Systolic Blood Pressure In Patients Research Articles

EVALUATION OF THE ANTIHYPERTENSIVE EFFECT OF THE THYME AMONG PATIENTS SUFFERING FROM HYPERTENSION IN IRAQ.

The aim: of research is to test effectiveness of thyme on patients with high blood pressure and comparing between blood pressure of patients who took thyme and patients who did not among different ages. Materials and methods: This study concerning patients with high blood pressure, (3/2022 to 3/2023). Collecting data was depend on interviewed patients directly to get information. A questionnaire paper includes several questions. Interview included convincing patients to take thyme for 15 days to know how could thyme effect on their blood pressure and over different patients. Results: A significant difference in distribution between male and female within control and treated groups. A significant difference between all age groups when compared control and treated group, and decrease in systolic blood pressure when patients taking own drug plus thyme compared with patients taking own drug alone, but non-significant decrease in systolic blood pressure when compared with control group, a non-significant decrease in systolic blood pressure in patients taking own drug when compared with control group. A significant decrease in diastolic blood pressure when patients taking own drug plus thyme in comparison with patients taking own drug alone, but non-significant reduction in diastolic blood pressure when compared with group which considered control, non-significant decrease in diastolic blood pressure in patients taking own drug when compared with control group. Conclusions: Thyme herbs induce normalization hypertension and keeps blood pressure in usual range. The available clinical trial data provide evidence for the safe utilization of herbal preparations containing Thyme in the treatment of hypertension.

PS-C14-10: THE INFLUENCE OF ARTERIAL HYPERTENSION ON THE PROGRESSION OF OBSTRUCTION IN HYPERTROPHIC CARDIOMYOPATHY

The nature of hypertrophic cardiomyopathy remains unexplored to date, but there is a very reasonable opinion about the genetic transmission of the disease. Given the presence of arterial hypertension in 88% of patients with hypertrophic cardiomyopathy, the issue remains relevant. To date, there is no clear understanding of hypertrophy in hypertrophic cardiomyopathy and hypertensive heart. Objective: To evaluate the effect of arterial hypertension on obstruction in hypertrophic cardiomyopathy. Material and Methods: From 2017 to 2022, 70 patients diagnosed with hypertrophic cardiomyopathy were under observation. Given the obstructive form of hypertrophic cardiomyopathy, 40 patients were operated on, Morrow operation, 30 patients diagnosed with hypertrophic cardiomyopathy without obstructive lesions are under observation, this group will take part in the study. All patients underwent genetic testing. The age of the patients ranged from 18.3 to 80.4 years, the median was 57.3 years; in most cases, pathology occurs in females, 67%, while in men it is 2 times less, 33%. Exclusion criteria for patients with aortic stenosis and “athletic” heart. Complaints were shortness of breath, headaches, dizziness, syncope. Results as a result of studies in 56% of patients test for genetic mutations is positive. Arterial hypertension was detected in 88% of patients. The duration of the disease in patients varied significantly from 1 to 35 years, the interquartile range was from 5.3 to 15.1 years, the median was 10 years. Systolic blood pressure in patients ranged from 92 to 260 mm Hg, the median was 180.5 mm Hg. Diastolic blood pressure in patients ranged from 61 to 130 mm Hg, the median was 90 mm Hg. In patients with a negative genetic analysis, 44%, a long history of arterial hypertension was revealed. Most of the patients were not adherent to therapy, despite the 3rd degree of arterial hypertension, only 13% were constantly taking antihypertensive drugs. Considering these data, we identified relevant data on echocardiography. In patients with a long history of hypertension, an increase in the left atrium, a concentric variant of hypertrophy, can be noted. There is thickening of both the aorta and the aortic valve cusps. Conclusions: The mechanism of development of hypertrophic cardiomyopathy is not completely clear; therefore, the genetic diagnosis of this disease is an integral part. Timely identified and initiated treatment of hypertension can prevent the risks of developing hypertrophy in the future.

PS-P15-1: EFFECT OF GARLIC EXTRACT SUPPLEMENTATION ON BLOOD PRESSURE CONTROL IN PATIENTS WITH CHRONIC HEMODIALYSIS

Objective: Studies have reported intradialytic hypertension and inadequate antihypertension drugs in hemodialysis patients. Garlic and its components like Allicin have biological activities in lowering blood pressure by induction of endothelin nitric oxide synthase (eNOS) to hydrogen sulfide (H2S), which leads to calcium channel closure and relaxation, which leads to vasodilation of vessels. This study aims to analyze the effect of garlic extract supplementation on lowering blood pressure in chronic hemodialysis patients at Moh Hoesin General Hospital, Palembang, Indonesia. Design and method: This study was a crossover randomized, placebo-controlled, double-blind trial. The subjects were 40 CKD stage 5 patients with chronic hemodialysis, randomly divided into 2 groups, namely the group that received 1000 mg of garlic extract per day (2x500 mg) for 6 weeks and the group that received a placebo, which was then carried out during a washing period for 2 weeks, and then the two groups were crossover. Each group measured the blood pressure before and after treatment. Results: The wilcoxon test revealed that systolic blood pressure before and after garlic extract administration was 144,5 ± 12,1 mmHg and 140 (125–164) mmHg with p = 0,037, respectively (vs placebo, p = 0,55). Diastolic blood pressure before and after garlic extract administration was 80 (70–100) mmHg and 80 (70–100) mmHg, with p = 0,703 (vs placebo, p = 0,9). Conclusion: There was an effect of garlic extract on lowering systolic blood pressure in patients with chronic HD at Moh Hoesin Hospital, Palembang, Indonesia.

Reducing Tourniquet Pressures in Hand Surgery: Are Lower Pressures as Effective?

Background Pneumatic tourniquets are widely used in hand surgery. Elevated pressures can be associated with complications, and thus, guidelines based on patient-specific tourniquet pressures have been recommended. The primary aim of this study was to determine whether lower tourniquet values based on systolic blood pressure (SBP) could be effectively applied in upper extremity surgery. Methods A prospective case series of 107 consecutive patients undergoing upper extremity surgery with use of a pneumatic tourniquet was performed. Tourniquet pressure used was based on the patient's SBP. The tourniquet was inflated based on our predetermined guidelines: 60 mm Hg was added for SBP < 130 mm Hg, 80 mm Hg for SBP between 131 and 190 mm Hg, and 100 mm Hg for SBP > 191 mm Hg. The outcome measures included intraoperative tourniquet adjustment, surgeon-rated quality of bloodless operative field and complications. Results The mean tourniquet pressure was 183 ± 26 mm Hg with a mean tourniquet time of 34 minutes (range: 2-120 minutes). There were no instances of intraoperative tourniquet adjustment. The surgeon-rated quality of bloodless operative field was excellent in all patients. No complications were associated with the use of a tourniquet. Conclusion Tourniquet inflation pressure based on SBP is an effective method to provide a bloodless surgical field in upper extremity surgery at significantly lower inflation pressures than are the current standards.

Acupuncture against the metabolic risk factors for stroke: A systematic review of systematic reviews.

Objective:This systematic review (SR) of SRs aims aimed to evaluate the current evidence of rehabilitation interventions in stroke patients after acupuncture treatment.Methods:Full-text SRs published in Chinese and English up to December 15, 2021 were searched in PubMed, Embase, Cochrane Library, CNKI, VIP, and Wanfang databases. The PRISMA statement and the assessment of multiple systematic reviews 2 (AMSTAR 2) scale were used to evaluate the quality of the included articles. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was employed to assess the outcome indicators for evidence quality evaluation.Results:A number of 42 publications were identified in this study. According to these articles, 4 metabolic areas were identified: systolic blood pressure, weight loss, glycemic index and cholesterol. The acupuncture is beneficial to improve the systolic blood pressure of patients, and the effect of acupuncture on diastolic blood pressure is better than that of sham acupuncture. The weight loss effect of acupuncture is better than that of lifestyle and western medicine. The improvement effect of acupuncture on body mass index (BMI) is also better than that of sham acupuncture. In the study of glycemic index of stroke patients, acupuncture significantly improved glycosylated hemoglobin and insulin sensitivity index compared with western medicine. In cholesterol-related research, acupuncture can effectively improve the content of triglycerides. However, studies on HDL and LDL show that acupuncture can significantly improve HDL, but has no significant effect on LDL.Conclusion:This review summarizes the available evidence and underpins findings of the acupuncture exhibited the therapeutic role in eliminating metabolic risk factors for stroke, including systolic blood pressure, weight loss, glycemic index and cholesterol. Acupuncture could have positive effects on a specific symptom, and the effects depend not only on intervention type but also on how and when the intervention is provided. And more prioritizing high-quality research in this field in the future is conducive to guiding clinical practice.

Performance of urinary liver-type fatty acid-binding protein in diabetic nephropathy: A meta-analysis

AimsDiabetic nephropathy (DN) is one of the main causes of chronic kidney disease (CKD), which increases the risk of cardiovascular diseases and progresses to end-stage renal failure. Thus, early diagnostic markers for diabetic patients are urgently needed to improve the prognosis of DN and predict DN progression.Materials and methodsPubMed, MEDLINE, EMBASE, and Scopus were searched for publications until February 24, 2021. Review Manager 5.4 software was used for meta-analysis. We performed the heterogeneity test using the I2 statistic: P < 0.1 and I2> 50% meant statistical significance.ResultsWe included 13 studies. The urinary liver-type fatty acid-binding protein (uL-FABP) concentrations in the normal albuminuria group were significantly higher than those in the normal control group without diabetes mellitus (DM) [P = 0.009, SMD 1.72, 95% CI (0.44, 2.99)]. Urinary F-LABP levels were elevated in the macroalbuminuria group compared with those in the microalbuminuria group with DM [P = 0.002, SMD 2.82, 95% CI (1.03, 4.61)]. Urinary L-FABP levels were also significantly increased in the progression and CKD groups compared with non-progression and CKD subjects with DM [P = 0.02, P < 0.00001, respectively]. Furthermore, uL-FABP concentrations were positively correlated with the albumin-to-creatinine ratio and systolic blood pressure in patients with DM [Summary Fisher’s Z = 0.58 P < 0.00001; Summary Fisher’s Z = 0.24 P < 0.0001, respectively] and negatively correlated with estimated glomerular filtration rate in patients with DM [Summary Fisher’s Z = −0.36, P < 0.0001].ConclusionUrinary L-FABP may be a potential marker for the detection of all stages of DN and for the prediction of the progression and severity of DN in patients with type 1 and 2 DM.

A Systematic Review of Maternal Serum Syndecan-1 and Preeclampsia.

Exploration of novel biomarkers has been gaining popularity in preeclampsia, which is currently being diagnosed based on clinical criteria alone. Soluble syndecan-1, released from one of the proteoglycans associated with the syncytiotrophoblastic layer of the placenta, is affected in patients with abnormal placentation. This article is the first systematic literature review that evaluates the relationship between the antepartum serum levels of the syndecan-1 and preeclampsia. Eight studies were selected after screening and quality appraisal, and data were analyzed. The serum concentration of syndecan-1 was found to correlate positively with the gestational age in all pregnancies and negatively with the systolic blood pressure in patients with preeclampsia. Extremely low levels of soluble syndecan-1 may be helpful as a predictor for the development of preeclampsia during gestation.

EFFECTS OF SGLT-2 INHIBITORS ON 24H AMBULATORY BLOOD PRESSURE IN PATIENTS WITH TYPE 2 DIABETIC AND HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: To analyze the effects of different types of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on 24-hour ambulatory blood pressure in patients with type 2 diabetes mellitus and hypertension. Design and method: In the meta-analysis, The PubMed, Web of science, and Cochrane Library were searched for relevant literature, and the references obtained from these sources were retrieved from inception till December 2020. The inclusion and exclusion criteria were formulated in accordance with the requirements of Cochrane systematic review. A total of 1354 articles were retrieved, 592 duplicate articles were excluded, 372 articles were excluded after reading the title and abstract, 87 articles were excluded from non-randomized control and irrelevant outcome indicators, and 7 studies with 2343 patients were finally included. Use RevMan5.3 software to compare the changes in 24-hour ambulatory blood pressure, day and night blood pressure of patients with type 2 diabetes and hypertension before and after treatment with different types and doses of SGLT2i. Results: A total of four types of SGLT-2i were evaluated in the application of patients with type 2 diabetes and hypertension. The result showed that compared with placebo,SGLT2i could reduce the 24-hour systolic blood pressure of patients with type 2 diabetes and hypertension by 4.36mmHg (95%CI -5.92--2.79,p &lt; 0.001),among which the antihypertensive effects of empagliflozin, canagliflozin, dapagliflozin and ertugliflozin were -4.59mmHg, -3.74mmHg, -5.06mmHg, -3.64mmHg, respectively; similarly, the 24-hour dynamic diastolic blood pressure decreased by 2.20mmHg (95%CI -2.74, -1.65,p &lt; 0.001), among which the antihypertensive effects of empagliflozin, canagliflozin, dapagliflozin and ertugliflozin were -2.38mmHg, -1.22mmHg, -2.00mmHg,- 2.69mmHg, respectively. At the same time, the systolic and diastolic blood pressure during the day and night decreased significantly. Conclusions: his meta-analysis shows that SGLT2i can have beneficial effects on the cardiovascular system by reducing 24-hour ambulatory blood pressure in patients with type 2 diabetes and hypertension, other than reducing blood sugar. Therefore, for patients with type 2 diabetes and hypertension, SGLT2i may be the best hypoglycemic choice.

Outcomes of a Stroke Response Team on the Emergent Management of Intracerebral Hemorrhage.

Spontaneous intracerebral hemorrhage results in high patient mortality or poor functional outcomes. Early access to specialty care allows for rapid implementation of evidence-based strategies that improve the patient's long-term outcomes. The aim of this study was to determine the impact of a dedicated stroke response team on timeliness of blood pressure control, administration of anticoagulation reversal agents, and emergency department arrival to a critical care bed. A stroke response team was developed from the neuro intensive care unit that compliments the hospital's current rapid response team. Development of an algorithm guides the implementation of key interventions for intracerebral hemorrhages. Widespread education targeting care of patients with hemorrhagic stroke provided the stroke response team and emergency department staff with knowledge to implement the plan of care. Baseline time interval data were collected on 70 consecutive patients with intracerebral hemorrhage. After implementation of a dedicated stroke response team, time interval data on 70 consecutive patients with intracerebral hemorrhage were collected for comparison with the baseline measurement. A significant decrease was seen in the time to control the patient's systolic blood pressure (median of 130 to 56 minutes, P = .000) and emergency department arrival to a critical care bed (240 to 132 minutes, P = .000). Patient arrival to anticoagulation reversal agent administration decreased from a mean of 98 to 72 minutes (P = .32). Implementation of a stroke response team increased the knowledge of the care team, improved the timeliness of blood pressure control, and decreased the time for emergency department arrival to a critical care bed, and to anticoagulation reversal agent administration.

The Effect of Family’s Scheduled Visitation on Vital Signs and Satisfaction Level of Patients Admitted to the Cardiac Care Unit: A Randomized Clinical Trial

Background: Visiting the family can have a great impact on hospitalized patients. Investigation of these effects is necessary to provide better care for patients admitted to the cardiac care unit (CCU). Methods: This randomized clinical trial study was performed in the Golestan Hospital in Ahvaz, Iran, in 2021. Sixty-two CCU patients were randomly allocated to intervention and control groups. The scheduled family visit was performed twice a day, 60 minutes each time, for 3 days in the evening and night shifts for the intervention group. The routine family visit was used for the control group. Data were collected by a satisfaction questionnaire and a checklist on vital signs. Data were analyzed using the chi‑square, t-test, and generalized estimating equations (GEE). Results: In the intervention group, unlike the control group, there was a significant difference between the mean heart rate and systolic blood pressure of patients during different times (P &lt; 0.000). Also, the level of satisfaction was higher in the intervention group than controls (P &lt; 0.000). Conclusions: This study demonstrated that scheduled family visits not only did not interfere with patients' vital signs but also increased their satisfaction. Therefore, it is necessary to design appropriate visitation policies for patients admitted to the cardiac intensive care unit.

The Effect of Angiotensin II Receptor Blockers in Patients with Hypertrophic Cardiomyopathy: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials.

Angiotensin receptor blocker (ARB) therapy has been evaluated to slow down the disease progression in patients with hypertrophic cardiomyopathy (HCM), but there is scarce evidence available to date. Therefore, our meta-analysis aimed to explore the efficacy of ARB therapy as a potential disease-modifying treatment in patients with HCM. A literature search was performed using PubMed, Scopus, Web of Science, Embase, Cochrane library, and Clinicaltrials.gov databases from inception to December 13th, 2021. We included only randomized controlled trials (RCTs). The quality of included studies was assessed by the Cochrane Collaboration's tool. Primary outcomes included the reduction in left ventricular mass and improvement in other echocardiographic features of myocardial dysfunction. The secondary outcome was a net reduction in systolic blood pressure. Meta-analysis was performed using pooled standardized mean difference (SMD) and corresponding 95% confidence interval (CI). A total of 1286 articles were screened. Seven RCTs met the inclusion criteria representing a total of 397 patients with HCM (195 patients were in the ARB group). ARB treatment was associated with significant reduction in left ventricular mass (SMD: -0.77; 95% CI: -1.40, -0.03; p = 0.04). ARB therapy was also associated with a significant reduction in systolic blood pressure (SMD: -0.33; 95% CI: -0.61, -0.05: p = 0.02). ARB therapy is associated with a marked reduction in left ventricular mass and systolic blood pressure in patients with hypertrophic cardiomyopathy. We recommend further studies with a larger patient population size to confirm the findings of our meta-analysis. OSF Registries, DOI: 10.17605/OSF.IO/DAS7C.

Analysis of Systolic Blood Pressure Level and Short-Term Variability in Masked Hypertension.

Background Patients with masked hypertension are at an elevated risk of cardiovascular events and all-cause death. This risk is close to that of sustained hypertension. The mean value and short-term variability of systolic blood pressure are considered to be risk factors for organ damage in hypertension. Objective To investigate the mean value and short-term variability of systolic blood pressure in patients with masked hypertension. Methods According to the results of in-clinic and ambulatory blood pressure measurement, participants were divided into four groups: normotension group, controlled hypertension group, masked hypertension group, and sustained hypertension group. The mean value and short-term variability of systolic blood pressure of masked hypertension group were evaluated by comparison with the other three groups. Results A total of 250 subjects were enrolled, with an average age of 65.46 ± 8.76 years, and 166 (66.4%) were male, including 62 in the normotension group, 78 in the controlled hypertension group, 69 in the masked hypertension group, and 41 in the sustained hypertension group. Compared with the normotension group and controlled hypertension group, the mean value, blood pressure load, standard deviation, and coefficient of variation of systolic blood pressure over 24 hours and during the day and night, were all higher in the masked hypertension group (P < 0.05), while the rate of the nocturnal systolic blood pressure decline was lower (P < 0.05). There were no statistically significant differences in the above indexes between the masked hypertension group and sustained hypertension group (P > 0.05). Conclusion There are higher mean value of systolic blood pressure and greater short-term variability in masked hypertension patients. Identification of masked hypertension is an important challenge in the clinic.

Association of Hypertension with serum ferritin level in local population of Mirpurkhas.

Introduction: Raised serum ferritin causes disturbance in the body metabolism leading to dyslipidemia, adiposity and hypertension.&#x0D; Objective: is to investigate the ferritin level and its possible effects on arterial blood pressure of local population.&#x0D; Methodology: This prospective, case control study was conducted during June 2017 to November 2018 in the Department of Physiology, Muhammad Medical College; Mirpurkhas Sindh after taking approval from ethical review committee. 50 hypertensive patients without any comorbid of either genders and an equal number of healthy age and sex matched controls were included in the study. Arterial pressure was measured by mercuric sphygmomanometer using standard method while serum ferritin was estimated by ELISA.&#x0D; Results: The mean age of patients was 55.2 ±11.14, and of controls was 47.12 ±14.29. The mean BMI of patients was 24.27 ±3.347 and of controls was 24.71±2.57. The difference in mean systolic blood pressure of patients (129.90 ±17.2mmHg), and controls (118.80 ±11.89) was statistically significant (p=0.013). Similarly, the mean diastolic blood pressure of patients was 83.60 mmHg ± 10.83 and for controls it was 76.40 ±7.63 with significant difference (p=0.025). The difference between mean serum ferritin level of patients (226.32±99.83) and controls (224.0 ±69.62) was also statistically significant (p=0.001). The correlation coefficient was statistically significant showing r value of ferritin with diastolic pressure r ═ 0.14, with systolic pressure r = 0.16 and with hypertension (both systolic and diastolic pressures) r = 0.21.&#x0D; Conclusion: This study showed significant association of Hypertension with serum ferritin.&#x0D; Keywords: Ferritin, BMI, Hypertension.&#x0D;

POS-255 EFFECT OF DAPAGLIFLOZIN ON BLOOD PRESSURE IN PATIENTS WITH CKD: A PRE-SPECIFIED ANALYSIS FROM DAPA-CKD

Hypertension is common in patients with chronic kidney disease (CKD). Sodium-glucose cotransporter 2 inhibitors decrease blood pressure in patients with type 2 diabetes, but the consistency and magnitude of blood pressure lowering with dapagliflozin in patients with CKD is unknown. We performed a pre-specified analysis of the DAPA-CKD trial to investigate the effect of dapagliflozin on systolic blood pressure in patients with CKD, with and without type 2 diabetes.

Determining The Recurrence of Diabetic Patients Recovery Time in BenishangulGumuz Hospitals, Ethiopia

Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar). About 90% of people with diabetes around the world have type II diabetes. It is the main global health issues and burden as well with serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. In middleand low-income countries the prevalence of diabetes has been rising more rapidly and needs great attention. The data from such case has been considered as recurrent event data and correlation between events should be taken into account in the analysis. Thus, the aim of the study was to identify risk factors for recurrence of diabetic patient’s recovery time in Benishangul-Gumuz hospitals (Assosa, Pawi and Wonbera hospital), Ethiopia. A retrospective study has been applied to obtain data on the recurrence of diabetic patient’s recovery time in Benishangul-Gumuz hospitals, Ethiopia, from September 1, 2019 to September 1, 2021. Kaplan-Meier plot (s) and Log-rank test were used for comparison of patient’s recovery time from diabetes; Standard Cox-PH and Shared Frailty model were used to identify factors significantly affect the recovery time of diabetic patients, using R version 4.1.1 for data analysis. Of the total diabetic patients in this study 61.87 % experienced recurrence of diabetic. The estimated median recovery time of diabetic patients was 6 months. The Shared Log-normal Frailty model was chosen to be best fit for this data set, based on Likelihood Cross-Validation value. Family history, other medical history and Systolic Blood Pressure of patients were significantly affected the recovery time of diabetic patient’s.

Direct Determination rather than Oscillometric Estimation of Systolic Blood Pressure in Patients with Severe Chronic Kidney Disease

Introduction: Although arterial hypertension is a major concern in patients with chronic kidney disease (CKD), obtaining accurate systolic blood pressure (SBP) measurement is challenging in this population for whom automatic oscillometric devices may yield erroneous results. Methods: This cross-sectional study was conducted in 89 patients with stages 4, 5, and 5D CKD, for whom we compared SBP values obtained by the recently described systolic foot-to-apex time interval (SFATI) technique which provides direct SBP determination, the standard technique (Korotkoff sounds), and oscillometry. We investigated the effects of age, sex, diabetes, CKD stage, and pulse pressure to explain measurement errors defined as biases or misclassification relative to the SBP thresholds of 110–130-mm Hg. Results: All 3 techniques showed satisfactory reproducibility for SBP measurement (CCC > 0.84 and >0.91, respectively, in dialyzed and nondialyzed patients). The mean ± SD from SBP as determined via Korotkoff sounds was 1.7 ± 4.6 mm Hg for SFATI (CCC = 0.98) and 5.9 ± 9.3 mm Hg for oscillometry (CCC = 0.88). Referring to the 110–130-mm Hg SBP range outside which treatment prescription or adaptation is recommended for CKD patients, SFATI underestimated SBP in 3 patients and overestimated it in 1, whereas oscillometry underestimated SBP in 12 patients and overestimated it in 3. Higher pulse pressure was the main explanatory factor for measurement and classification errors. Discussion/Conclusion: SFATI provides accurate SBP measurements in patients with severe CKD and paves the way for the standardization of automated noninvasive blood pressure measurement devices. Before prescribing or adjusting antihypertensive therapy, physicians should be aware of the risk of misclassification when using oscillometry.

COMPARISON OF HAEMODYNAMIC STABILITY WITH 0.5% AND 0.75% HYPERBARIC BUPIVACAINE DURING SPINAL ANAESTHESIA IN WOMEN UNDERGOING CAESAREAN SECTION

Objective: To compare the effect of 0.5% and 0.75% hyperbaric Bupivacaine on haemodynamic stability in terms of mean systolic blood pressure and heart rate recorded at 4 min in patients undergoing caesarian section in spinal anesthesia.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital, Malir, from Jul to Dec 2018.&#x0D; Methodology: The patients were assigned in two groups (A and B) using lottery method. Group A received 0.5% hyperbaric Bupivacaine solution. Group B received 0.5% hyperbaric Bupivacaine solution. Spinal anaesthesia was given, blood pressure and heart rate were recorded. Data were analyzed in SPSS version 23. Both groups were compared for mean systolic blood pressure and heart rate by using independent sample t-test.&#x0D; Results: The mean age of patients was 29.62 ± 6.21 years in 0.75% Bupivacaine group while 29.31 ± 6.20 years in 0.5% Bupivacaine group. The mean systolic blood pressure of patients was 111.63 ± 5.96 mmHg in 0.75% Bupivacaine group while 117.16 ± 7.12 mmHg in 0.5% Bupivacaine group. The difference was significant in both groups (p-value &lt;0.05). The mean heart rate of patients was 92.27 ± 4.71 beats per min (bpm) in 0.75% Bupivacaine group while 97.68 ± 4.58 bpm in 0.5% Bupivacaine group. The difference was significant in both groups (p-value &lt;0.05).&#x0D; Conclusion: 0.5% hyperbaric Bupivacaine was better than 0.75% hyperbaric Bupivacaine solution in spinal anaesthesia during caesarean section.

RETRACTED ARTICLE: Post-operative blood pressure and 3-year major adverse cardiac events in Chinese patients undergoing PCI

BackgroundThere is no clear evidence for the target value of blood pressure control after Percutaneous coronary intervention (PCI). Therefore, our study was designed to explore the relationship between blood pressure after PCI and major adverse cardiac events (MACE) during 3-year follow-up.MethodsThis study is a prospective study. We included the patients who were diagnosed with acute coronary syndrome and underwent PCI stent implantation operation. The study initially collected information of 552 patients. The start and end times of the study are from January 1, 2017 to December 31, 2020. The independent variables of this study are the average systolic blood pressure and the average diastolic blood pressure after PCI. The dependent variable is the occurrence of MACE events in patients within 3 years after PCI. MACE is defined as acute myocardial infarction, recurring chest pain, heart failure, stroke, revascularization and cardiac death.ResultsA total of 514 subjects met the inclusion criteria. The average age of the study subjects is 61.92 ± 9.49 years old, of which 67.12% are male. 94 subjects had a MACE event within 3 years, and the occurrence rate was 18.29%. There is no significant non-linear or linear relationship between diastolic blood pressure and MACE events. There is a curvilinear relationship between the average systolic blood pressure of patients after PCI and MACE events within 3 years and the inflection point is 121. On the left side of the inflection point, the effect size and 95% CI are 1.09 and 1.01–1.18, respectively (P = 0.029). The impact size and 95% CI at the right inflection point were 1.00 and 0.98–1.02(P = 0.604), respectively.ConclusionThere is a curvilinear relationship between systolic blood pressure and prognosis of patients after PCI. Under the premise of ensuring the safety of patients, maintaining lower blood pressure after surgery is beneficial to improve the prognosis of patients.

Assessment of Sepsis in the ICU by Linear and Complex Characterization of Cardiovascular Dynamics.

Sepsis is one of the pathological conditions with the highest incidence in intensive care units. Sepsis-induced cardiac and autonomic dysfunction are well-known effects, among others, caused by a dysregulated host response to infection. In this context, we investigate the role of complex cardiovascular dynamics quantified through sample entropy indices from the inter-beat interval, systolic and diastolic blood pressure time series as well as the cross-entropy between heartbeat and systolic blood pressure in patients with sepsis in the first hour of intensive care when compared with non-septic subjects. Results show a significant (p<0.05) reduction in the probability of being septic for a unitary increase in entropy for systolic and diastolic time series (odds equal to 0.038 and 0.264, respectively) when adjusting for confounding factors. A significant (p<0.001) odds ratio (0.248) is observed also in cross-entropy, showing a reduced probability of being septic for an increase in heartbeat and systolic pressure asynchrony. The inclusion of our measures of complexity also determines an increase in the predictive ability (+0.03) of a logistic regression model reaching an area under the receiving operating and precision recall curves both equal to 0.95.Clinical relevance The study demonstrates the ability of information theory in catching a reduction of complex cardiovascular dynamics from vital signs commonly recorded in ICU. The considered complexity measures contribute to characterize sepsis development by showing a general loss of the interaction between heartbeat and pressure regulation. The extracted measures also improve the ability to identify sepsis in the first hour of intensive care.

Effects of SGLT2i on 24-hour ambulatory blood pressure in patients with type 2 diabetes complicating hypertension: a meta-analysis

Objective: To analyze the effects of different types of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on 24-hour ambulatory blood pressure in patients with type 2 diabetes mellitus and hypertension. Method: In this meta-analysis, we searched for randomized controlled trials on the effect of SGLT2i on 24-hour ambulatory blood pressure in patients with type 2 diabetes and hypertension. Three databases, namely PubMed, Web of Science and Cochrane Library, were searched. The search was organized on the concept of 3 conceptual groups: the first group contained terms used to describe SGLT2i, the second group contained terms related to blood pressure, and the third group contained terms used to describe randomized controlled trials. The search time was from the establishment of the database to December 2020. The inclusion and exclusion criteria were formulated in accordance with the requirements of the Cochrane systematic review. According to whether the heterogeneity of the study was significant or not, a random effect model or a fixed effect model were used to conduct the analysis on the impact of different types of SGLT2i on 24-hour ambulatory blood pressure and day and night blood pressure in patients with type 2 diabetes and hypertension. Further subgroup analysis was performed to define potential factors, which might lead to clinical heterogeneity. Results: Seven clinical trials were finally included. The result of the meta-analysis showed that compared with placebo group, SGLT2i could reduce the 24-hour dynamic systolic blood pressure of patients with type 2 diabetes and hypertension by 4.36 mmHg (1 mmHg=0.133 kPa). Reduction was 4.59, 3.74, 5.06, and 3.64 mmHg by canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin respectively; SGLT2i could reduce the 24-hour dynamic diastolic blood pressure of patients with type 2 diabetes and hypertension by 2.20 mmHg, and the reduction was 2.30, 1.22, 2.00, and 2.69 mmHg by canagliflozin, dapagliflozin, empagliflozin and ertugliflozin respectively. SGLT2i could reduce the daytime systolic blood pressure of patients with type 2 diabetes and hypertension by 5.25 mmHg, and reduction was 5.38, 4.87, 6.00, and 4.37 mmHg by canagliflozin, dapagliflozin, empagliflozin and ertugliflozin, respectively. Simultaneously, SGLT2i could reduce the diastolic blood pressure of patients with type 2 diabetes and hypertension by 2.62 mmHg, and the reduction was 2.56, 2.47, and 2.80 mmHg by canagliflozin, empagliflozin and ertugliflozin, respectively. SGLT2i could reduce the nighttime systolic blood pressure of patients with type 2 diabetes and hypertension by 3.62 mmHg, and the reduction was 2.09, 2.06, 3.92, and 2.45 mmHg by canagliflozin, dapagliflozin, empagliflozin and ertugliflozin, respectively. At the same time, SGLT2i could reduce the nighttime diastolic blood pressure of patients with type 2 diabetes and hypertension by 1.60 and 1.51 mmHg, the reduction was 1.53 and 2.58 mmHg by canagliflozin, empagliflozin and ertugliflozin, respectively. Conclusion: SGLT2i can reduce 24-hour ambulatory blood pressure in patients with type 2 diabetes and hypertension.