Systolic Blood Pressure In Patients Research Articles

Systematic Review and Meta-Analysis of Second-Generation Sham-Controlled Randomized Trials of Renal Denervation Therapy for Patients with Hypertension.

Renal denervation has been associated with substantial and sustained blood pressure reduction and is considered to serve as an alternative treatment for patients with resistant hypertension. However, the first published SHAM-controlled trial assessing RDN safety and efficacy showed no difference between groups. We aimed to perform a meta-analysis quantifying the magnitude of blood pressure decrease secondary to renal denervation in patients with resistant hypertension. Databases were searched for RCTs that compared RDN therapy to SHAM procedure and reported the outcomes of (1) 24-hour ambulatory blood pressure; (2) Office systolic blood pressure; (3) Daytime systolic blood pressure; and (4) Night-time systolic blood pressure. Mean differences with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was examined with I² statistics. P values of < 0.05 were considered statistically significant. Statistical analyses were performed using RStudio 4.2.3. Nine studies and 1622 patients were included. The AMBP [MD -3.72 95%CI -5.44, -2.00 p < 0.001; I²=34%] and DSBP [MD -4.10 95%CI -5.84, -2.37 p < 0.001; I²=0%] were significantly reduced in the RDN arm. ODBP [MD -6.04 95%CI -11.31, -0.78 p = 0.024; I²=90%] and NSBP [MD -1.81 95%CI -3.90, 0.27 p = 0.08; I²=0%] did not reach a statistically significant difference between groups. Renal denervation demonstrates greater efficacy in reducing 24-hour ambulatory and daytime systolic blood pressure in patients diagnosed with resistant hypertension.

Masked uncontrolled hypertension in patients with impaired carbohydrate metabolism

Aim. To establish the prevalence of masked uncontrolled hypertension (HTN) (MUH) in patients with diabetes or impaired glucose tolerance (IGT) and determine its clinical and hemodynamic characteristics.Material and methods. The study involved 87 patients who received regular antihypertensive therapy for hypertension and had established diabetes or IGT. The mean age of patients was 62,6±9,9 years, of which 51,7% were women, 48,3% — men. Type 2 diabetes was revealed in 77,7%, IGT — 22,8% of patients. For 24-hour blood pressure monitoring, BpLAB system (OOO Petr Telegin) was used; blood pressure (BP) was determined in the brachial artery, central blood pressure — in the aorta. We analyzed risk factors and target organ damage. The results were processed using the Excel Microsoft Office 2007 package and the Statistica 6.0 and 10.0 package from StatSoft, Inc (USA).Results. Uncontrolled hypertension was revealed in 59,8%, MUH — in 18,4%, controlled HTN — 21,8% of patients. Mean daytime and mean nighttime systolic BP in patients with MUH and uncontrolled HTN were comparable. Patients with controlled hypertension compared with MUH had lower mean day- and nighttime aortic BP by 27,1% (p&lt;0,01) and 16,8% (p&lt;0,01), respectively. Aortic BP was comparable in individuals with MUH and uncontrolled HTN. Asymptomatic hyperuricemia was more common in patients with uncontrolled HTN compared with MUH and controlled hypertension by 29,3% and 41,8%, respectively. With MUH, compared with controlled HTN, we revealed a higher incidence of stroke by 18,8%, a decrease in glomerular filtration rate &lt;60 ml/min by 17,5%, albuminuria by 18,8%, left ventricular hypertrophy by 2,6 times.Conclusion. Only 41,2% of patients with diabetes and prediabetes achieve the target office BP level, while every second of these patients has MUH. MUH, compared with controlled HTN, is characterized by a higher incidence of stroke, kidney (decrease in glomerular filtration rate &lt;60 ml/min and albuminuria) and heart damage (left ventricular hypertrophy).

Harmonizing Hearts: Exploring the Impact of Music Therapy on Cardiovascular Health.

Music therapy (MT) is a music intervention involving a credentialed professional and a client, which has gained increasing recognition in current practices as an adjunct therapy for various conditions, including cardiovascular diseases (CVDs). MT demonstrates notable physiological as well as psychological effects leading to lowered anxiety, depression, and systolic blood pressure in patients with CVDs as well as having effects on heart rate and heart rate variability in healthy subjects. MT emerges as a promising adjunct in the prevention and rehabilitation of CVDs and its holistic impact on physiological and psychological parameters underscores its potential as a noninvasive, cost-effective intervention. Existing literature shows heterogeneity in methods in the studies such as the genre and quality of music utilized as well outcomes. While further research is warranted to optimize protocols and assess long-term effects, the current evidence highlights MT's substantial benefits in cardiovascular health care, making it a promising asset in modern therapeutic approaches. This comprehensive review explores the multifaceted role of MT in CVDs, discussing its mechanisms and clinical applications.

Intensive vs Conventional Blood Pressure Control After Thrombectomy in Acute Ischemic Stroke

Endovascular thrombectomy (EVT) is standard treatment for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO), but optimal post-EVT blood pressure (BP) control remains debated. To assess the association of different systolic BP targets following EVT with functional outcomes, mortality, and complications in patients with AIS due to LVO. Systematic review and meta-analysis of databases (PubMed, Embase, Web of Science, Scopus, and Cochrane Library) to September 8, 2023. Inclusion criteria consisted of randomized clinical trials examining post-EVT management of systolic BP in patients with AIS and LVO comparing intensive vs conventional targets. Nonrandomized studies, observational studies, noninterventional trials, meeting abstracts, duplicate studies, studies with overlapping data, and non-English language studies were excluded. Two authors independently applied these criteria through a blinded review, with discrepancies resolved through consensus. The risk of bias in the included studies was assessed using the revised tool for assessing risk of bias in randomized trials. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Three authors extracted data regarding study characteristics, baseline patient data, and outcomes of interest. The pooled data were analyzed using a random-effects meta-analysis. Rates of functional independence, 90-day mortality, symptomatic intracranial hemorrhage, and hypotensive events. A total of 4 randomized clinical trials with 1571 initially enrolled patients were included in the analysis. Lower functional independence rates were observed in the intensive control group (relative risk [RR], 0.81 [95% CI, 0.67-0.98]). No significant differences were found in 90-day mortality (RR, 1.18 [95% CI, 0.92-1.52]), symptomatic intracranial hemorrhage (RR, 1.12 [95% CI, 0.75-1.67]), or hypotensive events (RR, 1.80 [95% CI, 0.37-8.76]). There was minimal heterogeneity among the studies included in the functional independence outcome (I2 = 13% and τ2 = 0.003), which was absent among other outcomes (I2 = 0 and τ2 = 0). These findings suggest that intensive post-EVT BP reduction does not yield benefits and may carry risks. While awaiting the results of additional ongoing trials, a conservative BP management strategy after endovascular recanalization is favored in daily practice.

Association between processed red meat intake and cardiovascular risk factors in patients with type 2 diabetes: a cross-sectional study from China.

To explore the association between Processed red meat (PRM) consumption and cardiovascular risk factors in Chinese adults with type 2 diabetes mellitus (T2DM). Dietary survey, physical measurement, and blood biochemical examination were conducted on 316 patients with type 2 diabetes in Bengbu, China from May to July 2019. Possible confounding factors were identified by comparing between-group variability in the baseline table. To eliminate the effect of confounding factors, subgroup analysis was used to explore whether there were differences in the correlation between PRM intake status and the indicators in cardiovascular disease risk factors. A logistic regression model was used to analyze the association between PRM and the risk of abnormal levels of cardiovascular risk factors in T2DM patients. Restricted cubic spline plots were used to analyze the dose-response relationship between PRM intake and the indicators of cardiovascular disease risk factors. A total of 316 subjects were included in the study, of whom 139 (44.0%) were male and 177 (56.0%) were female. In the multiplicative interaction, there was an effect modifier for smoking (Pinteraction = 0.033) on the association between PRM intake and the risk of substandard FPG level control; sex (Pinteraction = 0.035), smoking status (Pinteraction = 0.017), and alcohol consumption (Pinteraction = 0.046) had effect modifying effects on the association between PRM intake and risk of abnormal systolic blood pressure. Sex (Pinteraction = 0.045) had an effect modifier on the association of PRM intake status with the risk of diastolic blood pressure abnormality. In addition, age had an effect modifier on the association of PRM intake status with risk of abnormal triglyceride index (Pinteraction = 0.004) and risk of abnormal HDL index (Pinteraction = 0.018). After adjusting for potential confounding variables, logistic regression showed that the OR for substandard HbA1c control in patients in the highest PRM intake group, T3 (3.4 ~ 57.2 g/d), was 1.620-fold higher than in the lowest intake, i.e., the no-intake group, T1 (0.0 ~ 0.0 g/d; OR = 2.620; 95% CI 1.198 ~ 5.732; p = 0.016). Whereas the OR for abnormal control of systolic blood pressure levels was 1.025 times higher (OR = 2.025; 95% CI 1.033 ~ 3.968; p = 0.040) in patients in the PRM low intake group T2 (0.1 ~ 3.3 g/d) than in the non-intake group T1 (0.0 ~ 0.0 g/d), the OR for substandard control of systolic blood pressure in patients in the highest group T3 (3.4 ~ 57.2 g/d) was 1.166 times higher than in the no-intake group T1 (OR = 2.166; 95% CI 1.007 ~ 4.660; p = 0.048). The OR for abnormal TG levels in patients in the highest PRM intake group T3 (3.4 ~ 57.2 g/d) was 1.095 times higher than in the no-intake group T1 (OR = 2.095; 95% CI 1.076 ~ 4.078; p = 0.030). Restricted cubic spline plots presented a nonlinear dose-response relationship between PRM intake and risk of substandard HbA1c and SBP control (P nonlinear <0.05), and an atypical inverted U-shaped association between PRM intake and TC and LDL-C levels (P nonlinear <0.05). The strength of the associations between PRM intake and the control levels of FPG, DBP, HDL-C, and TG were not statistically significant (p > 0.05). PRM intake was generally low in patients with T2DM, but a nonlinear dose-response relationship between PRM intake and the risk of suboptimal control of HbA1c and SBP, with an atypical inverted U-shaped association with TC and LDL-C levels, was observed. Appropriate control of PRM intake may be important for tertiary prevention of T2DM and cardiovascular disease prevention. We need to better understand these relationships to promote improved cardiometabolism and global health.

Factor V Leiden, MTHFR, and FXIIIVal34Leu gene polymorphisms and their association with clinical features and risk of diabetic retinopathy in patients with type 2 diabetes.

Diabetic retinopathy (DR) is expanding to epidemic levels globally due to the progressing prevalence of diabetes mellitus (DM). In this study, the association between factor V Leiden (FVL), MTHFRC677T, and FXIIIVal34Leu polymorphisms and diabetic retinopathy was investigated in Eastern Iran. This case-control study enlisted the participation of 300 people (diabetic patients=100, diabetic retinopathy patients=100, healthy controls=100), and polymorphisms were examined by Tetra primer ARMS-PCR. The frequency of FVL (p=0.294) and FXIIIVal34Leu (P=0.349) polymorphism showed no significant results between the genotype frequency in the mentioned groups. In contrast, MTHFRC677T SNP was significantly different in diabetic patients and controls (P=0.008). The MTHFRC677T polymorphism was foundtobeconnectedwithincreased systolic blood pressure in patients who had the TT genotype (130.96±11.92mm/Hg; P=0.011). Our study recommended that the MTHFRC677T polymorphism may offer to DR development. Studies with larger sample sizes and a wider spectrum of populations are authorized to verify this finding.

Blood Pressure Response to the Head-Up Tilt Test in Benign Paroxysmal Positional Vertigo.

The vestibular organ is involved in controlling blood pressure through vestibulosympathetic reflexes of the autonomic nervous system. This study aimed to investigate the effect of benign paroxysmal positional vertigo (BPPV) on blood pressure control by the autonomic nervous system by observing changes in blood pressure before and after BPPV treatment using the head-up tilt test (HUTT). A total of 278 patients who underwent the HUTT before and after treatment were included. The HUTT measured blood pressure repeatedly on the day of diagnosis and the day of complete recovery, and the results were analyzed using repeated measures analysis of variance. Regarding the difference in the systolic blood pressure of patients with BPPV, the blood pressure at 1, 2, and 3 min in the upright position after complete recovery was significantly lower than before treatment (p = 0.001, p = 0.001, and p = 0.012, respectively). Blood pressure at 1 and 2 min in the diastolic blood pressure of patients with BPPV in the upright position after complete recovery was significantly lower than before treatment (p = 0.001 and p = 0.034, respectively). This study shows that BPPV increases blood pressure during the initial response to standing in the HUTT.

Primary perioperative haemodynamic effects of ß-receptor blockade in patients with catecholamine-secreting tumours

IntroductionGuidelines for the treatment of catecholamine-producing tumours strictly recommend starting ß-receptor blocking medication only after α-receptor blockade has been established. This recommendation is supported only by non-surgical case reports. However, in clinical practice ß-receptor blockade is often started before the diagnosis of a phaeochromocytoma is made. As we routinely treat patients with catecholamine-producing tumours without α-receptor blockade, our aim was to evaluate haemodynamic changes in such patients with and without ß-receptor blockade. MethodsPerioperative blood pressure was assessed prospectively for all patients. The primary outcome was the highest pre-, intra-, and postoperative systolic blood pressure in patients with or without a ß-receptor blockade. Secondary outcomes were the incidence of intraoperative systolic blood pressure peaks >250 mm Hg and hypotensive episodes. Subsequently, a propensity score matching (PSM) analysis was performed. ResultsOut of 584 phaeochromocytoma and paraganglioma resections, 383 operations were performed without α-receptor blockade (including 84 with ß-receptor blockade). Before operation and intraoperatively, patients with ß-receptor blockade presented with higher systolic blood pressure (155 [25] and 207 [62] mm Hg) than patients without ß-receptor blockade (147 [24] and 183 [52] mm Hg; P=0.006 and P=0.001, respectively). Intraoperatively, patients with ß-receptor blockade demonstrated a higher incidence of hypotensive episodes (25% without vs 41% with ß-blockade; P<0.001). After propensity score matching no difference between the groups could be confirmed. ConclusionOverall, patients with isolated ß-receptor blockade developed higher blood pressure before operation and intraoperatively. After propensity score matching a difference could no longer be detected. Overall, ß-receptor blockade seems to be more a sign for severe disease than a risk factor for haemodynamic instability.

Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment in CKD

IntroductionCentral aortic blood pressure (BP) could be a better risk predictor than brachial BP. This study examined whether invasively measured aortic systolic BP improved outcome prediction beyond risk prediction by conventional cuff-based office systolic BP in patients with and without chronic kidney disease (CKD). MethodsIn a prospective, longitudinal cohort study aortic and office systolic BPs were registered in patients undergoing elective coronary angiography. CKD was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2. Multivariable Cox models were used for the association with incident myocardial infarction (MI), stroke, and death. ResultsAortic and office systolic BPs were available in 39,866 patients (mean age: 64 years; 58% males; 64% with hypertension) out of which 6,605 (17%) had CKD. During a median follow-up of 7.2 years (interquartile range: 4.6-10.1 years), 1,367 strokes (CKD: 353), 1,858 MIs (CKD: 446) and 7,551 deaths (CKD: 2,515) occurred. CKD increased the risk of stroke, MI and death significantly. Office and aortic systolic BP were both associated with stroke in non-CKD patients (adjusted hazard ratios with 95% confidence interval per 10 mmHg: 1.08 (1.05–1.12) and 1.06 (1.03–1.09), respectively) and with MI in CKD patients (adjusted hazard ratios: 1.08 (1.03–1.13) and 1.08 (1.04–1.12), respectively). There was no significant difference between prediction of outcome with office or aortic systolic BP when adjusted models were compared with C-statistics. ConclusionRegardless of CKD status, invasively measured central aortic systolic BP does not improve the ability to predict outcome compared with brachial office BP measurement.

Comparison of the Effectiveness of the FemoStop Device and Sandbag Pressure on Hemostasis During Sheath Removal and Reducing Puncture Site Complications Following Transfemoral Coronary Angiography: A Randomized Controlled Trial

Background: Management of common and unpleasant complications following the removal of the arterial sheath is one of the goals and priorities of nursing care in patients undergoing angiography. Objectives: This study aimed to design and manufacture a FemoStop device and compare its effectiveness with sandbag pressure on hemostasis during sheath removal and reducing puncture site complications following transfemoral coronary angiography. Methods: This randomized controlled trial was conducted between 2019 and 2021. Eighty patients undergoing elective transfemoral coronary angiography referred to a Heart and Vascular Hospital in Tehran were recruited by convenience sampling and were randomly assigned to experimental (n = 40) and control (n = 40) groups. FemoStop devices and sandbags were used in the experimental and control groups to control angiography complications, respectively. The patient’s individual characteristics questionnaire, visual analog scale, checklist of complications, and laboratory indicators were used for data collection. Pain intensity, heart rate, respiratory rate, temperature, systolic and diastolic blood pressure, arterial oxygen saturation, and the amount of hematoma and bleeding of patients before, after 15 minutes, 1 h, 2 h, 2.5 h, 3 h, 3.5 h, 4 h, 4.5 h, 5 h, and 6 h were measured after the intervention. Results: The trend of changes in pain intensity (P &lt; 0.001), heart rate (P = 0.036), and systolic blood pressure (P &lt; 0.001) of patients in the experimental and control groups after the intervention was significant, and in patients who had used the FemoStop device, it was less than the control group. However, the changes in respiratory rate (P = 0.308), diastolic blood pressure (P = 0.089), arterial oxygen saturation (P = 0.205), and temperature (P = 0.195) of patients in the 2 groups were not significant. The 2 groups were not significantly different in terms of these variables and the amount of hematoma and bleeding in the 12 stages of measurement. Conclusions: Compared to using a sandbag after transfemoral coronary angiography, the FemoStop device leads to fewer complications, such as pain intensity, lower heart rate, and systolic blood pressure in patients. Therefore, considering fewer complications, it is suggested to conduct more studies to confirm the use of this device to control complications in patients.

Vitamin C supplementation showed greater effects on systolic blood pressure in hypertensive and diabetic patients: an updated systematic review and meta-analysis of randomised clinical trials

Results from randomised controlled trials (RCTs) testing the effect of vitamin C supplementation on blood pressure (BP) have been inconsistent. This systematic review evaluated the effects of vitamin C supplementation on BP and included RCTs testing the effects of vitamin C supplementation alone, on systolic and diastolic BP in adult participants (≥18 years). Random-effect models were conducted to estimate the pooled effects of vitamin C supplementation on BP. A total of 20 studies with 890 participants were included. The median dose of vitamin C was 757.5 mg/d, the median duration was 6 weeks. Vitamin C supplementation was found to reduce systolic BP by −3.0 mmHg (95%CI: −4.7, −1.3 mmHg; p = 0.001). Subgroup analysis showed a more pronounced effect on systolic BP in patients with hypertension (−3.2 mmHg, 95%CI −5.2, −1.2 mmHg, p = 0.002) and diabetes (−4.6 mmHg, 95%CI −8.9, −0.3 mmHg, p = 0.03). Further research needs to evaluate the long-term effect of vitamin C on BP in populations with impaired cardio-metabolic health.

#4590 A PROSPECTIVE STUDY OF EPLERENONE IN THE TREATMENT OF PATIENTS WITH GLOMERULONEPHRITIS

Abstract Background and Aims Clinical evidence suggests that high aldosterone plasma levels contributes to progressive kidney disease. Although administration of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin type 1 receptor blockers (ARB) can delay kidney disease progression, plasma aldosterone levels may increase to a significant extent even after the initiation of such treatment. Thus, administration of mineralocorticoid receptor antagonists such as spironolactone, on top of treatment with ACEi or ARBs has been shown to reduce albuminuria and slow down kidney function deterioration. Nevertheless, there is scanty evidence on the effect of eplerenone in patients with kidney disease due to glomerulonephritis. Method In this prospective open-label study, we evaluated the effects of eplerenone in patients with biopsy proven glomerulonephritis already treated with ACEi or ARBs. Patients were divided in the active treatment arm, who received 25 mg of eplerenone daily besides ACEi or ARBs, and a control group that received only standard treatment. Protein excretion in 24 h urine, eGFR, blood pressure and serum K+ levels were measured at 3, 6 and 12 months after study initiation. Results Out of 83 patients who were screened, 62 patients were included in the final analysis. Twenty-six received eplerenone and 36 were treated with ACEi (25) or ARBs (9) alone (controls). After 1 year of treatment with eplerenone, proteinuria decreased from 1597 to 1145 mg/24 h while it did not alter in controls. Eplerenone reduced proteinuria especially in those with baseline proteinuria of &amp;gt;1000 mg/24 h. Kidney function remained stable in patients treated with eplerenone (from eGFR: 82.51±22.6 to 84.68±31.7 ml/min/1.73 m2, p = 0.8) and showed a non significant deterioration in controls (from eGFR: 68.39±26.2 to 66.63±29.8 ml/min/1.73 m2, p = 0.08). Systolic blood pressure was significantly reduced in the active treatment arm (from 128.1±17.5 to 126.3±10.93 mmHg, p = 0.03), whereas eplerenone did not increase serum K+ levels or had any other significant adverse effect. Conclusion Administration of eplerenone at a dose of 25 mg/day, on top of treatment with ACEi or ARBs, can further reduce proteinuria and systolic blood pressure in patients with chronic glomerulonephritis.

ABSENT VASOREACTIVE RESPONSE TO HIGH SODIUM INTAKE COINCIDES WITH SALT SENSITIVITY IN CKD PATIENTS

Objective: Chronic kidney disease (CKD) patients are advised to limit salt intake, because of its detrimental effects on blood pressure (BP) and albuminuria. The salt-sensitive BP response in CKD is classically attributed to impaired renal ability to excrete sodium (Na+) resulting in fluid overload. Yet, BP sensitivity to salt is also linked to vasodysfuction, and may even be fluid independent. We aimed to investigate which factor contributes to BP sensitivity to salt in CKD. Design and method: In this randomized crossover study, CKD patients (KDIGO stage G2-3A, proteinuria &gt;0.5 g/d) and healthy controls (HC) followed a 7-day low sodium diet (LSD, &lt;50mmol/d) and high sodium diet (HSD, &gt;200mmol/d), respectively. After each diet, assessment of the hemodynamic profile included daytime BP (Mobil-O-Graph) and cardiac output (CO) measurements (using NexfinTM), by which SVR was calculated accordingly. Extracellular fluid volume (ECV) change was assessed with multi-frequency body impedance spectroscopy (FHCresenius). Results: We included 16 HC (median age 36.0 yrs) and 8 CKD patients (median age 49.5 yrs, and median (IQR) proteinuria 0.6 (0.5-1.1) g/d and plasma creatinine 144 (103 - 167) μmol/l. Dietary salt intervention was successful with median difference in urine Na+ excretion of 242.2 vs 224.6 mmol/day in HC and CKD respectively (p = 0.74). After HSD, the median (IQR) change in systolic BP of patients with CKD was 14 mmHg (4 - 18; p = 0.04), while systolic BP change (4 mmHg (-3 - 8)) in HC was not significant (Fig 1A). After HSD, we observed a significant ECV expansion in both CKD and HC subjects (Fig 1B), but no effect on CO. No associations between HSD-induced BP changes and both ECV and CO were found. Systolic BP increase was correlated with SVR decline in HC, but not in CKD patients (Fig 1C). Conclusions: In contrast to healthy persons, BP salt sensitivity in CKD does not associate with vasodilation. Regarding the absence of differences with ECV and CO between healthy and CKD persons, our data indicate that the incapacity for vasodilation might explain salt sensitivity in CKD.

Longitudinal machine learning model for predicting systolic blood pressure in patients with heart failure.

Systolic blood pressure (SBP) strongly indicates the prognosis of heart failure (HF) patients, as it is closely linked to the risk of death and readmission. Hence, maintaining control over blood pressure is a vital factor in the management of these patients. In order to determine significant variables associated with changes in SBP over time and assess the effectiveness of classical and machine learning models in predicting SBP, this study aimed to conduct a comparative analysis between the two. This retrospective cohort study involved the analysis of data from 483 patients with HF who were admitted to Farshchian Heart Center located in Hamadan in the west of Iran, and hospitalized at least two times between October 2015 and July 2019. To predict SBP, we utilized a linear mixed-effects model (LMM) and mixed-effects least-square support vector regression (MLS-SVR). The effectiveness of both models was evaluated based on the mean absolute error and root mean squared error. The LMM analysis revealed that changes in SBP over time were significantly associated with sex, body mass index (BMI), sodium, time, and history of hypertension (P-value < 0.05). Furthermore, according to the MLS-SVR analysis, the four most important variables in predicting SBP were identified as history of hypertension, sodium, BMI, and triglyceride. In both the training and testing datasets, MLS-SVR outperformed LMM in terms of performance. Based on our results, it appears that MLS-SVR has the potential to serve as a viable alternative to classical longitudinal models for predicting SBP in patients with HF.

Quantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study.

Visit-to-visit variability (VVV) in blood pressure values has been reported in clinical studies. However, little is known about VVV in clinical practice and whether it is associated with patient characteristics in real-world setting. We conducted a retrospective cohort study to quantify VVV in systolic blood pressure (SBP) values in a real-world setting. We included adults (age ≥18 years) with at least 2 outpatient visits between January 1, 2014 and October 31, 2018 from Yale New Haven Health System. Patient-level measures of VVV included SD and coefficient of variation of a given patient's SBP across visits. We calculated patient-level VVV overall and by patient subgroups. We further developed a multilevel regression model to assess the extent to which VVV in SBP was explained by patient characteristics. The study population included 537 218 adults, with a total of 7 721 864 SBP measurements. The mean age was 53.4 (SD 19.0) years, 60.4% were women, 69.4% were non-Hispanic White, and 18.1% were on antihypertensive medications. Patients had a mean body mass index of 28.4 (5.9) kg/m2 and 22.6%, 8.0%, 9.7%, and 5.6% had a history of hypertension, diabetes, hyperlipidemia, and coronary artery disease, respectively. The mean number of visits per patient was 13.3, over an average period of 2.4 years. The mean (SD) intraindividual SD and coefficient of variation of SBP across visits were 10.6 (5.1) mm Hg and 0.08 (0.04). These measures of blood pressure variation were consistent across patient subgroups defined by demographic characteristics and medical history. In the multivariable linear regression model, only 4% of the variance in absolute standardized difference was attributable to patient characteristics. The VVV in real-world practice poses challenges for management of patients with hypertension based on blood pressure readings in outpatient settings and suggest the need to go beyond episodic clinic evaluation.

EVALUATION OF CHANGE IN BLOOD PRESSURE IN REPOSITIONING FROM LITHOTOMY TO SUPINE POSITION IN PATIENTS UNDERGOING SURGERIES UNDER SUB-ARACHNOID BLOCK- AN OBSERVATIONAL STUDY

Objective: Spinal anaesthesia is associated with variety of hemodynamic alterations, because of sympathetic blockade. Hemodynamics are also affected by a variety of surgical techniques. The lithotomy posture and the effects of autotransfusion increases the Systolic Arterial Pressure in the sub-extremities. Study was designed to evaluate the changes in blood pressure in repositioning from lithotomy position to supine position in patients undergoing surgeries under sub-arachnoid block. This Methods: observational study was performed in 41 patients who underwent for elective/ emergency surgeries under subarachnoid block requiring lithotomy position. Demographic information such as age, height, weight, BMI, ASA grade, height of sensory block, quality of motor block and hemodynamics such as Heart Rate (HR), Pulse Oximetry (SpO2), non invasive Blood Pressure (NIBP) during lithotomy position and repositioning to supine position were also recorded. In this study there is no signi Results: cant difference was observed in patients in repositioning from lithotomy position to supine position following sub-arachnoid block. There is slightly increased in Systolic blood pressure in patients in lithotomy position compared to supine position. This study was performe Conclusion: d on 41 patients who underwent surgeries under subarachnoid block requiring lithotomy position and this study concluded that there is no difference was observed in patients in repositioning from lithotomy position to supine position. The purpose of the study is to take necessary precautions will be taken to prevent blood pressure changes intraoperatively. Spinal anaesthesia is most commonly used neuro-axial anaesthesia technique, where the local anaesthesia is directly injected into the intrathecal space (sub-arachnoid block). The uid that surrounds the brain and spinal cord is called cerebro-spinal uid, is present in the sub-arachnoid region (1). Spinal Anaesthesia is usually given in patients in lateral position or sitting position, Trendelenburg position will produce higher level of block as compared to supine position (2). The spinal anaesthesia was rst performed in 1885 by Dr. James Corning of New York City. He used cocaine and the patient was a dog. However, August Bier performed the rst sub-arachnoid block surgery in Germany in 1898. Sub-arachnoid block is the type of regional anaesthetic that was most frequently used for obstetrics and caesarean sections after the 1950s (3). Spinal anaesthesia is used in patients undergoing procedures: femur, ankle orthopaedic hip, tibia and knee surgery, including haemorrhoidectomy and leg vascular surgery, Endovascular aortic aneurysm repair, joint replacement, arthroplasty, Hernia (inguinal or epigastric), Combined general anaesthesia and cystectomy, nephrectomy, transurethral resection of bladder tumours, Transurethral excision of the prostate and Caesarean sections, various hysterectomy methods, cases of urology. By using spinal anaesthesia, a patient can avoid the hazards of a difcult airway, consciousness, and aspiration that come with general anaesthesia in pregnant patients. By using spinal anaesthesia, a patient can avoid the hazards of a difcult airway, consciousness, and aspiration that come with general anaesthesia in pregnant patients. (4) . Hypotension is the most common complication of spinal anaesthesia, which is linked to a variety of haemodynamic abnormalities. The sympathetic blockade, which causes venous and arterial dilatation, are the primary mechanism (5). Total peripheral resistance reduces as a result of arterial dilatation, and cardiac output and venous return both decrease, which can result in severe hypotension (6). Hypotension do occur in almost all patients and signicant hypotension (systolic BP)

Effect of whole-body vibration on cardiac function and functionality in patients with chronic non-communicable disease: a systematic review and meta-analysis

Objective: To investigate evidence of the use of whole-body vibration training (WBV) on cardiac autonomic function and functionality in patients with chronic non-communicable diseases related to the cardiovascular, respiratory and metabolic systems. Methods: The search involved Medline/PubMed, Lilacs, PEDro and Scopus databases. Randomized or quasi-randomized controlled trials were eligible for this review when comparing a group of patients with cardiovascular, respiratory or metabolic conditions who trained with WBV with a control group without intervention or other training modalities. Results: A total of 12 studies were included. Subgroup analyzes were performed considering sample size and age of participants. WBV training improved sympathovagal balance and reduced systolic blood pressure in patients with obesity and hypertension. There was a trend towards an increase in the distance covered on the six-minute walk test (6MWT) in COPD patients and a decrease in heart rate (HR) in overweight or obese women and hypertension after WBV, but no difference was found between the groups. No repercussions were observed in kidney transplant patients. Conclusion: WBV can be an alternative training modality to improve cardiac autonomic function and systolic blood pressure in obese and hypertensive patients, with moderate quality of evidence. We suggested that larger studies be carried out to assess the effect of WBV on outcomes such as distance covered in the 6MWT, HR, VO2max, diastolic blood pressure, gait speed and balance.

Efficacy of Intrathecal Bupivacaine with Dexmedetomidine and Bupivacaine Alone in Lower Segment Caesarian Section Patients

Objective: This research aims to compare the effectiveness of intrathecal bupivacaine combined with dexmedetomidine to bupivacaine alone in patients having caesarian procedures. Methods: This randomized, controlled study was conducted at in operation theatre in Liaquat national hospital, with the agreement of the hospital's institutional review board. There were 272 patients total, and they were split evenly in two groups of 136 using non-probability consecutive sampling technique. Group A: Patients received subarachnoid block (2 ml of 0.5 % hyperbaric bupivacaine and 10 micrograms of normal saline). Group B: Patients received subarachnoid block (2 ml of 0.5 % hyperbaric bupivacaine and 10 micrograms of dexmedetomidine at L3-L4 or L4-L5 inter-vertebral space). Before the induction of anaesthesia, the patient's systolic blood pressure (BP), diastolic blood pressure (BP), mean arterial pressure (MAP), heart rate (HR), and peripheral capillary oxygen saturation (SPO2) will be monitored Results: The mean age of the participants in both study groups were 27.14±5.3 and 25.9±3.65 years. A significant difference in the mean systolic blood pressure of the participants in both groups as observed at 15-, 45- and 60-minutes interval (p=0.000). The mean time interval from blocks to shivering occurrence in the participants in both study groups were 57.08±3.8 and 81.03±2.8minutes. A significant difference (P=0.000) in the mean time interval from blocks to shivering occurrence in the participants in both study groups was observed. 49% participants in the groups experienced shivering while 24% in group B. Conclusion: From our findings, we infer that adding 10µg of dexmedetomidine to strong bupivacaine in SA may reduce the frequency and severity of shivering without causing any serious side effects.

PS-C19-1: EFFECTS OF COMBINED SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS AND LOOP DIURETICS ON SYSTOLIC BLOOD PRESSURE: SYSTEMATIC REVIEW AND META-ANALYSIS

Background and Objective: Sodium-glucose co-transporter-2 (SGLT2) inhibitors are considered a standard of care in patients with heart failure, chronic kidney disease (CKD), and diabetes. They have substantial positive effects on cardiovascular and renal outcomes including reducing heart failure hospitalization and slowing glomerular filtration rate (GFR) decline. Loop diuretics, on the other hand, are commonly prescribed to manage volume expansion in patients with CKD and heart failure. However, the effects of combining SGLT2 inhibitors with loop diuretics are not consistent across different clinical trials. The purpose of our meta-analysis is to investigate the effect of combined SGLT2 inhibitors and loop diuretics on systolic blood pressure. Method: Using Pubmed, Scopus, Web of Science, VHL, metaRegister of Controlled Trials (mRCT), and Clinical trials.gov, a systematic review and meta-analysis of literature on the effect of adding SGLT2 inhibitors to loop diuretics on blood pressure were conducted. The comprehensive review covered randomized controlled trials (RCTs), non-randomized studies, prospective, retrospective, and post hoc investigations examining the effect of SGLT2 inhibitors on systolic blood pressure in healthy and heart failure patients. The outcome was calculated using Cohen's d formula as the standardized mean difference between the first group (SGLT2 inhibitors plus loop diuretics) and the second group (loop diuretics alone). To ensure the data's validity, a sensitivity analysis was conducted using just RCTs. Results: Eleven studies with a total of 3343 participants met all the analysis's inclusion criteria. The pooled standardized mean difference for all studies was -0.17, indicating that SGLT2 inhibitors may have a little effect on blood pressure reduction (p value = 0.06). When RCTs were excluded from the analysis, the pooled standardized mean difference was -0.10 with a p value of 0.40. Conclusion: Compared to loop diuretic alone, SGLT2 inhibitors combined with loop diuretics are not associated with a significant reduction in systolic blood pressure in patients with heart failure.

PS-C30-11: EFFECTS OF SGLT-2 INHIBITORS ON 24 H AMBP 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. 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, Using sodium-glucose cotransporter 2 inhibito, hypertension and randomized controlled trial as keywords. 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 (Empagliflozin, Canagliflozin, Dapagliflozin, Ertugliflozin) 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, 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, 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: This 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.