Heart Rate Systolic Blood Pressure Research Articles

Early life cardiovascular risk factor trajectories and vascular aging in midlife: a 30-year prospective cohort study

Abstract Background Vascular aging, as assessed by structural and functional arterial properties, is an independent predictor of cardiovascular outcomes. We aimed to explore the associations of individual cardiovascular risk factors from childhood to midlife and their accumulation over a 30-year span with vascular aging in midlife. Methods Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, 2180 participants aged 6 to 18 years at baseline were followed for over 30 years. Distinct trajectories of systolic blood pressure (SBP), body mass index (BMI), and heart rate (HR) from childhood to midlife were identified by group-based trajectory modeling. Vascular aging was assessed by carotid intima–media thickness (cIMT) or brachial-ankle pulse wave velocity (baPWV). Results We identified 4 distinct SBP trajectories, 3 distinct BMI trajectories and 2 distinct HR trajectories from childhood to midlife. Persistently-increasing SBP, high-increasing BMI, and high-stable HR were all shown to have a positive association with baPWV in midlife. For cIMT, similar associations were observed for persistently-increasing SBP and high-increasing BMI. After further adjustment for SBP, BMI and HR at the time of vascular assessment in 2017, associations were also observed for cardiovascular risk factor trajectories accumulation with baPWV (β=0.656 (95%CI, 0.265-1.047)] and with cIMT [β=0.045 (95%CI, 0.011-0.079)] in adulthood. Conclusions Longitudinal exposure to individual cardiovascular risk factors from childhood to midlife and cardiovascular risk factor accumulation were associated with an increased risk of vascular aging in midlife. Our study lends support for early targeting of risk factors in order to prevent cardiovascular disease later in life.Long-term SBP, BMI, HR trajectories

EARLY LIFE CARDIOVASCULAR RISK FACTOR TRAJECTORIES AND VASCULAR AGING IN MIDLIFE: A 30-YEAR PROSPECTIVE COHORT STUDY

Objective: Vascular aging, as assessed by structural and functional arterial properties, is an independent predictor of cardiovascular outcomes. We aimed to explore the associations of individual cardiovascular risk factors from childhood to midlife and their accumulation over a 30-year span with vascular aging in midlife. Design and method: Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, 2180 participants aged 6 to 18 years at baseline were followed for over 30 years. Distinct trajectories of systolic blood pressure (SBP), body mass index (BMI), and heart rate (HR) from childhood to midlife were identified by group-based trajectory modeling. Vascular aging was assessed by carotid intima–media thickness (cIMT) or brachial-ankle pulse wave velocity (baPWV). Results: We identified 4 distinct SBP trajectories, 3 distinct BMI trajectories and 2 distinct HR trajectories from childhood to midlife. Persistently-increasing SBP, high-increasing BMI, and high-stable HR were all shown to have a positive association with baPWV in midlife. For cIMT, similar associations were observed for persistently-increasing SBP and high-increasing BMI. After further adjustment for SBP, BMI and HR at the time of vascular assessment in 2017, associations were also observed for cardiovascular risk factor trajectories accumulation with baPWV (↓ = 0.656 (95%CI, 0.265 - 1.047)] and with cIMT [↓ = 0.045 (95%CI, 0.011 - 0.079)] in adulthood. Conclusions: Longitudinal exposure to individual cardiovascular risk factors from childhood to midlife and cardiovascular risk factor accumulation were associated with an increased risk of vascular aging in midlife. Our study lends support for early targeting of risk factors in order to prevent cardiovascular disease later in life.

Glucose intolerance is associated with resting heart rate among individuals without diabetes

Elevated resting heart rate is associated with cardiovascular diseases and all-cause mortality. Unmanaged diabetes is associated with high blood pressure and high resting heart rate. Persistent high blood glucose levels in diabetes is known to contribute to the dysfunction of the autonomic nervous system including cardiovascular autonomic nerve fibers leading to higher resting heart rate, heart failure and stroke. In a population without diabetes, however, there is limited knowledge about the relationship between glucose tolerance and indicators of cardiovascular health, therefore, the purpose of the study was to determine how glucose intolerance is associated with resting heart rate and blood pressure in individuals without diabetes. We hypothesized that glucose intolerance will be associated with resting heart rate and blood pressure in a healthy population without diabetes. Eighty five (32 males, 53 females) individuals without diabetes from the border region of El Paso participated in this study (age 26.69±9.45years; BMI 27.85±6.45kg/m2; fasting blood glucose 95.38±10.09mg/dL; resting heart rate 66.15±10.54 bpm; systolic blood pressure 109.2±11.74 mmHg and diastolic blood pressure 71.24±9.03 mmHg). Following an overnight fast of at least 8 hours, resting heart rate systolic blood pressure and diastolic blood pressure were measured with a sphygmomanometer. Fasting blood glucose was measured and a 3-hour oral glucose tolerance test (OGTT) was performed by consuming 75 grams of glucose drink and measuring blood glucose at 15, 30, 90, 120, 150 and 180 minutes after the glucose consumption via a handheld glucometer. Glucose tolerance was assessed by calculating glucose area under the curve (AUC) during OGTT. Spearman’s correlations were performed at 0.05 alpha to determine the associations. Glucose area under the curve, AUC positively correlated with resting heart rate (r=0.39, p=0.0005) whereas fasting blood glucose did not (r=0.02, p=0.9). Blood glucose concentrations at 15 minutes (r=0.10, p=0.4), 30 minutes (r=0.07, p=0.6), and 60 minutes (r=0.2, p=0.1) did not correlate with resting heart rate while blood glucose concentrations at 90 minutes (r=0.3, p=0.02), 120 minutes (r=0.35, p=0.002), 150 minutes (r=0.33, p=0.003), and 180 minutes (r=0.29, p=0.01) during OGTT positively correlated with resting heart rate. Glucose area under the curve was not associated with neither systolic (r=-0.02, p=0.9) nor diastolic (r=0.2, p=0.2) blood pressures. Fasting blood glucose was not associated with neither systolic (r=0.2, p=0.2) nor diastolic (r=0.1, p=0.4) blood pressure. Glucose intolerance rather than fasting blood glucose is reflective of elevated resting heart rate among a healthy population without diabetes. Dodson Grant This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Effect of Isotonic Exercise on Cardiovascular Parameters in Medical Students with Different Body Mass Indices: A Cross-sectional Study

Introduction: Obesity is a known risk factor for hypertension. Baseline Heart Rate (HR) and blood pressure are known to scale linearly with Body Mass Index (BMI) values. Recent studies have reported an exaggerated acute response of blood pressure and HR to exercise. Aim: To assess the effect of isotonic exercise on cardiovascular parameters among individuals with different body mass indices in students at Osmania Medical College and look for any association between BMI and cardiovascular responses to isotonic exercise. Materials and Methods: A cross-sectional study was conducted in the Department of Physiology at Osmania Medical College, Hyderabad, Telangana, India, from January 2022 to December 2023, involving 100 healthy individuals with different body mass indices in the age group of 17 years-30 years. The subjects were divided into four groups based on their BMI. Baseline HR, Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) were measured for all participants. Subsequently, the participants performed isotonic exercise for three minutes. Post-exercise HR, SBP, and DBP were measured immediately. One-way ANOVA was used to determine the significance of HR, SBP, DBP, Mean Arterial Pressure (MAP), and Pulse Pressure (PP) among the different BMI groups. A p-value of <0.05 was considered statistically significant. Results: A total of 100 subjects (28 males, 72 females) with a mean age of 18.64±0.92 years participated in the study. Significant differences were observed in pre-exercise HR (p=0.0002), SBP, DBP, and MAP (p<0.001), and post-exercise HR, SBP, DBP, and MAP (p<0.001) among the different BMI groups. Overweight and obese individuals showed an increased tendency for an exaggerated increase in HR. Changes in PP and MAP, affected by a combination of SBP and DBP, also showed statistical significance. Furthermore, there was an increased tendency for an exaggerated increase in blood pressure in the overweight and obese BMI groups. Conclusion: Individuals with higher BMI exhibit exaggerated increases in SBP, Mean and PP, as well as HR. Additionally, obese individuals demonstrated a significant elevation in DBP. The response of blood pressure and HR after exercise in overweight/obese individuals suggests a higher risk of developing hypertension and other cardiovascular diseases.

TIMI RISK INDEX, A SIMPLE TOOL IN EMERGENCY PERCUTANEOUS REVASCULARIZATION FOR THE PREDICTION OF CONTRAST INDUCED NEPHROPATHY

Objectives: Contrast induced nephropathy (CIN) is a common complication seen after primary percutaneous coronary intervention (PCI) which can contribute to increased morbidity and mortality in patients of acute ST elevation myocardial infarction (STEMI). Aim of this study was to validate the TIMI Risk Index (TRI) for the risk stratification of CIN in patients undergone primary PCI.
 Methodology: A total of 507 consecutive patients of STEMI undergone primary PCI at a tertiary care cardiac center were included for this study. Patients in Killip class IV at presentation, patients with history of any PCI and chronic kidney diseases were excluded from this study. TRI was calculated using the formula “heart rate systolic blood pressure” and post-procedure serum creatinine level increase of either 25% or 0.5 mg/dL was taken as CIN.
 Results: A total of 507 patients were included in this study out of which 82.2% were males and 17.8% were females. In total 8.7% (44) patients developed CIN. In the receiver operating characteristic (ROC) curve analysis, area under the curve (AUC) for TRI was found to be 0.717, [0.649 to 0.758] for the prediction of CIN. Sensitive, specificity, positive predictive value and negative predictive value of TRI>22.8 to predict the development of CIN were 59.09%, 76.69%, 19.55% and 95.19% respectively.
 Conclusion: In conclusion, our study has consolidated the findings of previous studies using TIMI risk index in STEMI patients undergoing primary PCI and has established that this easy to calculate and readily accessible score has good accuracy to evaluate the risk of CIN in primary PCI setting and could be of great help to take any pre-emptive strategies in those identified at high risk of post-procedure CIN.

Effects of pre-injection of pressors on pressor response and bispectral index of patients receiving lower abdominal surgery under total intravenous anesthesia

Surgery in the lower abdomen can cause many adverse reactions in nervous system, metabolic and endocrine systems. Conventional intravenous anesthesia applied for lower abdominal surgery can cause the drop in blood pressure leading to hypoperfusion of vital organs. Hence, an ideal anesthesia state is required to make patients unconscious, unaware and have no postoperative memory during anesthesia. In this study, we investigated the effects of pre-injection of different pressors on the pressor response and bispectral index (BIS) of patients receiving lower abdominal surgery under total intravenous anesthesia. For this, 300 patients undergoing lower abdominal surgery under total intravenous anesthesia were divided into normal saline (Gr. A), ephedrine (Gr. B) and phenylephrine groups (Gr. C) (n=100). Hemodynamics indices were recorded before anesthesia induction (T0) and 1, 3, 5, 7 and 9 min after drug injection (T1-T5, respectively). We observed the following reactions and recorded. BIS values at T0-T5 as well as the time points when the values rose to 65, 75, 85 and 95 and those for respiratory recovery, consciousness recovery and extubation after stopping target-controlled infusion were recorded. Compared with Gr. A, Gr. B had significantly higher systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and cardiac output (CO) at T1-T5 (P <0.05), and Gr. C had higher SBP, DBP, MAP and lower HR (P <0.05). Adverse reactions viz., intraoperative hypotension, hypertension, postoperative bradycardia, tachycardia, nausea and vomiting were also observed. The incidence rates of hypotension and total adverse reactions in groups B and C were significantly lower than those of Gr. A (P <0.05). Group B had significantly higher BIS values at T1-T5 than those of Gr. A (P <0.05). The time when BIS values recovered to 65 and 75 in group B was significantly shorter than that of Gr. A (P <0.05). Pre-injection of ephedrine and phenylephrine to patients undergoing lower abdominal surgery under total intravenous anesthesia elevated the blood pressure and reduced the incidence rate of adverse reactions without affecting the recovery time.

THE ROLE OF BLOOD PRESSURE LEVEL IN THE DEVELOPMENT OF ATRIAL FIBRILLATION AFTER CORONAVIRUS INFECTION

Objective: It is known, that arterial hypertension (AH) is the main cause of atrial fibrillation (AF). The aim of our study was to assess the parameters of systemic hemodynamics as a predictor of AF development after coronavirus infection (CI). Design and method: We examined 118 patients with AF, at the age of 62.5 + 0.09 years with AF, who, on average, 6.2 + 0.5 months had undergone CI. Of these, 14 people (8.4%) also had atrial flutter. 72 people (61 %) had AF before CI (1st group of patients). The remaining 46 patients (39 %) had no history of this arrhythmia (2nd group of patients). Office blood pressure was measured according to the generally accepted method. Results: In the 1st group, the indicators of systolic blood pressure (SBP) were significantly lower than in the 2nd group (131.4 + 1.72 and 139.5 + 2.99 mm Hg, p &lt; 0, 05), indicators of diastolic blood pressure (DBP) (81.5 + 0.74 and 87.9 + 2.41 Hg, p &lt; 0.05), and heart rate (HR) (83, 0 + 1.86 and 98.0 + 2.4 bpm, p &lt; 0.05). This difference in the groups was more significant between patients with hypertension: SBP, respectively (134.7 + 1.5 and 143.9 + 3.8 mm Hg, p &lt; 0.05), DBP (83.3 + 1.1 and 90.5 + 2.6 Hg, p &lt; 0.05), and heart rate HR (83.0 + 1.86 and 98.0 + 2.4 bpm, p &lt; 0.001). In addition, in group 1, AH was found significantly less frequently (in 59 out of 72 patients, 81.9%) than in patients in group 2 (in 42 out of 46 patients, 91.3%), p &lt; 0.05. Conclusions: An increase in SBP, DBP HR and AH, are predictors of the development of AF in patients after CI.

A comparative study on regional cerebral oxygen saturation and central venous oxygen saturation as predictors of outcome in patients on off-pump coronary artery bypass graft surgery

Background: Off-pump coronary artery bypass grafting (OPCABG) is a common and acceptable surgery. Aims and Objectives: The study was conducted to compare central venous oxygen saturation (ScvO2) and regional cerebral oxygen saturation (rSO2) to see which of the two is better predictor for the prognosis of patients undergoing OPCABG. Heart rate (HR), invasive blood pressures, and partial pressure of oxygen (pO2) have also been recorded to see if they are independent predictors of prognosis in OPCABG patients. Materials and Methods: A total of 56 patients undergoing OPCABG were included in the study. Baseline values and intraoperative values of ScvO2, rSO2, HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pO2 at different time periods were recorded. Post-operatively the patient was shifted to intensivecare unit (ICU) in intubated condition, and time to extubation since shifting to ICU was noted. Results: The ScvO2 values after sternal closure (correlation coefficient r=−0.4821, P=0.0002), and on shifting to ICU (correlation coefficient r=−0.4575, P=0.0004) showed good correlation with time to extubation. Similarly, the rSO2 values after sternal closure (correlation coefficient r=−0.5198, P&lt;0.0001) and on shifting to ICU (correlation coefficient r=−0.5498, P&lt;0.0001) showed good correlation with time to extubation. HR SBP, DBP, MAP, pO2 individually did not show any correlation with time to extubation (P&gt;0.05). Conclusion: ScvO2 and rSO2 both have strong correlation with time to extubation and are capable of predicting prognosis in OPCABG patients.

Comparison of Regional Cerebral Oxygen Saturation (rSO2) and Central Venous Oxygen Saturation (ScvO2) as Predictors of Outcome in Off Pump Coronary Artery Bypass Graft (OPCABG) Surgery Patients

Objectives: Aim of the study was to compare central venous oxygen saturation (ScvO2) and regional cerebral oxygen saturation (rSO2) to see which of the two is better predictor of prognosis of patients undergoing off–pump coronary artery bypass grafting (OPCABG). Heart rate (HR), invasive blood pressures, and partial pressure of oxygen (pO2) have also been recorded to see if they are independent predictors of prognosis in OPCABG patients. Materials and Methods: A total of 56 patients undergoing OPCABG were included in the study. Baseline values and intraoperative values of ScvO2, rSO2, HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), pO2 at different time periods were recorded. Post-operatively the patients were shifted to Intensive care unit (ICU) on elective ventilation, and time to extubation since shifting to ICU were noted. Results:The ScvO2 values after sternal closure (correlation coefficient r= -0.4821, P=0.0002), and on shifting to ICU (correlation coefficient r= -0.4575, P=0.0004) showed strong correlation with time to extubation. Similarly the rSO2 values after sternal closure (correlation coefficient r=-0.5198, P&lt;0.0001) and on shifting to ICU (correlation coefficient r = -o.5498, P&lt;0.0001) showed strong correlation with time to extubation. HR SBP, DBP, MAP, pO2 individually didn’t show any correlation with time to extubation (P&gt;0.05). Conclusion:ScvO2 and rSO2 both have strong correlation with time to extubation and are capable of predicting prognosis in OPCABG patients.

Spectral analysis of cardiovascular oscillations in the 7-day regimen of losartan administration with and without cold stress.

Spectral analysis of heart rate (HR) and blood pressure (BP) variabilities (BPV and HRV) is widely available and utilized in understanding the dynamic cardiovascular autonomic regulation in a variety of pathophysiological conditions. In conscious cold-stressed (CS) rats, we examined the effect of a 7-day regimen administration of losartan, a selective nonpeptide angiotensin AT1 receptor blockade, on BPV and HRV at three frequency components: very-low frequency (VLF), low frequency (LF), and high frequency (HF). Key findings in changes of systolic BP (SBP), HR, and spectral power densities for cardiopulmonary oscillations (HF), sympathetic oscillations (LF), cardiovascular myogenic oscillations (VLF), and overall autonomic activity total power (TP) showed: (I) In the resting PreCS trial, compared with the saline, losartan increased HFBPV, TPHRV, all three HRV frequency powers, and the occurrence of the dicrotic notch (DN). However, it decreased SBP, HR, and the LFBPV frequency power. (II) In the CS trial, losartan significantly decreased SBP and DN occurrence and HR and LF/HFHRV but significantly increased HFHRV, TPBPV, and all three BPV frequency powers. In addition, similar to the saline, losartan showed positively correlated LFBPV and VLFBPV. Conversely, losartan converted the original inverse correlations between LFHRV and LFBPV of CS to a positive correlation. (III) Compared with saline in PreCS and CS trials, losartan detached the corresponding sympathetic oscillations between LFBPV and LFHRV. The overall result indicates that endogenous angiotensin II, through stimulation of the AT1 receptor, augments sympathetic tone but attenuates sympathetic oscillations in rats, particularly under the stressful cooling impacts.

Abstract 10138: Evening Blood Pressure and Heart Rate: An Age-Specific Association of Nocturia in the Japanese at High-Risk of Cardiovascular Disease

Background: Earlier epidemiologic studies have reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology has not been established in relation to heart rate (HR). Hypothesis: We hypothesized that blood pressure (BP), HR, and the class of antihypertensive agent might be associated with severity of nocturia in the Japanese at high-risk of cardiovascular disease. In addition, these associations were hypothesized to be moderated by age. Methods: In the Japan Morning Surge-Home Blood Pressure Study, measurements of home BP as well as HR at evening (mean 11.2 days) were performed in the 4310 patients with one or more cardiovascular risks (64.9 years old, male 47%). A self-administered questionnaire included items on nocturia was used. Results: The mean levels of evening systolic BP (SBP) and HR were 130±15mmHg and 70±9.6bpm, respectively. According to the number of nocturia, we divided into the three groups (no void: n= 2382; one void: n=847; &gt; 2 voids per night: n=1082). In the multinomial logistic regression analysis adjustment for confounders including age, gender, smoking, total cholesterol, fasting blood glucose, HbA1c, log B-type natriuretic peptide, beta-adrenergic blockade use, clinic SBP and clinic HR, the use of diuretics (OR, 1.23, 95%CI, 1.01-1.50, p&lt;0.05) was significantly associated with one nocturnal void, while evening SBP (OR per 1SD, 1.14, 95%CI, 1.05-1.24, p&lt;0.01) and evening HR (OR per 1SD, 1.12, 95%CI: 1.02-1.24, p&lt;0.05) were significantly associated with multiple nocturnal voids. In the lower aged group (&lt;66yrs), only evening HR remained significant (p=0.003), while only evening SBP remained significant for multiple nocturnal voids in the higher aged group (66yrs &lt; ) (p=0.007). A significant interaction was found between age and evening HR for multiple nocturnal voids (p&lt;0.05). Conclusions: In this study, evening SBP and evening HR were significant indicators of multiple nocturnal voids in the high-risk Japanese population. Increased evening HR was specifically associated with severe nocturia in the lower aged group. Age-stratified approach to reduce BP and HR burdens might be important to improve sleep disturbance caused by nocturia.

Prognostic value of simple risk index and plasma volume status in patients with acute decompensated heart failure

Abstract Background Increased heart rate (HR) and low systolic blood pressure (SBP) are associated with adverse clinical outcomes in patients admitted for acute decompensated heart failure (ADHF), and simple risk index (SRI) based on easily assessed clinical characteristics (age, HR, and SBP) provides prognostic information. On the other hand, plasma volume (PV) expansion plays an essential role in heart failure, and PV status is has been reported to be associated with adverse outcomes in ADHF patients. However, there is no information available on the value of the combination of SRI and PV status in patients admitted for ADHF. Methods and results We studied 301 patients admitted for ADHF. At the admission, SRI was calculated as (HR x [age/10]2)/SBP. PV status was calculated as the following: Actual PV = (1 − hematocrit) x [a + (b x body weight)] (a=1530 in males and a=864 in females, b=41 in males and b=47.9 in females), Ideal PV = c x body weight (c=39 in males and c=40 in females), and PV status = [(actual PV − ideal PV)/ideal PV] x 100(%). During a follow-up period of 4.3±3.2 yrs, 95 patients had all-cause death (ACD) and 68 patients had cardiovascular death (CVD). At multivariate Cox analysis, SRI and PV status were significantly associated with ACD and CVD, independently of the prior history of heart failure hospitalization and serum creatinine and sodium levels, after the adjustment with serum albumin level and anemia. Patients with both greater SRI (≥35.1 by ROC analysis; AUC 0.599 [0.524–0.674]) and greater PV status (≥8.1% by ROC analysis; AUC 0.625 [0.550–0.700]) had a significantly higher risk of ACD and CVD than those with either or none of them (ACD: 49% vs 27% vs 24%, p&amp;lt;0.0001, CVD: 39% vs 18% vs 15%, p&amp;lt;0.0001,respectively). Conclusion The combination of SRI and PV status might be useful for stratifying patients at risk for the total mortality and cardiovascular death in patients with ADHF. Funding Acknowledgement Type of funding sources: None.

Retrospective evaluation of the relationship between admission variables and brain herniation in dogs (2010-2019): 54 cases.

To document the admission systolic blood pressure (SBP), heart rate (HR), and modified Glasgow coma scale (MGCS) score in dogs with and without brain herniation and to determine their relationship with brain herniation. Retrospective study between 2010 and 2019. University veterinary teaching hospital. Fifty-four client-owned dogs with brain herniation and 40 client-owned dogs as a control group, as determined on magnetic resonance imaging. None. SBP, HR, MGCS score, and outcome were extracted from medical records. MGCS score was retrospectively calculated based on initial neurological examination in dogs with adequate available information. Dogs with brain herniation had a significantly higher SBP (P=0.0078), greater SBP-HR difference (P=0.0006), and lower MGCS score (P<0.0001) compared to control dogs. A cutoff value of an SBP≥178 mm Hg, SBP-HR≥60, and MGCS score≤14 each provides a specificity of 90%-98%. A combination of an SBP>140 mm Hg and HR<80/min provided 24% sensitivity and 100% specificity to diagnose dogs with brain herniation (P<0.0001). A high SBP, a greater difference between SBP and HR, a combination of higher SBP and lower HR, and a low MGCS score were associated with brain herniation in dogs presenting with neurological signs upon admission. Early recognition of these abnormalities may help veterinarians to suspect brain herniation and determine timely treatment.

Comparison of effect of Labetalol and fentanyl with only fentanyl for attenuating pressure responses to intubation and skull pin insertion in neurosurgery

Introduction: Laryngoscopy and intubation as well as application of skull pin in neurosurgical procedure is a highly noxious stimulus which causes hemodynamic changes and can be detrimental in patients with raised intracranial pressure. We studied the effect of addition of intravenous labetalol with fentanyl to attenuate the pressure response to intubation and skull pin insertion in neurosurgery. Materials and Methods: Fifty patients undergoing elective neurosurgical procedure were randomised into two groups as group LF and group F. Patients of group LF received intravenous Labetalol 0.25mg/kg 5 minutes prior and intravenous fentanyl 2µg/kg 3 minutes prior to intubation. Patients of group F received intravenous saline 5 minutes prior and intravenous Fentanyl 2µg/kg 3 minutes prior to intubation. Heart rate (HR) systolic and diastolic blood pressure (SBP and DBP) and mean arterial pressure (MAP) were noted at baseline, after study drug administration, after induction, immediately after intubation, immediately after skull pin insertion, 5 minutes interval till 20 minutes after that. Results: Immediately after intubation HR was 82.60+5.0 per minute in LF group and 97.64 + 4.71 per minute in group F (p=0.01). MAP was higher in group F than group LF (106.84+3.89 mm of Hg, 83.02+3.75 mm of Hg respectively p=0.001). Immediately after skull pin insertion rise in HR (group LF 79.76+5.07 per minute, group F 97.84+4.40 per minute respectively p=0.001) and MAP ( group LF 80.28+5.32 mm of Hg, group F 103.17+7.66 mm of Hg respectively p=0.001) was at lesser extent in group LF. Conclusion: Addition of single dose intravenous labetalol to fentanyl gives better haemodynamic stability to laryngoscopy and intubation as well as skull pin insertion than fentanyl alone. Keywords: Skull pins, Labetalol, fentanyl, Hemodynamic changes, Pressure response.

Infusion therapy for sepsis in patients with burns

Background. Sepsis develops in 8-42.5 % of patients with burns and is the leading cause of death among them. The criteria for sepsis are suspected or documented infection and the presence of two or more criteria on the SOFA scale. The involvement of remote from the primary pathological focus organs or systems in the generalized pathological process is the key sign of sepsis.&#x0D; Objective. To describe infusion therapy (IT) for sepsis in patients with burns.&#x0D; Materials and methods. Analysis of literature data on this topic; own research. The study involved 52 patients with sepsis due to severe burns, who were prescribed individually selected comprehensive treatment. Patients in group 1 received IT according to the following scheme: Ringera lactate (“Yuria-Pharm”) + glucose + isoosmolar crystalloids, group 2 – Ringera lactate + glucose + Reosorbilact (“Yuria-Pharm”) at a dose of 10 ml/kg, group 3 – Ringera lactate + glucose + Reosorbilact at a dose of 15 ml/kg.&#x0D; Results and discussion. Sepsis in patients with burns differs from sepsis in general surgery patients, as the former lose the main protective barrier – their skin. Due to the hypermetabolic response patients with burns for several months may have tachycardia, tachypnea, leukocytosis, shift of the leukocyte formula to the left, fever, signs of multiorgan dysfunction. The development of sepsis in patients with burn disease depends on the area and depth of the injury, as well as on the condition of the patient’s immune system. Treatment of sepsis may include antibiotic therapy, surgery (removal of non-viable tissues, closure of skin defects), IT, vasopressor therapy, heparin, inotropic support, glucocorticoid therapy, administration of blood products, mechanical lung ventilation. Despite the leading role of IT in the treatment of sepsis in patients with burns, the question of the optimal solution and its dose is still unclear. The goals of IT in this case are to ensure the delivery of oxygen to tissues in conditions of increased consumption and detoxification. According to the results of our own study, patients in groups 2 and 3 had a significantly lower heart rate (HR) and higher systolic blood pressure (SBP) than in group 1 (HR: 1st group – 119.5±5.4 bpm, 2nd group – 108.2±4.3 bpm, 3rd group – 104.5±5.3 bpm; SBP: 1st group – 82.6±5.3 mm Hg, 2nd group – 82.5±4.6 mm Hg, 3rd group – 92.4±3.2 mm Hg). The increase in SBP was accompanied by an increase in glomerular filtration rate and rate of diuresis. The use of Reosorbilact at a dose of 10 ml/kg/day reduced the total volume of infusions by 7.8 %, and at a dose of 15 ml/kg/day – by 19.5 % compared with group 1. Patients in both groups of Reosorbilact had a lower frequency of septic shock (11.8 and 12.5 % vs. 15.7 % in group 1) and shorter duration of treatment with vasopressors. The use of Reosorbilact in both doses helped to reduce the level of leukocytes, urea, creatinine, C-reactive protein. Hemodynamic, osmodiuretic and detoxifying effects of Reosorbilact justify its use in patients with severe burns and sepsis.&#x0D; Conclusions. 1. Sepsis develops in 8-42.5 % of patients with burns and is the leading cause of death among them. 2. Sepsis in patients with burns is different from sepsis in general surgery patients. 3. Despite the leading role of IT in the treatment of burn sepsis, the question of the optimal solution and its dose still remains unclear. 4. The use of Reosorbilact helps to reduce heart rate, increase SBP, reduce the total volume of infusions, reduce the frequency of septic shock and reduce treatment with vasopressors.

Compared presentation, management and long-term outcomes after acute myocardial infraction in men and women &amp;lt;50 years of age. The FAST-MI programme

Abstract The number of young women suffering acute myocardial infarction (AMI) is increasing. There are conflicting results on the prognostic impact of gender in young patients with AMI. The aim of the present study was to assess in-hospital and 5-year outcomes in men and women ≤50 years old admitted for AMI and participating in the FAST-MI programme. Methods FAST-MI consists in one-month nationwide French surveys of patients admitted for a recent AMI, repeated every 5 years since 2005. We used the 2005, 2010 and 2015 data with up to 5-year follow-up, to describe baseline characteristics and outcomes according to gender in young patients. Of 13,130 patients included, 1,912 were ≤50 years old (335 women, 17.5%). Results Men and women had a similar age (44±5 years), BMI, current smoking (72% vs 75%), diabetes, family history, prior history of CVD, GRACE score (104±22 vs 106±23), and LVEF (54±10%). LDL at admission was lower in women (127±46 vs 138±46 mg/dl). Women had a higher admission heart rate (81±19 vs 78±17 BPM) and lower systolic blood pressure (133±26 vs 136±25 mm Hg). Presenting AMI was STEMI in 63% in women vs 68% in men (P=0.08). All in-hospital complications except reinfarction (1.8 vs 0.6%, p&amp;lt;0.03) were similar in women and men; in-hospital death was 1.5% vs 0.8%, P=0.20. Coronary angiography was performed slightly less often (97.6% vs 99.0%, P=0.047) and more women had non-significant coronary artery disease (CAD) (13% vs 6%, P&amp;lt;0.001); PCI was less often used (74% vs 85.5%, P&amp;lt;0.001). At discharge, ESC guidelines-recommended medical treatment was less often prescribed in women (41% vs 53%, P&amp;lt;0.001), even in patients with significant CAD (46% vs 55%, P=0.004). Kaplan-Meier 5-year survival did not differ in women (94.7%) and men (95.2%), P=0.56 (Figure). The respective figures for hospital survivors were 96.1% and 96.0% (HR 1.00, 95% CI 0.52–1.91; HR adjusted on age, type of MI, previous history of CAD, presence of significant CAD, LVEF, Killip class and appropriate medications at discharge: 0.99, 95% CI 0.51–0.92). Similar results were found for the combined end-point of death, AMI or stroke. Conclusion There were more similarities than differences between women and men who sustained an AMI at age ≤50 years. Women had lower LDL-c, lower haemoglobin, higher heart rate and lower blood pressure on admission. Non-significant CAD was more frequently found in women, who were less often treated with PCI and recommended medications at discharge. Five-year outcomes, however, did not differ according to gender. Five-year mortality Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Pfizer, MSD, AstraZeneca

Circadian rhythms of blood pressure and rate pressure product in children with postural tachycardia syndrome.

To investigate circadian rhythms of blood pressure (BP) and rate pressure product (RPP) in children with postural tachycardia syndrome (POTS) by performing 24-hour ambulatory blood pressure monitoring (24-h ABPM). 103 POTS children and 84 age- and gender-matched healthy children were enrolled and they got 24-h ABPM under usual routine of diurnal activity and nocturnal sleep. Although the mean awake systolic BP (SBP), 24-h diastolic BP (DBP), awake DBP, asleep heart rate (HR) did not differ between two groups (P>0.05), the mean 24-h and asleep SBP, asleep DBP, 24-h and awake HR, 24-h, awake and asleep RPP were significantly higher in POTS children (P<0.01). Non-dipping BP was more prevalent in POTS children (67.0% vs. 46%, P<0.001). The RPP of POTS and control children showed 24-h circadian variations with peak roughly occurring approximately 2h after waking from nocturnal sleep. Compared with controls, the RPP values of POTS children were significantly higher during 2h before and 3h after waking (P<0.05). For the RPP value of 1h after waking, a cutoff value of 8995.6bpm·mmHg yielded a sensitivity of 75.8% and a specificity of 65.4% for predicting POTS. Abnormal circadian BP regulation is prevalent in POTS children. POTS children present with daily sympathetic hyperactivity, especially during nocturnal sleep and within 3h after waking. And the excessive morning surge in RPP parallels with the morning surge of orthostatic HR increments and OI symptoms.

Early drop in systolic blood pressure, heart rate at admission, and their effects on worsening renal function in elderly patients with acute heart failure

BackgroundRegardless of patients’ baseline renal function, worsening renal function (WRF) during hospitalization is associated with poor outcomes. In individuals with acute heart failure (AHF), one predictor of WRF is an early drop in systolic blood pressure (SBP). Few studies have investigated WRF in elderly AHF patients or the influence of these patients’ heart rate (HR) at admission on the relationship between an early SBP drop SBP and the AHF.MethodsWe measured the SBP and HR of 245 elderly AHF inpatients (83 ± 6.0 years old, females 51%) at admission and another six times over the next 48 h. We defined ‘WRF’ as a serum creatinine increase ≥0.3 mg/dL by Day 5 post-admission. We calculated the ‘early SBP drop’ as the difference between the admission SBP value and the lowest value during the first 48 h of hospitalization.ResultsThere were significant differences between the 36 patients with WRF and the 209 patients without WRF: early SBP drop (51 vs. 33 mmHg, p < 0.01) and HR at admission (79 vs. 90 bpm, p < 0.05), respectively. In the multiple logistic regression analysis adjusted for the confounders, higher early SBP drop (p < 0.04) and lower HR at admission (p < 0.01) were significantly associated with WRF. No significant association was shown for the interaction term of early SBP drop × HR at admission with WRF.ConclusionsIn these elderly AHF patients, exaggerated early SBP drop and lower HR at admission were significant independent predictors of WRF, and these factors were additively associated with WRF.

Role of oral gabapentin in attenuating cardiovascular response to laryngoscopy and tracheal intubation.

Objectives: To determine the role of 800 mg oral gabapentin in attenuating cardiovascular response to laryngoscopy and tracheal intubation. Study Design: Double Blind Randomized Control Trial. Setting: Independent University Hospital/Independent Medical College, Faisalabad, Pakistan. Period: Six months from January1st 2019 to June 30th 2019. Material &amp; Methods: This study included 60 patients which were divided into two equal groups. 800 mg oral gabapentin was given to group I while capsule placebo was administrated to group II patients in pre-operative area one hour prior to surgery. Heart rate, systolic, diastolic and mean arterial blood pressure were taken after induction of anesthesia at base line and then 1,2,3,4,5,10 and 15 minutes after endotracheal intubation. SPSS version 11 was used to analyze the data. Heart rate systolic, diastolic and mean arterial blood pressure were dependent variables while placebo and gabapentin were independent variables. Results: Out of total 60 patients there were 36 (60 %) males and 24 (40 %) females. In group I mean age was 37.1 while in group II it was 36.3. As compare to group II there was decreased cardiovascular response in group I. There was a significant decrease in systolic blood pressure at 1,2 and 10 minutes; diastolic blood pressure at 3 minutes; heart rate at 10 and 15 minutes and mean arterial blood pressure at 3 minutes after induction in group I. Conclusion: Cardiovascular response to laryngoscopy and intubation is significantly reduced with oral gabapentin.

Association between heart rate response during orthostatic test and falls in polymorbid patients aged 60 years and older

Background. Orthostatic hypotension is a significant risk factor of falling in older adults. To diagnose the orthostatic hypotension an orthostatic test is used with assessment of heart rate (HR) response, systolic (SBP) and diastolic blood pressure (DBP) at the 3rd minute after the rise. However, according to studies, measurement of SBP and DBP at the 1st minute after rising can be more sensitive to detect older adults at risk of falling than at 3rd minute.Objective. The purpose of this study was to evaluate the role of changes in SBP, DBP and HR at the 1st, 2nd and 3rd minutes when performing an orthostatic test for identification of the elderly at high-risk of falls.Design and methods. This cross-sectional study included 100 adults aged 59+. Among them women comprise 56 % (n = 56). The following procedures were performed: the orthostatic test, anthropometry, medical history, assessment of drug treatment, depression evaluation, dementia and the degree of autonomy decline.Results. HR response at the 1st minute after the transition from horizontal to vertical position is more significant factor of falls risk than SBP and DBP changes during performing of orthostatic test. Absence of HR increasing during the transition from horizontal to vertical position associates with 10‑fold of risk falls among older adults: odds ratio 95 % confidence interval (OR 95 % CI) 10,5 (2,9–37,8). This association remained significant even after adjusting for age, gender, β-blockers use and comorbidity.Conclusion. Absence of HR increasing during the transition from horizontal to vertical position is a high sensitive marker of detecting older adults with polymorbidity in patients with the high risk of falls.