Increase In Systolic Blood Pressure Research Articles

Abstract 4136202: Incident Hypertension and Survival Outcomes After Immune Checkpoint Inhibitor Initiation

Introduction: Immune checkpoint inhibitors (ICIs) are commonly used as anticancer agents linked with dramatic antitumor response but are associated with cardiotoxicity. Recent isolated reports have suggested ICIs may link with hypertension (HTN) after years of treatment. Yet, the timing and long-term ramifications of this HTN are unknown. Methods: From a large cohort of well-phenotyped cancer patients treated with ICIs from 2011-2022, we assessed the incidence of new or worsened HTN [systolic blood pressure (SBP) ≥130 mmHg (or in a higher HTN stage) on two occasions within a three-month period or addition of an antihypertensive medication] after ICI initiation. Secondary endpoints included major cardiovascular events (MACE), defined as symptomatic arrhythmia, myocardial infarction, stroke, heart failure, or cardiac death. Observed incident HTN rates were compared to Framingham-predicted rates, using JNC 8 cutoffs of 140/90 mmHg. Landmark analysis, excluding patients who were observed to have new HTN but had SBPs ≥130 mmHg on two occasions within six-months prior to ICI initiation, identified patients with possible undiagnosed HTN. Multivariable regression and survival analysis were used to define factors associated with new worsened HTN and MACE and the relationship between SBP increase and MACE risk. Further, the effect of standard antihypertensive classes on the prevention of ICI-related HTN will be assessed. Results: Overall, from 312 patients treated with ICIs (mean age 63.5 years, 67.4% baseline HTN, 11.0% on dual ICI-therapy), 50.0% (156/312) developed new or worsened HTN over a mean of 27 months follow-up. Cumulative incidence of new HTN by 1-year was 50.0% wherein the mean peak increase in SBP was 12 mmHg. In landmark analysis, excluding those with undiagnosed HTN and applying the JNC 8 cutoff of ≥140/90 mmHg, the observed new HTN rate was 21.4% at 1 year, >2-fold higher than the Framingham-predicted rate of 9.3% (RR 2.3, P <0.0001). In those with preexisting HTN, 49% developed worsened HTN. In multivariate analysis, only time on ICI treatment, ECOG status, and autoimmune disease history were associated with new or worsened HTN after ICI-initiation ( P <0.05 for all). Further, only prior autoimmune disease and ECOG status associated with MACE; while beyond traditional cancer factors, only new or worsening HTN associated with lower mortality. Conclusions: Collectively, these data suggest that HTN may be common with ICIs, and prognosticates survival.

Abstract 4127413: High-normal Blood Pressure (130-139/85-89mmHg) is Associated with an Increased Risk of Mortality

Background: The relationship between high-normal blood pressure (BP) and mortality lacks high-quality evidence based on large population cohort. The aim of this study was to comprehensively investigate the association of high-normal BP and its trajectory with all-cause and cause-specific mortality. Methods: In a community-based population cohort from the China Health Evaluation And risk Reduction through nationwide Teamwork (ChinaHEART) project, 3,598,940 participants aged 35-75 years with baseline BP were included. High-normal BP was defined as a systolic blood pressure (SBP) of 130-139 mmHg and/or a diastolic blood pressure (DBP) of 85-89 mmHg at baseline. Four trajectories of BP change were identified in 105,894 participants included in the study, who had more than 2 follow-up BP measurements, using latent mixture modeling. Among them, high-normal-increasing was defined as an increase in SBP from 130-139 at baseline to over 140 at the last follow-up. Findings: Compared with the optimal BP group (SBP < 120 mmHg and DBP < 80 mmHg, [18.1%]), participants with high-normal BP (18.7%) had a 4% increase in all-cause mortality risk (hazard ratio [HR] 1.04, 95% confidence interval [CI]: 1.01-1.07) and a 28% increase in CVD mortality risk (HR 1.28, 95% CI: 1.21-1.34), with the greatest increase in mortality risk observed from hemorrhagic stroke (HR 1.75, 95% CI: 1.55-1.98). Among BP trajectories, compared with participants with optimal-stable BP (25.3%), those with high-normal-increasing BP (3.5%) had a 25% increase in all-cause mortality risk (HR 1.25, 95% CI: 1.00-1.54) and a 67% increase in CVD mortality risk (HR 1.66, 95% CI: 1.21-2.30), with the greatest increase in mortality risk also observed from hemorrhagic stroke (HR 3.15, 95% CI: 1.38-7.20). In our study cohort, approximately 0.7% and 1.3% of all-cause mortality was attributable to the high-normal BP at baseline and high-normal-increasing BP trajectory, respectively. Interpretation: Individuals presenting high-normal BP at baseline or high-normal-increasing BP trajectory afterward exhibited a significantly elevated mortality risk, which is most pronounced for hemorrhagic stroke. Early management of BP in patients with high-normal BP is crucial for the prevention and treatment of hypertension.

Heat-sensitive moxibustion combined with medication for orthostatic hypotension of yang-qi deficiency in the elderly: a randomized controlled trial

To observe the effect of heat-sensitive moxibustion combined with medication on orthostatic hypotension (OH) of yang -qi deficiency in the elderly. Sixty elderly patients with OH of yang -qi deficiency were randomly divided into an observation group (30 cases, 1 case dropped out) and a control group (30 cases). The patients in the control group were treated with oral midodrine hydrochloride tablets, 2.5 mg each time and twice daily, while the patients in the observation group were treated with heat-sensitive moxibustion in addition to the treatment in the control group. Acupoints selected included Dazhui (GV 14), Fengfu (GV 16), and Baihui (GV 20), with each session lasting 30-40 min, once daily. Both groups were treated for 4 weeks. Blood pressure in the supine and standing positions, as well as the decrease of blood pressure when the position changing from supine to standing, were measured before treatment and after 2 and 4 weeks of treatment. Clinical efficacy was also evaluated. After 4 weeks of treatment, both groups showed an increase in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in both the supine and standing positions (P<0.05), and the decrease in SBP and DBP when the position changing from supine to standing was reduced (P<0.05). Compared with the control group, the observation group had higher SBP and DBP in both positions and a smaller decrease in SBP and DBP when the position changing from supine to standing (P<0.05). The total effective rate was 96.6% (28/29) in the observation group, which was higher than 70.0% (21/30) in the control group (P<0.05). Heat-sensitive moxibustion combined with medication could increase the blood pressure in both supine and standing position, and decrease the reducing of blood pressure when the position changing from supine to standing in elderly patients with OH of yang-qi deficiency.

THE IMPACT OF EXOGENOUS AND ENDOGENOUS FACTORS ON VASCULAR WALL ELASTICITY AND POTENTIAL CLINICAL EFFECTS (Review Article)

Vascular aging is associated with profound changes in the structural properties of the arterial wall. Arterial hypertension, diabetes mellitus, and chronic kidney disease are the primary determinants of the loss of elasticity and reduced compliance of the vascular wall. Arterial stiffness is a key parameter for assessing the elasticity of the arterial wall and can be easily evaluated using non-invasive methods such as pulse wave velocity. Early assessment of arterial stiffness is critical, as its changes may precede the clinical manifestations of cardiovascular disease. With age, arterial walls become stiffer, leading to an increase in systolic blood pressure and an increased risk of cardiovascular events such as stroke, myocardial infarction, or heart failure. The gradual decrease in vascular elasticity is accompanied by remodeling of their structure, an increase in collagen fibers, and a decrease in elastin, which exacerbates the problem. In addition, the mechanical stress on the vascular wall, which increases with age, worsens its condition, provoking the formation of atherosclerotic plaques. Arterial stiffness, as an important biomarker of vascular aging, is also an indicator of increased cardiovascular risk, independent of other factors such as blood pressure or the presence of comorbidities. Therefore, timely diagnosis of arterial stiffness can help prevent serious complications and adjust treatment for patients at risk. Important are also preventive measures, including a healthy lifestyle, physical activity, and control of the underlying diseases that contribute to the acceleration of vascular aging processes. Moreover, the influence of endogenous and exogenous factors, such as diet, the presence of chronic diseases, and bad habits (in particular, smoking), contribute to the acceleration of these processes. Innovative diagnostic methods, such as magnetic resonance imaging (MRI) or ultrasound, allow detecting these changes at early stages and, accordingly, adapting treatment.

Safety and efficacy of catheter-directed thrombectomy without thrombolysis in acute pulmonary embolism: A systematic review and meta-analysis

BackgroundThis meta-analysis aims to investigate the safety and efficacy of catheter-directed thrombectomy (CDT) without using adjunct thrombolysis as reperfusion therapy to manage intermediate and high-risk pulmonary embolism (PE). MethodsA literature search of Ovid MEDLINE, Embase, CiNAHL, Cochrane Library, and Web of Science was conducted from inception to January 2024. Eligible studies reported more than 10 patients treated for acute PE with catheter-directed thrombectomy only, who were over 18 years of age. Primary endpoints were major bleeding, in-hospital mortality, and hemodynamic changes. ResultsEighteen studies (n = 803) were included for quantitative analysis. The pooled estimate of incidences of in-hospital mortality and major bleeding was 1.8 % (95 % CI 0.009, 0.027) and 2.1 % (95 % CI 0.011, 0.031) respectively. A pooled estimate reported a post-procedural increase in oxygen saturation and systolic blood pressure by 8.96 % (95 % CI: 3.54, 14.38) and 15.02 mmHg (95 % CI 6.35, 23.69) respectively. Post-procedural mean pulmonary artery pressure, right ventricle/left ventricle (RV/LV) ratio, and Miller score were reduced by 10.30 mmHg (95 % CI -14.94, −5.66), 0.29 (95 % CI -0.50, −0.08) and 8.09 (95 % CI -10.70, −5.47) respectively. ConclusionCDT without adjunctive thrombolysis may lead to improvements in hemodynamic outcomes and appears to exhibit favorable safety profiles. This meta-analysis provides a rationale for further research comparing CDT alone against using adjunct thrombolysis to determine optimal management strategies for intermediate to high-risk acute PE.

Impact of systolic blood pressure on epicardial adipose tissue in patients with chronic coronary artery disease

Abstract Objectives The current study aimed to investigate the impact of systolic blood pressure (SBP) on epicardial adipose tissue (EAT) volume in a large, multi-center cohort of patients with chronic coronary artery disease (CAD). Methods We included 879 patients with CAD (mean age: 58±11 years; 294 females; 72% Chinese, 20% Indian/Malay, 8% Others) in the APOLLO study. The EAT volume was measured using non-contrast computed tomography (CT) imaging. The contour of the pericardium was traced from the pulmonary artery bifurcation to the apex of the heart. CT attenuation between -190 and -30 Hounsfield units (HU) was used to select the EAT on every axial slice. The EAT volumes were automatically calculated from 3-dimensional fat voxels at each axial slice, which were then summed to obtain the total EAT volume (Figure 1). Results EAT volume was positively correlated with age (r=0.261, P&amp;lt;0.0001). With a one-year increase in age, the EAT volume was found to increase by 1.5 cm3, adjusting for other confounders. The mean EAT volume for males was 8.3 cm3 higher than for females (P=0.015). Patients with hypertension had significantly higher EAT volume (134±51 vs. 114±48 cm3, P&amp;lt;0.0001) compared to those without hypertension. Multivariable analysis adjusted for age, gender and other cardiac risk factors showed that the presence of hypertension (P=0.043) was independently associated with EAT volume. Compared to the highest SBP tertile (≥148 mmHg), those in the lowest SBP tertile (≤132 mmHg) had lower EAT volume (117±52 vs. 128±51 cm3, P=0.007). When examined as a continuous variable, higher SBP was significantly associated with higher EAT volume: for every 10mmHg increase in SBP, EAT volume increased by 2.6 cm3. Conclusion The study found a significant association between hypertension and increased EAT volume, emphasizing the importance of managing hypertension to reduce cardiovascular risk.

Mood instability and cardiovascular modification in cardiovascular disease outpatients. The ABC study on heart disease

Abstract Introduction Mood instability (MI) is a condition characterized by unpredicted frequent fluctuations in a person's emotional state. It is a common personality trait observed in the general population, and it has been reported to be associated with a range of adverse health outcomes, and may also serve as an additional risk factor for cardiovascular morbidity. Purpose To assess mood instability and its effects on cardiovascular function among CVD outpatients. Methods Consecutive patients who were presented to the cardiac outpatient clinic in the last 5 years were recruited and divided into 2 groups according to the presence or absence of MI symptoms based on the patient’s self-assessment psycho-emotion questionnaire. Cardiovascular functions were assessed and compared between both groups. Results A total of 415 patients were included in this preliminary analysis. Patients' mean age was 66±18 years, and 57% were males. Coronary artery diseases were registered in 93(22%) patients. 137 (33%) patients suffered mood instability symptoms, and they shared most demographic and clinical characteristics with patients who did not suffer from MI. However, males were more frequent among patients with no MI symptoms. Interestingly, we observed a significant difference in systolic blood pressure values (SBP) between both groups, (SBP= 150±23 Vs 145±21 mmHg, p= 0.02, for patients with and without MI, respectively). Yet, no difference was observed in diastolic blood pressure (DBP) values (80±12 Vs 79±11 mmHg for patients with and without MI, respectively, p&amp;lt;0.19). Patients with MI symptoms had also a higher heart rate (HR) (77±15 bpm) than patients without symptoms (72±13 bpm, p=0.0003). Using multivariable linear regression models, mood instability (β±SE= 4.3±2.2, p&amp;lt;0.049) and age (β±SE= 0.4±0.05, p&amp;lt;0.0001) were independent predictors for higher SBP values. Mood instability was also independently associated with a higher heart rate (β±SE= 5.1±1.4, p=0.001). Results Kept true even stronger with repeated BP and HR measurements. Conclusion Our results showed that mood instability is associated with a significant increase in systolic blood pressure and heart rate values in cardiac outpatients.

Differences in resting sympathetic nervous activity between orthostatic hypertension, conventional hypertension, and healthy individuals

Abstract Introduction Standing places a significant hemodynamic burden on the cardiovascular system. In healthy individuals, neurohumoral reflex mechanisms, particularly the arterial baroreflex, maintain blood pressure during standing. However, in some cases, the counterregulatory response can be excessive, resulting in a condition known as orthostatic hypertension (OHT), which appears to be linked to an increased cardiovascular risk. In recent years, OHT has been recognized as an indicator for assessing the effectiveness of renal denervation. It is suggested that abnormalities in sympathetic nervous system regulation, particularly related to the renal sympathetic nerves, may play a role in influencing RDN outcomes, however, the relationship between OHT and sympathetic nerve activity remains poorly understood. This study aims to assess the differences in sympathetic nerve activity between OHT patients, conventional hypertensive(cHT) patients and healthy individuals using muscle sympathetic nerve activity (MSNA) measurements. Methods We conducted an examination of hypertensive patients undergoing drug treatment at our clinic between April 1, 2023, and June 30, 2023, to identify cases of OHT. OHT was defined as a sustained increase in systolic blood pressure ≥20 mmHg and/or diastolic blood pressure ≥10 mmHg within 3 minutes of standing. We measured MSNA in the cases for which consent was obtained. Results Among the 138 cases, 31 were diagnosed with OHT, and 7 of them consented to MSNA measurement. Of the 11 cases of cHT patients who consented, two groups were well age-matched. And it was also compared with 11 cases of healthy individuals who underwent MSNA measurement during the same period. Both of the MSNA burst frequency and burst incidence in OHT (38.4 +/- 12.2 bursts/min, 61.1 +/- 21.3 bursts/100 heartbeats) was significantly greater (p&amp;lt;0.05) than that in cHT (28.3 +/- 5.7 bursts/min, 44.6 +/- 11.1 bursts/100 heartbeats), and all these were significantly greater (p&amp;lt;0.05) than in healthy individuals (21.8 ± 7.3 bursts/min, 35.8 +/- 11.3 bursts/100 heartbeats) at rest. Conclusions OHT is associated with sympathetic hyperactivity compared to normal hypertensive patients, contributing to an increased cardiovascular risk. These results indicate that therapy for OHT in hypertensive patients would be required to prevent sympathetic augmentation.

The role of IL15 in angiotensin II-mediated cardiac remodelling

Abstract Hypertension (HTN) mediated target organ damage, such as cardiac remodelling, is a major cause of death and disability. Cytokines are important regulators of cardiac function, inflammation, and remodelling in cardiovascular disease. Increased levels of interleukin 15 (IL15) have been noted in HTN, but its role in HTN heart disease remains unknown. This study investigates the role of the IL15 axis in the pathogenesis of cardiac remodelling in HTN. Male 12-week-old IL15 receptor α knock-out (IL15RAKO), IL15 knock-out (IL15KO) and matching wild type (WT) mice were administered vehicle or angiotensin II (AngII) (490 ng/min/kg) for 2 weeks by osmotic minipump. Blood pressure was measured by tail cuff (n=5-8). Cardiac function was analysed by echocardiography (n=3-4). Cardiac infiltrating immune cells were analysed by flow cytometry (n=2-3 for IL15RAKO, n=6-10 for IL15KO). Cardiac remodelling was assessed by picrosirius red, WGA staining (n=5-8) and expression of markers of remodelling using RT-qPCR and western blots (n=5-8). Data are presented as mean±SEM and analysed using two-way ANOVA. AngII infusion caused a significant increase in systolic blood pressure in WT and IL15KO animals. In contrast, in IL15RAKO, the response to AngII was blunted. This was in line with a decrease in ejection fraction, however only WT mice had an increase in global longitudinal strain (-20.3±2.0 vs -10.9±1.2, p=0.0039 in WT and 19.9±0.8 vs -16.0±2.1, p=0.1878 in IL15RAKO). HTN was associated with increased cardiac IL15 protein levels in mice. The heart-to-body ratio, along with cardiomyocyte cross-sectional, were significantly increased in WT, but not in IL15RAKO HTN mice. Furthermore, histological analysis showed significantly higher cardiac collagen accumulation in WT but not IL15RAKO upon AngII infusion (5.8±1.0% in WTvvs. 2.1±0.5% in IL15RAKO, p=0.0021). This was in line with a higher expression of col1a1 in WT but not IL15RAKO HTN hearts (20.0±6.0 vs 4.5±1.7, p=0.0173). Similarly, the FN1 protein level was significantly increased in WT but not IL15RAKO AngII-treated mice. These changes were associated with a higher number of Cd11b+ macrophages accumulated in WT hypertensive hearts only. In contrast to IL15RAKO, mice lacking IL15 showed similar increases in global longitudinal strain, heart hypertrophy, and cardiomyocyte cross-sectional area as WT mice upon AngII infusion. Similarly, IL15KO hypertensive hearts showed a significant increase of col1a1 and FN1 in comparison to vehicle-treated mice. A similar level of Cd11b+ macrophages was found in hypertensive IL15KO and WT mice's hearts. In conclusion, IL15RA, but not IL15, plays a critical role in cardiac remodelling mediated by AngII infusion. This suggests that the IL15-IL15RA axis may play an important yet complex role in hypertensive heart disease.

Comparative analysis of muscle sympathetic nerve activity in patients afflicted with orthostatic hypertension versus conventional hypertension

Abstract Introduction Standing places a significant hemodynamic burden on the cardiovascular system. In healthy individuals, neurohumoral reflex mechanisms, particularly the arterial baroreflex, maintain blood pressure during standing. However, in some cases, the counterregulatory response can be excessive, resulting in a condition known as orthostatic hypertension (OrthoHT), which appears to be linked to an increased cardiovascular risk. Epidemiologically, orthostatic hypertension has been reported in 5-30% of hypertensive patients. Furthermore, in recent years, it has garnered attention as a responder group in renal denervation therapy. Purpose In hypertensive patients, sympathetic hyperactivity is expected to exacerbate cardiovascular risk. However, the relationship between OrthoHT and sympathetic nerve activity remains poorly understood. This study aims to assess the differences in sympathetic nerve activity between OrthoHT and conventional hypertensive patients using muscle sympathetic nerve activity (MSNA) measurements. Methods We conducted an examination of hypertensive patients undergoing drug treatment at our clinic between April 1, 2023, and June 30, 2023, to identify cases of OrthoHT. Only patients with essential HT were included in the HT group; patients diagnosed with secondary HT were excluded. HT patients with other active CV diseases (i.e., symptomatic cerebral/coronary artery diseases or heart failure) and/or severe renal dysfunction (estimated glomerular filtration rate &amp;lt;30 mL/min/1.73 m2) were also excluded. OrthoHT was defined as a sustained increase in systolic blood pressure ≥20 mmHg and/or diastolic blood pressure ≥10 mmHg within 3 minutes of standing. MSNA was recorded from the left peroneal nerve using a tungsten microelectrode at supine position. We measured MSNA in the cases for which consent was obtained. Statistical analyses were performed using SPSS software. Results Among the 183 cases, 31 were diagnosed with OrthoHT, and 7 of them consented to MSNA measurement. Of the 11 cases of hypertensive patients who consented, two groups were well age-matched. We assessed body mass index, resting systolic blood pressure, diastolic blood pressure, heart rate, blood glucose level, creatinine, cholesterol, brain natriuretic hormone, and ejection fraction measured by echocardiography, but found no significant differences between the two groups. OrthoHT patients exhibited elevated MSNA burst frequency (28.3 +/- 5.7 vs. 38.4 +/- 12.2 bursts/min, P &amp;lt; 0.05) and burst incidence (44.6 +/- 11.1 vs. 61.1 +/- 21.3 bursts/100 heartbeats, P &amp;lt; 0.05) at rest. Conclusions OrthoHT is associated with sympathetic hyperactivity compared to normal hypertensive patients, contributing to an increased cardiovascular risk.

Orthostatic blood pressure changes and incident atrial fibrillation in patients with hypertension: Insights from the SPRINT trial

Abstract Background Exaggerated orthostatic changes in systolic blood pressure (SBP) were associated with adverse cardiovascular events. However, the predictive role of SBP hyperactivity to standing on incident atrial fibrillation (AF) is unclear. Purpose We aim to assess the association between orthostatic SBP changes and incident AF. Methods We performed a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a randomized controlled trial comparing intensive (&amp;lt;120 mm Hg) and standard (&amp;lt;140 mm Hg) SBP interventions in participants with hypertension. Participants with standing SBP &amp;lt;110 mm Hg were not eligible for randomization according to the SPRINT protocol. Participants without AF who had seated and standing SBP measurements at baseline and available baseline or follow-up ECG were included in this analysis. Orthostatic SBP changes were defined as standing SBP minus seated SBP. Patients were grouped into tertiles of orthostatic SBP changes. AF was ascertained from the standard 12-lead ECG obtained at baseline, year 2, year 4, a close-out visit, and any visit when suspected of serious adverse events. We used Cox proportional regression models and restricted spline curves to assess the association of orthostatic SBP changes with incident AF. Results Among 8,455 participants included in this analysis, 327 incident AF cases occurred during follow-up. The restricted spline curve depicted a U-shaped relationship between orthostatic SBP changes and incident AF in the unadjusted model (P for nonlinearity = 0.012) (Figure 1). After adjusting for age, female, race, smoking, alcohol use, history of cardiovascular disease, history of chronic kidney disease, and body mass index, a SBP increase ≥ 6 mm Hg to standing was independently associated with a 43% higher risk of incident AF (HR: 1.43; 95% CI: 1.07-1.90; P = 0.014) compared to nonsignificant orthostatic SBP changes (&amp;gt;-4 mm Hg to &amp;lt;6 mm Hg). A SBP decrease ≥ 4 mm Hg to standing showed a nonsignificant higher risk of developing AF compared to SBP changes of &amp;gt;-4 mm Hg to &amp;lt;6 mm Hg (Figure 2). In subgroup analysis, the results presented a similar tendency to the main result. Sensitivity analyses also generated consistent results while additionally adjusting for seated and standing blood pressure or heart rate. Conclusion In this post hoc analysis of the SPRINT trial, exaggerated SBP increase to standing independently predicts incident AF.Figure 1Figure 2

Aerobic exercise capacity improvement of patients with human immunodeficiency virus one year post-treatment initiation by integrase inhibitors

Abstract Background Infection by Human Immunodeficiency Virus (HIV) leads to chronic inflammation and subsequently to the early development of cardiovascular (CV) disease in young adults. Initiation of antiretroviral therapy (ART) usually leads to patient’s body weight and blood pressure increase. Cardiopulmonary exercise test (CPET) evaluates aerobic exercise capacity and subsequently cardiovascular and respiratory function. Aim of this study is the investigation of any treatment-induced changes in aerobic exercise capacity in treatment naïve young HIV patients’ at 1-year post HIV treatment initiation by different ART agents. Methods We studied 46 recently diagnosed and treatment naïve young HIV patients (37+10 years, 87% males, 62% smokers) at baseline and 1-year post ART initiation (integrase or protease inhibitors). Twenty-six (26) patients were randomly treated by the newer integrase inhibitor Dolutegravir (Group A, mean age=36+9 years, 100% males, 77% smokers) while 19 patients by the older protease inhibitor Darunavir/Cobicistat (Group B, mean age=37+10 years, 90% males, 47% smokers). All patients were submitted in CPET at baseline and 1-year post ART initiation. We estimated any changes in body mass index (BMI), systolic blood pressure (SBP) and CPET parameters (peak VO2, Oxygen pulse, WorkLoad, VE/VCO2) at 1-year post ART initiation. Results At baseline and 1-year re-evaluation, we found no differences between groups regarding age, BMI and CPET parameters. In the whole HIV population, we found an increase in body weight (76+12 vs. 82+15kg, p&amp;lt;0.001), SΒΡ (124+12 vs. 132+14mmHg, p&amp;lt;0.001), WorkLoad (176+35 vs. 186+35watt, p&amp;lt;0.001) and peak VO2 (2171+437 vs. 2299+491ml/min, p=0.03) at 1-year re-evaluation. In Group A, body weight (p&amp;lt;0.001), SBP (p=0.07), WorkLoad (p=0.006) and peak VO2 (p=0.01) were increased while in Group B, body weight (p&amp;lt;0.001), SBP (p=0.001) και WorkLoad (p=0.01) were also increased. Conclusions Aerobic exercise capacity is improved 1-year post-treatment initiation by the newer integrase inhibitor Dolutegravir in treatment-naïve HIV patients despite the adverse BMI and SBP increase. The newer Dolutegravir probably exhibits a more favorable CV profile in HIV patients compared to the older Darunavir/Cobicistat.Re-evaluation 1-year post ART initiation

A flattening systolic blood pressure response at the end of ramp exercise testing is not associated with all-cause mortality

Abstract Purpose Systolic blood pressure (SBP) is expected to rise linearly during ramp exercise, but sometimes plateaus before the end of exercise. We aimed to examine the predictive value of a plateauing SBP response at the end of a cycle exercise test. Methods We analyzed 9,001 consecutive patients aged ≥18 years with maximal cycle ergometer ramp tests, after excluding subjects with valvulopathy, pacemaker, arrhythmia during the test, or body mass index (BMI) &amp;gt;40kg/m², as well as tests with resting SBP &amp;lt;80mmHg or &amp;gt;200mmHg, exercise SBP &amp;lt;100 mmHg, &amp;lt;2 SBP measurements during the second half of the test or a test duration &amp;lt;4 minutes. The data were cross-linked with nationwide registries for mortality and in- and outpatient hospital diagnoses. The difference in SBP between the two last SBP measurements was standardized to the difference in Watts between the same time points, categorized as i) an SBP decrease (drop), ii) an SBP increase of &amp;lt;2.5 mmHg per 10 Watts increase (flat), iii) an SBP increase of 2.5-15 mmHg/10 Watts (intermediate), and iv) an SBP increase &amp;gt;15 mmHg/10 Watts representing the 97.5th percentile (steep). Hazards ratios (HR, [95% confidence interval, CI]) for all-cause mortality were calculated, stratified for exercise capacity (peak Watt % of predicted) with the intermediate SBP response as reference. Adjustments were made for age, sex, BMI, resting SBP, baseline diagnosis of ischemic heart disease, heart failure, chronic obstructive pulmonary disease, and the use of beta-blockers or anti-hypertensive medication. Results Decreasing, flat, intermediate, and steep SBP responses at the end of exercise were present in 1.1%, 25.6%, 70.8% and 2.5% of patients respectively (Table 1). During median follow-up 8.6 years (interquartile range 5.9–11.6 years) there were 844 deaths. When compared to an intermediate SBP response, a flat SBP response was not associated with all-cause mortality in any of the exercise capacity strata: lowest tertile of Wmax%pred unadjusted HR 0.88 (95% CI 0.69–1.11), middle tertile HR 0.91 (95% CI 0.66–1.24), and highest tertile HR 0.95 (95% CI 0.64–1.41), with HRs remaining non-significant after adjustment for covariates (Table 2). Conclusion In patients referred for exercise testing, a flattening SBP response at the end of exercise was not associated with increased all-cause mortality risk compared to an intermediate SBP response, consistent across the different exercise capacity strata.

Raised blood pressure affects reactivity to expressive music features

Abstract Background Music has been shown to lower hypertensive patients’ blood pressure in the long-term, but predominant approaches overlook the wide range of complex real-time responses. Mapping the acute dynamics of music features can help discern blood pressure (BP) reactivity. Understanding the mechanisms of music BP effects can broaden the scope for precision medicine. Purpose The aims of this study are to determine: (1) if reshaped music features alter BP reactivity; and, (2) whether BP reactivity differs for individuals with high and normal BP. Methods Participants listened to music with computationally altered tempo and loudness played back on a Disklavier piano. We compared continuous BP measurements in 40 participants (23 females, mean age of 41.3 y (95%CI: 37.2-45.4)), 20 with baseline BP measurement above 140/90 mmHg (H-bBP) and 20 with bBP below (N-bBP), paired by playlist. Continuous BP was recorded while listening to a playlist of 9 reshaped versions of 8 distinct pieces (≈40 min) after a 5-minute baseline silence. Results The mean increase in systolic and diastolic BP during music (reactivity) was significantly higher for N-bBP than H-bBP (mean (95%CI); mmHg): systolic 8.6 (6.2-11.1) vs 5.0 (2.7-7.3); p=0.031; diastolic 7.7 (5.9-9.5) vs 4.6 (2.9-6.3); p=0.0046. No significant difference in pulse pressure (PP) reactivity was found; however, the N-bBP subjects had significantly lower mean PP during music than H-bBP subjects (45.2 (40.2-44.8) vs 54.2 (51.7-56.7) ; p&amp;lt;0.001). Based on mean tempos, N-bBP subjects had significantly lower average PP than H-bBP subjects during slow (&amp;lt;60bpm; 44.6 (40.6-48.6) vs 52.6 (48.9-56.3); p=0.016) and fast (&amp;gt;120bpm; 43.9 (39.9-47.9) vs 57.2 (52.9-61.5); p&amp;lt;0.001) music, though not medium pace music. Similarly, N-bBP participants had significantly lower PP during quiet (&amp;lt;13 dB; 44.0 (39.6-48.4) vs 55.7 (50.7-60.7); p&amp;lt;0.001) and loud (&amp;gt;17 dB; 44.0 (39.6-48.4) vs 55.5 (51.1-59.9); p&amp;lt;0.001) music, but not during moderately loud music. H-bBP and N-bBP participants’ PP measures are more similar during moderately fast and moderately loud music. In addition, N-bBP’s baseline-normalised mean PP was significantly lower only during fast music (3.3 (-2.3-8.6) vs 12.9 (6.9-18.9); p = 0.04). Separating responses to unaltered vs reshaped music––i.e. music made faster and/or louder, in the case of one piece, slower and/or quieter––significant differences are found between N-bBP and H-bBP groups only for reshaped music in baseline-normalised diastolic BP (6.8 (4.7-8.9) vs 3.9 (2.1-5.7); p=0.02) and PP (45.0 (42.2-47.8) vs 54.8 (51.8-57.8); p&amp;lt;0.001). Conclusions H-bBP subjects had less BP reactivity to music, especially in resting vascular tone PP. Reshaping of music can modulate the level of differences between groups, particularly for immoderate tempo and loudness. Music can induce significant changes in BP profile, which indicates that it could potentially be utilised as a tailored anti-hypertensive therapy.Differences between music and baselineDifferences in tempos and loudness cat.

The association between dietary patterns and cardiovascular disease risk factors in Iranian adults: a cross-sectional study

BackgroundDietary patterns are important factors associated with cardiovascular diseases (CVDs). We examined the association between dietary patterns derived from factor analysis and CVD risk factors.MethodsIn the present cross-sectional study, a total of 3,687 adults (aged 40 to 70 years) with one or more types of CVDs were enrolled as participants. A validated semi-quantitative food-frequency questionnaire was utilized to assess food intakes, and then dietary patterns were extracted by factor analysis. Fasting blood sugar (FBS), lipid profile, anthropometric indices, and blood pressure (BP) were measured. Multivariable-adjusted logistic regression analysis was employed to ascertain the odds ratio (OR) of CVD risk factors associated with posteriori dietary patterns. In this study, healthy and unhealthy dietary patterns were identified.ResultsAdherence to a healthy dietary pattern was associated with a decrease in systolic BP (SBP) (OR = 0.78; 95% confidence interval (CI): 0.62–0.99) and high-density lipoprotein cholesterol (HDL-C) levels (OR = 1.32; 95% CI: 1.06–1.64). Additionally, greater adherence to the unhealthy dietary pattern was positively associated with SBP (OR = 1.43; 95% CI: 1.13–1.80) and diastolic BP (DBP) (OR = 1.33; 95% CI: 1.01–1.76).ConclusionsWe concluded that greater adherence to an unhealthy dietary pattern was associated with an increase in SBP and DBP. On the other hand, greater adherence to a healthy dietary pattern could be effective in reducing SBP. Further investigation is recommended to validate these findings.

Leisure sedentary time and elevated blood pressure: evidence from the statutory retirement policy.

The relationship between sedentary behaviors and elevated blood pressure remains inconclusive, and the socioeconomic mechanisms underlying the linkage are rarely discussed. Since retirement is often associated with behavioral changes that impact health, this study aims to provide evidence on changes in leisure sedentary time after the statutory retirement age on elevated blood pressure, along with the socioeconomic mechanisms. We utilized data from five waves (2004-2015) of the China Health and Nutrition Survey (CHNS), focusing on males aged 55-65 employed in the formal sector. Leisure sedentary time, the independent variable, was measured based on self-reported data, while diastolic (DBP) and systolic (SBP) blood pressure were the dependent variables. Using statutory retirement policy as an exogenous variation, we employed a continuous difference-in-differences (DID) framework and a propensity score matching difference-in-differences (PSM-DID) approach to examine the relationship between changes in leisure sedentary time after the statutory retirement age and elevated blood pressure. The analysis was conducted using ordinary least squares (OLS). To address potential endogeneity, we applied the instrumental variable (IV) method via two-stage least squares (2SLS). Our findings indicate an increase in diastolic blood pressure after statutory retirement, attributed to increased leisure sedentary time. However, there was no significant increase in systolic blood pressure. Moreover, physical activity did not appear to offset this rise in blood pressure, while higher educational attainment and having family members employed in the medical field helped mitigate its negative effects. This study highlights the potential adverse impact of increased leisure sedentary time on diastolic blood pressure among middle-aged men in the formal sector, while also exploring the socioeconomic factors that may alleviate these effects. These results provide a foundation for public health initiatives aimed at addressing the rising prevalence of sedentary behavior and its association with blood pressure issues.

Correlation Between Anxiety, Depression and Hemodynamic Changes in Office-Based Laryngeal Surgery.

To investigate the correlation between anxiety, depression, and hemodynamic changes during office-based laryngeal surgery (OBLS). All patients undergoing OBLS between February 2024 until July 2024 were invited to participate in the study. Participants had their vital signs recorded throughout the procedure at a 5-min interval. They also had to fill the Generalized Anxiety Disorder scale-7 (GAD-7) to assess anxiety severity and the Patient Health Questionnaire-9 (PHQ-9) to assess depression severity. Demographic data included age, gender, history of smoking, history of reflux disease, history of cardiovascular diseases, type and duration of procedure. A total of 45 patients were recruited in the study. During OBLS, 35.5% of patients developed hypertension and 28.9% developed tachycardia. There was a significant increase in mean systolic blood pressure (SBP) by 30.16 mmHg (p < 0.001), in mean diastolic blood pressure (DBP) by 31.44 mmHg (p < 0.001), and in mean heart rate (HR) by 14.2 beats per minute (p < 0.001). There was also a significant decrease in the mean O2 saturation by 0.4% (p = 0.001). There was no correlation between anxiety and SBP, DBP, HR, and O2 (r < 0.1). There was also no correlation between depression levels and SBP, DBP, HR, O2 (r < 0.1). There was a significant increase in the mean SBP, DP, and HR and a significant decrease in the O2 saturation in patients undergoing OBLS. However, there was no correlation between anxiety, depression and the changes in these vital signs. Future investigations are needed to understand the causes of hemodynamic instability in OBLS. 2 Laryngoscope, 2024.

Surgeon experience affects perioperative pain in cats undergoing elective ovariohysterectomy: a randomized clinical trial.

This study aimed to compare the outcomes between surgeries performed by either experienced or inexperienced surgeons by assessing intraoperative nociception and perioperative analgesia. 16 healthy, client-owned female cats were randomly allocated into 2 groups of 8: one undergoing surgery by an experienced surgeon (GES group) and the other by inexperienced surgeons (GIS group). Both groups received IM premedication with acepromazine (0.05 mg/kg) and methadone (0.3 mg/kg). After 20 minutes, venipuncture and induction with propofol (dose-response, IV) were performed. Maintenance was achieved with inhaled isoflurane. Intraoperative vital parameters were monitored, and fentanyl (2.5 µg/kg, IV) was administered as rescue analgesia when needed. Postoperatively, pain was assessed with a visual analog scale and the multidimensional pain scale of the Universidade Estadual Paulista in Botucatu; morphine (0.2 mg/kg, IM) was used for rescue analgesia, as necessary. In the GIS group, significant increases in heart rate and systolic blood pressure were noted during surgery, especially during pedicle clamping. Respiratory rate and end-tidal isoflurane levels were higher in the GIS group at specific surgical stages. Survival analysis indicated that the GIS group had a greater need for fentanyl. Postoperative pain scores were generally low, but a higher proportion of GIS cats required rescue analgesia. Surgeon experience influences intraoperative parameters and fentanyl consumption. Inexperienced surgeons contribute to increased postoperative pain and poorer wound healing outcomes in cats undergoing elective ovariohysterectomy. Ovariohysterectomy is a common procedure in veterinary practice, and surgical expertise significantly impacts pain management and recovery. Yet, its effects have been underexplored, potentially compromising animal welfare.

Acute Changes in Myocardial Work during Isometric Exercise in Hypertensive Patients with Ischemic Heart Disease: A Case-Control Study.

Background: The acute hemodynamic response to isometric exercise in hypertensive patients' ischemic heart disease (IHD) has been poorly investigated. The aim of this study was to assess acute changes in left ventricular myocardial work (MW) during isometric bilateral knee extension in patients with IHD. Methods: Twenty stable hypertensive patients with IHD and ten healthy, age-matched controls (HC) were enrolled. All subjects performed an isometric knee extension exercise at 30% of their maximal voluntary contraction. The effort was maintained for three minutes or until exhaustion. At baseline, at peak exercise, and after 10 min of recovery, echocardiography evaluation was performed and blood pressure (BP) and heart rate (HR) were measured. Results: The exercise was well tolerated by all subjects. At peak exercise, systolic BP in the IHD was significantly higher than HC (37.6 ± 7.2 vs. 8.4 ± 2.3 mmHg; p 0.002). The HC group had a greater increase in HR than IHD (19.7 ± 6.2 vs. 8.4 ± 2.2 bpm; p 0.009). The E/E' ratio increased in IHD and was unchanged in the control group. The global work index increased significantly in IHD compared to HC (+15% vs. +3%; p 0.026). Global constructive work increased significantly in IHD compared to HC (+29.8% vs. +7.4 respectively, p 0.031). Global wasted work increased by 92.3% in IHD and was unchanged in HC. The global work efficiency decreased in IHD (-18%), but was unchanged in HC (between-groups p 0.019). Stroke volume decreased in IHD and was unchanged in HC. Cardiac output was unchanged in IHD, while it increased in HC. Conclusion: In patients with hypertension and underlying IHD, an acute isometric load causes a great increase in systolic BP and LV filling pressure. It follows a mostly ineffective increase in MW that fails to maintain stroke volume.

HUBUNGAN ANTARA DERAJAT HIPERTENSI DENGAN KUALITAS TIDUR PADA PASIEN HIPERTENSI DI RUMAH SAKIT PMI KOTA BOGOR

Background: According to the Ministry of Health (2021), Hypertension or high blood pressure is characterized by an increase in systolic blood pressure exceeding 140 mmHg and diastolic blood pressure exceeding 90 mmHg in two measurements taken five minutes apart in a sufficiently rested/quiet state. Poor sleep quality occurs due to increased cortisol hormone, caused by the activation of the sympathetic nervous system, which enhances vasoconstrictor effects (epinephrine and norepinephrine) that influence the increase in blood pressure. Individuals with good sleep quality tend to experience a better quality of life. This study aims to determine the relationship between the degree of hypertension and sleep quality in hypertensive patients at PMI Hospital Bogor City in 2023. Method: This is a quantitative study with a cross-sectional analytical study design. The sampling technique used in this study is non-probability sampling with a sample size of 82 individuals using accidental sampling. Sleep quality was measured using the PSQI questionnaire. Data analysis employed univariate and bivariate analyses with the chi-square statistical test. Results: The Chi-square test analysis for the relationship between the degree of hypertension and sleep quality in hypertensive patients yielded a p-value of 0.115 (p &gt; 0.05). Conclusion: Based on the results of this research, it is concluded that there is no significant relationship between the degree of hypertension and sleep quality in hypertensive patients at PMI Hospital Bogor City in 2023. Keywords: Hypertension Severity; Sleep Quality; PSQI