrated delivery network (IDN) with multiple community pharmacy practice sites and a practice group of endocrinologists. A new practice model called Adherence Pharmacy was conceptualized and implemented within the community setting and was accessible to patients.&#x0D; Main Outcomes Measures: Medication adherence, measured using proportions of days covered (PDC) and pill count scores at baseline, 3 months, 6 months, 9 months, and 12 months; Hemoglobin A1c (HbA1c), body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressures (DBP) were collected at baseline, 6 months, and 12 months&#x0D; Results: A mixed-model ANOVA was used to study the impact of these services on medication adherence, using PDC and pill count scores. Results of the 61 patients in the study revealed that there was a statistically significant difference between the PB and BP groups (p=0.008); between the PB and BP+MTM groups (p=0.023); and between the PB+MTM and the BP+MTM groups (p=0.041). Except at baseline, adherence scores at all time points (0, 3, 6, 9, and 12 months) were significant with the patients in the BP and BP+MTM groups having higher adherence compared to those in the PB and PB+MTM groups. Pill count scores had similar results to the PDC measures. Insert data from HBA1c, BMI, SBP and DBP. Clinical outcomes were also analyzed using the mixed between-within ANOVA and were measured at baseline, 6, and 12 months. Patients in the MTM groups reached the American Diabetes Association goal of 7%, whereas the patients in the PB group did not reach a goal at 12 months. All groups, except for the PB only group, indicated a statistically significant change from baseline to 12 months. When comparing body mass index (BMI) scores across groups over time, patients in the BP+MTM group showed the lowest BMI at 12 months. There were not any significant differences across the groups, but patients in the two MTM groups saw greater improvement in their BMI scores than patients in the other two groups. There were no significant differences between groups in SBP and DBP reduction. However, patients in the two BP groups reached a SBP goal sooner (per the Eighth Joint National Committee) than patients in the PB+MTM and PB groups.&#x0D; Conclusion: Patients had improved clinical outcomes and adherence rates when using blister packaging and medication therapy management services, individually and in combination. Blister packaging seemed to have a greater impact on medication adherence while MTM services helped improve clinical endpoints. However, patients who received the combination of services offered within the AP demonstrated higher improved clinical outcomes and adherence rates when compared to patients who did not. While each of these services was found to be more impactful that dispensing medications in pill bottles, combining them can provide a greater benefit to patients.&#x0D; &#x0D; Type: Original Research

Impact of Admission Hypertension on Rates of Acute Kidney Injury in Intracerebral Hemorrhage Treated with Intensive Blood Pressure Control.

Current guidelines recommend that rapid systolic blood pressure (SBP) lowering to 140mmHg may be considered in intracerebral hemorrhage (ICH) patients regardless of initial SBP. However, limited safety data exist in patients presenting with varying degrees of severe hypertension. The purpose of this study was to determine whether there was an increased risk of acute kidney injury (AKI) based upon degree of presentation hypertension in ICH patients whose blood pressure was reduced intensively. This retrospective, cohort study evaluated ICH patients treated with intensive blood pressure control (SBP≤140mmHg) who presented with three degrees of presentation hypertension: mild (SBP 141-179mmHg), moderate (SBP 180-219mmHg), and severe (SBP≥220mmHg). Univariate analysis of demographics variables, ICH severity, and factors known to impact AKI was conducted between the three groups. Post hoc testing was used to compare differences between specific groups, with a Bonferroni correction adjusting for multiple comparisons. Additionally, we conducted logistic regression analysis to determine whether baseline SBP group independently predicted AKI. We included 401 patients (177 with mild, 124 with moderate, and 100 with severe hypertension). There was a significant increase in the prevalence of AKI between groups, with the severe group experiencing the highest rate (p<0.001). The presence of severe hypertension was also found to independently predict AKI development (odds ratio 2.6; p<0.001). Our study observed higher rates of AKI in patients presenting with severe hypertension. Further research is needed to determine the most appropriate strategies for managing blood pressure in ICH patients presenting with higher SBP.

Relationship between systolic blood pressure and all-cause mortality: a prospective study in a cohort of Chinese adults

BackgroundThe association between systolic blood pressure (SBP) and all-cause mortality in Chinese adults remains unclear. This study aimed to identify the relationship of SBP with all-cause mortality in Chinese men and women.MethodsOne hundred twenty-one thousand eighty-two employees of the Kailuan Group Corporation, aged 18 or older, who participated in physical examination from 2006 to 2007 or from 2008 to 2009, were enrolled and followed up for all-cause mortality. The information used to ascertain the outcome of death during follow-up was extracted from provincial vital statistics offices, hospitalization records from the 11 hospitals, or medical records from medical insurance companies.ResultsThe average age was 50.06 ± 12.85 in the overall sample. Over 7 years of follow-up, 5945 participants, including 5520 men and 425 women had all-cause mortality. After multivariate adjustment, men in SBP group of <100, 120–139, 140–159, 160–179 and ≥180 mmHg had hazard ratios (HR) of 1.46 (1.14–1.86), 1.14 (1.04–1.26), 1.29 (1.16–1.44), 1.57 (1.38–1.79) and 2.07 (1.76–2.43), respectively, and displayed significantly increased risk of all-cause mortality compared to those with SBP in the range of 100–119 mmHg. Compared with the group of 100–119 mmHg, women in SBP group of 140–159, 160–179 and ≥180 mmHg had significantly greater risk with HRs of 1.44 (95% CI, 1.01–2.07), 1.63 (95% CI, 1.04–2.55) and 2.31 (95% CI, 1.27–4.20).ConclusionsEither lower (<100 mmHg) or higher (>120 mmHg) SBP was associated with an increased all-cause mortality risk and a J-shaped relationship was observed between SBP and all-cause mortality in men. Only SBP exceeding 140 mmHg was related to a higher risk in women. The relationship between SBP and all-cause mortality among Chinese adults may differ by sex.

Long-term effect of massage therapy on blood pressure in prehypertensive women.

BACKGROUND:Prehypertension is one of the cardiovascular disease predicators. Management of prehypertension is an appropriate objective for clinicians in a wide range of medical centers. Massage therapy is primarily nonpharmacological treatment that is used to control blood pressure (BP). This study intends to investigate the long-term effect of massage therapy on BP in prehypertensive women.METHODS:This was a single-blind clinical trial study conducted on 50 prehypertensive women who referred to Sedigheh Tahereh Cardiovascular Center, during 6 months in 2009. Participants were selected by simple random sampling and were divided into control and intervention groups. The test group (25 patients) received massage for 10–15 min, three times a week for 10 sessions, and the control group (25 patients) was relaxed in the same environment but with no massage. Their BP was measured before and after each session and 72 h and 2 weeks after finishing the massage therapy. Analyzing the data was done using descriptive and inferential statistical methods (Chi-square, Mann–Whitney, paired t-test, and Student's t-test) through SPSS software version 18 and a significant level was considered as P < 0.05.RESULTS:The results indicated that the mean systolic BP (SBP) and diastolic BP (DBP) in the massage group were significantly lower in comparison with the control group (P < 0.001). Evaluation of durability of the massage effects on BP also indicated that 72 h after finishing the study, still there was a significant difference between the test and control groups in SBP and DBP (P < 0.001), but after 2 weeks, there was not a significant difference in SBP and DBP (P > 0.05) between the two groups.CONCLUSIONS:Although massage therapy seems to be a safe, effective, applicable, and cost-effective intervention to control BP of prehypertensive women, its effects do not persist for a long time.

Effect of telmisartan on blood pressure in patients of type 2 diabetes with or without complications.

Introduction:Telmisartan is one of the preferred choices of antihypertensive in patients of diabetes with hypertension (HTN) and lowers blood pressure (BP) effectively.Objective:The objective of the study was to determine BP-lowering efficacy of telmisartan monotherapy in patients of Stage I HTN with or without complications of type 2 diabetes mellitus (T2DM).Materials and Methods:In this retrospective study, patients of T2DM without (Group A) or with (Group B) complications who had Stage I HTN and were prescribed telmisartan (20–80 mg/day) treatment were identified from database. Patients included were adults 18 years and above with BP ≥140/80 mmHg but <160/100 mmHg. Data related to demographics, systolic and diastolic BP, blood glucose parameters, and weight before initiation of telmisartan and at the end of 12 weeks treatment were compared with appropriate statistics.Results:In 132 patients included, 28 (21.2%) patients had one or more complications of T2DM. Mean age in Group A and B was similar whereas mean duration of diabetes was significantly higher in Group B than Group A (10.0 ± 5.8 vs. 7.1 ± 5.9, P = 0.023). Telmisartan 40 mg was most frequently used strength (97.1% and 100.0% patients in two groups). Change from baseline in systolic BP in Groups A and B was −19.5 mmHg (95% confidence interval [CI] −16.3, −22.7; P < 0.0001) and −24.9 mmHg (95% CI −17.3, −32.5; P < 0.0001), respectively. Reduction in diastolic BP was also significant in two groups. There were no significant differences in adjusted means of systolic and diastolic BP in two groups. In Group A and B, change from baseline in fasting glucose was −3.7 mg/dL (P = 0.647) and −8.4 mg/dL (P = 0.593); in postmeal glucose was −14.8 mg/dL (P = 0.280) and −36.9 mg/dL (P = 0.046), respectively.Conclusion:Telmisartan is effective in lowering BP and improving metabolic parameters in patients of T2DM with or without complications. A larger and long duration study is needed to substantiate our findings.

Impact of systolic blood pressure on the safety and tolerability of initiating and up-titrating sacubitril/valsartan in patients with heart failure and reduced ejection fraction: insights from the TITRATION study.

The TITRATION trial investigated two strategies to initiate and up-titrate sacubitril/valsartan (LCZ696) to the same target dose, over a condensed (3-week) or conservative (6-week) period, in patients with heart failure with reduced ejection fraction (HFrEF) and systolic blood pressure (SBP) of ≥100 mmHg. This post hoc analysis examined the relationship between baseline SBP at screening and achievement of the target dose of sacubitril/valsartan of 97 mg/103 mg (also termed 'LCZ696 200 mg') twice per day during the study. Patients (n = 498) were categorized in four groups based on SBP at screening: 100-110 mmHg (n = 70); 111-120 mmHg (n = 93); 121-139 mmHg (n = 168) and ≥140 mmHg (n = 167). Overall, 72.7%, 76.1%, 85.6% and 82.9%, respectively, of patients in these SBP categories achieved and maintained the target dose of sacubitril/valsartan without down-titration/dose interruption over 12 weeks ('treatment success'). Compared with patients with SBP of 100-110 mmHg, rates of treatment success among patients in the higher SBP groups [111-120 mmHg (P = 0.96); 121-139 mmHg (P = 0.06) and ≥140 mmHg (P = 0.25)] did not differ significantly. A higher percentage of patients with lower SBP (100-110 mmHg) achieved treatment success with gradual up-titration (6 weeks) (∼80%) than with rapid up-titration (∼69%). Similar findings were observed with regard to 'tolerability success' (maintenance of the target dose for at least the final 2 weeks prior to study completion). Hypotension occurred more frequently in patients with lower SBP. The majority of patients (>80%) with SBP of ≥100 mmHg achieved and maintained the target dose of sacubitril/valsartan if the treatment was titrated gradually. These findings suggest that low SBP should not prevent clinicians from considering the initiation of sacubitril/valsartan.

Longitudinal Blood Pressure Changes and Kidney Function Decline in Persons Without Chronic Kidney Disease: Findings From the MESA Study.

While changes in blood pressure (BP) are independently associated with cardiovascular events, less is known about the association between changes in BP and subsequent changes in renal function in adults with an estimated glomerular filtration rate (eGFR) of >60 ml/min/1.73 m2. The present study included 3,920 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) study who had ≥2 BP measurements during the first 5 years of MESA and had eGFR measurements at both year 5 and 10. Change in BP was estimated as the annualized slope of BP between year 0 and 5 based on linear mixed models (mean number of measurements = 4.0). Participants were then grouped into 1 of 3 categories based on the distribution of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) change (top 20%, middle 21-79%, bottom 20%). We calculated eGFR from cystatin C (ml/min/1.73 m2), estimated annual change in eGFR (ml/min/1.73 m2/year), and defined rapid kidney function decline as a >30% decrease in eGFR from year 5 to 10. We used multivariable logistic regression adjusting for year 0 demographic and clinical characteristics, including eGFR and BP, to determine associations of BP change with rapid kidney function decline. Median age was 59 [interquartile range (IQR): 52, 67] and median eGFR at year 0 was 95.5 (IQR: 81.7, 105.9) ml/min/1.73 m2. Median SBP at year 0 was 111, 121, and 147 mm Hg for increasing, stable, and decreasing SBP change, respectively. Increasing SBP and widening PP change were each associated with higher odds of rapid kidney function decline compared with stable SBP and PP groups, respectively [odds ratio, OR 1.7 (95% confidence interval, CI 1.3, 2.4) for SBP; OR 1.4 (95% CI 1.1, 1.9) for PP]. Decreasing SBP was associated with rapid kidney function decline after adjusting for all covariates except for year 0 BP [OR 1.4 (95% CI 1.0, 1.8)], but this association was no longer statistically significant after adjustment for year 0 BP. There were no significant associations between DBP change and rapid decline in the fully adjusted models. Similar findings were seen with annual change in eGFR. Increasing SBP and widening PP over time were associated with greater risk for accelerated kidney function decline even at BP levels below established hypertension thresholds.

Association of Systolic Blood Pressure with Progression of Symptomatic Intracranial Atherosclerotic Stenosis.

Background and Purpose Elevated blood pressure (BP) is associated with greater severity of intracranial atherosclerotic stenosis (ICAS) and increased risk of ischemic stroke. Because little is known about the relationship of maintained BP level with progression of symptomatic ICAS (sICAS), we evaluated the independent association of maintained systolic BP (SBP) with risk of sICAS progression.Methods We analyzed the Trial of cilOstazol in Symptomatic intracranial Stenosis 2, which evaluated 402 stroke patients with sICAS (mean age, 64.5±11.3 years; male, 52.2%). Study participants were categorized into four groups according to mean SBP level: low-normal (<120 mm Hg), normal to high-normal (120 to 139 mm Hg), high (140 to 159 mm Hg), and very-high (≥160 mm Hg). Progression of sICAS was defined as worsening in the degree of stenosis by ≥1 grade on the 7-month magnetic resonance angiography follow-up.Results sICAS progression was observed in 52 (12.9%) subjects. Percentages of sICAS progression by mean SBP category showed a J-shape pattern: low-normal (21.4%), normal to high-normal (10.7%), high (11.4%), and very-high (38.9%). In multivariable analysis, compared to the normal to high-normal SBP group, odds ratios (95% confidence intervals) were low-normal, 1.88 (0.62–5.67); high, 1.06 (0.47–2.37); and very-high, 8.75 (2.57–29.86). Rate of sICAS progression by 10-mm Hg strata showed a similar pattern to findings from mean SBP category (9.47; 2.58–34.73 for SBP ≥160 mm Hg).Conclusions Among individuals with a recent ICAS stroke, very-high SBP level during the short-term period after the index stroke was associated with significantly greater odds of sICAS progression.

Study Supports Higher BP Target for Frail Elderly

Study Supports Higher BP Target for Frail Elderly

Comparative evaluation of hemodynamic and capnographic changes in low pressure versus normal pressure pneumoperitoneum in laparoscopic cholecystectomy

Background: In laparoscopic cholecystectomy (LC), the extent of hemodynamic changes associated with creation of pneumoperitoneum depends on the intra-abdominal pressure attained, volume of CO2 absorbed, and patient’s intravascular volume. In our study, we attempted to compare the hemodynamic and capnographic changes in the low pressure (&lt;8mm Hg) and standard pressure (12-14mm Hg) LC.Methods: In this randomized case control study, Group A included patients undergoing Low pressure LC (&lt;8mm Hg). In group B, Standard pressure LC (12-14mmHg) was performed. Both groups were evaluated for the hemodynamic and capnographic changes and other parameters.Results: Difference in mean heart rate of Group A and Group B was found to be statistically significant at 10 min after induction. After 30 minutes of surgery, systolic blood pressure of Group B was found to be higher than that of Group A (p &lt;0.05). Differences in diastolic blood pressure among patients of Group A and Group B were found to be statistically significant only at 30 min and 40 min after induction. Except at 30 min after induction, differences in EtCO2 levels of patients of Group A and Group B were found to be statistically significant.Conclusions: It appears that low pressure pneumoperitoneum appears to be having fewer effects on blood pressure- both systolic and diastolic, as compared to standard pressure pneumoperitoneum in patients undergoing LC. It also appears to be causing fewer derangements in ETCO2. This may help in smooth recovery and less post-operative problems.