Trends In Systolic Blood Pressure Research Articles

A four-in-one first-in-human study to assess safety, tolerability, pharmacokinetics, pharmacodynamics, and concentration-QTc relationship of HRS-1780, a selective non-steroidal mineralocorticoid receptor antagonist, in healthy men.

This first-in-human study evaluated HRS-1780, an oral selective non-steroidal mineralocorticoid receptor antagonist, in healthy men. In single ascending dose (SAD) part, 10 participants for each dose cohort (5, 10, 20, 40, 60, and 80 mg) were randomized (8:2) to HRS-1780 or placebo. In multiple ascending dose part, 12 participants for each dose (10, 20, and 40 mg) were randomized (9:3) to HRS-1780 or placebo once daily for 7 days. The primary endpoint was safety and tolerability. HRS-1780 was well tolerated with all adverse events being mild. In the steady state, the median time to maximum concentration (Tmax) was 0.750 h and mean half-life was 1.76-1.96 h. High-fat/high-calorie meal prolonged Tmax but did not affect exposure. Multiple dosing of HRS-1780 at 40 mg showed a decreasing trend in systolic blood pressure compared with placebo. Changes in plasma aldosterone and norepinephrine with HRS-1780 were higher compared to placebo. Upper bounds of two-sided 90% confidence interval of placebo-adjusted change-from-baseline QTcF were below 10 msec at the maximum concentration in SAD. The trial had limited sample size and short study duration. HRS-1780 had favorable safety and pharmacokinetic profiles and did not cause clinically meaningful QTcF prolongation. ClinicalTrials.gov (NCT05638126).

Association of heavy metals exposure with lower blood pressure in the population aged 8-17 years: a cross-sectional study based on NHANES.

The existing evidence regarding the joint effect of heavy metals on blood pressure (BP) in children and adolescents is insufficient. Furthermore, the impact of factors such as body weight, fish consumption, and age on their association remains unclear. The study utilized original data from the National Health and Nutrition Examination Survey, encompassing 2,224 children and adolescents with complete information on 12 urinary metals (barium, cadmium, cobalt, cesium, molybdenum, lead, antimony, thallium, tungsten, uranium, mercury and arsenic), BP, and core covariates. Various statistical methods, including weighted multiple logistic regression, linear regression, and Weighted Quantile Sum regression (WQS), were employed to evaluate the impact of mixed metal exposure on BP. Sensitivity analysis was conducted to confirm the primary analytical findings. The findings revealed that children and adolescents with low-level exposure to lead (0.40 μg/L, 95%CI: 0.37, 0.42), mercury (0.38 μg/L, 95%CI: 0.35, 0.42) and molybdenum (73.66 μg/L, 95%CI: 70.65, 76.66) exhibited reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP). Conversely, barium (2.39 μg/L, 95%CI: 2.25, 2.54) showed a positive association with increased SBP. A 25th percentile increase in the WQS index is significantly associated with a decrease in SBP of 0.67 mmHg (95%CI, -1.24, -0.10) and a decrease in DBP of 0.59 mmHg (95% CI, -1.06, -0.12), which remains statistically significant even after adjusting for weight. Furthermore, among individuals who consume fish, heavy metals have a more significant influence on SBP. A 25 percentile increase in the WQS index is significantly associated with a decrease of 3.30 mmHg (95% CI, -4.73, -1.87) in SBP, primarily attributed to mercury (27.61%), cadmium (27.49%), cesium (17.98%), thallium (8.49%). The study also identified a declining trend in SBP among children aged 10-17, whereas children aged 11-18 exhibited lower levels of systolic and diastolic blood pressure, along with a reduced risk of hypertension. Some heavy metals demonstrate an inverse association with the BP of children and adolescents, particularly notable in groups with fish consumption and older children and adolescents. Future studies are warranted to validate these findings and delve deeper into the interplay of heavy metals.

Evaluating the implementation of a hypertension program based on mHealth and community pharmacies integration to primary care centers at a municipality level in Argentina during the COVID-19 pandemic.

While pharmacists-led interventions in hypertension have proven effective in high-income countries, their implementation and impact in low- and middle-income countries (LMIC) remain limited. This study assessed the implementation and outcomes of the hypertension program FarmaTeCuida (FTC), which integrated community pharmacies into the public primary care level using information and communication technologies. The study took place during the pandemic in General Pueyrredón, Buenos Aires, Argentina, so modifications to the implementation strategy and expected outcomes were also analyzed. A mixed-methods study was conducted using the non-adoption, abandonment, scaling-up, dissemination, and sustainability (NASSS) conceptual model. Qualitative in-depth interviews were conducted with key stakeholders using snowball sampling until thematic saturation was achieved. The quantitative approach employed a quasi-experimental, prospective, longitudinal design in a cohort of hypertensive patients enrolled in the FTC program since October 2020 to March 2022. Adoption, access, adherence to follow-up, and blood pressure levels were assessed. Clinical outcomes were compared to a cohort of hypertensive patients attending primary health care centers (PHCCs) in 2021 but not enrolled in the FTC program. Routine data from this cohort was obtained from the municipal health information system (HIS). Out of 33 PHCCs, 23 adopted the FTC program, but only four collaborated with community pharmacies. A total of 440 patients were recruited, with 399 (91%) enrolled at PHCCs. Hypertension was detected in 63% (279/440) of cases at the first visit (113 were possible hypertensive patients; 26 new hypertensive patients and 140 already diagnosed). During follow-up, FTC identified 52 new hypertensive patients (12% out of 440). Reduction of systolic blood pressure (SBP) was observed in patients enrolled in both the FTC program and the comparison group over 60 days. In the multivariate analysis that included all hypertensive patient (FTC and HIS) we found strong evidence that for each month of follow up, SBP was reduced by 1.12 mmHg; however, we did not find any significant effect of the FTC program on SBP trend (interaction FTC*months has a p-value = 0.23). The pandemic was identified as the main reason for the program's underperformance; in addition we identified barriers related to technology, patient suitability, implementation team characteristics, and organizational factors. Our study, grounded in the NASSS model, highlights the profound complexity of introducing innovative strategies in low- and middle-income settings. Despite substantial challenges posed by the pandemic, these obstacles provided valuable insights, identified areas for improvement, and informed strategies essential for reshaping the care paradigm for conditions like hypertension in resource-constrained environments.

Daily trend of blood pressure in staff under conditions of shift work of railway transport

Introduction. The results of the study of features of the daily rhythm of blood pressure in people who constantly work in a rotational shift schedule, arising under the influence of night shift work, are discussed.
 The purpose of the study was to determine the modifying effect of working night wakefulness on the parameters of the daily rhythm of blood pressure in persons employed in work with a night shift schedule.
 Materials and methods. The analysis was carried out, in two cohorts of 19 years – 62 years employees of locomotive crews of Russian Railways. The study included drivers, assistant locomotive drivers, for at least 1 year, with night shifts n = 30,566, the number of measurements = 4,497,122, but borderline (high normal) blood pressure.
 Results. The lowest levels of systolic blood pressure (SBP) were found to be recorded in a cohort of subjects per day with a night shift, the highest – in the general group of workers and in a cohort of subjects per day with a day shift.
 The daily trend of SBP was characterized by a regular change of phases in all observation groups. In the general group, a subgroup of persons with normotonia, in a cohort of subjects, when working on a day shift, a DECLINE curve of the same type in configuration was formed.
 Limitations. The representativeness of the sample size was ensured by the participation in the study of employees of locomotive crews with a range of ages 
 of 19-62 years. The limitations of the study are related to the distribution of respondents by gender: there are no female respondents in the sample.
 Conclusions. Parameters of the daily rhythm of blood pressure sensitively react to changes in working hours. To the greatest extent, changes in the daily rhythm during the hours of night working wakefulness are typical for the indicators of the daily rhythm of diastolic blood pressure.

Nebulised fentanyl, dexmedetomidine and magnesium sulphate for attenuation of haemodynamic response to laryngoscopy and tracheal intubation: A double-blinded, randomised comparative study.

Direct laryngoscopy and tracheal intubation cause an increase in heart rate (HR) and blood pressure, called as pressor response. This study aimed to compare nebulised forms of fentanyl, dexmedetomidine and magnesium sulphate to attenuate the haemodynamic response to laryngoscopy and tracheal intubation. This double-blinded, randomised study was conducted on 90 patients undergoing elective surgery requiring endotracheal intubation. Nebulisation was done with fentanyl 1 μg/kg (Group A), dexmedetomidine 1 μg/kg (Group B) and magnesium sulphate (MgSO4) (40 mg/kg) (Group C). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and HR were recorded before nebulisation (T0), post-nebulisation (T1) and at 2, 5 and 10 min after intubation (T2, T3, T4). The statistical analysis for comparing continuous variables between the groups was performed using analysis of variance (ANOVA), and a P value <0.05 was considered statistically significant. Compared to T0, an increase in HR at T2 and T3 was seen in Group A only, which reached baseline values at T4 (P values <0.0001 and 0.037, respectively). No HR value was higher than the baseline readings in groups B and C. The decreasing trend of SBP, DBP and MAP was seen in all three groups. Groups B and C had a statistically significant decrease in all the values from baseline (P values <0.0001). Nebulised form of dexmedetomidine (1 μg/kg) and magnesium (40 mg/kg) seems to be superior to fentanyl (1 μg/kg) in blunting the stress response to laryngoscopy and tracheal intubation.

Sex differences in impact of cumulative systolic blood pressure from childhood to adulthood on albuminuria in midlife: a 30-year prospective cohort study

Background and objectivesAlbuminuria is recognized as being a predictor of cardiovascular and renal disease. We aimed to identify the impact of the long-term burden and trends of systolic blood pressure on albuminuria in midlife, as well as to explore sex differences concerning this relationship.MethodsThis longitudinal study consisted of 1,683 adults who had been examined 4 or more times for blood pressure starting in childhood, with a follow-up time period of 30 years. The cumulative effect and longitudinal trend of blood pressure were identified by using the area under the curve (AUC) of individual systolic blood pressure measurement with a growth curve random effects model.ResultsOver 30 years of follow-up, 190 people developed albuminuria, including 53.2% males and 46.8% females (aged 43.39 ± 3.13 years in the latest follow-up). The urine albumin-to-creatinine ratio (uACR) values increased as the total and incremental AUC values increased. Additionally, women had a higher albuminuria incidence in the higher SBP AUC groups than men do (13.3% for men vs. 33.7% for women). Logistic regression showed that the ORs of albuminuria for males and females in the high total AUC group were 1.34 (0.70–2.60) and 2.94 (1.50–5.74), respectively. Similar associations were found in the incremental AUC groups.ConclusionsHigher cumulative SBP was correlated with higher uACR levels and a risk of albuminuria in middle age, especially in women. The identification and control of cumulative SBP levels from an early age may assist in reducing the incidences of renal and cardiovascular disease for individuals in later life.

PS-C03-5: REAL-WORLD DATA OF BLOOD PRESSURE IN DIALYSIS PATIENTS WITH AND WITHOUT DIABETES IN JAPAN USING THE WEB-BASED DATABASE

Objective: Diabetic nephropathy was the most common primary disease among patients undergoing dialysis, and the number is growing each year. Despite advancements in dialysis technique, cardiovascular complications and mortality in dialysis patients with diabetes remain higher than in those without diabetes. Furthermore, hypertension is commonly known to contribute to the development of cardiovascular complications in dialysis patients, and we aimed to compare the systolic blood pressure (SBP) in dialysis patients with and without diabetes using the Web-based Analysis of Dialysis Data Archives (WADDA) system database. Design and Methods: From 2014 to 2020, we enrolled dialysis patients who had their predialysis SBP measured using the WADDA system 2.1. We classified SBP and evaluated its trends over time by gender, age, and presence of diabetes using the Japanese Society of Hypertension guidelines 2019 (JSH2019). Furthermore, we looked at the relationship between SBP and cardiovascular death in patients with and without diabetes. Results: Dialysis patients with diabetes (n = 168,227) had a mean age of 69.2 (11.7) years versus 69.4 (13.3) years, a mean predialysis history of 5.5 (5.3) years versus 9.4 (9.3 years), and a mean dialysis SBP of 156.6 (25.0) mmHg versus 147.9 (23.6) mmHg, respectively. Dialysis patients with diabetes had higher rates of cardiovascular complications than those without diabetes. From 2014 to 2020, the percentage and absolute values of hypertension were higher in dialysis patients with diabetes than across all age groups and in both men and women. Patients with cerebrovascular death had a higher rate of hypertension, but there was no difference in the rate of grade I and II hypertension between the two groups. Conclusion: We summarized the recent trends in SBP of Japanese dialysis patients with and without diabetes using the WADDA system. Dialysis patients with diabetes had higher SBP than those without diabetes in all age groups and in both men and women. As a result, optimal blood pressure management for dialysis patients with and without diabetes is important for the prevention of cerebrovascular death.

S-30-4: SEX DIFFERENCES IN IMPACT OF CUMULATIVE SYSTOLIC BLOOD PRESSURE FROM CHILDHOOD TO ADULTHOOD ON ALBUMINURIA: A 30-YEAR PROSPECTIVE COHORT STUDY

Background and Objectives: Albuminuria is recognized as being a predictor of cardiovascular and renal disease. The aim of this study was to identify the impact of the long-term burden and trends of systolic blood pressure on albuminuria in midlife, as well as to explore sex differences concerning this relationship. Methods: This longitudinal study consisted of 1,683 adults aged 6–15 years who had been examined 4 or more times for blood pressure starting in childhood, with a follow-up time period of 30 years. The cumulative effect and longitudinal trend of blood pressure were identified by using the area under the curve (AUC) of individual systolic blood pressure measurement with a growth curve random effects model. Albuminuria was defined as a urine albumin-to-creatinine ratio (uACR)¡Ù30 mg/g. Results: Over 30 years of follow-up, 190 people developed albuminuria, including 53.2% males and 46.8% females. The uACR values increased as the total and incremental AUC values increased. Additionally, women had a higher albuminuria incidence in the higher SBP AUC groups than men do (13.3% for men vs. 33.7% for women). Logistic regression showed that the ORs of albuminuria for males and females in the high group were 1.34 (0.70–2.60) and 2.94 (1.50–5.74), respectively, after adjustments. Similar associations were found in the incremental AUC groups. Moreover, there was a significant interaction between AUC groups and sex on the outcomes of albuminuria. Conclusions: The presence of higher cumulative SBP was correlated with higher uACR levels and a risk of albuminuria in middle age, especially in women. The identification and control of cumulative SBP levels from an early age may assist in reducing the incidences of renal and cardiovascular disease for individuals in later life.

The Influence Of Different Intensity Acute Exercises On The Blood Pressure Of Male College Students

PURPOSE: To examine the changes in blood pressure (BP) before and after different intensities-based exercise interventions in healthy university students. METHODS: Eight healthy college students without regular exercise habits were recruited. Physical Activity Readiness Questionnaire (PAR-Q) was used to screen participants’ healthy statuses and to exclude those who were with hypertension or cardiovascular diseases. Based on the Astrand procedure of bicycle ergometer, 70%, 80% and 90% of the VO2max were determined. And then they engaged in acute exercise for 30 min with one week interval with each intensity exercise. Their BP was measured at seven times (before exercise, and instant, 5 min, 10 min, 30 min, 60 min, and 120 min after exercise). Repeated measure was applied to examine the intervention effect. RESULTS: Systolic blood pressure (SBP) showed the first increase and then decrease trend, after different exercise intensities. Compared with quite SBP, instant SBP after exercise increased significantly to 136.75 mmHg for exercise at 70% VO2max (p < 0.05). SB after 5 min, 10 min, 30 min, 60 min, and 120 min declined gradually from 118.9 mmHg to 112.5 mmHg, with no significant differences compared to quite SBP (p > 0.05).For exercise intensity at 80% VO2max Similar trend was observed. CONCLUSIONS: Change trends of SBP were similar after different exercise intensities, being first increase and then decrease. While, DBP declined after exercise. No significant difference existed at the same time point with different exercise intensities.

Long-term variability and change trend of systolic blood pressure and risk of type 2 diabetes mellitus in middle-aged Japanese individuals: findings of the Aichi Workers' Cohort Study.

Studies have reported that short-term blood pressure (BP) variability (BPV) is associated with type 2 diabetes mellitus (T2DM) incidence, but the association with long-term BPV remains unclear. The present study investigated the associations of long-term BPV as well as the time trend of BP changes over time with the incidence of T2DM. This study followed a cohort of 3017 Japanese individuals (2446 male, 571 female) aged 36-65 years from 2007 through March 31, 2019. The root-mean-square error (RMSE) and the slope of systolic BP (SBP) change regressed on year were calculated individually using SBP values obtained from 2003 to baseline (2007). A multivariable Cox proportional hazard model was applied to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for tertiles of SBP RMSE and continuous SBP slopes adjusted for age, sex, smoking status, regular exercise, sodium intake, family history of diabetes, sleep disorder, body mass index (BMI), SBP, andfasting blood glucose (FBG) at baseline, and BMI slope from 2003 to 2007. The highest RMSE tertile compared to the lowest was associated with a significantly higher incidence of T2DM after adjusting for covariates (HR: 1.79, 95% CI: 1.15, 2.78). The slope was also significantly associated with T2DM incidence until baseline SBP and FBGwere adjusted (HR: 1.03, 95% CI: 0.99, 1.07). In conclusion, long-term SBP variability was significantly associated with an increased incidence of T2DM independent of baseline age, sex, BMI, SBP, FBG, lifestyle factors and BMI slope from 2003 until baseline.

Serum sodium variation is a major determinant of peridialytic blood pressure trends in haemodialysis outpatients

Intradialytic hypotension (IDH) and peridialytic blood pressure (BP) trends are associated with morbidity and mortality in haemodialysis (HD) patients. We aimed to characterise the respective influence of volume status and small solutes variation on peridialytic systolic BP (SBP) trends during HD. We retrospectively analysed the relative peridialytic SBP decrease in 647 prevalent outpatients attending for their mid-week session with corresponding pre- and post-HD bioelectrical impedance analysis. Mean SBP decreased by 10.5 ± 23.6 mmHg. Factors positively associated with the relative decrease in SBP were: serum sodium (Na) decrease, body mass index, serum albumin, dialysis vintage, ultrafiltration rate and urea Kt/V (p < 0.05 for all). Antihypertensive medications and higher dialysate calcium were negatively associated with the relative decrease in SBP (p < 0.05 for both). Age had a quadratic relationship with SBP trends (p < 0.05). Pre-HD volume status measured by extracellular to total body water ratio was not associated with SBP variation (p = 0.216). Peridialytic SBP trends represent a continuum with serum Na variation being a major determinant while volume status has negligible influence. Middle-aged and overweight patients are particularly prone to SBP decline. Tailoring Na and calcium dialysate concentrations could influence haemodynamic stability during HD and improve patient experience and outcomes.

CLONIDINE AS AN ADJUVANT TO HYPERBARIC BUPIVACAINE FOR SPINAL ANESTHESIA IN ELDERLY PATIENTS UNDERGOING INFRAUMBLICAL SURGERIES

Background: Use of adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia for lower limb surgeries. This study tested the hypothesis that addition of small doses of clonidine augments the spinal block levels produced by hyperbaric bupivacaine in patients without affecting the side-effects. Materials and Methods: This was a prospective, randomized, double-blind study. Above 60 years patients were allocated to three equal groups. Group C received 10 mg hyperbaric bupivacaine without clonidine while Group C and Group C received 15 μg and 30 μg clonidine with 15 30 hyperbaric bupivacaine respectively for spinal anesthesia. Effect of clonidine on sensory block levels was the primary study outcome measure. Motor blockade and hemodynamic parameters were also studied. Results:Asignicantly higher median block levels were achieved in Group C (P &lt; 0.05) and Group C (P &lt;0.05) than Group C. Highest median 15 30 sensory block level, the mean times for sensory regression to T12 level and motor block regression were statistically signicant between Groups C15 and C and between Groups C and C. On comparison of fall in systolic blood pressure trends, there was no signicant difference in the clonidine 30 groups as compared with the control group. Conclusions: In elderly patients, clonidine when used intrathecally in doses of 15 μg or 30 μg with bupivacaine, signicantly potentiated the sensory block levels and duration of analgesia without affecting the trend of systolic blood pressure as compared to bupivacaine alone. Clonidine in doses of 30 μg however facilitated the ascent of sensory level block to unexpectedly higher dermatomes for a longer time.

Changes in blood pressure thresholds for initiating antihypertensive medication in patients with diabetes: a repeated cross-sectional study focusing on the impact of age and frailty

ObjectiveTo assess trends in systolic blood pressure (SBP) thresholds at initiation of antihypertensive treatment in patients with type 2 diabetes and the impact of age and frailty on these trends.Study...

P1081DIALYSATE SODIUM ALLIGNMENT AND SODIUM SET-POINT STABILITY IN HEMODIALYSIS PATIENTS: TWO-YEAR OBSERVATION

Abstract Background and Aims The low dialysate sodium (NaD) reduces intradialytic weight gain (IDWG) and blood pressure (BP), which are associated with improved outcomes. However, the intervention probably also increases intradialytic hypotension and reduces serum sodium (NaS), that are associated with increased mortality risk, so NaD should be individualized and brought closer to NaS. Predialysis natraemia in hemodialysis (HD) patients is considered constant (set-point) but some observations contradict this statement. The significance of clinical parameters, dialysis parameters and body water distribution is not clear. Method We undertake the retrospective observation among 45 HD patients for 24 months before large-scale prospective intervention investigation for individualization of NaD. We used two-year routinely monthly fixed data: NaS, NaD, IDWG, frequency of intradialysis hyper- and hypotension and seizures, peri- and intradialysis BP, home BP estimates, clinically and by bioimpedance estimated dry weight, ultrafiltration rate, frequency and duration of HD sessions. Results We included 27 males and 18 females of 60 (34-83) years old, with median HD vintage of 63 (29÷93) months. 1048 NaS measurements revealed mean natraemia of 137.1±2.8 (Q5-Q95 132-141) mmol/l (corrected for glucose). No differences in mean NaS according to gender, age, HD vintage, cardiac or liver dysfunction and residual renal function were found. Intraindividual NaS mean varied from 132 to 141 mmol/l and median of coefficient of variation (CV) was 1.4% (1.2÷1.6) (range 0.9-2.0%) which could be attributed mainly to measurement accuracy. The intraindividual NaS Q10-Q90 did not exceed 6 mmol/l with its median 3.0 (2.7÷3.7). Among whole group we revealed slow decreasing NaD trend (-0.12 mmol/l per year, R?0.45) which was accompanied by more prominent trend in systolic BP (-3.3 mmHg/year, R?0.64) and diastolic BP (-1.6 mmHg/year, R?0.49). In parallel, the frequency of intradialytic hypotension increased by 1.6 episodes/100HD per year (mean 2.3±0.6 after excluding the trend). 33 patients (73%) showed no significant individual trend in NaS (&amp;lt;1 mmol/l per year) for 24 months, 8 (18%) demonstrated decreasing trend (mean -1.5 mmol/l per year) while only 4 (9%) - increasing trend (mean +1.6 mmol/l per year). We observed no trend in prescribed bicarbonate level in dialysate. There were no significant associations between intraindividual deviations from individual mean weight before HD and from mean individual NaS. In whole group, intraindividual variations in NaS had no link with mean NaS. We observed the significant variations in NaS only in patients with large CV of predialysis weight (Q90-Q10&amp;gt;5 kg over 2 years). Overall mean of sodium serum to dialysate gradient (NaG) was slightly positive (+0.15±3.0 mmol/l) while 58% of patients had negative or neutral NaG. The latter had lesser IDWG but no difference in intradialytic hypotension frequency. We evaluated the number of random consecutive monthly predialysis NaS need to get acceptable estimation of real mean two-year predialysis NaS: five values gave 94% hit in range -1÷ +1 mmol/l. Conclusion Serum sodium is stable over time in HD patients with the only exception of patients with large intraindividual predialysis weight variation. Pre-HD serum sodium may be used as a parameter for individualizing dialysate sodium prescription.

Clinical characteristics and course of out-of-hospital shock in a national emergency medical services cohort.

BackgroundShock from medical and traumatic conditions can result in organ injury and death. Limited data describe out‐of‐hospital treatment of shock. We sought to characterize adult out‐of‐hospital shock care in a national emergency medical services (EMS) cohort.MethodsThis cross‐sectional study used 2018 data from ESO, Inc. (Austin, TX), a national EMS electronic health record system, containing data from 1289 EMS agencies in the United States. We included adult (age ≥18 years) non‐cardiac arrest patients with shock, defined as initial systolic blood pressure ≤80 mm Hg. We compared patient demographics, clinical characteristics, and response (defined as systolic blood pressure increase) between medical and traumatic shock patients, looking at systolic blood pressure trends over the first 90 minutes of care.ResultsAmong 6,156,895 adult 911 responses, shock was present in 62,867 (1.02%; 95% confidence interval [CI] = 1.01%–1.03%); 54,239 (86.3%) medical and 5978 (9.5%) traumatic, and 2650 unknown. Medical was more common than traumatic shock in women and older patients. The most common injuries associated with traumatic shock were falls (37.6%) and motor vehicle crashes (18.7%). Mean initial and final medical systolic blood pressure were 71 ± 10 mm Hg and 99 ± 24 mm Hg. Systolic blood pressure increased in 88.8% and decreased or did not change in 11.0%. Mean initial and final trauma systolic blood pressure were 71 ± 13 mm Hg and 105 ± 28 mm Hg; systolic blood pressure increased in 90.4% and decreased/did not change in 9.6%. On fractional polynomial modeling, systolic blood pressure changes were greater and faster for trauma than medical shock.ConclusionsIn this national series, 1 of every 100 EMS encounters involved shock. These findings highlight the current course and care of shock in the out‐of‐hospital setting.

Effectiveness of intravenous boluses of phenylephrine, ephedrine and mephentermine as vasopressors for management of perioperative hypotension in elective lower segment caesarean section under spinal anaesthesia – A prospective comparative study

Hypotension after subarachnoid block for caesarean section is the commonest but serious complication encountered by anaesthesiologists. Various vasopressors are used to prevent/treat this complication. This study was done to compare the efficacy of three commonly used vasopressors – phenylephrine, ephedrine, mephentermine for treatment of perioperative hypotension. Sixty American Society of Anaesthesiologists (ASA) physical status class II parturients undergoing elective caesarean section under subarachnoid block were randomly allotted three groups (P, E, M) (n = 20) to receive intravenous boluses of phenylephrine 100 mcg, ephedrine 6mg &amp; mephentermine 6mg respectively, following hypotension. Maternal Haemodynamic parameters, complications &amp; neonatal APGAR scores were recorded. P-value &amp;#60; 0.05 was considered significant and P-value &amp;#60; 0.001 considered highly significant. Demographic values, baseline vital parameters and mean number of vasopressor boluses required were similar in the three groups (P &amp;#62; 0.05). The mean trends of systolic blood pressure (P = 0.06), diastolic blood pressure (P = 0.7) and mean arterial pressure (P = 0.6) were similar in the three groups. Heart rate was raised during periods of hypotension; the mean heart rate was lower in the phenylephrine group after vasopressor administration. The overall trend was similar (P = 0.1) among the three groups. There was (P = 0.003) higher incidence of bradycardia in the phenylephrine group. The neonatal APGAR scores were &amp;#62; 7 in the three groups at the 1st and 5th minute (P = 0.5). All three vasopressors effectively maintained arterial blood pressure during the subarachnoid block for caesarean section. Phenylephrine caused a significant reduction in heart rate compared to ephedrine or mephentermine.

Association of visit-to-visit variability of systolic blood pressure with cardiovascular disease, chronic kidney disease and mortality in patients with hypertension.

This study aimed to evaluate the association between visit-to-visit variability of systolic blood pressure (SBP) and cardiovascular disease, chronic kidney disease, and mortality among hypertensive patients. A population-based cohort included 225 759 Chinese hypertensive adults without diabetes, cardiovascular disease, and chronic kidney disease during 2011-2012. SBP variability was determined based on standard deviations of SBP over the previous 5 years before baseline. Cox regressions adjusted with patients' baseline characteristics, mean, and temporal trend of SBP was applied to the associations between variability and incident cardiovascular disease, chronic kidney disease and all-cause mortality. In all, 25 714 patients with cardiovascular disease, 27 603 with chronic kidney disease, and 16 778 deaths have occurred during the median follow-up of 70.5 months (1.2 million person-years). SBP variability was continuously and positively associated with higher cardiovascular disease, chronic kidney disease and mortality risk among hypertensive patients without evidence of a threshold. Each 10-mmHg increase in SD of SBP was associated with 35% [hazard ratio 1.35, 95% confidence interval (CI) 1.30-1.39], 39% (HR 1.39, 95% CI 1.35-1.43), and 40% (HR 1.40, 95% CI 1.34-1.45) higher risk of cardiovascular disease, chronic kidney disease and mortality, respectively. HRs were attenuated with increased age, mean SBP, and Charlson index, and decreased temporal trend of systolic blood pressure, but it remained significant and consistent in most of the different subgroups. Findings suggested that SBP variability is a significant prognostic value, in addition to baseline or mean of SBP for the risk of cardiovascular disease and mortality.

Heterogeneity in Trajectories of Systolic Blood Pressure among Young Adults in Qingdao Port Cardiovascular Health Study.

Background:Although increased age is associated with higher systolic blood pressure (SBP) in general, there may be variation across individuals in how SBP changes over time. The goal of this paper is to identify heterogeneity in SBP trajectories among young adults with similar initial values and identify personal characteristics associated with different trajectory patterns. This may have important implications for prevention and prognosis.Methods:A cohort of 12,468 individuals aged 18–35 years in the Qingdao Port Cardiovascular Health Study in China was followed yearly during 2000–2011. Individuals were categorized into three strata according to their baseline SBP: ≤110 mmHg, 111–130 mmHg, and >130 mmHg. Within each stratum, group-based trajectory analyses were conducted to identify distinct SBP trajectory patterns, and their association with sociodemographic and baseline health characteristics was assessed by ordinal logistic regression.Results:Five distinct groups of individuals exhibiting divergent patterns of increasing, stable or decreasing SBP trends were identified within each stratum. This is a first report to identify a subgroup with decreasing trend in SBP. Individuals with more advanced age, having less than high school education, family history of cardiovascular diseases, greater body mass index, greater waist circumference, and hyperlipidemia at baseline were more likely to experience trajectories of higher SBP within each stratum.Conclusions:The diverging trajectories among young adults with similar initial SBP highlight the need for prevention and feasibility of effective blood pressure control, while the identified risk factors may inform targeted interventions.

Effects of nitroglycerine spray and lignocaine spray on the hemodynamic responses to laryngoscopy and endotracheal intubation: A comparative study

BACKGROUND: Laryngoscopy and tracheal intubation cause hypertension and tachycardia in anesthetized patients, which is undesirable, especially in patients with cardiovascular or neurosurgical diseases undergoing anesthesia. Various drug regimens and techniques have been used from time to time for attenuating the pressor response to laryngoscopy and tracheal intubation. The aim is to study, evaluate, and compare the efficacy of nitroglycerine (NTG) spray and 10% lignocaine spray in the attenuation of hemodynamic responses to laryngoscopy and endotracheal intubation and to observe and evaluate any side effects if any associated with the use of these drugs and their management. MATERIALS AND METHODS: This study was conducted on ninety patients under the American Society of Anesthesiologists (ASA) I and ASA II scheduled for elective surgeries. The patients were divided randomly into equal groups of 30 patients and received the following drugs before induction of general anesthesia: Group N-30 patients will be given NTG sublingual spray (2 puffs) 800 mcg 60s before laryngoscopy and group L-30 patients will be given lignocaine spray (2 puffs) 20 mg 60s before laryngoscopy. Hemodynamic variables were continuously recorded from baseline until 15 min after intubation and statistically analyzed. RESULTS: The demographic profile was comparable. The heart rate (HR) increased in both groups, although the increase in HR in the lignocaine group is higher than the increase in HR in NTG group. There was a significant difference in HR values immediately after intubation, 1, 3 min, and 5 min after intubation when the values were lower in group N, and the difference was statistically significant (P 0.05). There was a significant difference in systolic blood pressure (SBP) values immediately after intubation, 1, 3, and 5 min after intubation when the values were lower in group N and the difference was statistically significant (P 0.05). At 1, 3, and 5 min after intubation, the SBP values were significantly higher than baseline in the lignocaine group. However, there was a downward trend in SBP observed in the NTG group until 5 min after intubation, and it was statistically significant. There was a significant difference in diastolic blood pressure (DBP) values immediately after intubation, 1, 3 and 5 min after intubation when the values were lower in group N and the difference was statistically significant (P 0.05). The increase in mean DBP observed in the lignocaine spray group was statistically highly significant when compared to the increase in mean DBP in the NTG spray group. There was a significant difference in mean arterial pressure (MAP) values immediately after intubation, 1, 3 and 5 min after intubation when the values were lower in group N and the difference was statistically significant (P 0.05). NTG spray decreases the MAP more effectively as compared to lignocaine following laryngoscopy and endotracheal intubation. CONCLUSION: Based on our study, we conclude that: In lignocaine spray group patients who received a dose of 20 mg (2 puffs), there was a significant rise in HR, SBP, DBP, mean arterial blood pressure. In the NTG spray group patients who received a dose of 800 mcg (2 puffs), there is effective attenuation of the pressor response to laryngoscopy and intubation in normotensive ASA I–II patients. However, NTG is not able to attenuate the rise in HR due to reflex tachycardia due to vasodilation. Thus, it can be a better alternative in attenuating the hemodynamic responses to laryngoscopy and intubation.

Blood pressure fluctuation pattern and stroke outcomes in acute ischemic stroke.

Blood pressure (BP) fluctuates widely during the acute phase of stroke. Compared to single BP assessment, patterns of BP over time may have greater power in predicting stroke outcome. This study aims to investigate the effect of BP fluctuation patterns on stroke outcomes in acute ischemic stroke (IS) patients. IS patients within 24 h of onset registered in the BOSS registry between 2012 and 2014 were analyzed. Fluctuation of BP was predefined as the change trend in systolic BP (SBP) from Day 1 to Day 7 after onset and was used to divide patients into groups with sustained high SBP (≥160 mmHg) during the first 7 days (C1); rapid (C2: within the first 2 days) or delayed (C3: after 2 days) decline from high (≥160 mmHg) to low (<160 mmHg); consistently low SBP (C4); and elevation from low to high (C5). The primary stroke outcome was defined as a modified Rankin Scale score ≥3 at 3 months after onset. Of 1,095 IS patients, C1 (n = 90) had the highest risk of poor outcome (23.3%), while C2 (n = 198, risk = 11.6%) and C4 (n = 650, risk = 12.2%) had the lowest risk. C2 and C4 had a significant reduction in poor outcome risk when compared to C1, even after adjustment for average BP and BP variability (BPV) during the first 7 days (adjusted odds ratio[OR]C2 = 0.32, 95% CI: 0.12-0.80; ORC4 = 0.37, 95% CI: 0.14-0.97). The BP fluctuation pattern in the acute phase of IS might be a useful predictive parameter for functional outcome independent of average BP and BPV.